Employee policy handling lax work effort that may lead to internal theft

A medical practice recently had two instances of what appears to be cash theft by an employee.  The staff in the reception area that handles the cash boxes had been quite lax for some time now when it comes to the security of their cash.  The practice wants to have zero tolerance but was unable to determine who is taking the missing cash. The practice recently adopted the following changes:

1.    The safe combination has been changed.

2.    New cash boxes and keys have been purchased. 

3.    New locks have been put on reception area draws where the cash boxes are kept during the day.

So what is a good policy regarding theft/missing cash?  Obviously if a theft can be proven, immediate termination must occur. But what about sloppiness or carelessness that could lead to a theft? How do you handle that?

I like how one physician office handles it – a policy called automatic Corrective Action - Decision Making Leave – used when employees don't lock draws; leave cash unsecured, can't identify where cash has gone due to sloppy work, etc. Under this policy, employee is sent home for a day without pay. It sounds much better than “Suspended Without Pay.”

Registration evaluation

Does the staff make it a priority to accurately gather and enter the necessary registration information for each patient? ___Yes ___No

 

Do they know what information is necessary to prevent claim delays or rejections? ___Yes ___No

 

Do they clearly understand the importance of recording information accurately? ___Yes ___No

 

Is there a clear understanding of what information is essential? ___Yes ___No

 

Is staff aware of what information is needed to do appropriate follow-up? ____Yes ___No

 

Does the staff discuss and obtain preauthorizations and referral information from patients? ___Yes ___No

 

Is there a clear understanding of when and how to obtain preauthorizations and referrals? ___Yes ___No

 

Does the staff understand and effectively communicate the financial expectations to patients? ___Yes ___No

 

Are copays collected at registration? ___Yes ___No

 

Does the staff discuss the payment options that are available to patients (credit cards, debit cards, cash, checks)? ___Yes ___No

 

Does the staff try to identify credit risks? ___Yes ___No

 

Does the staff recognize their potential to reduce patient statements? ___Yes ___No

 

Reducing payment denials

So what advice do I have for ways to reduce payment denials? Start simply – but right away – by implementing a system such as the following:

 

1.    Flag all denied charges, making a copy of the related EOBs and placing them in a folder.

2.    Hold staff meetings of the billing and collection personnel twice a month if possible or, at a minimum, once a month. In the meetings review and discuss the denials; why they occurred, and what corrective action needs to be taken to prevent them in the future.

3.    Implement the corrective action by communicating with the individuals who are involved with the process. In most cases this will be the people in attendance at these meetings – but not always. It could also include anyone from front desk personnel to even the physicians. For example, a denial pattern might be identified as stemming from the fact that a particular physician is filling out the patient charge ticket incorrectly.

Some things just don't change

I ran across the following email post from April, 2006; for some reason I kept it in one of my Outlook folders and after reading it, I can see why I did. The poster will remain anonymous but it sums up the level of frustration I am seeing out there today, especially in mid-size medical practices. It again shows physicians are too concentrated on overhead when the real problem is growing the top line. It also shows the level of frustration management has out there with their physicians. It’s not too amazing that the issues of 2006 are the same as those in late 2009. What do you think?

 

I'm ten days behind in posts, and just took some time today to try and catch up.  The thread on age, job performance and turnover, and all the rest was just outstanding.  Well done to each and every one of you.  I am so proud to be a member of this listserv.  I am taking a huge risk in posting this, because some of you know me, and some of you know my group.  I am relying on the kindness of strangers (as well as known colleagues) to listen to my rant without using it in any way against me or my organization.  I am just so frustrated I have to get this out:

 

The reason I am ten days behind in my email (not to mention job, and life) is that three of my doctors walked in ten days ago and demanded that I make deep cuts in our staffing.  The actual document that I was presented stated that I was expected to have two employees per physician as a staffing goal, and no more than three staff per physicians at the outside.  I do not need to explain to any of you that the rest of the document was equally deranged and out of touch with reality.  I tried to explain median staffing.  I tried to explain benchmarking.  When that didn't work, I turned to the most delusional of the three and stated, "Alrighty, then.  We'll leave your medical assistant and surgery scheduler.  You're out of luck for anyone to answer your phones, schedule your appointments, verify insurance eligibility, register your patients, code your office visits and surgeries, key them, collect them, perform your transcription, take your x-rays, handle your credentialing, negotiate your contracts, and pay your bills." 

 

I feel as though I was watching my entire life flash before the list's eyes as I read everyone's posts.  Been here three years this month, so the honeymoon is over.  The group is compensated based solely on production (you eat what you kill, so we don't play well with others and we REALLY don't cooperate with projects over the long-term that might affect an individual's bottom line adversely, despite improving the overall health of the organization).  God forbid anyone make or keep a plan for more than a month at a time.

