Finding 61318 (2022-001)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
$1
Year
2022
Accepted
2023-09-28
Audit: 54388
Organization: Baptist Health (AR)
Auditor: Forvis

AI Summary

  • Core Issue: Funds were improperly claimed for a patient who had insurance, violating eligibility criteria.
  • Impacted Requirements: Compliance with 2 CFR Part 200 regarding uninsured individuals was not met.
  • Recommended Follow-Up: Establish stronger controls to verify patient insurance status and ensure timely refunds for incorrect claims.

Finding Text

Department of Health and Human Services HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Assistance Listing 93.461 Program Year 2022 Criteria: Eligibility ? Per 2 CFR Part 200, services must be for individuals, who at the time the services were provided, were uninsured as described in the terms and conditions. Condition: The Corporation received program funds for a patient who had insurance coverage. Questioned Costs: Projected questioned costs are estimated to be $703.74. Context: Two patients were initially considered uninsured, and the claims were billed to the federal program. It was later determined that the patients had insurance coverage through Arkansas Blue Cross; however, the refund process for the program funds was not initiated until this error was noted during the audit. We tested a random sample of 40 claims billed to the federal program during 2022, from a total population of 3,432 claims billed to the federal program. This error was noted for two claims out of the 40 sampled. The sample was not intended to be, and was not, a statistically valid sample. Effect or Potential Effect: Program funds were drawn to cover a claim for a patient who had insurance. Cause: Internal controls were not adequately designed and implemented to ensure compliance with the program?s eligibility requirements. Identification as a Repeat Finding: Yes, 2021-002 Recommendation: We recommend implementing controls to ensure review of patient insurance coverage and that the refund process is completed timely. Views of Responsible Officials and Planned Corrective Actions: Management concurs with the finding and recommendation and will implement controls to ensure all patient insurance coverage is reviewed and that the refund process is completed timely.

Corrective Action Plan

Corrective Action Plan ? 9/26/2023 Responsible Party: Donna Crutchfield, Director of Revenue Cycle Finding: During audit review of the COVID 19 HRSA testing and treatment payments received in 2022, two claims were discovered incorrectly charged to the COVID uninsured grant. Comments on the Finding and Recommendation Management is in agreement with this finding. Action(s) Taken or Planned on the Finding ? Build already existed in Epic to stop any uninsured patients that met COVID guidelines at time of service for review. This also includes build that stops claims if HRSA plan added later in the process for review. Expanded Plan on Actions Taken ? 09/26/2023 1. Actions planned on one claim found in audit. Refund will be issued for $122.69 for TIN 710236856 NPI 1043240682. 2. Actions planned for additional claim found in audit. Refund will be issued for $74.20. TIN 710236856 NPI 1174553796. 3. Refund process - Current credit balance policy is attached. Note all government payers are due to be reviewed and worked within a 60-day timeline. This is current as of 4/10/2023. 4. Note that auditors listed an extrapolated figure under projected costs based off the two claims found in the sample audit. The two claims found will be refunded. Missed other insurance information was due to patients? lack of presentation of insurance info at the time of service. 5. Going forward to ensure all meet credit guidelines. If there is a HRSA credit on a claim, it will be worked within policy guidelines. 6. As mentioned in previous plan, initial build exists (as of May 2020) in Epic to stop any uninsured patients that met COVID guidelines at time of service for review. This review allows to check for other coverage. There is also build that stops coverage if HRSA coverage is added later on in the process for a second review. Insurance coverage can be retroactively assigned after HRSA is filed. In this event, this would show as a credit if another payment was received and then be refunded by policy. In summary: ? Patient visit is set to review and confirm no active coverage is present, insurance coverage discovery was run, patient's visit was associated with COVID related service. ? HRSA coverage added and patent is keyed to HRSA portal for member ID to file claim. HRSA also checks insurance verification on their side and will notify if HRSA found active coverage not located by us. 5. Contact information for additional Questions: Donna.Crutchfield@baptist-health.org or 501-202-6440.

Categories

Questioned Costs Cash Management Eligibility Internal Control / Segregation of Duties

Other Findings in this Audit

  • 637760 2022-001
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
97.036 Covid-19 Disaster Grants - Public Assistance (presidentially Declared Disasters) $3.48M
84.268 Federal Direct Student Loans $3.00M
93.575 Child Care and Development Block Grant $2.74M
93.498 Provider Relief Fund (prf) and American Rescue Plan (arpa) Rural Distributions $2.21M
93.697 Covid-19 Testing and Mitigation for Rural Health Clinics $1.40M
84.063 Federal Pell Grant Program $1.16M
84.425 Education Stabilization Fund $1.07M
93.461 Hrsa Covid-19 Claims Reimbursement for the Uninsured Program and the Covid-19 Coverage Assistance $881,301
93.155 Rural Health Research Centers $684,898
93.889 Covid-19 National Bioterrorism Hospital Preparedness Program $650,120
10.766 Community Facilities Loans and Grants $357,000
32.005 Universal Service Fund - Rural Health Care $196,194
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $45,291
93.301 Small Rural Hospital Improvement Grant Program $43,891
84.007 Federal Supplemental Educational Opportunity Grants $27,500