Finding 497398 (2024-001)

U.S. Department of Health and Human Services Federal 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 Costs: None Context: A sample of 25 patients were tested out of a total population of 3,222 encounters. Two patients did not receive the proper sliding fee adjustments. The sampling methodology used is not and not intended to be statistically valid. Effect: Incorrect sliding fee discounts were given to patients. Cause: The Organization did not comply with its sliding fee policy. Identification as a Repeat Finding, if Applicable: Not a repeat finding. Recommendation: We recommend management continues to ensure all personnel understand the sliding fees 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 findings. CABUN will open an item with Aprima requesting a modification to the Practice Management system to make an automatic classification of the slide category instead of a manual classification as is currently required. Front Office, Billing and Collections staff will be reeducated on the entire process of sliding fee; from application to ensuring adjustments are made correctly. A new version of the slide application will be considered to simplify the process. CABUN will go back to a 100% review of all sliding fee patients, with a second audit in place to spot checking behind the Billing department. 1. Patient applications will be updated using the new version. 2. On the CHC tab where the slide is mentioned, the requested modification once made will become an automatic entry instead of a manual entry to prevent errors. 3. When the insurance is created, the slide category will match not only the CHC tab, but the application as well. 4. Billing will make any corrections to the slide applications and categories, and when errors are made directly contacting the person making the error for reeducation. Management and all personnel involved will review and determine the appropriate sliding fee discount in order to be in compliance with Uniform Guidance. All patients will be offered an application to participate in the sliding fee discount. Information will be entered into the syste as declined or appropriate to arrive at the sliding fee category. The application will then come to Hampton where a billing clerk will review the application for accuracy. The CHC and Insurance tab will reflect the correct sliding fee category. Corrections to the patient account will be made if there are any inaccuracies found. Education will be provided to those making the error and corrective action taken if continued omissions. In the Organizations PMS, the slide is setup as an insurance, if no other insurance is primary the adjustment is automatically made. The PMS has been checked for accuracy of slide categories, adjustment codes and insurance types.