 

When the dust settled, I had 36 hours to make the cuts, although they were not as severe as originally demanded. I set a world's record for firing people last Friday morning, and terminated 9 individuals, one of whom had been with the group for fifteen years.  And oh yeah, in writing, the doctors stated (and this is a quote):  "Our ultimate goal is to make this a fun place to work, while providing excellent orthopedic care in a cost efficient manner.   Perhaps an employee purpose statement is required by which to screen and evaluate workers and to assist in our decision making processes."  Note to list:  I have no idea what that sentence means.  None of the doctors participated in making decisions on the cuts, nor did they want to.  None of them participate in the hiring process.  One did charge that I maintain office morale.  Always a happy statement to hear when combined with demands for significant cuts.

 

That I can take.  Business is business.  I made the best choices I could under the circumstances, and I think we will survive the this short-sighted and hysterical response to a temporary problem (a doc just decided to retire with one month's notice).  I handled it all as professionally as possible under the circumstnaces, but what I did NOT appreciate were the threats made by one doctor.  He suggested that he suspend my pay, since the group is in transition and his paycheck has been affected.  He also stated that I do nothing, know nothing, and am incompetent.  I have had situations before where I clashed, disagreed with, or had other conflicts with physicians, but nobody has EVER stated that I wasn't working hard, or that I was incompetent.

 

So, I guess this is where age comes in:  I am old enough and mean enough at fifty-two to survive this, and I'm old enough and mean enough at fifty-two to smile at a young doctor who has the affrontery to claim that I am both incompetent and lazy and say, "Oh, no, I don't think so." 

 

Sometimes being a survivor just means working hard and staying lucky, and smiling in that special way that reminds your physicians that they really are better off with you, or waiting until you electively move on.

Lawyers Warn: Bosses Who 'Friend' Are Begging to Be Sued

Tresa Baldas

The National Law Journal

October 23, 2009

 

Bosses who "friend" their subordinates on social networking sites may seem warm and harmless, but they've got liability risk written all over them. So warn employment lawyers.

Managers sending friend requests to staff via Facebook, Twitter and other sites constitute a growing trend in the workplace. And it's one that needs to stop, the lawyers stress, because online relations between boss and employee can trigger or exacerbate a host of legal claims, including harassment, discrimination or wrongful termination, as well as touch off cries of favoritism if the boss friends only a select few subordinates.

"The intention may not be a bad one," said management-side attorney Michael Schmidt of the New York office of Philadelphia's Cozen O'Conner. But "it's the unintentional consequences" they need to be concerned about.

Given that social networking sites are loaded with personal information, Schmidt said, a manager is bound to learn things about an employee that he or she will wish the boss didn't know. Moreover, when a manager learns of some personal attribute through the site, the worker now has the opportunity to argue that any later adverse employment decision "was based on this personal information," Schmidt said.

For example, a supervisor may learn from someone's Facebook page that he or she belongs to a gay rights group. If the same employee is later fired for a performance problem, the employee could claim he or she were fired for being gay.

Shanti Atkins, an attorney and president of ELT Inc., which specializes in compliance training in the workplace, listed other kinds of intensely personal information -- religious affiliation, age, ethnicity, political affiliation, health problems -- that is not supposed to influence employment decisions but does appear on social networking sites. She posited a boss, planning to discipline or even terminate an employee, who sees a profile update about the person's severe medical condition or frustration over perceived religious intolerance. Will this knowledge influence the manager's decision -- or be seen as doing so?

Atkins pointed up another way that online friendships between managers and workers can put the managers in a difficult position. If the employee refers to being drunk at work or makes discriminatory remarks about co-workers, the manager may be obligated to investigate such behavior and report it to higher authorities at work.

Atkins said employers need to upgrade their policies on online worker-manager friendships. Specifically, she said, employers should ban them. "You should just, very politely, tell everyone, 'Don't do this,' " she said.

Meanwhile, employees may also want to hold off on friending their bosses. According to a recent survey by the staffing service Office Team, nearly half — 48 percent — of executives are uncomfortable being friended by those they manage. Another 47 percent don't want to be friended by their bosses either.

Schedule for patient convenience

Physicians used to be advised to keep their office hours during the "civilized" part of the day-between 9 a.m. and 5 p.m. Things have changed, however. Now you must increasingly apply marketing principles in order to offer your patients the features that they (the buyers of your services) want. And this leads to maintaining hours that better suit the buyers. In marketing, these buyers have become known as the "nocturnal market," working by day and buying goods and services during traditionally closed hours.

This shifting market has caused many physicians to open their offices on one or more evenings per week. Larger groups have either created apparently separate "convenience centers" or simply stayed open all weekday evenings until 9 p.m. or 10 p.m. While harder on physicians' personal lives, the changes have been more than necessary.

