Finding Text
2022-101 Special Tests and Provisions - Sliding Fee Scale Discounts Federal Program: FAL#: 93.224 Health Center Program Cluster: Health Center Program U.S. Department of Health and Human Services Federal Grant Number: H80CS12848-VARIOUS Questioned Costs: None Criteria: Patients applying for sliding fee scale (SFS) discounts should have their income levels adequately documented and accurately calculated, and patients should be given the proper discount based upon their income level in accordance with 42CFR Section 51c.303(f). Condition: Wesley requires patients that apply for the SFS discount to complete attestation forms that includes their household sizes and income levels, and these forms are then used to determine patients' SFS discounts. Two SFS encounters that we tested had incorrectly calculated SFS discount applied in the patient management system. Cause: Unknown. Effect: For two of forty sliding fee patient encounters tested, Wesley utilized outdated Federal Poverty Guidelines to calculate FPL%; therefore those patients were not charged the correct copays in accordance with federal requirements. In addition, Wesley did not consistently update income levels for existing patients. Recommendation: To help ensure that sliding fee patient records are properly calculated and documented, Wesley should strictly adhere to its formal written policies and procedures, and conduct random reviews of sliding fee scale applications in order to detect and correct errors or incomplete applications on a timely manner.