MT Exchange Medical transcription exchange

Just in case you didn’t know, we are in the “healthcare documentation sector.” We still do medical transcription and we’re still called medical transcriptionists, but only because there’s no organized group <ahem> that’s been able to either decide what else to call us and/or make it stick.

However, medical transcriptionists everywhere can rejoice, knowing that AHDI now has a manual of ethical best practices available for us healthcare documentation sector workers.

And signaling that yes indeed, the practitioner member is once again not as important as the practitioner MTs themselves would like to think, there is no special pricing for practitioner members. Should you decide you can’t live without knowing why there’s a section for AHDI Code of Ethics and another for MTIA Code of Ethics, this baby will cost you a whopping $4,000.

Which is, I’m sure, just the start of the confusion.

After stating (very convincingly, I might add) that this is much, much less expensive than you’d pay if you put this together yourself or pay someone to do it for you (can you put a price tag on the AHDI Code of Ethics or the MTIA Code of Ethics? I think not), then setting you back on your heels with the $4,000 price tag – they soothe your ruffled feathers by letting you know that everybody except practitioner members can get this for less than $1,000.

Damn – I sure hope practitioners don’t actually need this for anything because at a reported average annual income of $30,000/year, the cost of this is just over 13% of an MT’s annual pay.

The pricing on this package (and possibly even the package itself) signals that not only is AHDI still floundering when it comes to offering anything of value to this membership group, they also don’t mind spitting in their faces. Because just in case you missed the part where you’re paying more than anyone else, there’s this friendly reminder:

It’s comforting to know that Gold Members of MTIA – which I’m sure includes companies that could actually afford to develop this information inhouse – don’t have to pay a dime. I’m sure this contributes mightily to the credibility of the claims that the relationship between AHDI and MTIA is good for both. I wonder how many Gold level members are on the MTIA Board. Just wonderin’, that’s all.

Isn’t it nice to know that AHDI knows which side its bread is buttered on? I’m looking on their web site and trying to find some indication as to who they think is going to pay the dues to keep the organization afloat if they piss off enough practitioner members, which still constitutes the largest membership group. Maybe AHDI has given up trying to find something of value to offer to the practitioner members.

Since I’m never going to pay $4,000 (or, let’s face it, $250, $750 or $950) to actually take a look at this manual of ethics and best practices, I really shouldn’t can’t say much about the package itself. I am, however, going to latch onto the term production location transparency. It’s a whole lot catchier – and easier – than “where is this work being transcribed?” I guess I’m just going to have to wither away with curiousity as to the difference between AHDI’s code of ethics and MTIA’s code of ethics.

This came up at the Restuvus MT forum. For some reason, people started e-mailing me (maybe because I live in California, maybe because I’m a loudmouth – hard to tell) and I decided to blog it because Restuvus doesn’t archive their conversations and this one should stick around for awhile.

I’m not going to go into the whole story or link to the original post (because it’s just going to move off the page and be lost forever anyway), but here’s the general idea. The original poster (OP) did some work as an independent contractor for an MTSO in California. The 1099 she received had, for some inexplicable reason, the correct name but the address on it was the MTSO’s address in California. She then asks how she proves she’s not a California resident so she doesn’t have to pay 7% income tax in California.

There are many things wrong with this. First of all, whoever did the 1099s needs to go back to tax school. The address of the person the 1099 is being issued to is what’s supposed to be on the 1099, not the address of the person they did the work for. My advice? Send the MTSO a letter requesting that the 1099 be reissued with the correct address and send a copy of the letter to the California Franchise Tax Board.

Second of all, the withholding being referenced doesn’t go into effect until January 1, 2010, and even then it doesn’t apply in this situation.

Beginning January 1, 2010, the state of California is requiring payers to withhold 7% tax on reportable income for non-resident workers. There are details and notable exceptions of course. Companies and individuals doing work in California needs to download the guidebook (PDF) and read it.

