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Job Descriptions & Performance Appraisals – Who Needs ‘Em?! (Part 2)

This is part II of our four-part series on job descriptions and performance appraisals. Monday, we discussed the importance of job descriptions and how to craft them.  Our discussion left off after an in-depth look at the essential functions or tasks for the position.  Today, we’ll look at the other requirements.

Work environment is key to conveying the conditions under which the employee will perform the work.  For example, the phrase “demanding and fast-paced environment” gives the employee a good idea of what to expect. Clarifying physical demands is also paramount to preparing the candidate for the position.  If an essential function of the position entails lifting large boxes, specify the weight.

An important aspect to remember is that employers cannot discriminate against disabled individuals.  So the job description must provide information that is useful for even a disabled person to assess whether he or she can do the job. That’s why the Americans with Disabilities Act (ADA) has many guidelines that must be incorporated into a job description.  In a nutshell, the ADA protects an employee or job applicant who has the prerequisite skills and knowledge and is able to perform the essential functions of the job, with or without the employer making a “reasonable accommodation for that disability.” For that reason, be sure to summarize the position’s supervisory responsibilities, mental and physical demands as well as the work environment.

The important thing to remember is that a job description needs regular review.  Perhaps once a year, you can assess your overall organization, review the positions and their functions, and plan for changes or expansions.  Then it’s a good idea to revise the job description so it is a current representation of each position.  Remember to review the new job description with the employee and obtain a signed acknowledgment of having done so.

Here is an example of the main elements of a job description.

Next week we will discuss performance appraisals to understand how these two concepts tie together to maximize your organization’s success.

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Job Descriptions & Performance Appraisals – Who Needs ‘Em?! (Part 1)

Our experience has shown that sometimes smaller organizations don’t follow established conventions in the human resources arena. One such item is the job description, and its cousin, the performance evaluation.  In this four-part series, we will explore the need for each and share tips to make your work easier, or at least less tedious.

Job descriptions are useful and critical for many reasons.  Keep in mind that employment is an unofficial contract.  You will exchange payment for the performance of certain functions.  After all, you wouldn’t sign on with an insurance company if you didn’t understand the coverage, right?  Similarly, employees need a good understanding of the position, their tasks and accountabilities; and you, as the employer, need to convey the expectations for which you will exchange a salary and benefits. In addition, as a manager, you need to know that all the critical functions in your department or business are covered and have the ability to measure whether they are being met to your satisfaction.

In the most basic terms, a job description is a list of the global tasks performed by the individual, his/her areas of responsibility and the requirements of the position.  But it’s important not to underestimate the importance of having one.  Although the process can seem daunting at first, writing a job description is a very good exercise for the manager or business owner.  First of all, it’s important to understand the tasks that need to be performed by the individual.  Consider what the person will be responsible for doing and list the tasks in order of importance and/or frequency performed.  Be specific enough to cover the functions without dictating the “how” of the work as this may vary over time.  It’s also a good idea to provide any measurable standards if they will be monitored and used to gauge performance.  An example is, “Answer incoming calls by the third ring,” but only if this is a key factor for the business, if it will be tracked and if the individual will be held accountable for meeting this standard.  Be careful not to box yourself in with too many rigid requirements that are ‘nice to have’ but not required for the job and that will be difficult – if not impossible – to enforce.

Another important aspect of the job description is the area for qualifications.  In this section, the manager should list the minimum requirements for the position in terms of skills, education, effort, etc.  Although you may prefer a college-trained person, is that degree of education really needed for someone to do the job? It’s best to consider your minimum standards because you may encounter difficulty in finding enough candidates if your requirements are very narrow.  In addition, many candidates have top-notch skills and become loyal, valued employees but they might be overlooked if your requirements are too stringent and screen them out of consideration.  Of course, if specific training is germane to the position, by all means, require it.  However, in many cases, the minimum standard you set is adequate and you can indicate that the additional training is ‘preferred.’

Thursday, we’ll look at the balance of the requirements for a good job description and provide an example you can use to create your own department or company job descriptions.

