Amador Health Center, Inc.Non-Profit

Criteria: The Health Center Program Compliance Manual requires that a health center establish and maintain systems for determining sliding fee eligibility. The Organization should implement procedures to assess and reassess all patients’ income and family size in accordance with board-approved policies and applicable poverty guidelines. Additionally, management should establish a defined cutoff date for updating poverty guidelines in the billing system and implement a review process to ensure that patient records are properly updated when discrepancies between applied categories and recorded information occur. Condition: During our testing of sliding fee applications, we noted that one of the patients tested was assigned an incorrect sliding fee category based on available income information. In addition, for three patients, data extracted from the billing system reflected a different sliding fee category than that shown in the patient’s individual profile. Management attributed these discrepancies to a system glitch and to timing differences in updating the poverty guidelines within the billing system. Cause: Although management has established “Sliding Fee Scale Procedure” policies, the registration guidelines are not being consistently followed. Furthermore, monitoring procedures in the Athena system have not been sufficient to detect or prevent these recurring discrepancies. Effect: Failure to properly apply the sliding fee scale may result in patients being charged an incorrect fee or no fee, a condition could be placed on the grant’s Notice of Award if HRSA determines that the Organization is not demonstrating compliance with the sliding fee program requirements. Recommendation: We recommend that management provide periodic training to intake personnel to ensure accurate application of the sliding fee scale based on verified income and household information. In addition, management should enhance review and monitoring procedures within the Athena system to ensure the accuracy of patient data and coordinate with billing staff as needed to update poverty guidelines by a designated cut-off date. Management's response: Management agrees with auditor's recommendation. Refer to Corrective Action Plan for expected date of completion.

Criteria: The Health Center Program Compliance Manual requires that a health center establish systems for sliding fee eligibility determination. The Organization should implement procedures that include assessing and re-assessing all patients for income and family size consistent with board-approved policies and poverty guidelines, including the maintenance of related records of such assessments. Condition: During our procedures on the application of the sliding fee, it was noted that 2 out of 53 patients tested were placed on the incorrect sliding fee based on available information regarding the individual?s income. For 1 patient out of 53, no documentation was maintained supporting sliding fee placement. Cause: The Organization began training intake staff on policies regarding application of sliding fees during the fiscal year under audit; however, corrective action was not fully implemented due to lack of time. Effect: In addition to charging an incorrect fee or no fee to the patient, a condition could be placed on the grant?s Notice of Award if HRSA determines that the Organization is not demonstrating compliance with the sliding fee program requirements. Recommendation: We recommend that management continue providing trainings to intake personnel to ensure that patients are placed on the correct sliding fee category based on information provided upon admission and that the fee determination is reviewed and updated as needed. Management?s response: Management agrees with auditor recommendation. Refer to Corrective Action Plan for expected date of completion.

Criteria: The Health Center Program Compliance Manual requires that a health center establish systems for sliding fee eligibility determination. The health center should implement procedures that include assessing and re-assessing all patients for income and family size consistent with board-approved policies and poverty guidelines. Condition: During our procedures on the application of the sliding fee, it was noted that 2 out of 25 patients tested were placed on the incorrect sliding fee based on available information regarding the individual?s income. Cause: The health center experienced turnover during the year under audit which caused a disruption in the intake process for patients admitted with sliding fee discounts. Effect: An incorrect fee or no fee was charged to the patient. Recommendation: We recommend that management establish procedures to ensure that patients are placed on the correct sliding fee category based on information provided upon admission and that the fee determination is reviewed and updated as needed. In addition, we recommend that new staff receive appropriate training on the health center?s policies regarding application of sliding fees. Management?s response: Management agrees with auditor recommendation. Refer to Corrective Action Plan for expected date of completion.