The state of California is, as most of us already know, broke and grasping at straws. It seems the purpose of this particular requirement is to make sure it captures revenue that has been lost due to not being reported. This law will most affect people who come to California from out of state, work for a short period of time, then return home. It targets California non-resident independent contractors specifically.

But here’s the catch: the work must be performed in the state of California. Which lets out remote workers because you aren’t actually located in California. You can work for an MTSO located in California on an account for a hospital in California, but as long as your butt is in a chair in Kansas or anywhere else that isn’t California, you are exempt.

Download the guidebook and read it. I find the horse’s mouth is always the best place to get information. And my husband (a CPA) says you should never take tax advice from anyone but a tax professional. (I’m sure he means this as a warning to me, should I be inclined to give out tax advice on this blog!)

Now available for download: MT Desk 2009 Advent Calendar recipe collection (331)

An interesting subject came up on one of the MT boards this week. (I’m not going to give them a link back, because they don’t allow links to other MT sites on their site.)

The MT posting the topic said she’s an independent contractor for an MT service company and was recently notified that if the hospital account she works on goes out of TAT, there is a 15% penalty – so the MTSO is passing that penalty onto the MT contractors.

Huh??

Whether you’re working as an employee or an independent contractor, I have news for you, so MTs – sit up and take notice.

The contractual agreements between an MTSO and client, including penalties for failing to meet turnaround, aren’t your problem, whether you’re an employee or an independent contractor. Unless, of course, you’re the employee responsible for staffing, scheduling and making sure the account stays in turnaround. If you’re an MT (employee or IC) who is just putting in your lines – not your problem.

And MTSOs – here’s a news flash. If you agree to a TAT penalty, it’s your responsibility to meet it – not the MTs who are doing the work. It simply isn’t the responsibility of your contractors or employees to make sure you are meeting the contractual obligations agreed upon between your business and your client.

In my opinion, it’s just shameful for a business to attempt to pass contractual penalties along to the MTs doing the work.

Let’s understand something – being an independent contractor isn’t the same as being a chump. Your IC business may accept TAT penalties from your clients, but they’re agreed upon in advance and you would only agree to them if you have full responsibility – and control – for the entire account. If you’re one of five MTs contracting with a client (because maybe they don’t want to work with a unified service), you would never agree to a contractual penalty for TAT because you have no control over what the other four MTs working on the account are doing. Working on an account for an MTSO as an IC is no different – you have no control over their staffing, their management, their operations management, their workflow process or the other MTs. Why in the world would you accept a penalty because they’re not meeting their contractual TAT?

The post I’m referring to also makes a reference that this is how you treat employees, not ICs. Another news flash – you don’t treat employees like this, either. Would you, as an employee, agree to a policy that makes YOU responsible for the overall TAT of the account? It’s the same story – whether you’re a contractor or an employee, you don’t control the management of the entire account.

Here’s a clue: the people who control the management of the account are the ones responsible. And they should take that responsibility, not pass the buck on to the people who don’t control the process. And it doesn’t matter whether those people are employees or independent contractors.

My advice to this MT is to write a letter to management, pointing out that contractual obligations are being met by the independent contractor and that any attempt to reduce payments will result in suspension or termination of services. Then start looking for another contract.

I recently received an e-mail from a transcriptionist who described a situation that I think will surprise most medical transcriptionists. It’s an issue I found especially interesting in light of a post by Nae at MT Chat, and the responses it got: Yep, my ESP is working real well today doc …

I hadn’t even discussed this with Nae, so when she posted that thread, she was not aware of this MT’s e-mail to me.

Let me preface this by saying there are usually 2 sides to a story and I only have one, so my conclusions are going to be based on that. I’m not going to name names, but if any MTSOs have had a similar experience from their side, or if you’re in management and you think this is your company, I’d like to hear the “other” side.

In a nutshell, an MT who was being paid a premium line rate because of her experience and skills on multiple accounts, was demoted due to “potential reportable events” (PREs) involving privacy and security breaches.

