Finding 624 (2022-005)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-10-24
Audit: 1205
Auditor: Capincrouse LLP

AI Summary

  • Core Issue: The sliding scale assessment for patient fees was not always done correctly, leading to potential non-compliance.
  • Impacted Requirements: This finding violates 42 CFR Part 51c.303 (f), which mandates accurate fee assessments based on patient income.
  • Recommended Follow-Up: Implement a system to better flag sliding scale assessments and conduct regular reviews to ensure accuracy.

Finding Text

Sliding Scale Assessment Significant Deficiency U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ALN #: 93.224 Federal Award Identification #: H80CS00594 Condition: The sliding scale assessment based on the patient’s ability to pay was not always accurately performed or applied. Criteria: 42 CFR Part 51c.303 (f) Questioned Costs: $0 Context: Out of 6 patients tested, CCHC incorrectly calculated a sliding scale fee discount when the patient didn’t qualify based on income. For another patient, the assessment was correctly made but they did not charge the patient the sliding scale fee. Cause: Human error, challenges with the system in even identifying patients assessed a sliding scale fee. Effect: Non-compliance with federal regulations Identification as repeat finding, if applicable: not applicable Recommendation: We recommend that the system be set up to better flag patients who have been assessed for sliding scale and a periodic secondary review be completed to ensure accuracy of assessment. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. See corrective action plan.

Corrective Action Plan

Sliding Scale Assessment Planned Corrective Action: (Patients accounts were tested for eligibility for the sliding scale and found that the patient was not eligible for the discount. We are training staff to follow guidelines during their assessment. Sliding fee discounts will be approved by Sanara Leake. Person Responsible for Corrective Action Plan: (Sanara Leake, Revenue Cycle Manager) Anticipated Date of Completion: 10/30/2023

Categories

Significant Deficiency

Other Findings in this Audit

  • 625 2022-006
    Significant Deficiency Repeat
  • 626 2022-007
    -
  • 577066 2022-005
    Significant Deficiency
  • 577067 2022-006
    Significant Deficiency Repeat
  • 577068 2022-007
    -

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) $2.80M
93.224 Covid-19 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.01M
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $293,792
93.917 Hiv Care Formula Grants $214,036
14.241 Housing Opportunities for Persons with Aids $139,921
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $133,172
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $122,331
93.526 Covid-19 Affordable Care Act (aca) Grants for Capital Development in Health Centers $98,355
14.218 Community Development Block Grants/entitlement Grants $69,526
14.267 Continuum of Care Program $49,821
14.231 Covid-19 Emergency Solutions Grant Program $36,341
93.940 Hiv Prevention Activities_health Department Based $31,679
93.928 Special Projects of National Significance $23,919
93.914 Hiv Emergency Relief Project Grants $12,992