CURRENT CIRCULATION: 7,846 th DATE: 14 August, 2011 ISSUE NO: 183
Welcome to Health & Life‟s free email newsletter service. Tell a friend that we would be happy to add their email address to the distribution list. This service is to provide Health and Life‟s clients and those who attended our presentations with up to date information on key financial and practice management issues that may affect your practice. Please do not use this as a substitute to seeking professional advice. Writer in charge: Mr David Dahm BA.Acc, FCPA, FTIA, Ffin, FAAPM, GLFG.
Fair Work and Medicare Audits
“Leaders cannot expect to be followed unless they tell it like it is.” - Menke
Good leaders exercise courage daily! If you are an owner and or a manager of a practice like it or not you are in a leadership role. People expect you to lead. If not, it is like a riding in a taxi without a driver. You would never get into one, why would you expect anyone else to. This is a key to successful recruitment and retention. We thought this article on how courage taken daily is a sign of a good leader is a practical tool see: “Everyday courage is the mark of a true leader” by Fiona Smith Tuesday 30th August, 2011. Share this with your staff as it should open up communications and encourage them to speak up to avoid anymore surprises and to take advantage of the real potential that lies within your staff. This is how good practices become great practices.
TABLE OF CONTENTS 1. Fair Work Act – new Federal audit activity THE MOST COMMON ERRORS PRACTICES ARE STILL MAKING!. 2. Medicare – Professional Services Review Senate Enquiry – we are off to Canberra!?!. 3. New Medicare Administrative Record Keeping Guidelines 4. 2011 Seminar Presentations 5. Catching up with David Dahm and the Team 6. Where to from here?
Fair Work and Medicare Audits
1. Fair Work Act – new 2011 Federal audit activity There are no short cuts, get it right, and right now, or risk facing the consequences. A medical practice is facing large fines up to $33,000 in relation to a doctor who has claimed an underpayment of wages see http://bit.ly/nW32dV. He has made a complaint to Fair Work. If your doctors are employees or contractors you may have a problem. As advised in our earlier news alerts the heat is being turned up on practices. It is important to get all provider and support staff contracts right as it significantly affects morale and practice overheads see http://bit.ly/pR7m9R Wages represent up to 60% of a practices total overheads this is the most significant expense that needs to be managed carefully. This problem has been compounded with external agencies taking a big interest. The Australian Nursing Union and various government aligned employer unions are actively querying employment practices. Pardon my cynicism, but I feel this tends to imply there is an industry wide problem. To the contrary most practices pay above the Award however poor processes and documentation is what is causing all the unnecessary attention with the risk of up to $33,000 fines. The latest participants are the Federal Government. A new federal audit on healthcare practices in South Australia was announced last week see http://bit.ly/onc8hM.
THE MOST COMMON ERRORS PRACTICES ARE STILL MAKING! Many practices have contacted us for our no fee, no obligation and confidential check. Despite people thinking they were compliant because they were paying significantly above the award, the most common errors we have noted mean they can still be hit with an underpayment of wages claim. They are summarised below: 1. Over award payments – still can lead to an underpayment of wages claim Agreements do not include “all in” payment clauses that include all award entitlements written into the over award payment. This means if legislated over time and allowance are included in the hourly rate they need to be in writing and the business case consented by the employee without undue force. Line by line your contracts should refer to the relevant Award clauses and references. 2. Over classification We note that many practices have unnecessarily over classified staff at a higher level, say a level 5 receptionist should have been classified as a level 3 at the lower base wage
rate. This is a problem because legally the employment contracts and job descriptions do not correctly reflect the role. This means the practice has not gone through the process correctly by matching the job description to the award first before paying the appropriate and higher market rate and putting this in writing. What this means is that any above Award payments might be smaller than you think, which means a claim for underpayment of wages is a lot higher. 3. No actual contracts have been put and signed It is one thing to buy templates or get a lawyer to draft you some agreements; however every employee must have a signed written contract for it to be effective. Many practices are not aware this should have been completed on the 1st January 2010. See our past news alert editions by visiting http://bit.ly/pR7m9R and go to the bottom of the page and click on “more healthandlife” to access our archives
Our template contracts and job descriptions for doctors, nurses and support staff do cover all these areas for those who have purchased and implemented them correctly and have followed our news alert updates. Email us for a confidential no obligation chat and send us in your contracts if you are not sure to pa@healthandlife.com.au. This maybe a simpler solution to inviting unions and lawyers to reinvent the wheel.
