Blog and Helpful Articles

Form I-9 – Compliance, Audits and Common Mistakes

Every employer in the United States is required to complete an I-9 form for all employees and this must be completed within three business days of hire. The rule has been in effect since 1986 and only employees hired prior to 1986 are exempt from this rule.

Compliance – What is required to be compliant?

  •  The employer is responsible for filling out the I-9 form and verifying identity and authorization to work in the United States. The form must be completed within three business days and any employee who fails to produce the necessary documents within this time frame must be terminated. Instructions are provided on the back of the form as to how to complete the form and what are acceptable documents.
  • The employee may submit any of the documents listed in section A, B & C of the form as instructed. Employers may not ask for specific items such as a passport or green card.
  • Forms only need to be completed for applicants that are hired.
  • Employers can only accept original documents. The only exception is a certified copy of a birth certificate

Audits – When should files be audited and what are the rules for retention?

  • Employers must have a system in place to track documents that expire.  For example: Some green cards (Alien Registration Cards) expire after 10 years of issuance. In this case, a new card will have to be produced by the employee and a new I-9 will have to be completed on or before the expiration date. Larger companies use electronically generated reports to track these dates but a simple tickler system or use of outlook calendars can work for smaller organizations.
  • All non agricultural employers must retain an employee’s I-9 file for three years after the date employment begins or one year after the person’s employment termination, whichever is later. This simply means that you must maintain the files for as long as the person is employed and for one year after termination. However, please note that if the employee leaves before having been employed for three years, the employer must maintain the file for up to the minimum requirement of three years.
  • Internal audits should be performed semi annually as US Immigration sanctions for incorrect or missing I-9s can range from $110 to tens of thousands of dollars per infarction.
  • Anti-discrimination rules are also scrutinized during US Immigration audits, and employers can be fined for failing to hire authorized workers for discriminatory reasons. Examples of this would be asking for specific documents such as a US Passport or asking to see more than the minimum documents required.

Mistakes – Some frequent errors that can and will bring compliance fines and sanctions include:

  • Documentation errors, such as incorrect dates on the form, missing signatures, incomplete check boxes and, at times, failure to complete a form.
  • Non compliance of the three-day rule. This will happen mostly if the employee does not have the documents on the first day and the employer forgets to follow up.
  • Files with expired documents and those for which the employer has not completed re-verification.
  • Invalid documents that are requested on the form to validate identity and authorization to work.
  • Incorrect retention maintenance as discussed above.

As the Federal Government continues to tighten immigration laws and crack down on noncompliant employers, it is now the time for HR departments to train and educate staff on the rules and legal risks associated with this issue.  In addition, companies should implement accurate and consistent practices to prepare, maintain and dispose of I-9 forms, as this will minimize the likelihood of potential liability and violations.

 

 

 

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Employee Orientations = Company/Employee Success

Employee turnover is very costly.  Aside from the tangible costs of recruitment, the revolving employment door takes its toll on your customers and other employees.  A solid orientation process creates a win-win for all parties, as well as a roadmap for a productive work relationship.

However, companies often assume that a new employee’s credentials automatically make him or her knowledgeable about the workplace and the employer’s expectations. The reality is that in order for employees to be successful, they need to know the specifics of their duties and the company’s rules and expectations.  Does it sound impossible to add time for staff orientation to your already-jam-packed day? Here are some suggestions to make the task easier and accomplish the goal of informed, committed staff with a successful and efficient orientation:

  • Try to hold the orientation session on the new employee’s start date if at all possible.  This will foster a positive first impression on the employee and communicate that you value the work relationship.
  • Sketch out an outline of the information to communicate.  The entire orientation process needn’t be conducted solely by the manager; capable, long-standing employees who understand and uphold the company’s policies can help too.  Make sure the company president stops in to welcome the new staff member.
  • Remember that you can use technology by including videos as well as printed materials.  These items can supplement the orientation process but should not take the place of human interaction.
  • Be sure to include an organizational chart.  In very small organizations (less than five employees), this might seem like over-kill, but in larger companies, it’s helpful for the new employee to understand the organization and specifically his or her role in the ‘grand scheme of things.’
  • Do include a company history and a company philosophy, making sure to include vision and mission statements.  If your company doesn’t have those, you may want to take some time to refine these concepts for your organization’s benefit.
  • Present and review in detail the company handbook which should include company rules, hours of work, disciplinary action, time off policies and benefit package, payroll schedules, etc.
  • Don’t forget to include items that may seem simple or self explanatory, such as how to transfer telephone calls, and other workplace expectations.
  • Discuss training and advancement opportunities.
  • Make sure to include plenty of question-and-answer opportunities.
  • If possible, assign a mentor or buddy to the new employee to ensure a good transition. Make sure this individual is one of your star performers who can uphold your company’s performance standards and set a good example.

