Finding 409857 (2022-001)

- Repeat Finding
Requirement
E
Questioned Costs
-
Year
2022
Accepted
2023-07-23
Audit: 311951
Organization: Goshen Medical Center, Inc. (NC)

AI Summary

  • Core Issue: 3 errors were found in income calculations across 75 applications at 3 locations, affecting patient billing.
  • Impacted Requirements: GMC must ensure accurate billing for federally supplemented services; inconsistent procedures led to calculation errors.
  • Recommended Follow-Up: Implement a review process for recalculating fees by site leaders and provide ongoing training for front desk staff on the sliding fee scale.

Finding Text

Criteria: 75 applications at 3 locations were tested. 3 errors were found. The table summarizes the findings. Issue: Incorrect calculations of income, fees charged would not change, 2 errors. Incorrect calculations of income, fees charged would change, 1 error. Condition: GMC has the responsibility of ensuring proper billing of patients for services that are supplemented by the federal government. Effect: The findings had various effects depending on the issue noted above. In most instances where fees would change, more income would be due to GMC from patients. Cause: Application calculations were not checked by another employee. Procedures and standards were inconsistently followed. Recommendation: The review process of the sliding fee scale application should include a recalculation by the site leader. Front desk employees should receive continuing education classes on the proper way to calculate the sliding fee scale. Management response: Management concurs with the finding and has proposed corrective action.

Corrective Action Plan

Development continues for staff regarding the slinding fee program. Thetrainers will continue to focus on electronic medical records and practicemanagement systems along with the sliding fee process. Staff will berequired annually to watch the sliding fee training video that explains how tocalculate sliding fee, what documentation was needed, how to determinehousehold size, and how to store the documentation. The sliding fee scalepolicy that was updated in August, 2021, will continue to extend the selfdeclarationfrom one visit to allowing the patient six months to bring in alldocumentation. The Internal Auditor continues to meet with the site leaders todiscuss any findings which inclues calculation of income while at site visits.All new front desk staff will continue to receive training on the sliding feereference sheet that was created as a guide for income source, use andvalidation of gross income calculation, household members, and documentstorage. Billing staff members will continue to send site leaders weekly slidingfee queries to address issues along with a required response of resolution foroversight of the sliding fee process.

Categories

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Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $14.15M
10.766 Community Facilities Loans and Grants $971,353
93.498 Provider Relief Fund $783,720
93.968 Immunization Cooperative Agreements $417,188
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $19,370
93.247 Advanced Nursing Education Grant Program $771