Finding 498647 (2024-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2024-09-26

AI Summary

  • Core Issue: A patient did not receive the required sliding fee discount despite providing adequate income verification.
  • Impacted Requirements: Compliance with the Department of Health and Human Services regulations for fee discounts based on federal poverty guidelines.
  • Recommended Follow-Up: Review and reinforce training for staff on applying sliding fee discounts to ensure compliance and prevent future occurrences.

Finding Text

SPECIAL TESTS AND PROVISIONS UNDER THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTH CENTER CLUSTER, REQUIRE THAT A FULL SLIDING FEE DISCOUNT IS APPLIED TO FEES FOR HEALTH CENTER SERVICES PROVIDED TO INDIVIDUALS AND FAMILIES WITH ANNUAL INCOMES AT OR BELOW 100 PERCENT OF THE FEDERAL POVERTY GUIDELINES, OR THE HEALTH CENTER APPLIES ONLY A NOMINAL CHARGE. ONE INSTANCE WAS NOTED WHERE A PATIENT WAS NOT GIVEN A SLIDING FEE DISCOUNT WHEN PROVIDING ADEQUATE INCOME VERIFICATION SUPPORTING THE DISCOUNT QUALIFICATION. THIS ONE INSTANCE RESULTED IN THE PATIENT NOT RECEIVING A SLIDING FEE DISCOUNT ACCORDING TO THEIR FEDERAL POVERTY LEVEL (FPL).

Corrective Action Plan

TERRY REILLY HEALTH SERVICES (TRHS) REVIEWED THE AUDIT EXCEPTION AND DETERMINED THAT IN THIS ONE INSTANCE, WE DID NOT PROPERLY APPLY THE SLIDING FEE SCALE TO THE PATIENT’S SERVICE WHERE IT SHOULD HAVE BEEN APPLIED, AND THE BILLING TEAM IS CORRECTING THIS ACCOUNT TO ISSUE A REFUND FOR THE ADDITIONAL DISCOUNT. TRHS BELIEVES THE SIGNIFICANT DEFICIENCY NOTED IN THE SCHEDULE OF FINDINGS AND QUESTIONED COSTS WAS ATTRIBUTABLE TO HUMAN ERROR EXACERBATED BY A MISTAKE IN COMMUNICATION BETWEEN TWO STAFF MEMBERS. TO ADDRESS THE ISSUES TRHS TRAINING MATERIALS HAVE BEEN REWRITTEN TO ENSURE STAFF UNDERSTAND HOW TO ENTER AND VERIFY THE DATA IN THE ELECTRONIC HEALTH RECORD SYSTEM (EPIC) AND FRONT DESK STAFF WHO ASSIST PATIENTS WITH THE COMPLETION OF THE SLIDING FEE DISCOUNT APPLICATION WERE RETRAINED TO ENSURE THAT THEY UNDERSTAND HOW TO INPUT DATA AND THE IMPORTANCE OF DATA ACCURACY. IN ADDITION, WE ARE CREATING A REPORT GENERATED FROM THE EPIC SYSTEM TO IDENTIFY CHANGED PATIENT SLIDE DISCOUNT INFORMATION AND ASSIGNING PATIENT FINANCIAL SERVICES STAFF TO AUDIT, REVIEW, AND ADDRESS ANY ISSUES. WE ARE REVISING AN INTERNAL AUDIT PROCESS OF THE SLIDING FEE DISCOUNTS. THE FRONT OFFICE SUPERVISORS, OR DESIGNEES, HAVE STARTED AN AUDIT PROCESS TO VERIFY NEW SLIDING FEE DISCOUNT APPLICATIONS AND DATA ENTRY FOR COMPLETENESS AND ACCURACY. IN ADDITION, THE PATIENT FINANCIAL SERVICES (PFS) DEPARTMENT WILL AUDIT A STATISTICALLY MEANINGFUL NUMBER OF PATIENT ACCOUNTS WHERE A SLIDING FEE DISCOUNT WAS TAKEN TO ENSURE THE ACCURACY OF THE CALCULATION. TRHS TAKES THIS ISSUE VERY SERIOUSLY AND HAS ALREADY STARTED TO IMPLEMENT CORRECTIVE ACTIONS.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 1075089 2024-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.696 Certified Community Behavioral Health Clinic Expansion Grants $1.54M
21.027 Coronavirus State and Local Fiscal Recovery Funds $363,600
93.217 Family Planning Services $208,440
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $146,238
93.994 Maternal and Child Health Services Block Grant to the States $105,298
93.224 Community Health Centers $89,636
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $66,212
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $54,163
16.575 Crime Victim Assistance $43,045
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $37,890
93.268 Immunization Cooperative Agreements $34,078
93.526 Fip Verification $27,805
14.267 Continuum of Care Program $18,533