FAC Explorer

Finding 485833 (2024-001)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2024-09-05
Audit: 318624
Organization: Mainline Health Systems, INC (AR)
Auditor: Forvis Mazars LLP

AI Summary

  • Core Issue: Patients did not receive the correct sliding fee discounts as per the Organization's policy.
  • Impacted Requirements: Compliance with the sliding fee policy was not maintained, leading to incorrect adjustments.
  • Recommended Follow-Up: Management should ensure ongoing training and implement regular audits to verify adherence to the sliding fee scale policy.

Finding Text

U.S. Department of Health and Human Services Assistance Listing Number 93.224 and 93.527 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 40 patients were tested out of the total population of 3,642 encounters. Six 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 – Yes 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. The Organization has also launched additional training for all individuals involved in the sliding fee application process as well as automated sliding fee adjustments to reduce errors.

Corrective Action Plan

Name: Mainline Health Systems, Inc. Contact Name: Elyse Knobloch Contact Phone Number: 870.538.5414 Auditor/Audit Firm: Forvis Mazars, LLP Audit Period: January 31, 2024 Finding #2024-001 – Statement of Condition Patients did not receive the proper sliding fee adjustments under the Organization’s policy. Response: 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. The Organization has also launched additional training for all individuals involved in the sliding fee application process as well as automated sliding fee adjustments to reduce errors.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 485834 2024-001
    Significant Deficiency Repeat
  • 485835 2024-001
    Significant Deficiency Repeat
  • 485836 2024-001
    Significant Deficiency Repeat
  • 1062275 2024-001
    Significant Deficiency Repeat
  • 1062276 2024-001
    Significant Deficiency Repeat
  • 1062277 2024-001
    Significant Deficiency Repeat
  • 1062278 2024-001
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.527 Grants for New and Expanded Services Under the Health Center Program $4.01M
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, Public Housing Primary Care) $1.50M
10.766 Community Facilities Loans and Grants $1.14M
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $710,032
93.527 Covid-19 Grants for New and Expanded Services Under the Health Center Program $313,732
93.224 Covid-19 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, Public Housing Primary Care) $126,046
93.526 Fip Verification $52,921