Finding 404735 (2023-003)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-06-29

AI Summary

  • Answer: Management should closely supervise and review processes to meet all requirements.
  • Trend: Implementing a second level independent review can enhance accuracy in demographic data and income verification.
  • List: Follow up by establishing a review process for patient billing data to ensure correct financial classification.

Finding Text

Recommendation: Management’s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.

Corrective Action Plan

Upon discovering issues related to our Sliding Fee Schedule, Valle del Sol, Inc. addressed and fixed the issues to ensure all patients who are eligible for discount are appropriately charged for services at a discounted rate. The actions taken included updating the Sliding Fee Schedule and Sliding Fee Policy to incorporate the annual changes in the federal poverty guidelines. Our software was also updated accordingly. We then implemented a training for all front office staff to include a better understanding of the sliding fee discount program, scripts for frequently asked questions from patients, and worksheets for staff to fill out to ensure all required documents are received, to aid in calculations of income, and to ensure proper application of slide category and collection of fees. Our staff were fully retrained on the application of the sliding fee and the review of demographic data and income verification based on our revised policy. We feel confident the adjustments, updates to the policy and sliding fee scale, and re-training to the front office staff and managers will ensure the accurate application of the policy and accurate discounts are given to our patients. Valle del Sol, Inc. will track and monitor compliance through our QA/QI Committee on a regular basis.

Categories

No categories assigned yet.

Other Findings in this Audit

  • 404736 2023-004
    Significant Deficiency
  • 404737 2023-005
    Significant Deficiency
  • 981177 2023-003
    Significant Deficiency Repeat
  • 981178 2023-004
    Significant Deficiency
  • 981179 2023-005
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.829 Section 223 Demonstration Programs to Improve Community Mental Health Services $1.02M
21.027 Coronavirus State and Local Fiscal Recovery Funds $754,576
93.958 Block Grants for Community Mental Health Services $716,069
93.665 Emergency Grants to Address Mental and Substance Use Disorders During Covid-19 $417,470
93.959 Block Grants for Prevention and Treatment of Substance Abuse $399,286
93.788 Opioid Str $321,580
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $281,719
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $201,315
93.498 Provider Relief Fund $120,787
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $25,000
93.185 Immunization Research, Demonstration, Public Information and Education_training and Clinical Skills Improvement Projects $5,000