You Said What About Us Online???

Social media is a part of our daily lives. Most people have at least a Facebook or Twitter account. Many have both. In addition, there are many popular blogging sites like Blogger, Word Press, Tumblr, etc. There are also discussion sites like Reddit where you can find a forum for just about anything imaginable. A health care provider/company may also have its own company social media pages.  For example, while we are not a provider, our law firm has a Google+ Page, a Facebook account, a Twitter account, a daily e-paper, two blogs, and a website.

With all the different outlets of expression on the Internet, your employees may be writing or blogging about your company.  Management may have even fostered such efforts, either directly or indirectly.  Whether use of social media by the employee is proscribed by the company or not, it is a good idea to have policies and procedures in place for your employee’s use of social media when saying anything about the workplace or a related matter using electronic means.

In several instances around the country, employees have been terminated for writing/texting about work related situations.  Of course, the comments placed the subject company or its management in an unfavorable light; however, your employee and possibly your company may be liable for slander or defamation if the comments were untrue.  Any author of such comments holding a license may suffer repercussions with licensing boards for unprofessional conduct or unethical practices if the comments rise to a level that makes the governing board takes interest. The company may also face an investigation from the Office of Civil Rights if protected health information of a patient or patients is disclosed online. For reference, a disclosure of phi would be deemed a breach.

Having policies and procedures to guide your employees will give the employees parameters to work within when using their ever-present electronic gadgets. 

As with all policies and procedures, they should be well thought out such that the company does not impose unreasonable limitations on the employee’s first amendment rights, while at the same time protecting the interests of the company and its reputation. 

It's All In The Form

Some governmental agencies have their own forms that must be completed at some point in  time. Other forms are left to the provider. Each provider type typically has leeway in some of their forms, whether the provider chooses to use a nationally recognized form, or to make one up to fit the need.

If the form is not relegated by an agency, you should make certain the form you use adequately  applies to your situation. Within the past 8 months or so, we have experienced state licensing boards (three different ones) lambasting the practitioner for not properly completing a form. Even if not all of the blanks are necessary all of the time or if your staff leaves a blank empty, it may be determined the blank was skipped rather than not applicable. That omission may result in a sanction.

If the form is relegated by an agency, you should make certain the form is correctly filled out.  For any sections that do not apply, the staff member should mark them as such. This way, the reviewer, whether with a Medicare, Medicaid, or insurance contractor or a licensing board, will know the section did not apply to the beneficiary/recipient and a full picture of the state of the patient can be known from the form itself. Further, if the form is mainly boxes to be checked, make certain there is room for comment, and then make certain the comments are made as needed.

If your records are electronic (which most providers’ records are), does a blank form come up for each client to be noted?  If not, how can you be certain that each blank that needed changing from the last note was changed? You can’t. A recent Board of Nurses review of home health records found the nurse had been in 2 places at the same time on a variety of days. What occurred was the prior home health visit note had been used as a template and sometimes the nurse forgot to change the time of the visit. When viewed as a group, the notes indicated the nurse had been in 2 different places at the same time on the same day. Of course he wasn’t, but the records showed that he was. While the nurse was a talented man, the Board of Nursing sanctioned him for making incorrect records.
  
In summary, licensing boards and Medicare and Medicaid Contractors all perform a record and document review prior to determining sanctions or overpayments. Make sure your forms give enough information for the reviewer to know what is going on with the patient. The time you take to properly complete a form is time well spent.

Put It In a Book

While it is not mandatory that an employer provide an employee handbook, it is recommended in order to maintain uniform procedures for all employees.  Employee handbooks help provide cohesive environments, fair treatment and they work to reduce the likelihood of a discrimination claim. Human nature lends itself to approaching individuals with individual treatment. In terms of employment there are numerous factors that can affect such treatment, for instance: effectiveness, work ethic, personality. However, a system such as this which maintains great disparities between the treatment of each individual can prove more liable towards claims of discrimination.

In order to avoid such dilemmas, the company should have an employee handbook that delineates the employees’ responsibilities and the general requirements for the workers there.  It is important that once an employee handbook is put in place it is followed.  Not following the handbook begs the same type of claim for discrimination as not following any prescription for employees at all. 

In the employee handbook, please include the company’s non-discrimination policies and complaint investigation procedures.  Following these steps ensures that all employees are made aware of the conduct expected from them. If the employer does receive a complaint, following standard investigation procedures will ensure that all claims are investigated equally and will help to avoid further complaints. 

Compliance by Contract

MCOs and other health insurance management companies have begun adding a “Compliance Program” to their service contracts.  The program manager establishes its own compliance program, and forces its compliance program upon its independent contractors and health care service providers by contract. 

The management company sets up its own reporting system or 1-800 hotline number and demands in the contract for services with your agency that the contractor explain and advertise to its employees the hotline and instructs them to use it if needed to report unethical activities, abuse, fraud, or other illegal acts. 

