NORTHWEST COLORADO VISITING NURSE ASSOCIATION

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 and Context During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified one visit where the Organization applied the incorrect sliding fee discount. Effect Potential that a patient would not receive the appropriate sliding fee discount or may receive a discount when they have not applied for one. Questioned costs None identified. Cause The updated sliding fee application in place at the date of service of the finding was not properly entered into the system due to staffing shortages. Thus, the old application and slide was applied to the visit. 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 applications are retained with the patient’s information. Views of Responsible Officials Management is in agreement with the finding. The Organization continues to make improvements to processes and procedures to ensure the accurate documentation and application of sliding fee discounts.