Maury Regional HospitalLocal Government

Criteria or Specific Requirement: Program requirements state that health centers must prepare and apply a schedule of sliding fee discounts so that amounts owed for health center services by eligible patients are discounted based on the patient?s ability to pay. Condition: Sliding fee discounts are not being applied to all eligible accounts. Processes and controls are not working effectively to identify and correct such errors on a timely basis. Context: We observed accounts selected for testing that appropriately identified the patient as eligible for a sliding fee discount. The discounted payment amount was noted in the billing record but the account was not adjusted for the sliding fee discount. Cause: Processes did not include a work que for sliding fee discount approved patient accounts to easily identify these account types in a single location resulting in the missed adjustments of sliding fee discounts. Approved patient accounts require the patient account liaison to look at the prior week?s encounters (via scheduling) in order to identify past encounters with a sliding fee discount approved status. The manual nature of identifying and working the approved patient accounts resulted in accounts being overlooked and not adjusted for the sliding fee discount accordingly. Effect or Potential Effect: The patient was billed for the account balance that had not been adjusted. Any remaining balance in the patient account after a set period of time with no payment activity is written-off as bad debt and the balance was sent to a collection agency for additional collection efforts. Context: For 25 haphazardly selected accounts of patients that received services at a qualified health center during fiscal year 2020, four patients that met the eligibility requirements for a sliding fee discount did not have such a discount posted to their account. Recommendation: Additional procedures and controls should be implemented to ensure that all accounts of patients that meet the requirements of the sliding fee discount policy are appropriately adjusted in a timely manner. Views of Responsible Official(s) and Planned Corrective Actions: Management agrees with the assessment that there were four accounts selected for testing that appropriately identified the patients as being eligible for a sliding fee discount in which the discounted payment amounts were collected, but the accounts were not subsequently adjusted for the sliding fee discount. In response to the noted condition, the following actions have been implemented to mitigate condition on an interim and a go forward basis: ? Revisions to the frequency and timeliness in which the pending and approved encounters are identified and worked from 7 days to every day, to ensure sliding fee discounts are applied timely. ? Renewed focus of staff dedicated to the process. ? Enhanced management involvement and oversight in identifying and working approved and pending accounts. ? Provided education to staff involved in the process to ensure there is understanding and completeness of the expected workflow and related timelines. ? Internal auditing and monitoring will take place to ensure program compliance. ? The development and implementation of an approved queue that provides a single location to identify accounts approved for financial assistance and sliding fee discounts for action. The queue went live March 16, 2021.