Finding 39596 (2022-001)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-06-07

AI Summary

  • Core Issue: One out of 60 sliding fee encounters lacked a sliding fee application, and 11 were discounted incorrectly.
  • Impacted Requirements: Health centers must obtain and verify sliding fee applications to adjust service costs based on patient ability to pay.
  • Recommended Follow-Up: Ensure all sliding fee patients complete applications and implement checks before billing; consider increasing internal audits to verify compliance.

Finding Text

Program information: AL # 93.224 and 93.527, Health Center Program Cluster, Department of Health and Human Services. Criteria: Health centers must obtain sliding fee applications so that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. Condition: We tested 60 sliding fee encounters and noted that 1 of 60 sliding fee encounters tested did not have a sliding fee application. In addition, 11 out of 60 encounters tested were discounted the incorrect amount. Questioned Costs: None. Cause and Effect: The Center failed to verify sliding fee applications were obtained for all patients receiving discounts and may have incorrectly charged sliding fee discounts to charges. Recommendation: We recommend that sliding fee applications be completed for each sliding fee patient. Procedures should be implemented to verify applications are completed before the encounter is billed. In addition, the Center could consider increasing its internal sampling throughout the year to verify sliding fee applications are obtained, completed, and agree to the discount applied. Views of Responsible Officials: Management agrees with the finding. Corrective Action Plan: See attached correct plan.

Corrective Action Plan

Community Health and Social Services Center, Inc. respectfully submits the following corrective action plan for the year ended September 30, 2022. The findings from the September 30, 2022, schedule of findings and questioned costs are discussed below. The findings are numbered consistently as assigned in the schedule. Government Auditing Standards Findings: Finding Number: 2022-001, 2021-001, Significant Deficiency and Noncompliance - Sliding Fee. Recommendation: We recommend that sliding fee applications be completed for each sliding fee patient. Procedures should be implemented to verify applications are completed before the encounter is billed. In addition, the Center could consider increasing its internal sampling throughout the year to verify sliding fee applications are obtained, completed and agree to the discount applied. Action Taken: CHASS management concurs with the audit finding. Every week, a member of the Billing Staff will review self-pay claims to locate an internal sample of 5 claims that have a sliding fee discount applied. Once the 5 claims are selected, they will check to make sure supporting documentation is in the patient?s record and that the patient-provided income is entered correctly into the billing system. The claim will also be reviewed to make sure the appropriate discount was applied. Any errors will be reported to the CSR supervisor for follow-up and corrections with the Customer Service Representatives responsible for the original entry. In addition, Henry Ford Community Connect (which administers the billing software) has been contacted to resolve issues with EPIC not applying the correct discount despite correct patient information being entered. Responsible parties: Angela Salgado, Chief Operating Officer, Mariana Gutierrez, Billing Manager. Anticipated completion date: These actions were implemented starting in April 2022, however turnover in management resulted in inadequate follow-up. This will be addressed more thoroughly beginning in June 2023.

Categories

No categories assigned yet.

Other Findings in this Audit

  • 39597 2022-001
    Significant Deficiency Repeat
  • 39598 2022-001
    Significant Deficiency Repeat
  • 616038 2022-001
    Significant Deficiency Repeat
  • 616039 2022-001
    Significant Deficiency Repeat
  • 616040 2022-001
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $2.15M
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $801,286
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $372,891
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $265,999
16.524 Legal Assistance for Victims $154,781
93.011 National Organizations of State and Local Officials $150,016
16.888 Consolidated and Technical Assistance Grant Program to Address Children and Youth Experiencing Domestic and Sexual Violence and Engage Men and Boys As Allies $148,227
16.016 Culturally and Linguistically Specific Services Program $123,097
16.588 Violence Against Women Formula Grants $98,095
16.575 Crime Victim Assistance $94,646
93.498 Provider Relief Fund $86,895
93.332 Cooperative Agreement to Support Navigators in Federally-Facilitated and State Partnership Marketplaces $80,466
93.185 Immunization Research, Demonstration, Public Information and Education_training and Clinical Skills Improvement Projects $42,000
16.017 Sexual Assault Services Formula Program $39,849
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nations Health $4,783