YAKIMA VALLEY FARM WORKERS CLINIC

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 center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay”. In one identified instance, an incorrect sliding fee discount was applied. 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 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 75% sliding fee discount, however, a nominal fee of …

Corrective action: Recommendation: CLA recommends a process be implemented to ensure the slide determined is properly used for the discount applied to the patient bill. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: A sliding fee verification checklist has been developed for use at all sites. The checklist will be completed by a staff member who did not assist the patient with their sliding fee application. The checklist requires the auditor to verify each data point of the application and compare the entries between the sliding fee form and the information entered in EPIC. The checklist will be completed electronically and …

Type of Finding: Significant Deficiency in Internal Control over Compliance Criteria or specific requirement: Under Compliance Requirement N- Special Tests and Provisions for CFDA #93.224 "Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay..." In one identified instance a sliding fee discount was applied, however there was no documentation of the clients application and the clinics determination of eligibility for the slide. Condition: CLA identified one instance of the key control not being met while performing testing over the special tests and provisions compliance requirement. Questioned costs: None Context: CLA identified one instance out of 40 total tested of the key control not being met while performing testing over…

Corrective action: Staff were retrained on sliding fee and FPL policy and procedure by Dental Department Supervisor 6/8/21, and planned time for dental front office staff to shadow Patient Benefit Coordinators to review sliding fee/FPL process, auditing, and filing. Going forward we will perform daily audits from the sliding fee applications received and entered the day before, prior to going to PBC for filing. After dental completes audit, forms are sent to PBC and reviewed a second time before filing for storage.