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What We’re Reading – 5 Ways to Build Customer Loyalty

For almost all businesses, customer service is crucial in solidifying customer loyalty is one key to a successful business. Loyal customers will do anything they can to help your business grow and become successful by turning first to your company for their business needs or by creating word of mouth for potential customers. Because it’s not always easy to create a dedicated customer base, this article explores five ways to build customer loyalty.

Start by getting to know your customers. Ask them what will make them happy and what would completely turn them off. Listening to what they want will help you provide them with the highest value. Your business should also have a ‘go-to person’ who has the right attitude as well as the power to ensure that customer issues are resolved to their satisfaction.

There are various types of communication, so avoid being repetitive with your clients. The author emphasizes dealing with customers as individuals. Communication is a two-way street, so listen to your customer’s needs and discuss the best way to meet them individually. This type of communication will build a special rapport with you customer and deliver their loyalty.

Another idea to consider is rewarding your loyal customers. Everyone likes to be appreciated, so think about a customer-only event or other loyalty discount. An informal event, like a customer appreciation cocktail party, gives your clients another reason to stick around.

Finally, know your market. Today’s customers hail from different ethnicities and backgrounds. Having a bilingual employee could go a long way in making your foreign-language-speaking customers feel comfortable.

The sky’s the limit on the ideas you can use and the dividends this creativity can pay to your business. This article gives a few great and inexpensive ways to build your business and keep your loyal customers.

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Latest ADR Update as of 02/22/2012 – Jurisdiction 11- Home Health and Hospice

Palmetto GBA conducts probe reviews on services provided by Medicare providers within Jurisdiction 11. These reviews are in an effort to prevent inappropriate payments. Data analysis is performed at regular intervals to determine the types of services or providers that will be subject to review. Based on the results of the data analysis, edits are set up in the system to select claims for a probe review, which is either service-specific or provider-specific.

For service-specific probe reviews, a sample of 100 claims will be selected. Based on the results of the data analysis, more than one service-specific review may be conducted at the same time. The total number of claims selected for provider-specific reviews is between 20 and 40 for each provider identified for review. Providers selected for the probe review will receive a letter from Palmetto GBA explaining the reason for the review, why the provider was selected, and the type of review being conducted.

The number of claims selected on a daily basis for each provider is based on the number of claims received from the provider in a given day. Palmetto GBA will randomly select a sample of claims meeting the review criteria each day for each provider until the total number of claims needed to satisfy the probe sampling has been reached. However, providers are cautioned not to alter their billing practices to reduce the number of claims selected for Additional Documentation Request (ADR). If this is identified, it may result in additional medical review, referral to other review entities and or extrapolated overpayments.

When a claim is selected for review, an ADR letter is sent to the provider. It is possible that providers may receive an ADR prior to receiving their probe notification letter if they were selected for a provider-specific probe review. Providers should also note that in the past, medical ADRs were mailed in yellow envelopes. ADRs are now mailed in white Palmetto GBA envelopes, so providers should ensure that internal office processes are set up to identify these requests.

Part A and home health and hospice providers may also use the Direct Data Entry (DDE) system to monitor which claim(s) are in the ADR status/location S B6001. To view claims in DDE that were selected for ADR:

  • Select menu option 01 ‘inquiries’. Press enter and select 12 for ‘Claims’ at the sub-menu.
  • Press enter. Tab to the S/LOC field and type SB6001.
  • All claims in this S/LOC will be reflected in the ‘Claim Summary Inquiry’ screen

Providers may also print their ADR letters from DDE rather than waiting for the hard copy to arrive in the mail. To print a copy of the letter after accessing the list of claims following the above instructions:

  • Tab to a specific claim and type an ‘S’ in the ‘SEL’ field;
  • Once in the claim, press page forward – the ADR will appear after the claim on page 6

In accordance with Medicare regulations, providers have 30 days to respond to an ADR. Providers may fax the records to the number listed in the ADR or mail the records to the address provided in the letter. If no response to the ADR is received within the specified timeframe, payment on the claim will be denied. Palmetto GBA has up to 60 days from the date the documentation is received to complete a review and make a determination on the claim. Once a determination is made, the processing of the claim will be finalized.

Every effort will be made to move providers through the ADR process as quickly as possible. Providers that need to contact the Medical Review (MR) department related to the review of their medical records can call (803) 763-7491. Before calling the MR department regarding significant financial hardships, providers should have responded to some of their ADRs in order for the MR department to provide feedback.