Implementing a proper orientation program will take some time to plan and can be costly. However, the cost of having high turnover vastly outweighs the cost of a good orientation. It is a great investment that will pay dividends in more productive and satisfied employees.

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What We’re Reading – Handling the toxic employee: How to avoid — or dilute — the poison

When you think about your current employees, is there one that stands out as a bit hard to manage?  Regardless of your answer, this helpful article will help you manage problem personnel and also avoid hiring them in the future.

The author starts by explaining that if you don’t have any toxic employees in your office and want to keep that cohesive work environment, just spend a little extra time in the hiring process to weed out the bad apples.  If you’ve already made one of those regrettable hiring decisions and you’re at a loss on how to proceed, the author suggests how to confront this type of employee and nip the behavior in the bud.  It’s important not to let the behavior linger because it will generally escalate into a bigger problem down the road, and possibly “infect” other employees.

The confrontation need not be traumatic.  Simply pull the employee aside and bring the issue to his attention; offer assistance in helping him resolve the issues so the work relationship can be more positive and productive.  This is just one suggestion in this article which is definitely worth the reading time; it will help you cultivate the right people to make your company successful.

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HEDIS: Is Yours a Five-Star Health Plan?

To most patients, quality is amorphous; we know it when we see it. To a healthcare administrator, however, quality has a whole other meaning. It’s measurable, measured and a measure of the congruence of several factors.  In managed care, quality is spelled H-E-D-I-S, which is a measurement of performance on criteria that support clinical excellence.  Using the Healthcare Effectiveness Data and Information Set, employers and patients can then compare plans on a level playing field and assess the value of their premium dollar.

HEDIS measures are refined every year, and include assessing successful diabetes and cholesterol management, in addition to several preventive measures, such as screenings for breast cancer, colo-rectal cancer, osteoporosis and glaucoma. HEDIS scores are reported as the percentage of patients who meet specific criteria.  For example, colorectal cancer screening includes services like fecal occult blood tests, flexible sigmoidoscopy and/or colonoscopy at certain intervals. Mammogram rates evaluate the percentage of females under the age of 70 who received the screening during the study period.

Health plans conduct HEDIS reviews primarily by assessing the presence of specific CPT codes reported on claims and encounters.  Chart reviews are also performed to glean additional information, and nurses have historically been integral to this effort.

CMS rates Medicare Advantage plans by assigning a ‘star-rating’ which adds HEDIS measures, member satisfaction scores and the results of a health outcomes survey to its own data.   The stars, which range from one (poor performance) to five (excellent performance), correspond to bonus payments added to the funding that plans receive from CMS. The Henry J Kaiser Family Foundation reports that 91% of MA plans will receive a bonus payment in 2012; the value of these bonuses is estimated at $3.1 billion. One-third of the plans rated four or more stars.  Nine percent of the plans received a score of two or less stars and consequently, have an incentive to work harder for the 2013 bonuses.

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Think Your Office is Too Small for Compliance Activities? Think Again.

There are countless reasons for CMS to request records to verify the accuracy and documentation of information submitted for payment; their approach is to ‘pay and pursue.’ Nevertheless, mistakes – no matter how innocent – can prompt prepayment review, which becomes a costly and frustrating endeavor for the provider.

Compliance is one of those nebulous, expensive-sounding areas that causes most providers to assume a “Don’t ask, don’t tell” posture. After all, we’ve never met a practitioner whose behavior knowingly straddled the fine line between legal and not. But mistakes do happen, and the best of habits erode over time. Proactive providers of a certain size rely on an established Compliance Program to keep them out of trouble. In our experience, however, practices with one or two providers mistakenly assume they’re too small to be on the radar and lack the financial resources for large-scale compliance activities.

But in the field of compliance, even a little bit is a good start. Here are some basic components you can put in place right now:

• ‘Audit’ is a fancy word for reviewing what’s been done. In order to realize any benefit, audits must be conducted by a knowledgeable individual who is not responsible for the daily work being audited and on a regular schedule. Quarterly reviews allow you to catch mistakes early, remediate behaviors and conduct education.

