2023-001, 2022-001 - MATERIAL WEAKNESS AND MATERIAL NONCOMPLIANCE - SLIDING FEE
Contact Person – Patricia Fournier, CFO
Completion Date – 02/01/2024
Finding – We tested 60 sliding fee encounters and noted that 10 out of 60 patients were discounted, charged or adjusted the wrong amount and 4 out of 60 patients sliding fee applications had documentation issues. The Organization failed to verify sliding fee applications were obtained for all patients receiving discounts and incorrectly applied sliding fee discounts to charges. We recommend the Organization continue with the corrective action plan implemented in the prior year in response to audit finding 2022-001 to ensure sliding fee applications are completed before encounters are billed. We recommend that management continue to review and monitor the internal sliding fee application auditing process for further improvements and consider increasing sample sizes.
RESOLUTION:
1.Staff Training. Honor continued in-depth monthly trainings for front-end processes. The training includes patient check-in, insurance verification, and sliding fee application completion. We determined through our audit process that health centers without a clinical receptionist continued to have issues. We expanded our training to include all employee classes that complete patient check-in This includes CHWs, BHCs, and call center staff. Participants complete a test to ensure the necessary knowledge and skills were obtained during the training. If the participant’s score is under our benchmark, they will complete the training again. All staff also complete the training as part of new employee on-boarding and participate in the all staff annual update training.
2.Dashboard Reporting. Honor Practice Managers use a daily dashboard to monitor prior day visits to ensure that all patient check-in, insurance verification, and sliding fee applications information is input correctly.
3.Monthly Audit & Follow-up. The Revenue Cycle Manager will publish a monthly report to include all sliding fee applications. The report will be sent on the 15th of the month for the prior month. The report will include all sliding fee applications by location that are not in compliance. The Practice Managers will work with staff to address and correct these applications. The RCM will publish a subsequent report on the 30th of the month to ensure all sliding fee applications have been corrected and are in compliance. Any location with remaining sliding fee application out of compliance on the 30th will report to their immediate supervisor to correct the sliding fee applications.
4.Sliding Fee Application Workflow. Honor worked with a consultant to review the sliding fee workflow process from patient registration through patient payment. With our review we identified processes to implement within the EHR that will automate steps in the workflow to eliminate errors in the entry process. We also updated the payment posting process to auto write-off the remaining balance of the encounter at the time of the patient payment.