Great Mines Health Center

Finding Number 2019-01 Criteria Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. Condition During the audit, we noted two instances of noncompliance with application of the sliding fee schedule. Cause In response to the 2018 finding, management met with each department manager and enacted training and Management Response. The medical Department Manager did not approve of the actions taken and was demoted on October 18, 2019. There was a transition period and initially, the new Department Manager noted areas of weakness and a plan of action to address those weaknesses. The two instances of noncompliance carry over from the previous Department Manager?s time. - Patient ?X?: Employee changed slide to correct discount after 30 days with no proof of income (POI), however, failed to review the expiration date. - Patient ?Y?: Slide discount was miscalculated, and patient was given an inappropriate discount. Employee did correct the calculation but failed to backdate to the appropriate date of service, therefore, corrective action was not taken. Effect Oversight of the approval and application process is a key control over compliance. Lack of oversight can result in issues with the approval process and appropriately applying the sliding fee discount schedule. Recommendation We recommend management incorporate proper training and education on the approval and application process. We also recommend management establish periodic review of the approval and application process. Management?s Response Management has a corrective action plan in place to address the finding as follows: ? Management will meet with each department manager to review Great Mines Health Center?s policy on the sliding scale discount and review the recommendations noted. ? Management is incorporating a Department Manager review checklist to ensure all required documentation is included in the applicant?s file, the calculation of income is included in the file and that the determination of the discount is noted as well as any other relevant documentation. ? The Center will undergo a remodel in which the registration area will be expanded to include four registration windows, one that will be utilized specifically for sliding fee applicants. The personnel who work this window will receive additional training on the sliding fee application process and the Center?s best practices. ? Management will enact internal auditing by each Department Manager and report findings to management on a regular basis. Any findings from the Department Manager will be updated by the Department Manager and a meeting will be held with the personnel to discuss findings and continue to train staff in areas of weakness.

Management has a corrective action plan in place to address the finding as follows: ? Management will meet with each department manager to review Great Mines Health Center?s policy on the sliding scale discount and review the recommendations noted. ? Management is incorporating a Department Manager review checklist to ensure all required documentation is included in the applicant?s file, the calculation of income is included in the file and that the determination of the discount is noted as well as any other relevant documentation. ? The Center will undergo a remodel in which the registration area will be expanded to include four registration windows, one that will be utilized specifically for sliding fee applicants. The personnel who work this window will receive additional training on the sliding fee application process and the Center?s best practices. ? Management will enact internal auditing by each Department Manager and report findings to management on a regular basis. Any findings from the Department Manager will be updated by the Department Manager and a meeting will be held with the personnel to discuss findings and continue to train staff in areas of weakness.

2018-001

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