Finding 47719 (2022-001)

Material Weakness
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-05-23
Audit: 52457
Organization: Clinica Msr. Oscar A. Romero (CA)

AI Summary

  • Answer: We found multiple errors in how sliding fee discounts were calculated for the health center.
  • Trend: This issue indicates a pattern of miscalculations that could affect patient billing and revenue.
  • List: Follow up by reviewing all sliding fee calculations, retraining staff on the correct process, and implementing a verification step.

Finding Text

During our testing of sliding fee discounts for health center, there were several instances in which the sliding fee was calculated incorrectly.

Corrective Action Plan

Upon discovering issues related to our Sliding Fee Schedule, Clinica Romero 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 in December 2022 and again in January 2023 to incorporate the 2023 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 on February 10, 2023. On March 15, 2023 we asked our EHR software company to ensure the system applies the discounts based on our policy correctly. 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. Clinica will track and monitor compliance through our QA/QI Committee on a regular basis. After all these corrective actions were implemented, we had a HRSA Operational Side Visit (OSV) in March 2023 and we are pleased to share that we passed the OSV?s Sliding Fee Discount Program (Chapter 9).

Categories

No categories assigned yet.

Other Findings in this Audit

  • 624161 2022-001
    Material Weakness

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) $1.36M
93.959 Block Grants for Prevention and Treatment of Substance Abuse $1.17M
93.217 Family Planning_services $245,638
93.498 Provider Relief Fund $186,952