Finding Text
2022-001 ? Application of Sliding Fee Schedule Discount Criteria: The Community Health Center is required to have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover the reasonable costs of operation. The corresponding sliding fee schedule of discounts applied and adjusted should be based on the patient?s ability to pay. The patient?s ability to pay is determined based on the official poverty guidelines, as revised annually by the U.S. Department of Health and Human Services. Condition: During our testing of the sliding fee schedule, we noted the Community Health Center has a sliding fee schedule, whereby the basis of the patient?s ability to pay is based upon the patient?s income, using the federal poverty guidelines as a basis for the percentage of the sliding fee schedule discount. However, in three of the forty patient files tested, the sliding fee schedule discount was calculated incorrectly causing the sliding fee schedule discount to be improperly applied. Cause: The Community Health Center is not following policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: The sliding fee discount applied is incorrect. Indication of Repeat Finding: This is a repeat finding. The finding in the prior audit was 2021-001. Recommendation: We recommend the Community Health Center?s sliding fee schedule discount be correctly applied by following established policies and procedures regarding the sliding fee schedule calculation. Views of Responsible Officials and Planned Corrective Actions: The Community Health Center has been focused on continuous improvement and ongoing focused training for the past two years. The Clinic has continued to implement new workflows and procedures. In January 2022, we started to internally review 100% of the sliding fee documents and correct any errors as soon as they are discovered. Additionally, our Billing department does a review of a random sample to ensure our internal audit is performing as planned. Our organization?s leadership and Board of Directors understand the importance of the requirement to apply our policies and procedures accurately and appropriately regarding the sliding fee discount calculations. The Community Health Center has taken swift and direct actions to improve our adherence to our policies and procedures related to the sliding fee discounts.