• The first step is to identify the criteria for review. We suggest a coding audit to launch your compliance activities. Select a sample of billed visits from each provider and review the documentation associated with the claims. Were the visits billed correctly? Timely? Were the proper codes (diagnosis, procedure and modifiers) assigned? Is medical necessity clearly documented? One frequent issue we find is the absence of documentation of venipuncture services performed when the provider checks the venipuncture service on the superbill.

• It’s a good idea to create an audit tool so you can objectively document the findings. Be sure to add criteria based on the coding guidelines for your specialty as well as your internal policies and procedures so you can assess staff compliance with the rules.

• Scoring is an important step so make sure to reduce the answers on your audit to a numeric value. Since 100% is the target, any score under that will prompt some corrective action.

• Corrective action needn’t be a huge burden. Simply identify the areas where your practitioners and/or staff fall short of the requirement and implement steps to remediate their behaviors.

• Education is a key factor in any corrective action plan, in addition to a more heightened re-audit schedule to check for improvement. Your investigation of the errors may also reveal office processes that are absent, broken, disregarded, confusing or contradictory, or a combination of these.

• Be sure to involve stakeholders in the corrective action process and make the changes you need. Quickly.

Finally, compliance work requires a commitment of time and resources. A half-hearted attempt with no follow-up is as bad as having no process at all. A demonstrated commitment to proper coding and billing may minimize any fines or penalties.

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What We’re Reading – Crisis Management Plans for Medical Practices

Sadly, tragedies like the shootings in Colorado, Wisconsin and Texas are occurring with more frequency, and no organization is immune from the threat of violence. These situations also prompt the questions: how would your workplace handle a similar crisis? Do you have a crisis management plan?

This article explores in a meaningful way some tactics that vary in sophistication and expense – from the routine and free, such as locking the door from the waiting room to the interior of the practice, to the more expensive, such as installing cameras and panic buttons. The key is to consider some precautions and educate your staff about the proper response.

The author provides tools your office can utilize in preparing for active threats to life and safety. He also recommends that you don’t overlook the everyday acts of nature, such as fires, and chemical & biological threats. While a crisis management plan can’t encompass every single threat, it goes a long way toward reassuring your employees and patients that you have their safety in mind.

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The Basics for Launching a Long-term Care-related Business

Not a week goes by without someone inquiring about how to open a long-term care related business.  Whether it’s because of the state of the economy, fears of downsizing or burgeoning entrepreneurial spirit, the demographics in Florida are certainly in our favor.  In case you’ve flirted with a similar idea, here are some points to consider:

  • Decide on the type of services you want to offer.  Skilled services are those that require a licensed professional, such as a nurse or therapist.  Non-skilled services encompass personal care, such as assistance with bathing, grooming, eating, etc.  Homemaker/companion services are also non-skilled, but include no “hands-on” care of patients.
  • Evaluate the various payors you would like to pursue.  Skilled services are medically necessary, so Medicare and third-party health insurance are the primary sources of revenue.  For non-skilled services, Medicaid, long-term care insurance and self-funding (private pay) are the most common options.  Health plans can make annual changes to their benefit offerings so we urge clients to periodically check with payors in case their policies related to your ideal business type change.
  • Based on the services you expect to provide and payors you will pursue, decide on the structure of your business.
    • All home health agencies (HHA) (skilled and non-skilled) are licensed by AHCA.  Those that will offer skilled care require accreditation from one of three organizations.  A one-year timeline from getting started, in earnest, to final accreditation isn’t unrealistic.
    • Nurse registries (NR) are also licensed by AHCA but do not require accreditation.  These can generally be launched in four to six months.
    • Homemaker/Companion Services (HCS) are registered with AHCA, do not require accreditation and can open in about 30 days.
    • Assess your background and candidates for leadership positions.  HHAs require a qualified administrator and alternate and director of nursing for skilled agencies or RN supervisor for non-skilled.  NRs need an administrator and alternate, as well as a nurse.  For an HCS, there are no special personnel requirements.
    • Capital requirements are hard to predict.  AHCA reviews financial projections for the first two years of the HHA and for the one year for a NR.  The various financial schedules, based on the business’s projected overhead and patient volume, yield the amount of capital required.  In addition, Medicare has separate financial requirements based on the costs reported by agencies in the proposed business’s geographic area.  For an HCS, AHCA does not have capital requirements.

