Finding 501987 (2023-001)

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Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-10-08
Audit: 324161
Auditor: D & CO LLP

AI Summary

  • Core Issue: Patients are not receiving the correct sliding fee discounts due to outdated or incorrect income and household size information.
  • Impacted Requirements: The Health Center Program Cluster mandates that sliding fee scales align with current Federal Poverty Guidelines.
  • Recommended Follow-Up: Amistad Community Health Center, Inc. should update policies and training related to sliding fee scale calculations to ensure accurate patient assessments.

Finding Text

Criteria: The Health Center Program Cluster requires Amistad Community Health Center, Inc. to perform a financial assessment on patients in order to places them on a sliding fee scale. The sliding fee scale must be based on the current Federal Povery Guidelines. Condition: Patients are not always provided the appropriate sliding fee discount based on factors such as income and household size. Questioned Costs: None Context: Forty (40) consumer files were tested for proper placement on the sliding fee scale. During our audit it was noted that six (6) consumer files placement on various sliding scales was determined by using outdated proof of income and/or household size information, or was incorrectly calculated in general, in accordance with Amistad Community Health Center Inc.'s policy. The sliding fee schedule is used to determine eligibility for patient discounts adjusted on the basis of the patient's ability to pay. This schedule is based on the most recent Federal Poverty Guidelines. Cause : Controls over placement of patients on the sliding fee scale necessary for financial assessment of patients are not operating effectively. Effect: Patients were provided incorrect discounts for services provided by Amistad Community Health Center, Inc. Recommendation: Amistad Community Health Center Inc. should review and modify the policies, procedures, and training surrounding the sliding fee scale calculation and placement. View of Responsible Officials: See management's corrective action plan.

Corrective Action Plan

1) Revisit our training materials provided to our Patient Access Representatives upon being hired and revise such materials to emphasize sliding fee requirements more thoroughly. Provide testing to new hires after training to establish if training was effective. a. Anticipated completion date: 10/31/2024 for revisions, ongoing with new hire training 2) Establish front desk (Patient Access Coordinator) supervisor “recap” trainings establishing the requirements for sliding fee designations. During this training, allow for on-hands role-playing of scenarios conducted both at group and individual levels. a. Anticipated completion date: 10/31/2024 3) Establish routine spot audits. Our Patient Access Coordinator will do spot audits on a monthly routine, and more a formal process at the CFO level completed quarterly. a. Anticipated completion date: Ongoing

Categories

Eligibility

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
93.526 Fip Verification $513,194
93.224 Community Health Centers $157,194
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $11,091