2. Medicare – Professional Services Review Senate Enquiry – we are off to Canberra!?! We have been expressing our concerns since 2007 that the Government is unconstitutionally interfering in the doctor patient relationship. Peer review both in setting, educating Medicare guidelines and enforcing them is critical. As advised in our earlier news alert we have made a submission see http://bit.ly/n9c3oM . Our primary concern is that according to recent research in the Medical journal of Australia 50% of generation Y doctors (as detailed in our submission) are planning on leaving practice in 10 years due to Medicare, bureaucracy and Super Clinics. With an ageing workforce and young practitioners not keen to keep long term careers we are now burning the candle at both ends. The Government‟s lack of transparency and accountability is unnecessarily spooking a greater national workforce shortage. Our submission has also been endorsed by Associate Professor Stuart Reece from the Australian Doctors Union see http://on.fb.me/nARi0l who established the Federal Senate Enquiry into the problems with Medicare and in relation to Medicare audits. This has seen the replacement of the PSR Chair Tony Webber and over 80 cases dropped because on invalid prosecutions. This includes the recent Federal Court decision that doctors cannot be prosecuted with statistical evidence. Actual evidence is required. We have acted pro bono on this matter and do not condone inappropriate practice or have clients that have been. As mentioned in our earlier news alerts, we believe unknowingly patients and providers st are having their rights unnecessarily violated under the new healthcare board rules commencing 1 July 2010 and the new Medicare rules.
As a consequence we have been invited by Associate Professor Stuart Reece to address our key concerns before 6 Senators at the end of the month. Our concerns are: 1. All healthcare providers are and have been denied natural justice. It has been legislated that providers from doctors, nurses, allied health can be prosecuted without evidence and be de-registered. Medicare matters can be referred to the relevant national healthcare provider registration board. Natural justice must prevail because it is a Constitutional right; 2. The Medicare rules lack clarity and practices face prosecution for breaking these rules where very little or no provider education. Medicare needs its own internal quality assurance program for its phone support and audit team; 3. The relevant professions must establish independent standards and review committees that work with Medicare. This also includes playing an education role. This has been successfully implemented in the accounting and legal profession in relation to the Australian Tax Office; and 4. Patients need to engage with providers and this may mean a small co-payment. Practice need to ensure they are transparent in relation to fees charged and for what services where possible. If anybody has any specific issues let us know. Reviewing the submissions on line is a good starting point. Our primary concern is that practices require legislative certainty so they can plan for the future with confidence. Patients are feeling the brunt of these activities from healthcare services being withdrawn or new ones not established due to fear and intimidation that any activity outside the norm, like a Womenâ€&#x;s clinic or ordering too many tests, will attract audit activity. Recent research shows that GP registrars order 50% more tests than experienced GPâ€&#x;s which leaves them open to a less than accommodating Medicare investigation. The nature and complexity of healthcare is complex and standardised care may work in most cases. Medicare should familiarise themselves with each providers practice before issuing computer generated audits. Patients should be free to choose their providers and seek services.
3. New Medicare Administrative Record Keeping Guidelines
Medicare has recently announced new administrative guidelines for paper based and electronic medical records see http://bit.ly/oh4G7j . Some key questions: 1. In the event a practice has a Medicare audit, do these new pilot standards if not met will result in a default finding against the practice? 2. Does a lack of systems and procedures make it easier to prosecute practices?
A doctor recently complained that a patient who denied the Government access to their patient medical records was not entitled to a Medicare rebate. This was an interesting statement allegedly made by Medicare (at least this is a good way for patients to insist on electronic medical records). Problems with the guidelines It looks like practice managers have really got their work cut out for them. After reviewing this document some initial comments include are:
The guidelines lack practical examples other than very broad and generic statements. This is qualified by doing a course that may not necessarily cover the pertinent issues. Does this mean practices need suitably qualified staff to meet this criteria? They provide a list of organisations practices can send their staff to for training;
If your practice is accredited it does not mean you meet the standard;
The administrative and electronic record keeping checklist companion is a useful but incomplete document. Under the heading „are you a aware of the laws that affect they way you keep records‟ the documents refers to the Tax Office but miss the obvious law called the Privacy Laws and a few others that may or may not be in conflict or considered with these standards. So please don‟t refer to this document as a definitive one. This is a material omission because protecting a patients privacy is the most critical issue that appears overlooked. Other material laws that should be considered but not referred to in the guidelines, the healthcare Board rules, Fair Trading, common law and the corporations laws.
