Finding 613499 (2022-001)

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Requirement
P
Questioned Costs
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Year
2022
Accepted
2023-01-29

AI Summary

  • Core Issue: The sliding fee discount was not applied correctly for some patients, leading to incorrect billing.
  • Impacted Requirements: The health center must ensure discounts are based on patients' ability to pay, as per federal guidelines.
  • Recommended Follow-Up: Collaborate with the billing system vendor to automate discounts and establish review processes before billing patients.

Finding Text

Finding 2022-001: Sliding Fee Discount Federal Agency: U.S. Department of Health and Human Services Award Name: Community Health Centers Program Year: October 1, 2021 ? September 30, 2022 Assistance Listing Number: 93.527/93.224 Criteria: The health center must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient's ability to pay. Condition: During compliance testing, it was identified that the sliding fee discount was not accurately applied to two patients out of a sample of 25. An additional patient did not have any support on file for the discount they received. Context: Some patients did not receive the proper discount based on the approved sliding fee schedule. Cause: The billing system utilized by the Organization does not automatically apply the discount, therefore requiring the Organization's billing team to review and manually adjust patient bills. Effect: As a result of the condition, some patients received incorrect bills. Recommendation: In the future, the Organization should work with the billing system vendor to automate the billing within the system. Additionally, the Organization should implement appropriate processes and controls to ensure a review is performed prior to sending patient bills. Views of Responsible Officials: Management acknowledges the finding and will work with the system vendor to correct the discount process.

Categories

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Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.34M
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $851,885
93.778 Medical Assistance Program $105,477
93.959 Block Grants for Prevention and Treatment of Substance Abuse $63,701
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $9,351
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $3,458