Uncompahgre Combined Clinics dba: Uncompahgre Medical Center

Criteria or Specific Requirement Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.”

Condition and Context During our testing of sixty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified seven visits that either received the incorrect sliding fee discount or received a sliding fee discount in error.

Effect Potential that a patient would not receive the appropriate sliding fee discount.

Questioned Costs None identified.

Cause Clerical error in which the incorrect discount was applied due to lack of an oversight process in place.

Recommendation We recommend the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter and that the support for the sliding fee discounts is retained.

Views of Responsible Officials The Organization has recognized the deficiency of internal controls regarding this determination, recording, and monitoring of the sliding fee process from application through making the adjustment. The Organization has implemented a comprehensive input and verification process that applies to both the initial application and the subsequent adjustment phases. This includes enhanced checks to ensure accuracy in data entry and calculation, as well as verification of application information. If the U.S. Department of Health and Human Services has questions regarding this plan, please call Tricia Lippert, Comptroller at 970-327-0537.

Criteria or Specific Requirement Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.”

Condition and Context During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge visits, we identified five visits that either received the incorrect sliding fee discount or the application could not be found to support the sliding fee provided.

Effect Potential that a patient would not receive the appropriate sliding fee discount.

Questioned Costs None identified.

Cause Clerical error in which the incorrect discount was applied or the application was missed being scanned into the patients chart due to lack of an oversight process in place.

Recommendation We recommend the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter and that the support for the sliding fee discounts is retained.