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MediStar Meducation AlertSM | ||||||||||||||||
Oh Where, Oh Where, Have the Red Flags Rules Gone? Physician Offices Are Exempt! By Pam Nole, Director of Consulting Services, MediStar
On November 30, 2010, bill S 3987, "Red Flags Program Clarification Act of 2010" was introduced and subsequently passed by both Senate and House. This bill clarified that small businesses are not classified as "creditors" and therefore are exempt from the Red Flags Rule. The bill was signed into law by President Obama on December 18. Still, in view of the rise in identity theft, in order to protect yourself and your patients, the best direction for your practice is to be aware of your vulnerabilities related to identity theft. You should have a written policy addressing how to control information when it comes into your office and how you control it when it leaves. Be cautious about risk, whether it is regulated or not!
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Another Whistleblower, A Connecticut medical practice recently entered into a settlement agreement in response to government allegations that it submitted false claims to Medicare for facet joint blocks/injections (treatment relating to back pain) that were not performed using fluoroscopic guidance (real-time radiologic imaging). The government further alleged that the practice improperly billed Medicare for services rendered by unlicensed individuals. Allegations arose from a complaint that was filed in the United States District Court under the "whistleblower" provisions of the False Claims Act by a former employee of the practice. According to the U.S. Attorney in the case, "The health care system relies on providers to bill government health care programs honestly and accurately. Abusing Medicare billing rules siphons critical resources away from Medicare and other government health care programs. Health care fraud is a national problem that the United States Attorney’s Office is devoted to combating." To settle the allegations, the practice agreed to pay $247,037, which covered conduct occurring from 1999 through early 2009. Provisions of the False Claims Act entitle the whistleblower to a percentage of the proceeds of any judgment or settlement recovered by the Government. The former employee's share was $41,996. | |||||||||||||||
The Human Resource Deadly Sins By Howard M. Cox, CPA, CMA, CIA Most entrepreneurs and executives agree that the hardest thing to get right in business is the human equation. From my 27 years of experience in the business world as a business owner, a business executive, a board member and advisor, I have organized the most common HR mistakes into the following categories: Hiring Sin Generally, we are too quick to hire. Some of our favorite hiring criteria are the 98.6 degree test and the fog the mirror test. Why are we in such a hurry? We assume that SOMEBODY is better than NOBODY; most of the time this is simply not true. We are really better off shorthanded, with a committed team of proven performers for a period of time, than to have to live with the consequences of a rushed decision. Furthermore, we have to endure our hiring mistakes for some period of time and they almost always end badly. They are also very expensive lessons, but more about that later when we discuss the Firing Sin in detail. Why do we often get this basic building block of business so wrong? Usually, the problem arises because we tend to hire from the wrong pool of candidates. We don't conduct the right pre-employment testing, and then we compound all of the above by neglecting to ask the right interview questions. What is the solution? The good news is that making the right hire is actually very simple. However, for most of us, hiring is not a core organizational competency. While we may have pockets of competency in this area, we are typically outside our skill level when engaging in the job placement process. One way to avoid this sin is to engage outside professionals. I recommend hiring a recruitment professional or executive search firm. Yes, these advisors cost money, but they are much less expensive than the cost of a bad hire for which estimates range from one to three times the annual salary of the position. In the case of a vacancy in a top level executive position, recruiters typically have direct access to the most qualified candidates. Firing Sin
We estimate the cost of someone who gets half the output that we expect from the position as costing us fifty percent of their salary. However, there is another cost to an unproductive employee which impacts the overall work force. If you have one employee who gets away with poor performance, then other employees may lose motivation to perform at their highest level. Conversely, if the tone of your office dictates a strong work ethic, then employees will feel compelled to meet the established standards for productivity and performance. The actual cost of tolerating underperformers is estimated at one-third of your total payroll cost including fringe benefits and payroll taxes. Promoting Sin This HR sin may be the most damaging of all because of what we call the Peter Principle double whammy. When you commit the Promoting Sin, you end up with an ineffective manager in your organization and you have lost one of your most, or in many cases your single most, productive front line employees. The good news is that the Promoting Sin is easily avoided if you understand the underlying root cause. The Peter Principle is caused by the fallacy that you should evaluate a person's preparedness for a promotion based on performance in the current job. The reality is that you need to evaluate an employee's skill sets in relation to those