The Medical Review telephone line is a voice messaging system. Providers should ensure that they leave a contact name and telephone number, their provider number, NPI and a brief message to explain the reason for the call. The MR Department will return calls within two business days of receipt in the order the calls are received. Making repeated calls to the MR department is not necessary.

For info or tips on Homecare Billing, contact Imark Consulting, Inc. at 888-370-3339 or visit us at www.homehealthbilling.com

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What We’re Reading – How to Turn Customer Complaints into Profits

For obvious reasons, it’s safe to say that companies never want to receive customer complaints. Businesses risk losing existing clients and potential new ones as well as ruining the image of the company. According to this article by Robert Moment, it’s possible to turn customer complaints into opportunities for growth and profit.

He suggests that businesses keep in mind that customers are going to complain every once in a while. Prepare yourself and your staff to deal successfully with complaints when they come. The key is to keep a positive attitude and assure your customer that the issue is a priority and you’re going to do whatever it takes to resolve the problem.

Another important point to consider is that, most likely, the customer is going to speak to you or your staff member in an aggressive and unprofessional way. It’s so important to remain professional and non-confrontational, allowing the customer to feel your genuine willingness to help. Reassure them that they’re in good hands and that you both want the same thing: a satisfactory resolution to the issue.

Because customers generally don’t care who’s to blame, don’t spend time in finger-pointing; just apologize and resolve the problem.  Most importantly, don’t make excuses; just take responsibility and do your best to make it right.  The author encourages businesses to compensate the customer for the inconvenience once the issue is resolved, such as with a discount on a future purchase; this will help your client focus on something positive again. Finally, don’t assume that everything is well and that no news is good news. As we learned from past articles, most customers will not let you know they’re dissatisfied. They’ll just stop doing business with your company.  So be sure to survey your customers and follow-up on their issues.

Because we all learn from our mistakes, try to use each complaint as an opportunity to coach and improve your business. So the next time your customer has a complaint, don’t get frustrated! Consider each complaint as a way to prove and remind your customers why they do business with you and show them you can handle whatever issue comes your way.

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What does it mean to be “at risk?”

The concept of being “at risk” has to do with the level of financial risk the entity has in funding the care its patients receive.   As profit-oriented enterprises, insurance companies generally assess the insured’s risk and base the premium on the anticipated cost of care with the ultimate goal of minimizing that risk.  MedicareAdvantage plans are insurance companies, in a sense, that are paid a capitation by the Centers for Medicare and Medicaid Services (CMS) for each enrolled member.  In exchange for that capitation payment, the Plan is financially liable for all the care given to the patient (e.g., all medications, surgical procedures, office visits, etc.) by any provider.

Depending on the plan’s business model, it may contract with physicians operating as Independent Practice Associations (IPAs) or with groups that own or manage multiple physician offices under a Management Services Organization (MSO).  In many cases, the plan’s risk is passed onto the IPA or MSO.

With an IPA or MSO, the MedicareAdvantage plan has deducted a percentage of the capitation for its administrative costs and pays the provider the balance of the capitation fee.  In exchange, the provider (IPA or MSO) assumes the financial risk for the patient’s care with usually few contractual exceptions (e.g., AIDS, hospice, other high risk diagnoses, etc.).

In the past (before MRA), the capitation payment paid by CMS to a MedicareAdvantage plan was primarily based on factors beyond anyone’s control:  the patient’s age, gender, and geographic location.  If a plan had two patients with a similar demographic profile, the Plan received the same capitation payment.  If, for example, one of the patients was extremely healthy (had low medical claims expense) and the other had metastatic cancer (very high claims expense), the Plan’s profitability was significantly impacted because the capitation payment received was not adjusted for the health risk of those specific patients.  Since managed care’s comprehensive coverage and low out-of-pocket patient costs typically draw patients with multiple chronic conditions, many plans had incentives to offer little care or were forced to leave geographic markets because their opportunity for profitability was limited.

To learn more about our Risk Adjustment (MRA) services, click here

Our consultants can help you manage your full-risk practice. To learn more, call us today.

