Finding 541978 (2024-003)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-03-31

AI Summary

  • Answer: One sliding fee discount lacked the required application on file, and four discounts were incorrectly adjusted.
  • Trend: This indicates potential issues with documentation and accuracy in the Practice Management System.
  • List: Follow up by ensuring all applications are filed and reviewing the PMS for proper adjustments to prevent future undercharges.

Finding Text

We randomly selected forty sliding fee discounts to test for compliance. One of the forty sliding fee selections did not have a sliding fee scale application on file at the date of service. Also, there were four instances in which the sliding fee discount was improperly adjusted in the Practice Management System (“PMS”), resulting in a net undercharge of $45.

Corrective Action Plan

The sliding fee determination will be reviewed by the front desk staff thoughtfully to ensure the proper charge to the patient. Once the patient is screened and determined to be eligible for the Sliding Fee program by the front office, the patient will complete the Sliding Fee application and self declaration of income and family size. The front office will verify the application, determine the scale for which the patient qualifies, and verify with the Center's practice management system. The lead biller will review all uploaded documents and approve the sliding fee in real time. Additional traning will take place with front desk personnel.

Categories

No categories assigned yet.

Other Findings in this Audit

  • 541977 2024-002
    Material Weakness
  • 1118419 2024-002
    Material Weakness
  • 1118420 2024-003
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
10.766 Community Facilities Loans and Grants $8.35M
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $4.48M
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $983,972
93.137 Community Programs to Improve Minority Health $318,669
93.526 Grants for Capital Development in Health Centers $154,004
93.527 Grants for New and Expanded Services Under the Health Center Program $102,373
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $9,561
93.778 Medical Assistance Program $3,432