Finding Text
Criteria: The District’s internal control structure should ensure that patients whom have filled out a sliding scale fee application were charged the appropriate rate.
Condition: During the audit, it was identified one patient out of twenty-five tested was charged an inappropriate amount when compared to the sliding fee scale application filled out. The patient was accurately determined to be a full discount eligible, self-pay patient. While reviewing the invoice billed to the patient, it was determined that all charge codes except the coronavirus lab test fee were fully discounted appropriately. After noting that one incident, an additional seven patients who were billed with the coronavirus charge code were reviewed. All of the seven patients reviewed, of varying discount eligibility, were noted to have been fully charged for the coronavirus lab fee.
Cause: The coronavirus lab test code was manually overwritten to exempt the sliding fee scale eligibility determination due to a previous grant covering the fee. The grant that covered this expense for self pay patients had lapsed and the manual override was not removed.
Effect: Self pay patients of varying discount eligibility were fully charged for the coronavirus lab test.
Recommendation: We recommend that the District review invoices for self-pay patients to ensure they are being accurately billed. We also recommend that manual overrides are reviewed periodically.
Managements Response: The District has reviewed the Independent Auditor’s recommendation. The District’s leadership is committed to developing processes to ensure all compliance requirements are met.