Finding Text
Criteria or Specific Requirement
Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.”
Condition and Context
During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified one visit that received the incorrect sliding fee discount.
Effect
Potential that a patient would not receive the appropriate sliding fee discount.
Questioned Costs
None identified.
Cause
Clerical error in which the incorrect discount was applied due to lack of an oversight process in place.
Recommendation
We recommend the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter.
Views of Responsible Officials
The Organization corrected the claim on November 15, 2023 to give the patient the appropriate sliding fee discount. The Organization has provided education to staff instructing them that the charges quoted at a patient's slide will change if the slide is different at the time of service. IT has also added verbiage to the dental treatment plans stating that the slide at the time of service will be applied even if the quoted price was at a different slide.