4. 2011 Seminar Presentations Below is a summary of dates for our seminars across Australia. At each seminar there is an opportunity to meet with us face to face for a no-obligation discussion of any practice issues you may have. Email us at pa@healthandlife.com.au to pre-book an appointment. If you would like your local medical organisation to host a seminar, forward them this email with our seminar details and copy us at pa@healthandlife.com.au. We will contact them directly about presenting in your local area. We thank you in advance for your interest and support. You would be surprised how it only takes one person to make things happen! New confirmed programs are detailed below. Please contact the organisations directly for details about the course program, content and costs. More seminars will be announced early next year.
Host and Location
Date
Contact Name
Contact Email
Topics
Victoria
October
Ashley Moore
pa@healthandlife.com.au
The Health Awards
Orthoptics ACT Senate Enquiry
Perth AAPM
Adelaide The Private Practice
Perth TBA
22nd – 23rd September, 2011
Ashley Moore
15th – 21st October, 2011
AAPM
4th November, 2011
Steve Macarounas
18th November, 2011
pa@healthandlife.com.au
*One on one meetings Contact us if you would like a complimentary meeting
pa@healthandlife.com.au
*One of one meetings Contact us if you would like a complimentary meeting
Ashley Moore
Steven.Macarounas@fintuition.com.au Practice set-up and review pa@healthandlife.com.au Options for private practice
pa@healthandlife.com.au
Setting up your practice
Managing your practice
Preventing fraud in your practice
Practice Set Up Seminar *One on one meetings Contact us if you would like a complimentary meeting
Vic city and regional
28th October, 2011
Ashley Moore
pa@healthandlife.com.au
*One on one meetings Contact us if you would like a complimentary meeting
NSW city and 30th regional November, 2011
Ashley Moore
pa@healthandlife.com.au
*One on one meetings Contact us if you would like a complimentary meeting
Darwin city and regional
9th February, 2012
Ashley Moore
QLD city and regional
10th February 2012
Ashley Moore
pa@healthandlife.com.au
*One on one meetings Contact us if you would like a complimentary meeting
pa@healthandlife.com.au
*One on one meetings Contact us if you would like a complimentary meeting
5. *So you are looking for that competitive advantage – why not catch up with David Dahm and the Team We can talk about succession planning, business structures, effective tax planning, employee vs contractor agreements, benchmarking and many more topics. We are using this time to catch up with existing clients. If you are not an existing client, this may be a good opportunity to tell us what is on your mind. Ask yourself the following questions:
What new challenges am I facing? What new opportunities do I anticipate? What kind of support or expertise would be most helpful to me now? What changes do I anticipate over the next year or so? What more can Health and Life do for you, if anything?
We are planning trips and one to one to meetings as detailed above. Please note that this is a first come first serve basis. In the meantime, feel free to contact us to arrange a no obligation teleconference to get you started on any significant. Email us at pa@healthandlife.com.au
6. Where to from here? 1.
Consult your professional adviser in relation to any advice suggested;
2.
If you require any back issues of our news alerts please email us;
3.
If you are not sure about any issues raised in this broadcast contact David Dahm on 1800 077 222 for an initial no obligation consult or email us at pa@healthandlife.com.au. Health and Life provides comprehensive Practice consulting, accounting, taxation and financial planning advice for group Practices and individuals. Email us for information about our Employment Template kits for providers and support staff and our Doctors pay Calculator.
Which topics would you like to be covered? If there is a particular topic that you would like covered in one of our future News Alerts, please email pa@healthandlife.com.au and let us know what it is. We will then endeavour to cover your requested topic. Do we have your email address? It is apparent in feedback we are receiving that there are persons receiving this regular email who are not on our email list. If you are receiving this email „second-hand‟ from another source, we would be delighted to receive your email address and we will add you to our database so that you can receive it first-hand on the day it is sent. This invitation is open to all Medical Practices. Please send your email address to pa@healthandlife.com.au. Do you wish to unsubscribe from our list? Please email pa@healthandlife.com.au if you wish to be removed from our distribution list. Copyright Notice 2011 This email, including any attachments, is for the personal use of the recipient(s) only. Republication and re-dissemination, including posting to news groups or web pages, is strictly prohibited without the express prior consent of Health & Life Pty Ltd. Disclaimer Notice Health & Life Pty Ltd’s Best Practice News Alert is designed as a comprehensive and up-to-date Accounting, Practice Management and Healthcare news service to alert readers to the latest in Practice and related developments affecting the medical, dental and allied health professions as they happen. It is published when there is news to report. No responsibility can be accepted for those who act on its content without first consulting us or obtaining specific advice.