Finding Text
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.? Condition: During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified five visits in which the incorrect sliding fee discount was applied or no sliding fee application was present at the date of service. Questioned costs: N/A Context: During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified five visits in which the incorrect sliding fee discount was applied or no sliding fee application was present at the date of service. Cause: Clerical error in which the discount fee applied was calculated incorrectly or an application was not received due to lack of an oversight process in place. Effect: Individuals may receive an incorrect sliding fee discount. Repeat finding: N/A 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. Management Response: The case management team conducted a comprehensive training in April 2022 including instructions for completing a sliding fee scale and appropriately filing the documentation in the EMR. In May 2022, an internal monthly audit process was implemented that includes a review of slides completed in the prior month to further reduce the error rate. In response to this audit finding, the case management team will conduct a training session highlighting issues identified during the recent audit including the appropriate utilization of sliding fees. The revenue cycle and pharmacy teams have also implemented processes to ensure that sliding fee scales are active on the service date for medical visits and/or prescriptions from the pharmacy.