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CMS Risk Adjustment Data Submission Deadlines and Payment Schedule

The nature of capitation and the risk adjustment payment method requires specific deadlines for data submission that correlate to dates of service and affect capitation payments.  The Centers for Medicare and Medicaid Services (CMS) observes the following three deadlines each calendar year when calculating and delivering funding payments to Medicare Advantage plans:

  • Data received by CMS by the first Friday in March affects the July funding payment;
  • Data received by CMS by the first Friday in September affects the January funding payment;
  • Data received by CMS by January 31st is considered a final reconciliation and the payment is received by the plan in August.

An example might help clarify the concepts:

The July 2012 funding payment that Medicare Advantage plans receive from CMS is based on the data that was received by CMS by March 2, 2012 and represents dates of service from the prior calendar year, January 1, 2011 to December 31, 2011. It’s important to understand that encounter data with dates of service outside the parameters in our example will be accepted by CMS but will not factor into the payment calculation at that time. So, if a plan submits data with dates of service in February 2012 by the March 2nd deadline, those diagnoses will not influence the July 2012 payment.  They will be reflected in the January 2013 payment as explained below.

The January 2013 funding payment will be based on the data submitted for the first six months of the current calendar year in addition to the last six months of the last calendar year.  The deadline for data submission for the January payment is the first Friday in September and will represent dates of service from July 1, 2011 through June 30, 2012.

And finally, the January 31st deadline is based on data submitted with date of services going back two calendar years; January 31, 2012 was the deadline for CMS to receive data for dates of service from January 1, 2010 through December 31, 2010. This is one last opportunity to transmit ICD-9-CM codes for information that was documented by the clinician, but coded incorrectly or not at all.

CMS follows a claim data review process called the Risk Adjustment Processing System (RAPS) to review the information that has been submitted by all plans.  From the claims and encounters submitted by the plan, CMS identifies the diagnosis (ICD-9-CM) codes that qualify for Hierarchical Condition Categories (HCC’s).  Each HCC carries a corresponding risk score which is then applied to the premium payment from CMS.

CMS recognizes about 3,100 risk-adjusted ICD-9-CM codes that are categorized into 70 HCCs.

 

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What We’re Reading – How to make a Personal Connection with Customers

It’s no secret that people buy from those to whom they can relate.  Rapport solidifies the connection with your clients; one idea is to keep a mental note of one or two details about your customer and then bring them up in a later conversation. Remembering little details will reinforce your interest in your customers and make them feel less like a dollar sign.  Asking open-ended questions is another good tip to allow customers to explain what they want or need, plus it minimizes the chance you’ll assume and be wrong.

This article provides tips and information to help businesses forge a better connection with their customers. The author describes as “The Art of Courtship” and the other is “The Art of Listening” and stresses that these are key to a successful client relationship.  Let’s start with “The Art of Courtship” which compares selling to dating. In a nutshell, the author suggests that you work hard to impress your customers and hope they do the same in return. The more you can woo them with your top-notch services, the longer they’ll do business with your company and better yet, spread the word to possible prospects.

The Art of Listening points out that there’s nothing more detrimental to a client relationship than feeling ignored in a conversation.  It’s not only considerate but also very important to actually listen to the response when you ask customers a question. In fact, this article states that small businesses have a bigger advantage in connecting with their clients because they have more of a face-to-face relationship than larger companies usually do. On the same note, we all know it’s easier and quicker to email a potential client. But it’s far more meaningful and effective to be creative and attempt a direct connection when pursuing future customers.  Overall, you never want your client to feel rushed or swindled. So take your time and be patient. This will make your customer feel confident that he or she made the right decision and you will feel great about developing a lasting relationship with the most important person to your business.

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The Employer’s Role in Determining Employee Competence

When was the last time you questioned whether the individual who provided you or a loved one with a health care service was qualified or competent?  I don’t know about you, but the last time I had blood drawn, I didn’t think twice about extending my arm for the nice lady with the long needle.  Why? Because as patients, we generally don’t question our healthcare workers.  We assume that the provider – physician, hospital, home health agency, pharmacy – has vetted its employees, ensured that they are licensed/certified (if needed), competent, trained and supervised to provide the care we receive.    Healthcare providers are in a unique position.  We enjoy the public’s trust, and once that trust is broken, it’s hard to recover.

