Finding 558976 (2024-001)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-05-01

AI Summary

  • Core Issue: There is a significant deficiency in internal controls regarding the sliding fee scale, leading to incorrect discounts for patients.
  • Impacted Requirements: The organization failed to comply with the Health Center Program Compliance Manual, which mandates proper assessment of patient income and family size.
  • Recommended Follow-Up: Review and update policies, and provide ongoing training for staff involved in sliding fee scale assessments to ensure compliance.

Finding Text

#2024-001 – Misapplication of the Sliding Fee Scale – Special Tests and Provisions – Assistance Listing Numbers: 93.224 and 93.527 Consolidated Health Center Cluster (Repeat Finding) Type of Finding: Significant Deficiency in Internal Control over Compliance Condition: Inadequate oversight in ensuring compliance with its sliding fee scale policies and federal sliding fee guidelines. Criteria: The Health Center Program Compliance Manual requires a health center to have operating procedures assessing and re-assessing all patients for income and family size consistent with approved sliding fee discount program policies. Effect: The Organization did not properly follow its sliding fee scale policy and procedures for patients that applied for a sliding fee discount. Context: 7 out of 60 patients selected for testing received an incorrect discount based on the approved sliding fee scale and patient income levels. Questioned Costs: None Cause: Inconsistent application of the policies and procedures approved by the Organization. View of Responsible Officials: Management agrees with the finding. 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

Corrective Action: 1. Sliding fee applications have been streamlined to provide registration colleagues with a more efficient process. 2. Registration and billing colleagues have received and will continue to receive ongoing training on the sliding fee discount application and process. 3. The information provided for the training will be translated to a process document and provided to all registration staff and billers. Colleagues will be expected to use this document as reference guide to improve program adherence. 4. Registration colleagues will participate in a peer review process where each colleague reviews 5 accounts monthly. They will audit demographics and insurance, as well as slide fee program adherence. Feedback will be provided to the colleagues responsible for errors to make corrections. 5. A leadership team member supervising patient registration colleagues will continue to audit 50 patient accounts each month. The accounts selected will have at least one billable medical, behavioral health, SUD, or dental encounter in the audit month. The audit criteria will include identifying the colleague responsible for inputting income information and application of discounts. Errors identified through the audit process will be sent to the colleage responsible for correction. Supervision and coaching will be provided to colleagues while fixing their errors to improve future performance. Responsible Party(s): Melissa Darko, Revenue Cycle Director and Lisa DeMallie, Associate Vice President of Patient Experience Estimated Completion Date: Applications were streamlined in March 2025; training was provided in April 2025 and will be ongoing; a process document will be provided to staff in May 2025; peer reviews were started in February 2025; and auditing has been ongoing and will continue.

Categories

Internal Control / Segregation of Duties Special Tests & Provisions Significant Deficiency

Other Findings in this Audit

  • 558977 2024-001
    Significant Deficiency Repeat
  • 558978 2024-001
    Significant Deficiency Repeat
  • 558979 2024-001
    Significant Deficiency Repeat
  • 1135418 2024-001
    Significant Deficiency Repeat
  • 1135419 2024-001
    Significant Deficiency Repeat
  • 1135420 2024-001
    Significant Deficiency Repeat
  • 1135421 2024-001
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.85M
17.268 H-1b Job Training Grants $395,088
93.526 Grants for Capital Development in Health Centers $278,311
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $277,486
93.530 Teaching Health Center Graduate Medical Education Payment $186,798
93.150 Projects for Assistance in Transition From Homelessness (path) $163,588
93.958 Block Grants for Community Mental Health Services $158,246
93.788 Opioid Str $155,796
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $126,400
93.575 Child Care and Development Block Grant $64,882
93.940 Hiv Prevention Activities Health Department Based $56,833
93.527 Grants for New and Expanded Services Under the Health Center Program $1,680