Finding 568837 (2024-001)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-06-30

AI Summary

  • Core Issue: Many sliding fee discounts were applied incorrectly, affecting patient billing.
  • Impacted Requirements: Health centers must ensure sliding fee applications are completed and discounts are based on patients' ability to pay.
  • Recommended Follow-Up: Implement procedures to verify applications before billing and ensure the billing system reflects the correct sliding fee schedule.

Finding Text

Criteria: Health centers must obtain sliding fee applications so that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: We tested 60 sliding fee encounters and noted that 40 out of 60 sliding fee encounters tested were discounted the incorrect amount. We further noted that the EMR system was not updated for the 2024 sliding fee schedule. Cause and Effect: The Center failed to verify sliding fee discounts were applied correctly to charges and agreed to sliding fee rate schedules. Recommendation: We recommend that sliding fee applications be completed for each sliding fee patient. Procedures should be implemented to verify applications are completed before the encounter is billed. Sliding fee discounts per policy should be agreed in the billing system to ensure the proper discounts are entered and updated. In addition, the Center could consider increasing its internal sampling throughout the year to verify sliding fee applications are obtained, completed, and agree to the discount applied. Views of Responsible Officials: Management agrees with the finding. Corrective Action Plan: See attached correct plan.

Corrective Action Plan

CHASS management concurs with the audit findings and will put the following corrective action plan in place to mitigate this finding in the future: During the Sliding Fee Testing, it was found that the actual charge to the patient (after the sliding fee was applied) did not match the actual discount that the patient should have allocated. We have reviewed all processes on how EPIC loads up charges (table with applied sliding fee tiers) and found that no one had a master list of the charges. When the Billing Department requests a CPT to be added, they alert the Accounting Department to add them, as well as when they request changes on charges for CPT codes. There is not one set of approved CPT charges/discounts creating discrepancies in patients' accounts. In response to these audit findings, CHASS has developed and implemented a comprehensive series of improvements. First, the implementation of key improvements involves the implementation of one person only authorized to request changes on the table of charges to EPIC. Second, implementation of a verification process for every patient receiving a sliding fee discount. To achieve this, the Center's Customer Service team now generates personalized labels for each eligible patient and cross-checks their entries by the end of each day. This process ensures each item is diligently reviewed to ensure no errors are made within this process, and if identified, they are rectified immediately via a Supervisor/Team Leader. Through this process, the Supervisor/Team Leader now conducts a second review of the labels to ensure the accuracy of the Center's labeling system for each patient utilizing the sliding scale discount program. This review also includes the actual charges on EPIC, verified with the CPT Tables. This process will also include what sliding discount the patient qualifies for according to their income and family size. Third, the Center's Billing Department is now responsible for performing regular weekly audits. During these audits, the Billing Department will now randomly select five claims with sliding fee discounts and examine the applied fees, and the corresponding discounts applied to the patient's account (using the approved CPT Table). This process will also include what sliding discount the patient qualifies for according to their income and family size. Through these improvements, CHASS aims to ensure that the Sliding Fee Discount Policy is used accurately and appropriately. These methods have been incorporated into the Center's Sliding Fee Discount Policy to guarantee their utilization and accuracy and to further strengthen the Center's initiatives in providing access to needed healthcare services.

Categories

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Other Findings in this Audit

  • 568838 2024-001
    Material Weakness Repeat
  • 568839 2024-001
    Material Weakness Repeat
  • 568840 2024-001
    Material Weakness Repeat
  • 568841 2024-003
    Material Weakness
  • 568842 2024-003
    Material Weakness
  • 568843 2024-003
    Material Weakness
  • 568844 2024-003
    Material Weakness
  • 1145279 2024-001
    Material Weakness Repeat
  • 1145280 2024-001
    Material Weakness Repeat
  • 1145281 2024-001
    Material Weakness Repeat
  • 1145282 2024-001
    Material Weakness Repeat
  • 1145283 2024-003
    Material Weakness
  • 1145284 2024-003
    Material Weakness
  • 1145285 2024-003
    Material Weakness
  • 1145286 2024-003
    Material Weakness

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) $644,230
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $329,735
16.524 Legal Assistance for Victims $143,317
16.888 Consolidated and Technical Assistance Grant Program to Address Children and Youth Experiencing Domestic and Sexual Violence and Engage Men and Boys As Allies $134,743
16.588 Violence Against Women Formula Grants $131,810
93.527 Grants for New and Expanded Services Under the Health Center Program $126,753
16.575 Crime Victim Assistance $103,945
16.017 Sexual Assault Services Formula Program $86,025
93.332 Cooperative Agreement to Support Navigators in Federally-Facilitated Exchanges $74,051
16.016 Culturally and Linguistically Specific Services Program $57,770
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $43,734
21.027 Coronavirus State and Local Fiscal Recovery Funds $12,243
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $3,128