Finding 404736 (2023-004)

Significant Deficiency
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-06-29

AI Summary

  • Answer: Management needs to carefully review eligibility determinations.
  • Trend: Inaccurate eligibility checks could lead to reimbursement issues with Mercy Care.
  • List: Follow up with Management to ensure proper review processes are in place.

Finding Text

Recommendation: Eligibility determination should be reviewed thoroughly by Management since Management will ultimately send invoices to Mercy Care for reimbursement.

Corrective Action Plan

Upon discovering issues related to eligibility requirements, Valle del Sol, Inc. addressed and fixed the issues to ensure all patients who are eligible to be covered under the Mercy Care City of Phoenix ARPA award are appropriately charged for services. We implemented a training for all front office staff to include a better understanding of the Mercy Care City of Phoenix ARPA program, scripts for frequently asked questions from patients, and worksheets for staff to complete to ensure all required documents are received, to ensure proper application of eligibility of the Mercy Care City of Phoenix ARPA program. Our staff were fully retrained on the Mercy Care City of Phoenix ARPA program. We feel confident that the re-training to the front office staff and managers will ensure the 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

Cash Management Eligibility

Other Findings in this Audit

  • 404735 2023-003
    Significant Deficiency Repeat
  • 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