Blog and Helpful Articles

Employee Burnout: The How (to Bounce Back)

Employee burnout can cause long-term losses for a business and also for the employee.  Burned out workers are more likely to take time off and call in sick; they are more apt to look for a new job and may resign with little/no notice, which can have ramifications for the business and the worker.  In the first two installments of this series on employee burnout (here and here), we considered its definition and how it differs from normal, everyday stress, and we examined some behaviors that may surface in those who are burned or burning out.  In this last section, let’s consider some recommendations from Indeed, the “world’s #1 job site:”

  1. Reach out to those who are struggling. We’ve blogged before that, especially in these tumultuous times, it’s important to keep an open dialogue. Employers who genuinely care about their employees will check in from time to time, not only out of concern for the work, but for the worker.  But even if you’ve been disconnected a bit yourself, and perhaps even on the path to your own burnout, request a private meeting with your staff member.  Share your concerns and encourage him or her to be honest; perhaps share some of your own struggles in light of the stressful environment to illustrate that your employee is not alone with these feelings.

Even if the person is not yet at burnout stage, talking over concerns may prevent any issues from coming up. Establish rapport and then work together to find a solution to the problem, which may include time off, flexible scheduling, or reassigning some responsibilities.  If nothing else, we’ve all learned a little creativity in the past year, and applying it to the work situation may yield a do-able solution that ends up being a win-win.

  1. Send an employee satisfaction survey. It’s always a good idea to take the pulse of your workforce although this suggestion doesn’t have the immediacy of #1.  Think about administering an anonymous survey with questions about how employees feel about their job overall and if they have what they need to do their job well.  It goes without saying that transparency is key.  Companies who hide negative responses from the workforce or fail to address widespread issues lose credibility and the survey can actually backfire on them.
  1. Distribute workloads carefully. We managers routinely give big projects to those who deliver, but this can also be a curse in disguise if we’re overloading one team or group because they just happen to do good work. As leaders, we need to reassess the entire workload and evaluate how we’ve distributed projects among all staff members.  Check in with your teams to find out how they’re handling their assignments and be ready to shift things around as needed.
  1. Assess your management style. Self-evaluation is critical to personal growth and as managers, we have to judge our tactics objectively.  Are we unwittingly adding fuel to the burnout fire (terrible pun-ish analogy, I know…)?  Think about perhaps adding questions about your management style to the survey, especially from the perspective of whether it helps or hinders your staff in avoiding burnout.
  1. Provide workplace variety. Doing the same things over and over can lead to excellence through specialization but it can also stifle growth and contribute to burnout.  Perhaps creating a rotating schedule for certain tasks might alleviate some of the boredom, or again, adding specific questions to your survey may help you determine whether staff like the specialization or find it drags them down.
  1. Take mental health seriously. What is your company’s mental health policy, and what does your group insurer cover? Managers should check in with HR to discover the available resources that can be offered to workers.  Think about how to reorganize the workload to offer a mental health day from time to time. Ask employees what the company can do to support them in dealing with or avoiding the stress that can lead to burnout, and then act on their suggestions as feasible.

Management is certainly not for the faint of heart.  We need to effectively juggle different constituents all day, every day:  the company, our workers and lastly, ourselves.  Honesty and empathy can go a long way to initiating and preserving the dialogues that convey you care and are ready to intervene for the wellbeing of your team.

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CARES Act Advance Repayments Are Starting Now

If you received an accelerated or advanced payment (AAP), the Centers for Medicare and Medicaid Services (CMS) will begin recouping the outstanding balance from any payments due to you for your Medicare claims.  If you recall, the repayments were set to begin on the one-year anniversary of receiving your advanced payment; for providers in the First Coast Service Options (FCSO) Medicare Audit Contractor (MAC) jurisdiction of Florida, Puerto Rico and US Virgin Islands, the first repayment begins on April 10th.  There is no possibility of delaying or postponing the recoupment process as it is automatic. 

Repayment Schedule

The repayment schedule is as follows:

  • For the first 11 months after your one-year payment anniversary, CMS will retain 25% of each remittance amount and apply it to your AAP balance until the balance is paid.
  • For the next six months after the first 11 months, CMS will retain 50% of your remittance amounts and apply it to any outstanding AAP balance until the AAP is repaid in full.

If there is any outstanding balance after the 17 months of deductions, providers will receive a demand letter from CMS, listing the outstanding AAP balance amount, which will be subject to immediate payment. If it is not paid within 30 days, four percent interest will begin to accrue.

