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.