COLUMBIA BASIN HEALTH ASSOCIATION

Finding 2022-001: Program Name/ALN Title: Health Center Cluster Federal Assistance Listing Number: 93.224/93.527 Federal Agency: U.S Department of Health and Human Services Award Period: 1/1/2022 ? 12/31/2022 Federal Award Number: N/A Type of Finding: Significant Deficiency Criteria: Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, ?health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health c enter services by eligible patients are adjusted (discounted) based on the patients ability to pay?. In on identified instance, an incorrect sliding fee discount was applied, resulting in the patient being overcharged for services provided. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirements. Context: CLA identified one instance out of forty total tested of which the key control was not being met while performing testing over the special tests and provisions compliance requirement. Cause: The sliding fee application effective for the transaction tested indicated the patient qualified for a Level 1 sliding fee discount, however, the system was not updated for this change and the patient?s charges were applied to the previous Level 3 sliding fee discount on file for the patient. Effect: Incorrect sliding fee discount was applied to the transaction tested resulting in the patient being overcharged for services. Recommendation: We recommend that CBHA implement a process for evaluating each patient application contract to ensure the most up to date patient application is being used to determine the appropriate slide amount to be applied. Views of the Responsible Officials: There is no disagreement with the audit finding.

Corrective Action Plan: CBHA updated its process to assign current year cases to patients under the sliding fee program. Previous cases are now closed at the end of the benefit year preventing staff from selecting an incorrect case under the sliding fee program. This alerts staff that the patient's coverage is expiring and needs to be renewed. In addition, an electronic audit is performed on all sliding fee appointments that identifies any discrepancy between the active billing profile and the sliding fee profile applied to a visit.