Blog and Helpful Articles

Overtime Pay Exemption for Companionship Services Comment Period Ends March 12

Comment Period extended until March 21, 2012.

In 1975, the U. S. Department of Labor (DOL) exempted companions and live-in workers from the requirement for overtime pay. On December 27, 2011, the DOL published a ‘Notice of Proposed Rulemaking’ to revise the companionship and live-in worker regulations for two purposes:

“To more clearly define the tasks that may be performed by an exempt companion and;
To limit the companionship exemption to companions employed only by the family or households using the services. Third party employers, such as in-home care staffing agencies, could not claim the exemption, even if the employee is jointly employed by the third party and the family or household.”

The proposed change would remove the exemption and force home health agencies and other long-term care organizations that employ companions to pay time and one-half for any hours worked over 40 in one week. The DOL stated that among the basis for its proposed rule change is that “workers that are employed by in-home care staffing agencies are not the workers that Congress envisioned when it enacted the companionship exemption”. However, critics of the proposed rule fear rising costs and decreased access to services by the elderly who primarily need these workers.

Because of the large number of requests to extend the comment period, the DOL published a notice on February 24, 2012, that it would extend the comment period to March 12, 2012.

The rule-making process allows individuals and organizations to have input into the proposed rule prior to the rule being modified and new regulations imposed. We encourage all individuals and organizations affected by this rule, as it stands now and as it may be modified, to submit written comments on the proposed rule on or before March 12, 2012 at http://www.regulations.gov/#!documentDetail;D=WHD-2011-0003-0001.

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Tagged companionship regulations, home health agencies, live-in worker regulations, long-term care business, notice of proposed rulemaking, overtime pay exemption, us department of labor |

Resolution of the 5010 Electronic Claims Submission 496 Edit

Jurisdiction 11 Home Health and Hospice

With the implementation of Accredited Standards Committee (ASC) X12 Version 5010, the Medicare Administrative Contractors (MACs) have received a large increase in calls from billers regarding the 496 edit, more commonly referred to as ‘the linkage problem.’ In some cases, the problem may be the result of a provider not being properly linked to a clearinghouse/vendor submitter in Medicare’s system; however, the problem may also be the result of billing errors. The tips that follow will assist you in determining the reason for receipt of a 496 edit and help you understand the resolution of the edit.

Since the 4010 and 5010 electronic claim formats are not the same, you cannot assume a successful provider and clearinghouse/vendor submitter linkage in 4010 means you should be successfully linked in 5010. Some linkages were initially made nearly a decade ago. We have found that several large clearinghouses that have been repeatedly bought, sold, and combined are now using new submitter numbers.

Prior to the implementation of the Common Edits and Enhancement Module (CEM) software, Medicare contractors maintained their own electronic data interchange (EDI) edits. Now that the 5010 format has a definitive CEM edit to ensure that all linkages are valid, invalid submitter IDs are being stopped for bad linkage.

In addition to the provider and clearinghouse/vendor linkage issue, the 496 edit can also occur because of the following National Provider Identifier (NPI) billing issues:

Using a Rendering Provider’s NPI instead of the Billing Provider NPI (Rendering Provider is not associated with the clearinghouse/vendor submitter)
Billing Part B services for a provider associated with a Group under his/her Individual NPI when the claim should be billed under the Group NPI

Resolution of the 496 edit requires evaluation of the Health Care Claims Acknowledgement message (277CA) and all edits incurred in addition to it. While generally a 496 edit may indicate a simple linkage issue, additional edits might focus on the submission of an inappropriate or incorrect NPI as a result of improper billing.