Obviously, many other issues factor into the decision to start a business, but consider that the US Census Bureau projects that over 49 million Americans are over the age of 65, and that this figure will grow to over 65 million in 2025.  The Census Bureau also estimates that, in 2021, almost 21% of the Florida population was over age 65. Each day, more than 10,000 Baby Boomers turn 65 years of age and become prospects for your long-term care related business.

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What We’re Reading – The Five Biggest Medical Practice Marketing Mistakes

There’s no doubt that these are trying economic times and marketing budgets often take a back seat to operating budgets.  But some prudent tips from this great article can help you make or keep our business successful.  By outlining some strategies to avoid when marketing your business, the author helps medical practice managers navigate victoriously through these dark times.  Specifically, he cautions that we shouldn’t:

  1. Treat marketing as an expense – never think of it as a chore but always as an investment in your practice’s future/livelihood.
  2. Promote specialties and services without relating them to solutions – since most patients are looking for solutions to a problem, market yourself/your practice as the solution to the problem.
  3. Confuse activity with results – remember, it is quality over quantity that helps you turn that prospect into a patient.
  4. Do the same thing and expect different results – if what you’re doing isn’t providing success, be adaptable to change.
  5. Go with your gut – don’t just go out with guns a blazing; take a step back and make sure that you have done adequate research, training, etc. before you move ahead.

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Minimize Claims Issues with One Simple Step

Most physician practices experience claims challenges, from denials and rejections to payment inaccuracies.  As frustrating (and costly) as those issues are, they are almost avoidable with one simple step:  verifying patient insurance eligibility.

For patients covered by Medicare, it may seem like a waste of time to verify insurance after the initial visit.  However, how can you be sure the patient did not knowingly or erroneously enroll in a Medicare HMO with which you are not contracted?  You would continue to see the patient and find out only when your claims are rejected that you, basically, volunteered your services with this patient.

For patients covered by Medicaid, eligibility can vary, so it’s crucial to verify that the patient is still enrolled in the Medicaid system for every visit.

Finally, for patients covered under third party insurance, the potential issues are numerous.  Coverage can end or change on a monthly basis.  We know that patients lose their jobs (and insurance coverage) and employers can change plans at any time. With the trend toward insurance premium increases, more employers are shopping around for less expensive coverage which can mean less benefits or more cost-sharing for your patients. Failure to verify that the patient is still eligible for your services, that the insurance is still active and the co-payment or co-insurance levels will certainly lower the chances that your practice will lose revenue.

We recommend that you create a short form to capture the information and then file it in each chart.  An alternative is to note the verification on the daily schedule and have the employee sign off that the verification has been done.  The manager should keep the proof of verification until all claims are paid. If there is any problem, you can ask the employee to explain how benefits were verified.

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What We’re Reading – 5 Vital Signs for Your Practice's Health

The phrase ‘vital signs’ makes most people think of patients, but did you know that your medical practice also has vital signs?  And just like in the human body, these business vital signs are just as crucial to your existence.  Here is an article that gives physicians a way to easily measure the life of their practice and determine if it needs CPR.  The author even provides a handy spreadsheet you can download and maintain.

Here are the top five vital signs every practice should track every month:

  1. Collections: Keeping track of collections on a monthly basis – and using the spreadsheet provided – can help you spot any trends as they begin to emerge. The author states that revenue rarely fluctuates more than 10% so anything above that merits scrutiny.
  2. Labor Costs:  These too don’t vary unless you’ve had an unusual event that necessitated overtime or use of a staffing service.  Monthly monitoring of the aggregate amount spent gives a quick reality check when one day of staff overtime starts to become a habit.
  3. New patients: Sometimes we get caught up in the day-to-day work and fail to notice any dramatic changes in the number of new patients.  If they decline precipitously, you might want to look over your operations and assess any new competitors.
  4. Top 5 CPT Codes:  Most healthy practices have a mix of E/M and procedure codes.  However, too many Level V visits, for example, could prompt payor attention and claims review, and reveal the need for external audit and provider education.
  5. Top 5 Referral Sources: Knowing who refers you the most patients is helpful in cultivating strong collegial relationships and to express appreciation.  Any significant changes in this area may clue you into environmental issues you may have ignored.

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