The reason? Selecting the wrong doctor as attending, and sending a copy to the wrong physician. In the first case, the error was noted by the MT, but too late – the report had already been sent in, at which point it was immediately distributed. Even though the MT sent an e-mail, noting the error, this error was counted in the disciplinary action that was taken against her. In the second instance, the name dictated sounded almost exactly like another name – and the MT selected the incorrect name.

As amusing as it is to say “we can’t read your mind, doc,” I’m wondering if some of the people responding to that post at MT Chat want to rethink their answer. Although Nae’s example is “send a copy to Dr. Patel,” in a case where there are multiple doctors with that name, it could have easily been “send a copy to Dr. Smith,” where there are not only multiple Dr. Smiths on a list, but Dr. Smyth, Smythe and etc. All it takes is one large university hospital or VA account to realize there are many, many ways to spell names we all thought had a common spelling, for both patients and physicians. With no training and no physician list, it would be obvious to an MT that picking the correct one among a number of Dr. Patels is impossible and needs to be flagged to QA – but what about Dr. Carter v. Karter? If someone says “send a copy to John Carter” and you find a John Carter on the roster – would you look any further to see if there was also a John Karter and therefore flag the report to someone up the food chain?

In my opinion, there were a couple of errors that occurred prior to the MT making the error.

1. It was a new account and no training was given.
2. No physician list was provided, including a list of attendings and their fellows or residents.
3. The MT company has no written policy regarding PREs and how they will be handled.
4. The MT company has no written policy regarding disciplinary action to be taken in the case of MT errors of this kind.
5. No software safeguards are in place.
6. As is usually the case, training for dictators at the facility also appears to be substandard – GIGO.

Some of these seem like no-brainers, don’t they? I don’t know how anyone can be expected to perform with minimal errors on a new account without any direction or instructions, regardless of how experienced they are. An experienced MT may be able to pick up and transcribe any dictator at any facility – but years of experience is going to give an MT the ability to somehow instinctively grasp account specifics.

This is not a small company, this MT is not an independent contractor. The disciplinary action taken cut the MT’s pay by 20% to 25% yet there’s no written policy in place. No inservice on HIPAA, no training on the account, no written disciplinary policy – but with no warning, the company takes action that cuts pay 25%.

Hello, MT employees – have you asked your employer what the written policy is for your company? What happens when a mistake like this happens? What are your responsibilities? What disciplinary action may be taken against you? What recourse do you have?

Technology being what it is, why doesn’t the EMR software – that same software that immediately routes the transcript to all interested parties upon completion by the MT unless it’s flagged – have some safeguards built in? I realize that EMR technology is evolving, but is anyone doing anything to ensure that copies don’t go to Dr. Carter if he’s not involved in the patient’s care and Dr. Karter is? If not, why not? You’d think that while everyone is out spending money on streamlining the process and reducing labor costs, they’d also be doing something to ensure security is more automated. Even a delay of a certain number of minutes would be helpful (something like the 7-second delay on newscasts), so if errors are caught shortly after the report is completed, there’s some hope of rerouting it before it’s gone out for distribution.

Are MTs paid enough to take on this kind of responsibility? Are YOU paid enough to take on this kind of responsibility? What I see happening is that more and more MTs will send every questionable physician name to QA or to the hospital staff to deal with. Then, someone will get mad – probably at the MTs. Because it seems nobody is willing to hold the dictators responsible. So here’s a tip for all you working MTs out there – unless you’re 100% certain, flag that report. The sooner these questions start piling up on the desks of people who are actually paid enough to deal with PREs, the sooner the problem will be resolved.

This situation was a FAIL of epic proportions, primarily on the part of the transcription service for not having policies in place, by not having in-service sessions for employees to train in HIPAA compliance and on account specifics. Well, shame on management for taking its shortcomings out on the transcriptionist.