required for the new job. An employee may be highly proficient in an autonomous capacity but may fail at a managerial function. Mentoring Sin The Mentoring Sin is that many of us spend far too little time mentoring in our organizations. Evaluations are performed on a periodic basis and many of us are not very good about that either. Mentoring, on the other hand, is to be a constant in your organization. The best role models for mentoring are successful college basketball coaches like Mike Krzyzewski and John Wooden. Coach K never misses an opportunity to coach and mentor his players on each and every possession in the real time of the game. Likewise, our internal meetings should be used for more structured mentoring. Coach John Wooden believed that he should spend as much time preparing for his team's practices as the time allotted for each practice itself. Take time to assess an employee's potential and then take a supporting role in helping your employee realize his or her potential. Burnout Sin The Burnout Sin is caused by the cumulative effect of all of the other HR sins. If you hire poorly, keep underperformers employed, promote people to positions where they do not have the skills to succeed and spend minimal time developing your human capital, you will end up with very few people in your organization you can truly count on. Someone will have to pick up the slack and that someone (it could be you) will eventually burn out. My hope is that by coming to terms with these five basic HR mistakes you can create an organization where you and everyone else in it can prosper and reach their full potential.
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Schedule Smart By Rosemarie Nelson, Principal, MGMA Healthcare Consulting Group How can you schedule smart? Start by thinking about the schedule from your patient’s perspective. When does the patient want to come in? Are you available at hours that are convenient for your patients? If a patient can obtain an appointment within hours or a day of requesting it, your "no show rate" drops dramatically! Does your practice open early enough for your patients who want to get in and then head to the office, or get their kids off to school? Do you stay open during the lunch hour when patients have some flexible time in the middle of the day to use an extended lunch hour to get into your office? Does your office offer any evening hours during the week? Think about creating an office template that provides some non-traditional office hour availability for your patient, like the one below.
Stagger staff hours to accommodate the long days without consistently paying overtime. Use the mid-day break to run errands or get through your inbox so you aren’t taking so much work home. Consider how your patient gets an appointment. Can your patient actually get on your website and find an open slot for an appointment? Or at least send in a request for an appointment? More and more practices are jumping into web interactivity and offering patients the convenience of getting on the web at any hour of the day or night. Will all patients get on? Not right away, but imagine how different your practice will function if you get 30 percent fewer incoming phone calls because 30 percent of your patients are using the web to request an appointment! How does smart web scheduling work? Patients will have a secure account and enter some preliminary information like their preferred provider, the reason for the appointment and maybe even their preferred day of the week or time of day for their appointment. In a smart scheduling practice, the patient’s request is manually fielded by one of your staff members who responds to the patient request with a specific appointment date and time via secure message. The patient opens an email that directs them via a URL link to the secure site where the patient can accept the appointment or revise their request. With very smart scheduling, the application searches available appointment slots and presents the patient with a potential date and time for their selected provider, which the patient can accept, or re-search. Behind the scenes you have identified specific appointment times available for patient self-scheduling, so the patient is presented with only those particular opportunities. Smart scheduling starts with a template that is patient-centric and follows through with tools like web-based scheduling for your patient’s convenience. That’s smart business! | ||||||||||||||||
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In November of 2007, the Federal Trade Commission (FTC) issued the "Red Flags Rule" requiring "creditors" to develop and implement written identity theft prevention and detection programs to protect consumers. The original compliance implementation date was November 1, 2008, but that date was extended several times as the result of continued objection from the AMA and others who believed that this rule should not apply to physicians. On May 21, 2010, the AMA filed a suit in federal court seeking to prevent the FTC from extending identity theft regulations to physicians and other healthcare providers. 
When it comes to firing an employee, we have the exact opposite urge than that associated with the Hiring Sin. While we may hire too quickly in an effort to get the unpleasant task behind us, we tend to fire too slowly to delay this even more unpleasant task. We forestall termination of an unwanted employee for a variety of reasons, including fear of liability, which, by the way, can be minimized with the correctly worded hiring contract and other documentation. But the most common reason most employers try to avoid firing is due to a miscalculation of the cost of retaining underachievers in their organizations. 