Pediatricians have plenty of legal paperwork to do, whether that’s taxes, equipment, or credentialing. But a small practice’s responsibilities go beyond the office, provider, and the patients: having a legal, compliant practice means taking care of pediatric staff as a fair employer and creating a culture of open communication.
Physicians and their staff have an important relationship when it comes to offering care to children and adolescents. They combat the same sick and well seasons, the same office challenges, the same community. The difference is that in an independent practice, the pediatrician is also the employer, meaning that by law, independent clinicians are required to provide their staff with resources, documentation, and clear expectations about how the practice is run.
If your practice is not run in a legal, compliant, safe, and amicable manner, there may be discrepancies that could result in a failed inspection from the U.S. Department of Labor, HIPAA, CMS, or even the IRS. These departments make sure that businesses are run fairly and safely, and protect everyone -- employers, employees, and patients. Failure to comply could mean paying fines and penalties which are completely preventable.
Lax practices are easy to fall into and sometimes difficult to see. Need help? Consider the following situation:
You are a biller for an independent pediatric practice. You have a long-standing relationship with your doctor, and are grateful that she allows you to come in before your scheduled office hours so you can be out early to pick up the kids. The new RN and new front desk person are scheduled to work the standard office hours.
A month or so after their hiring, you begin to notice that the RN has begun to arrive early for her shift. Since you pick up the payroll as well, you mention that she shouldn’t be arriving until her scheduled shift, since the practice can’t afford overtime. She says she just wants to help. Later, you also discover that the front desk person has taken after the RN and begun arriving fifteen minutes early. Combined, this behavior would eventually equal almost 150 hours of unapproved overtime a year that the practice cannot afford.
You tell your doctor you spoke to the RN about the ‘policy’ but that neither the incident nor the policy was written down at the time. The physician asks if the nurse should be paid for overtime which was not approved.
What’s a practice to do?
There are several problems with the above situation, which has proved itself all-too-common in private practices.
- The biller has reached an agreement with the physician about her schedule, but her ability to arrive and leave early has likely resulted in a miscommunication about the appropriateness of early punch-ins to the RN. The RN may even feel some resentment at perceived favoritism.
- The RN’s behavior has resulted in a culture where the front desk person accepts the behavior as normal, and has followed suit, leading to overtime not approved by the employer, the physician, and which the practice cannot withstand over the long term.
- The biller has a close relationship with the pediatrician, and is therefore in a place of power over the two new employees, who may fear communicating their needs or questions.
- Finally, neither the biller nor the pediatrician who owns the practice seem to have educated themselves on the legality payroll or other HR practices, leading them to question whether an employee should be paid unapproved overtime.
You can see where ignorance can lead to a potentially illegal situation! All employees must be paid for the work they perform, regardless if the business does not allow overtime or the overtime was not approved.
Another common occurrence among small practices is born of necessity: the combination of HR with other ‘primary’ responsibilities. This sometimes results in a biller, office manager, NP, or pediatrician taking on HR and compliance responsibilities, which can result in these important processes being left behind on the long list of things to tackle every day.
Here’s why that situation can get tricky for employees and employers: if the biller in the example above is the practice’s billing, HR, and payroll department, the new employees are in a bind when it comes to getting both the resources they need and meeting the expectations of the practice, because the person doing their payroll is also responsible for writing them up when they break rules.
The difference between the physician and their staff is that in an independent practice, the pediatrician is also the employer, meaning that by law, independent clinicians are required to provide their staff with resources to exercise their legal rights, documentation of policy, and clear expectations about how the practice is run.
Michelle Richards, BSHA, CPC, CPCO, CPMA, SHRM-SCP is the owner of Coding and Compliance Experts, LLC, and an HR and compliance expert who specializes in making sure physicians’ practices are legal, safe, and accountable. Richards spoke at the 2019 Users’ Conference in Burlington, Vermont and drew examples of situations like the one above, which she has witnessed in real life as a consultant. According to Richards, “Accountability is the key factor in an effective HR compliance program.”
Steps Towards a Great HR and Compliance Program
One of the first steps towards accountability is education. Do you know all that you need to as a partner, an office manager, or an employee of an independent pediatric practice? To be legal and compliant, you must follow the required procedures for checking equipment such as eyewash stations, conducting annual sexual harassment training and HIPAA training, and giving employees clear and appropriate training and expectations for their work. An employer must also provide resources for employees to exercise their rights to things like medical or parental leave.
Education is also ongoing both for employers and employees. HIPAA laws, for example, have minor updates each year, and while new laws are typically granted enough industry and media attention to make most providers aware of them, it is still necessary to educate yourself and your team on the specifications of any new state or federal law, whether it impacts your clinical work, payroll, or HR practices.
Clarity and accountability begin with written policies. Once you know how your practice measures up to the expectations of the law, it’s time to set down your own expectations as a practice. Is it okay to work unapproved overtime? Should employees be assigned holiday shifts based on their individual situations, such as having children or seniority, or determine the shifts among themselves?
The written HR policies should explain what is acceptable in your practice and what isn’t, and outline clear actions the practice will take when employees break the rules. This is also why incidents where employees are warned or disciplined should be recorded, so that any problems later can refer back to the actions the employee and their supervisor took at the time. The policy should be reviewed each year and updated accordingly.
The documented HR policies are separate from, but related to, the employee handbook or code of conduct, which sets clear expectations for your employees to follow as far as the parameters of their responsibilities, their ability to handle them, dress code requirements, and office culture. All employees should sign or otherwise document that they have read and acknowledge their responsibility to follow the practice’s code of conduct. This document is also a great place to offer the employee resources to turn to when they have questions or problems.
In Richards’ talk, “Is Human Resources Part of Your Compliance Plan?” she addressed many audience questions particular to small practices, such as auditing, and whether a small practice needs a dedicated HR staff member.
Auditing, Richards explained, should be done regularly, but especially if a practice has led lax HR and compliance practices or been penalized by a government inspector. Part of her work as a consultant is to review the policies, practices, and documentation of a practice to ensure that, in the event of a government inspection, the practice passes without the need to fear a fee or penalty.
She explains that while a practice does not necessarily need to hire a dedicated HR staff member, the responsibilities should not go to an office manager, biller, physician, or anyone else unless they are uniquely qualified and can attest to reasonable objectivity and are unbiased towards any practice or its owners or employees. Small practices can consider hiring a consultant HR professional, who is available via phone or email to provide advice or review policies with physicians and employees only when needed. This ensures that the practice is compliant, and also offers resources for its employees to ask questions and educate themselves on their rights.
Some office managers or physicians fear that strict policies and “writing up” of employees will cause harm to an easygoing or pleasant office culture. HR policies and adherence to compliance laws are not only in the best interest of your practice legally -- they also protect the practice so that a culture of support, education, and communication can flourish.
Remember, education is the first step! Take a few minutes to learn more about FMLA, parental leave, HIPAA, payroll laws, and U.S. Department of Labor laws -- make sure to check your state’s legal requirements at the appropriate site, and federal ones at www.dol.gov. Coding and Compliance Experts LLC also offers a checklist to see if your practice’s HR policies are up to scratch.