Here is an example from FCSO of the recoupment process for a provider who received an AAP on 4/1/20:

How the recoupment will be identified on your remittance

First, each recoupment amount is based on the specified percentage (25% for the first 11 months, 50% for the next 6 months) applied to the total dollar amount of your remittance. It will not be deducted from specific beneficiary claims, so those claims payments will be shown in their entirety.

The remittance advice will show the offset from the total remittance with code “WO” for withholding offset and an A/R transaction code that begins with the letters “CVD.”  This will help you identify the recoupment as being for AAP and not another reason.

CMS strongly advises providers to track their recoupments by creating a mechanism, such as a spreadsheet, with the total AAP amount, listing the deductions as payments are recouped, and “counting down” from the total balance.  CMS will not send periodic letters, summarizing your outstanding balance.

The total amount due was included in a letter sent to all providers in October 2020. This letter also provided your recoupment start date and the CVD account number.  If you cannot locate the letter, you can call the FCSO AAP Hotline.

Alternatives to the Recoupment Schedule

There are two alternatives for providers who wish to avoid the recoupment schedule above.

Request immediate offset.  By submitting a Request for Immediate Offset form, providers may request that instead of the 25%/50% recoupment amounts listed above, CMS withholds 100% of your remittance payments until the balance is paid in full.

Immediate payment.  Providers may hasten or speed up the AAP repayment by submitting a Return of Monies Voluntary Refund Form with their check for the outstanding balance.  It’s important to note that a patient’s name and Medicare ID# are not applicable since the recoupment is not associated with a beneficiary, so leave that section blank.  Under the reason for the claim adjustment, providers should list “17-Other – Please specify” and in the Additional Info field, list “COVID Accelerated/Advanced Payment Refund.”

Other Resources

CMS MLN: Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021

Fact Sheet: Repayment Terms for Accelerated and Advance Payments Issued to Providers and Suppliers During COVID-19 Emergency

FCSO Online Q&A on the AAP

FCSO AAP hotline: 855-247-8428, option 1 (Jurisdiction N), then option 2 for AAP representative.  Hours of operation 8:30 a.m. – 4 p.m. ET

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Employee Burnout: The When & Who

In the first installment of this series, we briefly explored the topic of stress and its connection to employee burnout as explained by Indeed, the job-search company.  One important factor to note:  burnout can happen to anyone, regardless of age or experience level. This means that not only might your workers be burned out, but they may be led by managers and directors who are similarly depleted.  If some of these signs are visible, does our attention stop long enough on them to recognize the problem?

Let’s consider what burnout look like:

  • Lack of interest or enthusiasm
  • Disengagement
  • Exhibiting a negative attitude
  • Frequent tardiness or absences
  • Producing inferior work

On any day, this can be all of us.  The distinction with burnout is the pattern of sustained behaviors from this list in addition to productivity declines, disinterest in conversation and even slower movement.

Higher than average burnout rates occur for those in emergency response occupations, lawyers, and sales/retail folks. As if the environmental factors aren’t enough, unrealistic deadlines or schedules, not enough praise or recognition for exceptional performance, lack of autonomy on the job and ineffective leadership – not to mention senior leaders who may themselves be burned out – may send workers off the cliff of control.

It behooves us all as managers to objectively assess our staff.  Whose behavior rings your warning bell?  How plugged in are you to the issues that employees are dealing with, personally and professionally?  Empathetic concern and dialogue may help a worker open up to you and admit a level of stress that’s negatively spilling over into the day-to-day. Read on a related topic here.

And then, read through some suggestions – also from Indeed – in Part Three of this series on what you can do to help your employees decompress, heal and return to full engagement.

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Employee Burnout: The What

The last 12 months stand out almost as a case study on the effects of stress and every employer is witnessing firsthand the its impact on workers. It’s no wonder that employee burnout is listed as one of the top Human Resource challenges for 2021! Indeed, the “world’s #1 job site,” posted some useful information we’ll share with you in three blogs.

In this message, let’s explore, exactly what is employee burnout.

The Indeed authors define burnout as a stage of extreme stress where employees become exhausted, frustrated, disengaged and unmotivated at work.  Before we even tackle workplace issues, we need to acknowledge that employees’ background stress has skyrocketed in the last year with issues like these taking center stage: fear of contracting or having family/friends sick with COVID-19; homeschooling children while perhaps also trying to work from home; spouse’s job loss and possible homelessness; social unrest; and a contentious election season.  It’s no surprise then to see the spillover effects of this stress in the workplace.

