During the 2023 audit of PrairieStar Health Center, FORVIS found two issues with the sliding fee set up.
The first issue was that CPT code 73610 was attached to the wrong slide level due to a change in price. The CPT code was attached to the Radiology 2 group which is for CPTs between $100.00 and $114.99. The price of the CPT had been changed from $102.00 to $120.00 and should have been moved to the Radiology 3 group which is for CPTs between $115.00 and $169.99.
The second issue was that CPT code 90620 was not set up to slide. In the six and one-half years that I have been at PrairieStar, we have made great strides in identifying CPT codes that were not attached to a sliding fee group and correcting them. I feel that this is a rare CPT code that has been missed in our review.
Plan to Correct Finding
Multiple steps have or will be taken to correct this finding.
• Both of the errors above have been corrected in our EMR.
• We are getting ready to update pricing. As part of this update, I will review the slide group attached to each CPT code to make sure that the correct slide is attached.
• We will continue to randomly review sliding fee calculations each month to help identify any errors in sliding fee calculations or setup.
Date of Completion
Both of the errors described above have been corrected.
There is no completion date for the monthly review. This is a part of our monthly routine.
Responsible Party
Shandi Stallman, Chief Financial Officer, is the party that has overall responsibility for this corrective action.