Finding Text
2022-001 Program Income ? Sliding Fee Scale Health Center Program Cluster # 93.224 U.S. Department of Health and Human Services Contract H80CS00094 Condition ? Out of 60 encounters tested we noted the following: 1. Five (5) instances where there was no registration form in patient file. 2. Nineteen (19) instances where the sliding fee scale discount was not properly applied. Criteria ? Health centers are required to have a corresponding schedule of discounts applied and adjusted based on the patient?s ability to pay (42 USC 254b(k)(3)(G)(i). The patient?s ability to pay is based on the official poverty guideline, as revised annual by HHS (42 CFR sections 51c.107(b)(5), 56.108(b)(5), and 56.303(f). Cause ? Failure to obtain the required documentation was due to failure of the Corporation to properly monitor the process. Errors in calculating and/or applying the sliding fee discounts were primarily due to staff not properly following the process of entering and substantiating income within the NextGen software and the Corporation not properly monitoring the process. Conditions No. 1, and No. 2 are repeat finding from the prior year. See Summary Schedule of Prior Audit Findings 2021-001. Effect ? The Corporation could be incorrectly billing for services and maintaining customer account balances at incorrect amounts. Recommendation ? Staff should make every effort to obtain documentation of patient income, identification, and registration in accordance with internal policies and procedures. Patients should be billed full billing rates for all services until all documentation is received. We recommend additional staff training focusing on software familiarization and additional monitoring of the process by the Corporation. Management?s Response ? Management agrees with the finding. The Corporation is increasing its efforts to ensure that its policies and procedures surrounding documentation of patient income, identification, and registration is followed, and specifically that this documentation is archived correctly within every patient file. The Corporation has conducted several staff trainings and has revised its review procedures for checking compliance to improve monitoring of the process by the Corporation.