Pend Oreille County Public Hospital District No. 1

2023-001 Provider Relief Fund Reporting of Lost Revenue Federal Agency Department of Health and Human Services Federal Assistance Listing Number 93.498 – Provider Relief Fund and American Rescue Plan Rural Distribution Award Numbers Not applicable Criteria [ X ] Compliance Finding [ ] Significant Deficiency [ X ] Material Weakness Under the terms and conditions of the award, the recipient certifies it will report actual net patient revenues for the periods reported on in its reporting of actual net patient revenues for its calculation of lost revenues due to coronavirus. Condition The District’s 2021 and 2022 net patient service revenue understated resulting in audit adjustments. As a result, net patient service revenues were not accurately reported. Context This finding appears to be an isolated problem. Cause The District prepared its lost revenue calculations before adjustments for estimated third-party payor settlements and the allowance for uncollectible accounts were posted. Effect The actual net patient service revenues for 2021 and 2022 did not reflect the correct amounts to be used in its lost revenue calculations. If the adjustment amount was properly allocated to those quarters, the District would still have sufficient healthcare-related expenses attributable to coronavirus and lost revenues to use all of the Provider Relief Fund amounts received. Therefore, there is no effect on the District’s retention of the Provider Relief Funds. Recommendation We recommend the District’s management correct its lost revenue calculation in subsequent period reporting for the Provider Relief Fund. Views of responsible officials and planned corrective actions The District moved to a new EHR in the first quarter of 2021. Implementation of the new system put our accounting department behind. When the PRF was reported on, the cost report settlement had not been booked. Therefore, the initial gross revenue amount was off. The District expects to have accounting closed much closer to its fiscal year end starting in 2024

2022-001 Provider Relief Fund Reporting of Lost Revenue Federal Agency Department of Health and Human Services Federal Assistance Listing Number 93.498 – Provider Relief Fund and American Rescue Plan Rural Distribution Award Numbers Not applicable Criteria [ X ] Compliance Finding [ ] Significant Deficiency [ X ] Material Weakness Under the terms and conditions of the award, the recipient certifies it will report actual net patient revenues for the periods reported on in its reporting of actual net patient revenues for its calculation of lost revenues due to coronavirus. Condition The District’s 2021 net patient service revenue and allowance for contractual adjustments and bad debt was understated resulting in audit adjustments. As a result, net patient service revenues were not accurately reported. Context This finding appears to be an isolated problem. Cause The District prepared its lost revenue calculations before adjustments for estimated third-party payor settlements and the allowance for uncollectible accounts were posted. Effect The actual net patient service revenues for 2021 did not reflect the correct amounts to be used in its lost revenue calculations. If the adjustment amount was properly allocated to those quarters, the District would still have sufficient healthcare-related expenses attributable to coronavirus and lost revenues to use all of the Provider Relief Fund amounts received. Therefore, there is no effect on the District’s retention of the Provider Relief Funds. Recommendation We recommend the District’s management correct its lost revenue calculation in subsequent period reporting for the Provider Relief Fund. Views of responsible officials and planned corrective actions The District moved to a new EHR in the first quarter of 2021. The new system performs an automated allowance calculation; however, a manual distribution of the allowance is required to record the adjustment in the proper period. Unbilled receivables are not adjusted by the system; therefore, a manual journal entry is required to record the allowance. The District was not familiar with the system design and the distribution was not recorded in each month. A manual journal entry must be performed at the end of each month to distribute the allowance in the proper period. The District’s monthly closing procedures have been modified to record the allowance at the end of each month.

2021-001 Provider Relief Fund Reporting of Lost Revenue Federal Agency Department of Health and Human Services Federal Assistance Listing Number 93.498 ? Provider Relief Fund and American Rescue Plan Rural Distribution Award Numbers Not applicable Criteria [ X ] Compliance Finding [ ] Significant Deficiency [ X ] Material Weakness Under the terms and conditions of the award, the recipient certifies it will report actual net patient revenues for the periods reported on in its reporting of actual net patient revenues for its calculation of lost revenues due to coronavirus. Condition The District?s 2021 net patient service revenue and allowance for contractual adjustments and bad debt was understated resulting in audit adjustments. As a result, net patient service revenues were not accurately reported. Context This finding appears to be an isolated problem. Cause The District prepared its lost revenue calculations before adjustments for estimated third-party payor settlements and the allowance for uncollectible accounts were posted. Effect The actual net patient service revenues for 2021 did not reflect the correct amounts to be used in its lost revenue calculations. If the adjustment amount was properly allocated to those quarters, the District would still have sufficient healthcare-related expenses attributable to coronavirus and lost revenues to use all of the Provider Relief Fund amounts received. Therefore, there is no effect on the District?s retention of the Provider Relief Funds. Recommendation We recommend the District?s management correct its lost revenue calculation in subsequent period reporting for the Provider Relief Fund. Views of responsible officials and planned corrective actions The District moved to a new EHR in the first quarter of 2021. The new system performs an automated allowance calculation; however, a manual distribution of the allowance is required to record the adjustment in the proper period. Unbilled receivables are not adjusted by the system; therefore, a manual journal entry is required to record the allowance. The District was not familiar with the system design and the distribution was not recorded in each month. A manual journal entry must be performed at the end of each month to distribute the allowance in the proper period. The District?s monthly closing procedures have been modified to record the allowance at the end of each month.