Finding Text
Health Center Program Cluster ? CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS28423-07-02 Program Year 2022 Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR Sections 51c.303(g); and 42 CFR Sections 56.303(f)) Condition ? Patients with insurance received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization?s policy. Questioned costs ? None Context ? A sample of 25 patients were tested out of the total population of 30,172 encounters. The sampling methodology used is not and is not intended to be statistically valid. Three patients with third-party insurance received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation. Effect ? Sliding fee discounts were given to patients with third-party insurance that were inconsistent with the Organization?s sliding fee discount policy. Cause ? The Organization did not comply with their sliding fee policy. Identification as a repeat finding ? Not a repeat finding. Recommendation ? We recommend management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual when combined with insurance plan contractual adjustments and payments. Views of Responsible Officials and Planned Corrective Actions ? It is the responsibility of the CFO, Seresa Howe, to oversee the Sliding Fee Discount implementation and policy. It is also the responsibility of Seresa Howe, CFO to keep Renee Hively, CEO informed of all possible non-compliance findings of the slide fee discounts being assessed to patient?s accounts. The planned corrective action is still in process of being implemented into our electronic medical records as the sliding fee discounts are automated. CEO will be notified when ticket has been completed by HCN and all testing of new sliding fee rules have been completed.