Finding Text
2023-001 Special Tests and Provisions
Criteria: Special Tests and Provisions under the Department of Health and Human Services, Health Center Cluster, require that a full sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge.
Condition: One instance was noted where the patient was given a 75% discount of $18.75 on a $25 charge, leaving a balance of $6.25. The patient should have been charged a nominal fee $20.
Cause: Inconsistent control activities related to the application of sliding fee discounts, resulting from a change in billing software and processes.
Effect: The incorrect fee was charged to a patient.
Recommendations: We recommend that the Organization establish written billing procedures and develop controls to ensure sliding fee discounts are consistently and accurately applied to all eligible patients.
Views of Responsible Officials and Planned Corrective Action Plan: Management agrees with the finding and is in the process of implementing and documenting procedures to provide additional oversight on the application of sliding fee discounts.