Finding 484741 (2023-001)

- Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-08-21

AI Summary

  • Core Issue: Errors in income calculations were found in 11 out of 75 applications tested, impacting billing accuracy.
  • Impacted Requirements: GMC must ensure proper billing for federally supplemented patient services, with inconsistent procedures noted.
  • Recommended Follow-Up: Implement a review process for recalculating fees by site leaders and provide ongoing training for front desk staff.

Finding Text

75 applications at 3 locations were tested. Eleven errors were found, 7 incorrect calculations of income, fees would not change and 4 incorrect calculations where fees would change. GMC has responsibility of ensuring proper billing of patient services that are supplemented by the federal government. Findings had various effects depending on the issues noted above. In most instances where fees would change, more income would be due to Goshen from patients. Applicagtion calculations were not checked by another employee. Procedures and standards inconsistently followed. Review process of the sliding fee scale application should include a recalculation by the site leader. Front desk employees should receive continuing education classes. Management concurs.

Corrective Action Plan

Staff turnover and new staff completing the sliding fee have contributed to incorrect calculation discovered during the audit. The trainers will continue focusing on electronic medical records, practice management systems, and the sliding fee process.  Staff will repeat the sliding fee training video explaining how to calculate sliding fees and complete a front desk training encompassing in-depth training detailing how documentation is used for correct calculation, determining household size, and storing the documentation.  Goshen also recognizes additional training on reading and recognizing gross income on tax forms. The sliding fee scale policy that was updated in 2021 and will be updated this year (2024) will continue to extend the self-declaration from one visit to allowing the patient six months to bring in all documentation.  During site visits, the Internal Auditor continues to meet with the site leaders to discuss any findings, including income calculation.  All new front desk staff will continue to receive additional training on the sliding fee reference sheet created to guide income source, use, and validation of gross income calculation, household members, and document storage.  Billing staff members will continue to send site leaders weekly sliding fee queries to address issues and a required resolution response for oversight of the sliding fee process. Goshen Management will ensure that all sliding fee applications have the second signature for accuracy.

Categories

No categories assigned yet.

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) $12.56M
10.766 Community Facilities Loans and Grants $257,744
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $225,733