The 277CA, if delivered back to the provider from the clearinghouse/vendor, will have the following message components in the Status Segment (STC) related to a 496 edit:

First part: Claim Status Category Code = ‘A8’ – Acknowledgement / Rejected for relational field error

Second part: Claim Status Code = ‘496’ – Submitter not approved for electronic claim submissions on behalf of this entity

Third part: Entity Identifier Code = ’85’ – Billing Provider

This message, ‘A8:496:85,’ utilizes the Washington Publishing Company (WPC)-maintained National Code values and relays that the claim was rejected for a relationship error between the submitter and the Billing Provider’s NPI. You will receive this same set of codes for a linkage problem and an improper billing problem (use of rendering vs. billing provider NPI, for example, as described above).

Clearinghouse/Vendor evaluation of all edits received should be completed before asking for linkage problem resolution from your MAC.

For tips on Home Health Billing or more info regarding this article, contact Imark Consulting, Inc. or www.homehealthbilling.com

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Tagged 496 edit, 5010, electronic claims submission, home health billing, imark billing, medicare administrative contractors, version 5010 |

HR Audits

HR Audits can be an excellent tool to protect your organization, establish best practices and identify areas that need improvement. The evaluation process includes using numerical data (e.g. How long it takes to fill an open position and employee satisfaction rates), and using an in-depth assessment of the how well policies, practices and processes work to support the organization and minimize risks.

Audits can be comprehensive or may be done separately and at different times, focusing on specific areas, such as recruiting, records management, hiring and firing, etc. Depending on the scope, the audits can be conducted by HR personnel, internal auditors, or external consultants.

The following steps should be included in an audit:

Determine scope and type of audit

Develop an audit questionnaire

Collect data

Use HR benchmarks to measure the data

Provide feedback

Create action plans

Create a continuous improvement environment

Be aware that audits in certain areas can create a record that could be discoverable and potentially damaging to an organization. Therefore, the HR professional should consult an attorney, if necessary, to learn how to minimize those risks and also to have an avenue to fix any legal compliance problems that may occur. Here’s a good example: Supposed you conduct an audit of job descriptions and discover that an employee is incorrectly categorized as exempt. If you do nothing to correct the situation, and this is later discovered as a part of a government investigation or in litigation, the violation will likely be seen as willful on the employer’s part.

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Tagged hiring and firing, home health agencies, hr audits, hr personnel, human resources, practice management, records management, recruiting |

What We’re Reading – Top 10 Changes in Patient Expectations (Part II)

Here is a continuation of a good article on patient expectations; below are the top five changes, according to the author. To view the first half of the article with the bottom five changes, click here.

Expectation #5 — Better Coordinated Care: Between greater cost-sharing and horror stories about duplicate therapies, patients expect their providers to coordinate the care and achieve better outcomes.

Expectation #4 — More Outpatient Procedures: Most insurance plans incentivize patients to select outpatient procedures over inpatient. Studies confirm that patients experience better outcomes and report higher satisfaction. The last of this win-win situation is outpatient settings are less expensive. The author also makes a case for more single-purpose ASCs.

Expectation #3 — New Alternatives to Pay for Care: Because of the large number of uninsured as well as high deductible plans, innovative payment options are a requirement for today’s patients. Flexibility that allows patients to seek care for chronic conditions and avoid acute (and costly) exacerbations translates into better health.

Expectation #2 — Customer Service, Technology, and Outcomes: Since the Internet factors greatly into a patient’s healthcare journey, it stands to reason that a provider’s website can be very useful. The author encourages providers to go beyond the marketing brochure approach and create a service delivery point. The second part of this expectation is that patients are increasingly voting with their feet. As patients experience more flexibility of payment, they will gravitate to quality-focused settings where they also feel valued. Finally, the author reminds us that perception is reality and the customer is the judge. The whippersnapper MDs need to convey experience (especially to us old fogies who don’t think they’re old enough to shave or drive!) while their seasoned counterparts need to impress their patients with command of technology and newer standards of care.