Among the signs of burnout are feelings of energy depletion or exhaustion, increased mental distance and negativism about the job and a sense of ineffectiveness.  Employees in its first stages experience short bursts of stress that can be handled with traditional coping mechanisms.  As stress escalates, employees begin experiencing more regular episodes of anxiety, fatigue, lost focus and headaches, which can chip away at their optimism and resilience. Those under chronic job stress feel these symptoms on a daily basis and may find their productivity negatively affected.  The last stage of burnout is heralded by stress that can’t be successfully managed, along with behavioral changes, lost productivity and engagement and even a plan to quit or look for a new job.

In Part Two of this series on burnout, we look at important symptoms and who is more susceptible to burning out.  Hope you’ll join us!

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What We’re Reading – Inappropriate Billing, Fraud Gaining Scrutiny

Despite the pandemic, the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG) has not missed a beat. Regulators are still focusing on fraud and non-compliance. This article refers to a bulletin,  issued in February 2021, that focuses on inappropriate billing. Even though it has to do with Medicare inpatient stays, the information should still raise a flag for all providers because COVID or not, government agencies are still going about business as usual.

You might be surprised to learn that even before the pandemic, it was reported that Medicare paid $109.8 billion for 8.7 million inpatient hospital stays in 2019.  Add COVID to the mix and you can understand why regulators need to make sure that every Medicare dollar is spent properly and legitimately.

Although this recent report is limited to inpatient claims, it reinforces that all providers need to ensure – when billing any insurance – that there is documented medical necessity for all procedure codes, modifiers, diagnosis codes, etc. In another blog, we summarized a different OIG report that concluded Medicare did not use its own error rate data to target error-prone providers, 100 of which received $3.5 million in overpayments and experienced a 60.7% error rate – much higher than the national average of 11.3% for all Medicare providers.

This is why we urge every medical practice, hospital and healthcare business to conduct regular audits to safeguard against fraudulent claims and identify any issues before they become problematic.   The most successful clients employ a combination of internal and external reviews to make sure they’re prepared to have any of these government agencies stop in and conduct a review.

It’s important not to overlook the emphasis in the article on protected health information (PHI) and HHS-OIG’s “Cybersecurity Team,” established to fight against all cyber fraud. With the proliferation of EHRs and telehealth, more and more services are being delivered online, and cybersecurity related fraud may be another area where False Claims Act activity may be evident.  Make sure your audits touch on the documentation and provision of telehealth services too.

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CMS Releases “Telehealth for Providers: What You Need to Know”

Despite all the information about telehealth (TH) published and available since the Spring of 2020, misconceptions and misunderstandings still exist and can be costly in lost revenue and billing error recoupments.  CMS has published a very comprehensive guide to TH for providers – with tons of external links for more info – and below are some handy tips and ideas.

  • Appropriateness for TH varies and it can be less useful for certain types of complaints, such as abdominal, eye, GYN and dental.  In addition, any situation in which a physical exam would change your recommendations is not ideal for a TH encounter.
  • Your patient portal may already have some TH functionality built in; check it out.  Otherwise, consider these questions when evaluating a TH platform:  does it protect PHI? Do you or the patient need special equipment? Do patients need to download an app before the visit? Is the information encrypted?
  • During the pandemic, HHS temporarily allowed providers to use Apple Face Time, Zoom, Skype, etc., which are non-public facing.  Tik Tok, Facebook Live and other public-facing tech cannot be used.  Since it seems some form of TH will remain after the public health emergency, it’s advisable for providers to use this time to research a more secure platform.  You can monitor updates from HHS here.
  • Establish (or refine) your TH workflow and protocols. After a year of TH, you probably have a sense of what works and what needs tweaking.  Some things to consider are: how you’ll support patients with disabilities (visual or hearing) for whom some TH platforms may not be successful; how easily can your M.A. greet the patient and conduct screenings, etc. before you see the patient; how to obtain consent for the TH visit; obtaining payment after the visit; and more.
  • Page 8 of the document lists great tips for all aspects of the visit, from how to prepare for it, how to establish rapport with a new patient, outlining the session so patients know what to expect and what the patient can do if he loses connectivity.
  • Behavioral health seems to be widely needed and accepted via TH.  The CMS document has a section to help you maximize your BH care, from making sure the patient has a safe space to communicate freely, to paying special attention to voice nuances, tempo, pitch and inflection to get a broader picture of what’s going on.
  • The last section focuses on billing and includes several links to CMS policy memos and an updated list of covered TH services.  Remember, for Medicare, use the POS code you would’ve used if the service was provided in person., and use the CPT modifier 95 for TH services provided in real-time.

The new CMS document is a must-read for all providers and their billing staff to make sure you maximize delivery and payment of your TH visits.

