FAC Explorer

Finding 398612 (2023-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-05-28
Audit: 307366
Organization: Innis Community Health Center, Inc. (LA)
Auditor: Hawthorn Waymouth & Carroll LLP

AI Summary

  • Core Issue: Some patients did not receive the correct sliding fee discounts based on their ability to pay.
  • Impacted Requirements: Health Centers must apply a sliding fee discount schedule accurately to ensure fair billing.
  • Recommended Follow-Up: Management should implement procedures to verify that all eligible patients receive the correct discounts.

Finding Text

Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted or discounted based on the patient’s ability to pay. Condition: Some patients did not receive the proper sliding fee discount. Cause: Errors within the setup of the Center's billing software. Questioned Costs: Known or likely questioned costs are less than $25,000. Context: Of the 40 patients sampled, 3 patients did not receive the proper adjustment or discount. Effect: Improper adjustments or discounts could lead to inaccurate financial statements as well as improper patient billings. Auditor's recommendation: Management should have procedures in place ensuring that each eligible patient receives the proper discount or adjustment.

Corrective Action Plan

In January, it was noted that the dental team had been substituting the dental code D0210 in place of another core service code for dental x-rays and had been discounting it to our sliding scale patients. The issue was immediately addressed with the dental team and with the billing department. Staff will be reeducated on how fees are set, and core services determined. Additionally, board approval will be required for all future code changes. Appropriate utilization of SFD program will be monitored closely by the Chief Administration Officer through quarterly audits of charts and with reports available in our EMR to ensure that core services and non-core are being coded and charged correctly.

Categories

No categories assigned yet.

Other Findings in this Audit

  • 975054 2023-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $2.28M
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.53M
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $276,436
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $226,000