Common and Avoidable Survey Issues – Independent Contractors

In this four-part series, so far, we’ve explored some of the most common and avoidable survey deficiencies:  illegible signatures and missing titles, expired documents and missing supervision, and failure to follow the plan of care.  Today we’ll cover certain aspects of independent contractors.

Rarely does an agency use only employees to provide care to patients.  Some clinicians are often independent contractors (I/Cs) or obtained by contract with another organization.  CMS specifically holds the home health agency accountable for anything done by a contractor.  It also has requirements for the relationship with the I/C and the monitoring of patient care.

To begin with, agencies must have a contract with the I/C that meets government requirements.  The contract should outline all aspects of the relationship and your expectations for performance.  Promptness of visits, documentation requirements, timely submission of notes, participation in case management and supervision of any assistants are just a few crucial items to include.

Keep in mind that I/C are considered part of your ‘staff’ or ‘personnel.’  So any regulations that address, for example, training requirements for personnel will require that your I/Cs be included.  When it comes to agency-specific information – like your compliance program or quality improvement program, for example – you must conduct the orientation and training to your agency’s specific policies and procedures.  While accepting proof of external education on topics such as OSHA and domestic violence is acceptable, your personnel need to understand the rules and operations of your organization.

Finally, the requirement for personnel files includes I/Cs regardless if they work for another company.  If they are providing care to your patients, you must have a file that contains the minimum hiring/contracting requirements, like background screening, health screenings, insurance, identification, etc.

Regulations create a level playing field for organizations, and they also protect us as patients from unprofessional or sloppy providers.  We understand that these guidelines can create a burden for healthcare providers, but knowledge and organization go a long way toward achieving compliance.

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