Your employees only have to pick up the telephone and call the program manager to report your agency’s alleged wrongdoings.  Then the program manager will investigate, and probably terminate the contract with you or impose some other sanctions on you in order to correct the issue.   

If the program involves a Medicare or Medicaid program, you will have a duty to investigate and may be required to report your findings to Medicare or Medicaid formally either through a report and refund process or through the self-disclosure protocol, just as if the compliance program was installed directly at your agency.

Will You Pass the PEPPER?

If you haven't noticed, CMS has a "new" measuring stick called PEPPER.  PEPPER stands for the Program for Evaluating Payment Patterns Electronic Report (yes, somebody really reached for that acronym). New is somewhat of a relative term as PEPPER reports have been available to short term acute care hospitals (since 2002), long term acute care hospitals (since 2005), all short and long term care hospitals (2009-2010) and more recently, hospices, skilled nursing facilities, and most recently, home health agencies. 

Nonetheless, PEPPER is a report the compares three years of data statistics for CMS targeted areas, comparing your agency’s performance to that of others in the nation. The advertising is that upper management of the healthcare agency can look to compare their agency to those in the nation to see where they compare, and where they don’t. 

Additionally, CMS and its contractors have access to the PEPPER reports. This means that CMS will be watching for billing patterns and error rates. Also, Medicare will also be comparing your performance to that of others in the nation. 

You can review the PEPPER website by going here.

EHR Alert

Providers that receive Electronic Health Record (EHR) incentive payments for participation in the Medicare or Medicaid EHR Incentive Programs may be subject to audits. CMS wants to make sure that the information providers provide and attested to is accurate and meets the thresholds established in the programs guidelines.  The audit can take place either before or after providers receive an incentive payment. Preparing in advance for these potential audits by saving the required documentation will make the process easier. The auditors will want to see ALL relevant detailed supporting documentation (in either paper or electronic format) that was used in completion of the Attestation Module responses. Providers must make sure the information is dated, the time period covered is documented, and that there is evidence to show that the report belongs to the provider for the providers EHR location.

According to CMS, it is the provider’s responsibility to save documentation that fully supports all data submitted during attestation. The reason is that an audit can include a review of any documentation needed to support the information in the attestation including documentation that demonstrates how data was accumulated and calculated, and to support each measure attested to, and any exclusions claimed by the provider.  This could even include a review of medical records and patient records.

Upon completion of an audit, an audit determination letter will be issued informing the provider whether or not they were successful in meeting meaningful use of electronic health records. If a provider is found not eligible, based on the audit, the payment will be recouped. Besides recouping payments, CMS may pursue additional measures against providers who attested fraudulently to receive an EHR incentive payment.

Revalidation: Cycle 2 has Sharper Teeth

Recently on a CMS conference call, the parameters of the Cycle 2 Revalidation were made known to providers who attended the telephone conference call. Revalidation is required for all providers enrolled in Medicare. DMEPOS providers revalidate every 3 years.  All other providers revalidate every 5 years.

CMS is compiling a table of revalidation filing due dates. CMS has a data look up for revalidation, and a sample PECOS revalidation form for your review on its website. Go to cms.gov and input “validation list” in the search box. The first result (currently Revalidations - Centers for Medicare & Medicaid Services) will take you to an article that gives you links to both the due date list and the PECOS revalidation sample form.

Things to know: 

Cycle 2 Late Filing Revalidations.   If you late file your revalidation in Cycle 2, your enrollment will be deactivated.  Whereas in Cycle 1, your payments were merely suspended until you filed the revalidation forms, in this instance, your enrollment is deactivated.  Once you file your revalidation form late, you will get to keep your NPI number, but your enrollment will be brand new.  CMS and the contractors will not reactivate your prior enrollment, but will re-enroll you or your entity.  You will not get to bill for any services provided during the deactivation period. 

Notice Letters. Each provider is scheduled to receive a notice letter for the revalidation.  If you do not receive a letter for some reason, you need to timely file your revalidation anyway.  Therefore, CMS recommended you check the Due Date List every month.   If your entity currently has TBD (to be determined) as the due date, your revalidation is not yet due, but keep checking.  The list is intended to give you approximately 6 months lead time.  

Group Enrollments that also have Individual Enrollments. Your groups and individuals may not have the same revalidation due dates.  Therefore, you must be diligent about keeping the Due Date List checked regularly.

855O enrollees. Those practitioners who has enrolled for ordering Medicare services only may be treated slightly differently, so please check the Due Date List, and call your enrollment contractor to make certain you understand the procedure you must go through for this process.

Change of Address, Ownership, Management, Adverse Legal Actions, etc. If you change addresses, ownership, managers, adverse legal action changes, or any other change that would necessitate filing an 855 form with your CMS contractor - go ahead and timely file the reported change on the appropriate 855 form as you normally would.  The Revalidation is not to take the place of reporting changes.