Expectation # 1 — Access to Care: It’s no surprise that accessing care is the main issue for most patients. Most patients who experience long waits get irritable. If they’re already sick, the outcome can be combustible. Providers should assess their office flow (or throughput, in newfangled lingo) to make sure services are delivered promptly. The use of physician extenders (PAs, ARNPs, etc.) are more widely accepted by patients and can alleviate a backlog.

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Tagged access to care, better coordinated care, customer service, home health, more outpatient procedures, patient expectations, physician extenders, practice management, technology |

Avoid the Payroll Issues That Can Jeopardize Your Business

Among the top laws enforced by the Wage and Hour Division of the US Department of Labor (DOL) is the Fair Labor Standards Act (FLSA). This Act governs minimum wage, overtime pay, and recordkeeping, among others, and can result in civil and criminal penalties for violators.

Overtime (OT) pay is a requirement for employees who are paid on an hourly basis, termed non-exempt employees. The law requires that any employee who works more than 40 hours per week is paid time and one-half for any hours over 40. OT cannot be waived by an agreement between the employer and employee, and any workplace rule that “overtime is not allowed” will not mitigate the employer’s obligation to pay OT if the employee worked more than 40 hours. The burden of monitoring work hours and preventing OT from occurring rests on the employer.

Some employers, especially small medical practices whose office hours may vary or small/young companies, attempt to classify workers as exempt (salaried) to avoid paying OT. The DOL has very specific criteria for the positions that qualify for this exemption and many workers would be incorrectly classified as exempt.

Recordkeeping can also be a hot issue for small employers who are notorious for operating rather informally and resisting the use of time cards or time sheets. It would be difficult for an employer to defend against an accusation of owed wages if the employee is not required to complete a document listing the actual hours worked. The emphasis in the previous sentence is intentional as some employees enter on the timesheet the same 8:30 am to 5:00 pm for each day regardless of the real hours worked. It’s not uncommon for an employee to begin work early and ‘clock in’ much later because the employer “won’t pay overtime.”

The last hot-potato issue for employers is the distinction between employees and independent contractors (I/C). The IRS has very specific and strict criteria for the classification of an I/C; in a nutshell, “The more control a company exercises over how, when, where, and by whom work is performed, the more likely the workers are employees, not independent contractors.” Employers who erroneously classify employees as I/C are subject to fines and unpaid payroll taxes.

Wage and hour issues can quickly put a business in hot water and result in monetary penalties, embarrassment and loss of employee goodwill. It’s advisable to re-assess your company’s activities to ensure compliance with these important regulations.

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Tagged classification of an independent contractor, employees, fair labor standards act, independent contractors, minimum wage, overtime, payroll issues, payroll taxes, recordkeeping, us department of labor |

What We’re Reading – Top Five Rejections Related to HIPAA Version 5010

The conversion to 5010 on January 1st has been relatively smooth one, but there has been some hiccups along the way that have caused denials and associated cash flow disruptions. Ken Bradley researched the reasons that claims were being denied and came up with the top five due to the 5010 changeover:

No Medicare Secondary Payer (MSP) reason code on a primary claim.

Lack of drug units when a National Drug Code (NDC) is present.

No detailed description of an unlisted service.

ZIP codes listed with only 5 digits.

Billing provider address is a PO Box.

Read the entire article to find out how to correct these denials and make sure that your cash flow stays on track.

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Tagged 5010, 5010 changeover, billing provider, hipaa version 5010, medicare secondary payer, national drug code, rejections from 5010 |

What We’re Reading – 5 simple ways to cut medical practice costs

The cost of operating a medical practice, especially a multispecialty group, has risen 52.6% since 2001, according to Karen Caffarini, the author of this article. With the current economic crisis, medical practices are looking for ways to cut costs without jeopardizing the care they provide to their patients. She reminds administrators of the need to be aware of where the money is being spent, and not just focusing on one area of the practice. In this article, the research has been done for you and the author cites five key areas to begin looking for savings. The areas include: office supplies, office equipment, medical supplies, finance and consulting, and finally, energy costs. Read the entire article to delve deeper into each specific area because as the saying goes, “A penny saved is a penny earned.”

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Tagged cost of operating, cut medical practice costs, economic crisis, medical practice, multispecialty group, operating a medical practice |

Do Your Processes Need a Check-up?

All companies that have been existence for some time develop policies and processes that are either documented or passed down in sometimes incidental fashion. If the steps are not written down and there’s a question, a long-tenured individual intervenes to clarify ‘how we do things.’ But when was the last time you examined how you do things to be sure it’s really the best, most efficient, way possible? All too often, we see clients married to a process they outgrew long ago and on which they have put band-aids to address new issues, when what they should have done is to blow up the system and start from scratch.

Hiring a new employee will often shed light on an outdated or outgrown process. When you explain how to do things to a newcomer, if you step outside yourself for a time and listen with a third ear – as it were – you will hear yourself question it. If you’re lucky, the new employee will be astute, forthright and assertive enough to ask good questions that highlight a convoluted process. Most of the time, though, new people keep quiet because you’re the boss and you know your business; they figure they’re new so they’re hardly in a position to opine without coming across as argumentative from the start. Another reason, and a sad one at that, is that they’re just not emotionally invested enough to want to find a better way. These walking-dead remain employed a very long time, satisfied to collect a paycheck and if the process requires them to go around their elbow to get to their ear, well, they figure they’re getting paid to do that. The result is never good for the company.

Is there a process in your organization that’s taking longer today than it used to? Something that needs correction or more increased oversight than it used to? Why not ask the people involved in the process to find a smarter, more efficient way to get things done? As long as the goal and your particular standard for accomplishment or excellence are communicated in advance, let the individuals themselves –or those inclined to – sort through the steps and identify resource-savers that accomplish the objective. This can be done via brief, group brainstorming sessions – ideally with no bosses in the room – or by small teams with a contest-type approach. Even individual employees can give a thorny issue some thought during non-peak time and outline a new process. You can ask the teams or people to present their ideas to a group for refinement (and even a vote for the winning idea), and/or consider empowering them to test their solution for a short time and then present the information.

I can boldly guarantee that a few things will happen:

1. You will learn of a great solution (or several!) that just might be better than the current process and be truly outside the box;

2. You will refine a current process, replacing a few steps with a more efficient way; or

3. You will reinforce that, really, the current process is just fine the way it is (as long as everyone’s been truly open-minded and not just adopted ‘group-think’)

Regardless of which result above eventually reigns, you will enjoy a more engaged, motivated workforce because your employees were asked their opinions and feel heard. People want to contribute if we will only let them. They want to feel valued, and part of something beyond themselves. Unfortunately, years of hitting the brick wall of the ‘way we’ve always done it’ sends the message that no one’s interested in their opinions. The key is to acknowledge the contributions and avoid making this another useless exercise where ideas are ignored or minimized.

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Tagged company policies, company processes, hiring a new employee, home health, individual employees, policies & procedures, processes, workforce |

What We’re Reading – 30 Ways to Show Your Customers They’re Always Right

This article offers creative ways to give better customer service which can impact business growth as well. In addition, the author discusses points to add to your customer service policy and the need to revisit your policies to make sure they’re being followed.

Let’s begin with phrases that’ll be sure to make your customer happy. Customers want the opportunity to explain themselves. So simply asking, “How can I help you” invites discussion. Remember to always start your conversation on a positive note. Another important tip to keep in mind is to never let your customers forget you. The article lists several effective ways to follow up on your customers, such as letting your customers know what you are doing for them. As explained, this can be in the form of a newsletter mailed to existing customers, or it can be more informal, such as a phone call. One colleague calls them “Howdy Calls.” The end of the article gives some real-life examples on dealing with unsatisfied customers and creating a positive outcome.

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Tagged customer service, customers are always right, make customer happy, positive outcome, unsatisfied customers |