Finding 398643 (2023-002)

-
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-05-29

AI Summary

  • Core Issue: An incorrect calculation of household income led to a patient being charged a lower copay than appropriate.
  • Impacted Requirements: The sliding fee scale must accurately reflect family size and income based on Federal Poverty Guidelines.
  • Recommended Follow-Up: Remind staff about the correct method for calculating annual income to prevent future errors.

Finding Text

Federal Assistance Listing Number 93.224/93.527 Health Center Program Special Tests and Provisions Finding 2023‐002 – Noncompliance Related to Charging Incorrect Sliding Fee Criteria: Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100% and at or below 200% of Federal Poverty Guidelines. The Center’s sliding fee scale, approved annually by the Board of Directors, is used to determine the patient’s sliding fee. Condition: For one of 25 encounters selected for testing, an incorrect calculation was used to determine the household income, which resulted in the individual being charged a lesser copay than they should have been charged. Cause: Due to a calculation error, the Center calculated a patient’s annual income by multiplying weekly income by 48 weeks instead of 52 weeks. Effect: The patient encounter was discounted to a copay of $30 when the patient qualified for a discounted copay of $35. Questioned Costs: There are no questioned costs. Context: This issue appears to be an isolated instance and is not systemic of a breakdown in internal controls over special tests and provisions. Repeat Finding: This is not a repeat finding. Recommendation: We recommend that all staff involved in reviewing sliding fee applications be reminded of the Center’s policy for calculating annual income based on support provided by a patient.

Corrective Action Plan

Management is committed to ensuring the application of the sliding fee scale program is equitable and accurate. During the annual in-service training for patient access specialists (PAS), the Patient Access Manager will conduct a thorough review of the policy, its intent, and the calculations, ensuring comprehensive understanding among staff. Demonstration of employees' compliance with the policy understanding and intended results will be documented, promoting accountability and adherence to established protocols. Management will determine the appropriate annual audit sample size per patient access team member and conduct regularly scheduled audits to asssess adherence to the sliding fee scale policy. Audit findings will be reported back to finance leadership (Diretor of Revenue Cycle and CFO) for review and oversight. These audits will also be included in the annual Compliance Audit Plan for review and attention to outcomes at the compliance commitee, ensuring alignment with regulatory standards and organizational compliance objectives.

Categories

Special Tests & Provisions Internal Control / Segregation of Duties

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
10.766 Community Facilities Loans and Grants $340,025
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $8,544
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $419