GOSHEN MEDICAL CENTER, INC

75 applications at 3 locations were tested. Six errors were found, 1 incorrect calculation of income, fees would not change and 5 incorrect calculations where fees would change. GMC has responsibility of ensuring proper billing of patient services that are supplemented by the federal government. Findings had various effects depending on the issues noted above. In most instances where fees would change, more income would be due to Goshen from patients. Applicagtion calculations were not checked by another employee. Procedures and standards inconsistently followed. Review process of the sliding fee scale application should include a recalculation by the site leader. Front desk employees should receive continuing education classes. Management concurs.

Corrective action: To help make sure we have accurate sliding fee applications with the correct calculations we have promoted a proven site leader to a front desk trainer that is responsible for working with each new front desk worker for an entire day once they are on board with Goshen Medical Center. The trainer will focus on electronic medical records, practice management systems, and the sliding fee process/application. Goshen also recognized last year that additional training was needed on reading and recognizing gross income on tax forms, so we discuss this at our monthly site leader meetings and have seen progress since the 2023 Audit with less findings on the 2024 audit. In addition to our regular mon…

75 applications at 3 locations were tested. Eleven errors were found, 7 incorrect calculations of income, fees would not change and 4 incorrect calculations where fees would change. GMC has responsibility of ensuring proper billing of patient services that are supplemented by the federal government. Findings had various effects depending on the issues noted above. In most instances where fees would change, more income would be due to Goshen from patients. Applicagtion calculations were not checked by another employee. Procedures and standards inconsistently followed. Review process of the sliding fee scale application should include a recalculation by the site leader. Front desk employees should receive continuing education classes. Management concurs.

Corrective action: Staff turnover and new staff completing the sliding fee have contributed to incorrect calculation discovered during the audit. The trainers will continue focusing on electronic medical records, practice management systems, and the sliding fee process.  Staff will repeat the sliding fee training video explaining how to calculate sliding fees and complete a front desk training encompassing in-depth training detailing how documentation is used for correct calculation, determining household size, and storing the documentation.  Goshen also recognizes additional training on reading and recognizing gross income on tax forms. The sliding fee scale policy that was updated in 2021 and will be update…

Criteria: 75 applications at 3 locations were tested. 3 errors were found. The table summarizes the findings. Issue: Incorrect calculations of income, fees charged would not change, 2 errors. Incorrect calculations of income, fees charged would change, 1 error. Condition: GMC has the responsibility of ensuring proper billing of patients for services that are supplemented by the federal government. Effect: The findings had various effects depending on the issue noted above. In most instances where fees would change, more income would be due to GMC from patients. Cause: Application calculations were not checked by another employee. Procedures and standards were inconsistently followed. Recommendation: The review process of the sliding fee scale application should include a recalculation by the site leader. Front desk employees should receive continuing education classes on …

Corrective action: Development continues for staff regarding the slinding fee program. Thetrainers will continue to focus on electronic medical records and practicemanagement systems along with the sliding fee process. Staff will berequired annually to watch the sliding fee training video that explains how tocalculate sliding fee, what documentation was needed, how to determinehousehold size, and how to store the documentation. The sliding fee scalepolicy that was updated in August, 2021, will continue to extend the selfdeclarationfrom one visit to allowing the patient six months to bring in alldocumentation. The Internal Auditor continues to meet with the site leaders todiscuss any findings which inclues calc…

U.S. Department of Health and Human Services Program Name: Health Center Program AssistanceListing Number: 93.224CLFinding: 2021-001 (Repeat) Sliding Fee Scale CalculationsCriteria: Seventy-five applications at four locations were tested. Thirteen errors werefound. The table below summarizes the findings:IssueIncorrect calculations of income; fees charged would not change Incorrect calculations; feescharged would changeApplication or pay documents incomplete; could not determine incomeNumber Errors742Condition: Goshen Medical Center, Inc. has the responsibility of ensuring proper billing ofpatients for services that are supplemented by the federal government.Effect: The findings had various effects depending on the issue noted above. In mostinstances where fees would change, more income would be due to Goshen Medical Center from patients.Cause: Application c…

Corrective action: Finding: 2021-001 (Repeat) Sliding Fee Scale CalculationsName of contact person: Kevin Tadlock, Internal AuditorRhonda Barwick, Director of OperationsCorrective action:Development continues for staff regarding the sliding fee program. In 2021, two trainers wereadded to focus on electronic medical records and practice management systems along with the slidingfee process. Also, the sliding fee training video was created on how to calculatesliding fee, what documentation was needed, how to determine household size, and howto store the documentation. The sliding fee policy was updated in August 2021 to extend theself-declaration from one visit to allowing the…

Criteria: Eighty-one plications at four locations were tested. Sixteen errors were found. The table below summarizes the findings: IssueIncorrect calculations of income; fees charged would not change, 11 Incorrect calculations; fees charged would change, 5 Condition:GoshenMedicalCenter,Inc.hastheresponsibilityofensuringproperbillingofpatientsforservices that are supplemented by the federal government.Effect:Thefindingshadvariouseffectsdependingontheissuenotedabove.Inmostinstanceswhere fees would change, more income would be due to Goshen Medical Center from patients.Cause:Applicationcalculationswerenotcheckedbyanotheremployee.Proceduresandstandardswere inconsistently followed. Recommendation:Thereviewprocessoftheslidingfeescaleapplicationshouldincludearecalculationbythesiteleader.Frontdeskemployeesshouldreceivecontinuingeducationclasseson the proper way to calculate the sliding fee sca…

Corrective action: Finding: 2017-001 (Repeat) Sliding Fee Scale CalculationsName of contact person: Kevin Tadlock, Internal AuditorRhonda Barwick, Director of OperationsCorrective action:Development continues for staff regarding fee program. In 2021, we developed a power point training and video to help new and existing staff better understand the sliding fee policy and how to calculate income. As partof the annual training, staff will also be required to watch the training video as part ofstaff development. The importance of verifying the staff's calculation of income by the siteleader has been discussed during site leader meetings. The Internal Auditor continues toaudit the task …

Finding: 2017-001 (Repeat)Sliding Fee Scale CalculationsCriteria: Eighty applications at three locations were tested. Twenty errors were found. The table below summarizes the findings:Issue Number ErrorsIncorrect calculations of income; fees charged would not change 9Applications or pay documents incomplete; could not confirm 8Incorrect calculations; fees charged would change 2Billing program does not match calculation per documents 1Condition: Goshen Medical Center, Inc. has the responsibility of ensuring proper billing of patients for services that are supplemented by the federal government.Effect: The findings had various effects depending on the issue noted above. In most instances where fees would change, more income would be due to Goshen Medical Center from patients. One patient was overcharged.Cause: Application calculations were not c…

Corrective action: 2017-001 (Repeat) Sliding Fee Scale CalculationsName of contact person: Kevin Tadlock, Internal AuditorRhonda Barwick, Director of OperationsCorrective action: In May, 2020, all sites were converted over to a new software for sliding fee scale calculations. When a new sliding fee is generated, a notification is sent to the site leaders for them to approve and make the sliding fee charge valid. This was put into place to help with minimizing calculation and household size errors. We continue to have site leader meetings every month, errors that are found during internal audits are used for trainings during meetings. For the 2020 fiscal year, we will hold trainings on the new softw…