Finding Text
Condition: As a result of our audit procedures, we found five errors in the application of the
sliding fee scale.
Criteria: The sliding fee scale discount is based on patient income and demographic
information. Controls should be in place to ensure the sliding fee scale is
consistently applied for each patient.
Effect: Continued noncompliance could result in a loss of funding. Additionally, it could
result in inequitable access to healthcare services for patients and expose the
Center to reputational risks.
Context: During our testing, we found 5 of the 60 patients tested were not billed for the
proper slide category based on the sliding fee scale provided by the PureView. No
questioned costs were identified.
Cause: The errors resulted from claims where the sliding scale was improperly recorded
within the claim. There was no check to verify that the claim scale matched the
scale within the patient files. These claims were missed during the billing
department’s internal review of scale application. Individuals responsible for the
primary and secondary review of sliding fee scale applications requires additional
training and resources to ensure errors are detected timely.
Recommendation: We recommend that PureView strengthen its internal controls by reviewing claims
to ensure proper application of the sliding fee scale.
Management Response: See Corrective Action Plan.