Finding 497616 (2023-002)

Finding 2023-002 – Health Centers Cluster Federal Agency – U.S. Department of Health and Human Services Grant Period – Year ended December 31, 2023 Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using the Center’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with the Center’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified five exceptions based on the SFDS. Three of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Two of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend the Center review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage the Center to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and the Center’s billing processes and procedures.