Finding Text
CONDITION: DURING THE YEAR ENDED MAY 31, 2022, THE CLINIC?S CONTROLS OVER INCOME VERIFICATIONS DID NOT CONSISTENTLY RESULT IN EVIDENCE SUPPORTING THE PATIENT?S INCOME. IN A SAMPLE OF 40 PATIENT ENCOUNTERS, TWO INSTANCES WERE IDENTIFIED IN WHICH DOCUMENTATION WAS INSUFFICIENT OR MISSING TO SUPPORT THE PATIENT?S INCOME AND ASSESSED SLIDING FEE. CRITERIA: THE CLINIC SHOULD BE ABLE TO SUPPORT THE ACCURATE DETERMINATION OF A PATIENT?S SLIDING FEE AND ASSESSED CHARGES. CAUSE: THE CLINIC WAS UNABLE TO SUPPORT ELIGIBILITY OF PATIENT?S SLIDE DUE ITS INABILITY TO LOCATE APPROPRIATE DOCUMENTS AND/OR INCOME CALCULATIONS WERE INCORRECT RESULTING IN PATIENT BEING CATEGORIZED TO THE WRONG SLIDING FEE.EFFECT: FOR 2 OF 40 PATIENT ENCOUNTERS SAMPLED, THE CLINIC WAS UNABLE TO SUPPORT WHETHER THE SLIDING FEES CHARGED TO PATIENTS WERE ACCURATE SINCE CRUCIAL DOCUMENTS WERE MISSING, AND/OR WAS INSUFFICIENT. RECOMMENDATION: THE CLINIC SHOULD IMPLEMENT POLICIES AND PROCEDURES TO ENSURE THAT DOCUMENTATION OF INCOME IS MAINTAINED FOR EACH PATIENT AND THAT THE DOCUMENTATION AGREES TO THE PATIENT?S ASSESSED SLIDING FEE.