Finding Text
2022-001 Sliding Fee Discounts
Criteria: Syracuse Community Health Center, Inc. (the Center) is required to have a sliding fee scale policy and to perform calculations in accordance with the established policy. The Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts given to patients in accordance with the Center's sliding fee scale.
Condition: During our audit, we attempted to test a haphazardly sample of 40 sliding fee scale calculations. Two patients received an inappropriate slide based on the application and supporting documentation. Two applications were not completed in accordance with the terms of the Center’s policy.
Context: We recalculated the sliding fee using the supporting income documentation maintained by the Center and the Center’s policy. The sample was not a statistically valid sample.
Effect: The Center is not properly maintaining sliding fee scale documentation for patients or applying the slide to patient charges properly.
Cause: The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper documentation is being maintained and that proper sliding fee discounts are being applied.
Recommendation: The sliding fee scale option is available as a result of grant funding. The Center should review and strengthen the current procedures in place for determining a patient’s financial responsibility for their visit using the sliding fee scale. This should include requiring a knowledgeable representative of the Center’s signature approval on the documentation received and the fee calculated and provided to the applicant. All applications should contain support for the individual’s income level or documentation of no income, and the determination of the resulting fee.
Views of management and planned corrective action: This finding was repeated in 2022. Since this was a repeat finding, an internal audit was performed on all 2023 approved sliding fee applications to ensure compliance with our policy. Any corrective actions to the 2023 application were address and the facility’s sliding fee scale was modified to reflect proper authorization and proper segregation of duties going forward. Going forward, all sliding fee scale applications are now reviewed and authorized by the Manager of Revenue Cycle. Future auditing procedures have been put in place to review applications and adjusted, if needed, in a timely manner between now and the end of the year.