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OIG Pursues Audits of Part B Telehealth

The Office of Inspector General’s work plan for 2021 includes audits on Medicare Part B telehealth (TH) use.  Phase one of these audits focuses on assessing, among other things, whether E/M services conducted via TH meet Medicare requirements. Phase two of these audits will center around reviewing Medicare Part B TH services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of TH technology, and annual wellness visits to determine whether Medicare requirements are met.

This is a good time for providers to extract reports of TH services from the billing system and review the documentation against Medicare’s guidelines.  Remember that medical necessity is an over-arching requirement for medical services and must be clearly documented in the visit note.  In addition, Medicare rules require that the documentation include:

  • The visit was conducted via TH (audio or audio/video)
  • That the beneficiary gave consent for this type of visit
  • The location of the patient
  • Anyone else involved in the visit, such as a family member

If your own review reveals that some of your TH visits do not meet Medicare criteria, you can send a corrected claim from your billing system or through the IVR and change the CPT code, or call your Medicare administrator and ask the best way to fix your claim.

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DOL Postpones Changes to Independent Contractor Rule

In earlier blogs (here and here), we explained the need for clearer guidelines when classifying workers as independent contractors and the changes to this important legislation.  The test for determining worker status has been ambiguous and subject to interpretation over the decades and the revision slated to take effect on March 8, 2021 added more specificity to these five factors:

  1. the nature and degree of control over the work;
  2. the worker’s opportunity for profit or loss based on initiative and investment;
  3. the amount of skill required for the work;
  4. the degree of permanence of the working relationship between the worker and the potential employer;
  5. whether the work is part of an integrated unit of production.

The Department of Labor is proposing a delay in order to “review the multiple issues of law, policy, and fact that warrant additional review and consideration” before finalizing the Independent Contractor Rule.

For now, the effective date of the changes has been postponed to May 7, 2021.

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What We’re Reading – Six ways to motivate your team for free

As employers, we appreciate our workers and have responded to COVID with as much flexibility as possible, but how do we motivate our teams when our emotional tanks and bank accounts may be depleted?  This article sets out some ideas to convey your appreciation and bring greatness out of your staff – and best of all, they’re free and they work!

  1. Name Names
    • Know everyone’s name, no matter how big your company, and when you say, “Thank you,” be sure to call the person by name. Appreciation is personal.
  2. Stay on Mission
    • Make sure your employees know the big-picture reason your company does what it does and especially, how what they do contributes to achieving it.
  3. Pat Backs
    • Always let people know when they do a good job. Don’t assume they know you appreciate them and their work.
  4. Be Specific
    • When you recognize an employee for outstanding work, remember to relate it back to a specific example/task/situation. General thank-yous miss the mark and can seem phony.
  5. Not Just the Boss
    • Recognition should not just come from the boss. Create a culture where all employees show support and appreciation for co-workers and let it be known when someone else does a good job.
  6. Have Fun
    • Yes, it’s a workplace but you want it to be a place everyone wants to come to and not somewhere they dread being. So, add an element of fun into the day.

Every employee would love extra money and some might think this is the way to get them to go above and beyond, but extra money is temporary and not always feasible.  If your employees don’t feel valued and invested in your company’s mission, all the money in creation won’t fix that.  Try these simple changes and see if they transform your workplace into a place people love to be.

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What We’re Reading – OIG Sets Guidelines for Hospitals Referring to Home Health Providers

CMS requires hospitals to provide patients being discharged with a list of home health providers in the area in addition to information about important metrics, such as quality measures, so patients can make informed decisions.  The Office of Inspector General (OIG) is going one step further: requiring hospitals to identify any home health providers in which they have a financial interest and vice versa.

Though patient provider choice has always been sacrosanct, the reality gets a little hazy when the patient is facing imminent discharge.  Hospital planners receive the order for home health and often proceed to make those arrangements guided by the patient’s insurer and list of participating providers.  They then have been known to present these discharge activities to the patient as a fait accompli because – let’s face it – most patients don’t usually have a preference on home care providers.

This article in Home Healthcare News echoes the anecdotal experiences of many home care clients:  hospitals steer patients to those agencies in which they have ownership or receive some sort of financial benefit.  This, of course, poses a huge issue to providers who are not affiliated with the hospital and who have long decried the lack of a level playing field for years.

Financial pressures (in revenue, market share, readmissions, etc.) have resulted in hospital systems controlling as much of the service delivery chain by vertically integrating services and owning more pre- and post-acute providers.  One can argue that this practice would make for a more seamless transition, for the patient’s benefit and overall health, but the end result can limit competition to the detriment of the system a whole.

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