Finding Text
2022-001 Provider Relief Fund Lost Revenue Payor Classification Cluster: Not applicable Grantor: Health Resources and Services Administration Award Names: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Year: PRF Period 2 Period of Availability from January 1, 2020 to December 31, 2021 Award Number: Not applicable Assistance Listing Numbers: 93.498 Criteria Reporting entities were required to submit revenues/net charges from patient care (prior to netting with expenses) incurred within the period of availability, by payer mix (including out of pocket charges), and by quarter for each quarter during the period of availability up to June 30, 2023, the end of the quarter in which the Public Health Emergency ends. Condition As we were performing our lost revenue tie out procedures, we noted the Net Charges from Patient Care by Payer (?Net Charges?) were inaccurately reported in the PRF Period 2 Reporting Portal Submission. More specifically, the System transposed the referenced Net Charges in the `Total Revenue/Net Charges from Patient Care (2021 Actuals)? table by the following: ? For Q2 (2021), the System understated the Medicaid/Children?s Health Insurance Program (CHIP) payer and overstated the Commercial Insurance payer Net Charges by $2,222,668. ? For Q3 (2021), the System understated Medicaid/Children?s Health Insurance Program (CHIP) by $973,100, understated Commercial Insurance by $289,399, and overstated Self-Pay (No Insurance) by $1,262,499. ? For Q4 (2021), the System understated Medicaid/Children?s Health Insurance Program (CHIP) by $411,383, understated Commercial Insurance by $99,064, and overstated Self-Pay (No Insurance) by $510,447. As Net Charges were transposed between payers, there was no impact to the total revenue and lost revenue calculation reported in the PRF Period 2 Reporting Portal Submission. Cause Management did not have a control in place to perform a second level of review to check the accuracy of the reporting at the time of completing the PRF Period 2 Reporting Portal submission. Effect Net Charges from Patient Care by Payer for were inaccurately reported in the PRF Period 2 Reporting Portal Submission. Questioned Costs None identified. Recommendation We recommend that management implement a second level of review over the PRF Reporting Portal submissions. Management?s Views and Corrective Action Plan Management?s Views and Corrective Action Plan are included at the end of this report after the summary schedule of prior audit findings and status.