Finding Text
Health Center Program Cluster CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS08239-14-01 Program Year 2020 Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g) and 42 CFR section 56.303(f)) Condition ? Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization?s policy. Questioned Cost ? None Context ? A sample of 25 patient encounters was tested out of the population of 76,129 adjustments. The sample is not, and is not intended to be, statistically valid. Of the 25 patient encounters tested, 4 were determined to have resulted in an improper sliding fee adjustment based on the Organization?s policy and screening of patient eligibility. Effect ? Sliding fee discounts were given to patients that were inconsistent with the Organization?s sliding fee policy. Cause ? The Organization did not comply with their sliding fee policy. Identification as a Repeat Finding ? Not a repeat finding. Recommendation ? All personnel involved in the sliding fee discount program should demonstrate their understanding of the sliding fee scale policy in order to improve application of the sliding fee discount program. Views of Responsible Officials and Planned Corrective Actions ?During the 2022 audit of PrairieStar Health Center, Inc. FORVIS found multiple instances of the sliding fee being either set up incorrectly or calculated incorrectly. Plan to Correct Finding Multiple steps will be taken to correct this finding. ? Meet with coding and billing staff to determine how to communicate when changes are made to the account after the sliding fee pulls in. There were several instances of the number of units being changed after the slide had applied to the account that were not communicated to the billing staff so that they could change the slide to the appropriate amount. ? Increased training of staff. This will be two pronged: 1) training for staff on calculating sliding fee eligibility and setting up the slide and 2) training for staff on making adjustments to sliding fees on a patient?s account. ? Increased review of slide setup, eligibility calculations, etc., to confirm compliance. Date of Completion Within the next month, we will hold a meeting with the billing and coding staff to determine the best way to communicate changes to accounts that have the sliding fee applied before units are changed. There is no completion date for the training and review. These will become routine, ongoing functions of the department. Responsible Party Shandi Stallman, Chief Financial Officer, is the party that has overall responsibility for this corrective action. In addition, the Business Office Managers for Medical, Dental, and Vision will play a key part in training and review.