Finding 507895 (2022-002)

Material Weakness Repeat Finding

Requirement

Questioned Costs

Year

2022

Accepted

2024-11-14

Audit: 328434

Organization: Community Health Center Dba Alluvion Health, Inc. (MT)

Auditor: Withumsmith+brown PC

AI Summary

Core Issue: The Organization misapplied its sliding fee scale policy, leading to improper documentation and incorrect discounts for some patients.
Impacted Requirements: Compliance with the Health Center Program Compliance Manual, which mandates proper procedures for assessing patient eligibility for sliding fee discounts.
Recommended Follow-Up: Review and update policies, and provide ongoing training for staff involved in sliding fee scale assessments to ensure adherence to procedures.

Finding Text

Misapplication of the Sliding Fee Scale – Special Tests and Provision – Assistance Listing Numbers: 93.224 and 93.527 Consolidated Health Center Cluster (Repeat Finding) Type of Finding: Material Weakness over Compliance and Compliance Finding Condition: The Organization did not properly follow its sliding fee scale policy and procedures for patients that applied for a sliding fee discount and did not properly maintain documentation to support qualification, and the sliding fee discount received. Criteria: The Health Center Program Compliance Manual requires a health center to have operating procedures for assessing and re-assessing all patients for income and family size consistent with approved sliding fee discount program policies. Effect: No material noncompliance or questioned costs were noted in the period under audit. Context: Our testing detected 7 out of 72 patients selected for testing either did not have proper documentation to support their qualification of the sliding fee discount received or received an incorrect discount. Cause: Inconsistent application of the policies and procedures approved by the Organization. Recommendation: We recommend the Organization review its current policies and procedures and continue to provide training to all staff members handling the sliding fee scale assessments to ensure assessments are performed in accordance with policy.

Corrective Action Plan

Misapplication of the Sliding Fee Scale The department responsible for gathering and recording patient income data, and applying sliding fee discounts, experienced high attrition rates due to the role being entry-level. Recognizing these challenges, the Organization is in the process of revising the training plan for this department and establishing a quality assurance process for monitoring. Additionally, the Organization will review and revise the sliding fee policy to enhance clarity of the process for application of discounts and proof of income documentation. Responsible Parties: Mark Groeller, Compliance Director, Lisa DeMallie, Associate Vice President of Patient Experience, and Melissa Darko, Revenue Cycle Director Estimated Completion Date: December 31, 2024

Other Findings in this Audit

507896 2022-002

Material Weakness Repeat
507897 2022-002

Material Weakness Repeat
1084337 2022-002

Material Weakness Repeat
1084338 2022-002

Material Weakness Repeat
1084339 2022-002

Material Weakness Repeat

Programs in Audit

ALN	Program Name	Expenditures
93.224	Community Health Centers	$641,776
93.527	Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program	$116,775
93.217	Family Planning Services	$90,267
93.639	State Planning Grants for Qualifying Community-Based Mobile	$60,990