Finding Text
2022 ? 002 Special Tests: Application of Sliding Fee Discount Federal Agency: U.S. Department of Health and Human Services Federal Program: Consolidated Health Centers Grant AL Number: 93.224 & 93.527 Award Period: 1/1/22 - 12/31/22 Type of Finding: Significant deficiency in Internal Control over Compliance and Compliance Criteria or Specific Requirement Per Title 42 Chapter 1 Subchapter D Section 51c303(f), ?Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient?s ability to pay.? Section III ? Findings and Questioned Costs ? Major Federal Programs (Continued) 2022 ? 002 Special Tests: Application of Sliding Fee Discount (Continued) Condition and Context During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified one visit that received the incorrect sliding fee discount. We also identified one visit where the Organization was not able to locate the sliding fee discount application. Effect Potential that a patient would not receive the appropriate sliding fee discount. Questioned Costs None identified. Cause Clerical error in which the incorrect discount was applied due to lack of an oversight process in place. Recommendation We recommend the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter. We also recommend the Organization put a process in place to make sure all applications are retained. Views of Responsible Officials The Organization will implement the following peer review process: ? A peer review is required to determine the appropriate sliding fee calculation was made based on family size and income of the applicant. ? A reference and training guide will be created by the Organization for front desk staff and enrollment specialists to utilize by September 30, 2023. ? Each sliding fee application will be reviewed by a peer and signed off by both the submitter and the peer reviewer. A verification checklist will be utilized to ensure the sliding fee application is accurate and complete. ? The finance department will receive a list of all new sliding fee applications from the previous month and pull a sample of twenty applications to review for accuracy and to confirm the peer review occurred. ? The Organization will implement a process where the patients will complete the sliding fee application prior to seeing the provider. The process is expected to be implemented by October 31, 2023.