Finding 485 (2023-001)

U.S. Department of Health and Human Services Assistance Listing Number 93.527 and 93.224 Health Center Program Cluster Criteria or Specific Requirement - Special Tests and Provisions: Sliding Fee Discounts Condition - Patients did not receive the proper sliding fee adjustments under the Organization's policy. Questioned Cost - None Context - A sample of 25 patients were tested out of the total population of 3,042 encounters. Two patients did not receive the proper sliding fee adjustments. The sampling methodology used is not and is not intended to be statistically valid. Effect - Incorrect sliding fee discounts were given in the sample selected for testing. Cause - The Organization did not comply with its sliding fee policy Identification as a Repeat Finding - No Recommendation - We recommend management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale. Views of Responsible Officials and Planned Corrective Actions - The Organization concurs with the finding and management has implemented procedures to ensure that eligible patients receive discounts in accordance with the sliding fee scale. The Office Managers will review all new sliding fee application on a monthly basis to ensure accuracy. The Billing Manager will conduct quarterly audits of sliding fee claims to ensure the adjustments are entered correctly by the billing department.