Good providers question whether they’re doing enough to assure competence.  The first thing most do is to check training and references.  We do this usually by requiring a copy of someone’s diploma, license or certification.  Do you check the certification at its source?  For licenses, that’s probably the case when you check the appropriate issuing state agency.  But what about other certifications? Are you ensuring the documents you receive are legitimate – as much as practical – or just taking things at face value and hoping for the best?

When it comes to references, many of our clients are a little lax.  Often, the HR manager or administrator sends out a reference request and no one tracks to make sure the request is returned, completed by the former employer.  Keep in mind that references can be checked orally as well.  While many employers won’t give you ‘the dirt’ on a former worker, they will at least verify the individual worked there, the dates of tenure and the position held.  This is enough to verify what the individual noted on the application or resume.  So when references aren’t returned in a timely manner, pick up the phone. The statement signed by your applicant, authorizing a reference check, will cover a phone call as well.  Some organizations have state and/or accreditation requirements to check references.  Understand that sending out a reference request two years ago and failing to follow up won’t meet the standard; we suggest a simple tickler system and regular personnel file reviews to make sure you have all your ducks in a row.

Does licensure ensure someone is competent?  I know a few people who wouldn’t agree with that assumption.  What responsibility does an employer have to assure its staff is competent?  The role of testing is seen as a challenge and its suggestion elicits four-letter words from many employers.  But a short 10- or 15- question quiz can give you a sense of someone’s skills and thought processes.  Commercially available tests may fit the bill or you could create a short list of areas in your organization for which you want to ensure an understanding and competence.  Demonstrations are helpful, as are verbal explanations.  The vogue in hiring practices these days is not, ‘Are you a team player?’ since only the dimmest bulb will tell you he isn’t (and you probably won’t want to hire him anyway).  Today’s HR manager asks the applicant to, “Tell me about a situation where you had to work as part of a team and the challenges you encountered.”  Open-ended questions give the manager the most information, not only about the subject matter but in observing the applicant’s choice of words and demeanor.

If this sounds like a huge burden for you, consider your organization’s turnover and pattern of hiring decisions.  Are you easily swayed by a good line, only to find out months later that the person doesn’t have the proper skills?  Or is otherwise not a good fit for your company or department?  A little extra time on front-end will minimize the likelihood that you’ll get a bad apple or someone who exaggerated his/her skill-set.

The last part of the loop on competence has to do with ongoing training.  For licensed or certified individuals, ongoing training in certain topics is a requirement.  Those employees may obtain the needed CEUs or training elsewhere and bring you a certificate for the personnel file.  However two items for consideration:  are employees being trained on a task the way you expect it to be performed?  What about regular training and review of your organization’s policies and standards?  This should be part of any good organization’s human resource plan. A regular review of your service standards as well as patient confidentiality, compliance, how to handle patient complaints, etc. will convey that you take these topics seriously and demand excellence from your staff.

After all, your patients expect it and more important, they trust you to ensure it.

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What We’re Reading – Keeping and Motivating Employees in the Current Economy

Given today’s economic issues, our outlook of the American Dream maybe somewhat altered because of the difficulties many Americans are currently facing. It’s no surprise that our uncertain economic environment is causing pressure on all social classes and in all areas, especially with employment.  Highly skilled and educated workers are accepting positions below their standards. This not only forces less skilled workers out of the job market, but impacts middle class workers as well.

As these social economic problems become more widespread, employers will continue to face many challenges.  A common issue for employers has been to sustain a loyal work environment for devoted employees through challenging times. It’s encouraging to read about management teams who reduced their bonuses to assure raises for other staff members. In addition, employees have voluntarily given up necessities to assure company survival and businesses have sacrificed profits to give back more to their employees. Without a doubt, when managers stay positive and encourage their employees, it urges workers to stay motivated and feel a sense of ownership and pride at their place of employment. This will not only create a positive long term benefit for your business but also give employees a sense of ease and drive in the company.

As stated in this article, there are no guarantees when or even if the economy will get it together and people will be restored to their former standard of living. But it is certainly safe to say that after reading this article, you will have a different perspective on what it will take to survive during these uncertain times and maintain long-term success.

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