Use caution when discussing your malpractice case

You may be tempted to ask a physician friend to review your malpractice case to determine whether you are missing anything. Resist this temptation. The rules of malpractice cases do not give you the privilege to talk to anyone but your lawyer without having to share the contents of the discussion with the opposing side. If you discuss your case with a colleague who does not feel you acted appropriately, the plaintiff's attorney may subpoena your colleague to testify against you.

Sorry for no post yesterday – I was traveling to Washington DC to attend the Mid-Winter meeting of the National Society of Certified Healthcare Consultants (www.nschbc.org). For updates from the conference, go to www.twitter.com/rtacpa.

Practice has cure for insurance paperwork – avoidance

Patients' frustrations with health insurance paperwork are well-known. But it's also a frustrating tangle for doctors and their staffs.  CNN reports about one innovative practice that has decided to take on the insurance paperwork monster -- by completely avoiding it.

Dr. Val Jones joined a small practice, DocTalker Family Medicine in Vienna, Virginia, where the doctors do not even take insurance.  They charge a simple, relatively low fee for each service. That's it. The doctors at DocTalker grew tired of seeing patients struggle with baffling insurance paperwork while both their health and wealth were on the line.  Jones does not believe the insurance industry set out to cultivate the paperwork jungle. She thinks it just grew over time. But now that it is there, she suspects they are making so much money off of it, that there is no real incentive to clear it up.

Former insurance industry executive Wendell Potter agrees. He said one way insurers make money is by allowing confusion to reign.  "And people often just give up," Potter said, "and don't pursue payment when a claim has been denied or been paid inappropriately or not adequately. And the same is true with doctors and hospitals." He believes billions of dollars are at stake.

IRS announces 2010 pension plan and social security wage limits

2010 Pension Plan Amounts: The major pension plan and related amounts will stay the same for 2010. This means that the following amounts will remain unchanged from their 2009 amount: (1) benefit limit for defined benefit plans ($195,000); (2) defined contribution plan limit ($49,000); (3) compensation limit for determining benefits and contributions ($245,000); (4) definition of a highly compensated employee ($110,000); (5) elective deferral limit ($16,500); (6) SEP contribution threshold ($550); and (7) SIMPLE retirement account limit ($11,500).

2010 Social Security Wage Base: The social security wage base will remain at $106,800 in 2010. As in prior years, there is no limit to the wages subject to the Medicare tax, so all covered wages are subject to the 1.45% tax. The FICA tax rate, which is the combined social security tax rate of 6.2% and the Medicare tax rate of 1.45%, remains at 7.65%, while the self-employment tax rate remains at 15.3%. In addition, the threshold for coverage for domestic employees will stay the same at $1,700. For more on the 2010 cost of living adjustments, go to http://www.ssa.gov/cola .

Train and monitor your front desk personnel – a personal story

After finishing a meeting yesterday in the Medical Center, I decided to walk down the street a couple of blocks to say hello to a client. As I entered the office it was near noon, so the reception area was empty; the morning patient load was almost done. The receptionist informed the doctor I was there and I was told she had two more patients to see and then she would be available.

So I sat in a chair and started reading a magazine. While I was waiting, a woman walked in and told the receptionist that she wanted a copy of her medical record. “Why?” the receptionist asked. The woman said her employer had just switched to Blue Cross for the company’s health insurance and the doctor she was seeing at the clinic was not a participating provider with Blue Cross. So she wanted a copy of her medical record for the doctor she was switching to, who was a participating provider with Blue Cross.

My client was the doctor who was not a participating provider with Blue Cross. She is also the owner of the clinic, which has 3 associate physicians. Finally I was led to her office. After exchanging greetings, I asked who was responsible for training and monitoring her front desk staff. She said she was since the practice really didn’t have a true office manager employed.

I asked, “Are any of the associate physicians participating providers with Blue Cross?” “Yes” she replied, “two of them are. Why do you ask?” I then began to relay the story of what had just happened at the front desk. The person who was dealing with the woman made no attempt to inform the patient that other physicians in the practice were participating with Blue Cross and would she like to see one of them.

As you can expect, my client started to seethe. The practice had lost a patient without any effort to retain her. I did tell the client that maybe the front desk might want to call this person and inform her that other physicians in the practice are “on” Blue Cross and find out if she would like to transfer her care to one of them before switching doctors.

The moral of all of this is that someone in your practice must constantly watch what is going on at the front desk, which we all know is the focal point of any medical practice. This is why I make an effort to always show up 30 minutes early for an appointment so I can sit there and watch the client’s front desk people in operation. It can be very eye opening at times.

So how are you monitoring your front desk? Are you training your front desk people adequately? Pay attention!