Finding 554840 (2024-001)

Significant Deficiency
Requirement
A
Questioned Costs
-
Year
2024
Accepted
2025-04-11
Audit: 353413
Organization: Tyler Family Circle of Care (TX)

AI Summary

  • Core Issue: Incorrect sliding fee discounts were applied in three cases.
  • Impacted Requirements: Compliance with the sliding fee discount schedule under ALN 93.224/93.527.
  • Recommended Follow-Up: Review and correct the sliding fee discounts to ensure they align with patients' ability to pay.

Finding Text

Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay”. In three identified instances the sliding fee discounts applied were incorrect.

Corrective Action Plan

We have resolved the issue by identifying that our EMR system, EPIC, was not calculating the slides correctly. Due to this issue, we were utilizing an Excel spreadsheet to manually calculate the slides for our SFS patients. This process did work and calculated the correct slides as long as our front desk staff input the patient’s data correctly. In the instance of the samples that had incorrect slides calculated, it appears that it was an user error where they must not have adequately reviewed the patient’s information and entered it correctly into the spreadsheet. Our corrective action plan is that we are no longer going to use the spreadsheet for calculating SFS slides for our patients. This will be done in EPIC now that it is able to correctly calculate the slides. We will continue to use our internal trainer to work with the front desk staff to ensure they understand how to review the SFS applications and supporting documentation, as well as enter the patient data into EPIC to calculate the correct slides. Furthermore, each clinic manager will review the SFS applications on a daily basis to verify the correct slides were calculated for each patient.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 1131282 2024-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.526 Grants for Capital Development in Health Centers $375,385
93.217 Family Planning Services $224,157
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $198,362
93.268 Immunization Cooperative Agreements $187,000
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $175,395
93.527 Grants for New and Expanded Services Under the Health Center Program $48,076
10.766 Community Facilities Loans and Grants $23,397