PIEDMONT HEALTH SERVICES INC

Health Center Program Cluster Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS00086-24-10 Program Year 25 Criteria or specific requirement – Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(G); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition – Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy. Cause – The Organization did not comply with their sliding fee policy. Effect or potential effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee discount policy. Questioned costs – None Context – A sample of 25 patients were tested out of the total population of 132,315 encounters. The sampling methodology used is not and is not intended to b…

Corrective action: Views of Responsible Officials and Planned Corrective Actions – Management agrees that the Sliding scale has been incorrectly applied on patient accounts and intends to do the following: A root cause analysis should determine whether the errors resulted from: • Staff calculation errors when annualizing income. • Failure to properly verify income documentation. • Incorrect data entry in the practice management system. • Inadequate training on sliding fee eligibility determination procedures. • Lack of secondary review or quality assurance monitoring by the revenue cycle team. In addition to the root cause analysis Piedmont Health Services will do the following: 1. Correct the three identifie…

Provider Relief Funds Assistance Listing No. 93.498 U.S. Department of Health and Human Services Criteria or Specific Requirement ? Reporting (45 CFR 75.342) and Activities Allowed/Unallowed and Cost Principles (45 CFR 75.403) Condition ? The Organization is required to prepare and submit period one provider relief fund reporting. This report is to be prepared using accurate financial information and submitted by the deadline established. Questioned costs ? Unknown Context - The period one Provider Relief Fund report was tested. The Organization initially selected option one to report lost revenues based on quarterly actuals. A material error in patient service revenue for the quarters reported was identified. This included a change to revenues that were included in the component values reported impacting the quarterly lost revenues reported. Management requested to amend the orig…

Corrective action: Management Response and Planned Corrective Actions - Management agrees with the condition. The audit revealed that material Patient Revenue was omitted from the Lost Revenue report. The following Corrective Actions are taking place: ? Lydia Mason, CFO will work to reopen the Period one report. ? Once the report is reopened, Lydia Mason, CFO will revise the methodology and the Net Charge amounts changing from option one to the option three methodology. The option three methodology used will compare 2020 actuals to the board approved 2020 budget and actual values in quarters one and two of 2021 to the actual results for the same quarters within 2019. This supports the full use of the Provider …

Health Center Program Cluster CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award Nos. 6 H80CS00086-18 Program Year 2019 Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR section 51c.303(g) and 42 CFR section 56.303(f)). Identification as a Repeat Finding ? Not applicable. Condition ? Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization?s policy. Questioned cost ? None Context ? A sample of 25 patients were tested out of the total population of 151,424 encounters. The sampling methodology used is not and is not intended to be statistically valid. Five patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documenta…

Corrective action: Management Response and Planned Corrective Actions - Management agrees with the condition. The audit sampling revealed that 4 out of the10 dental patient accounts selected had sliding fee errors. The following Corrective Actions are taking place: ? The COO for the Community Health Center had the Registration Audit schedule updated to list the medical and dental sites individually to insure both departments are audited. This was completed in April. ? The COO had the dental locations audited for the 1st Quarter of 2020 because they were omitted. ? Based on the registration audit findings, retraining and education materials are offered to staff by the Manager of Patient Engagement.