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Reducing my salary for late documentation


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I work (and live in) in MN for a Wisconsin based healthcare system and they are now reducing my salary every quarter for however many charts I have/had open (per chart/per length of time past due). This was not in my contract when I started. I also am under a non-compete which I know may be ending but it limits my options to work elsewhere. I will be fined $4500 for January through March of this year, and they said they will reduce it from my salary when we are supposed to get "raises" in June or July. Is this legal? Most of the non-medical people in my life think it is not, and I worked at another large MN healthcare system for 12 years before this one and never heard of this kind of treatment for a fam med provider. I tried contacting NCCPA but they said I had to talk to my medical board. I can't find anything on my MN medical board website remotely close to this subject. Any help would be greatly appreciated.

Katy

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42 minutes ago, EastCoastPA said:

I would call their bluff immediately. Find a new job and leave before they "fine" you (notice or not, forget about it at this point), and then see if they actually want to come after you for non-compete in this day and age (they won't).

Interesting but it depends on the OP's job history. Might need a reference from here sometimes. I'd leave, but it seldom pays to be a butt about it.

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Just a quick question from a management perspective (I have never been in a management position), how many charts do you have that are late? What is the definition of a late or overdue chart in your organization?  I find that my charting is more accurate if completed within 24 hours. Definitely not being critical here, just looking for some perspective to your situation. 

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It is wrong to take your pay because they decide to. Double-check your contract to make sure there isn't something about this in there. (I have signed agreements that state I must complete documentation within a "reasonable" or an actual specified timeframe.) Consult an attorney for next steps.  

Of note, I have heard of an academic center recently "fining" aka withholding pay for physicians because of documentation and certain chart review expectations. I don't know the exact details but the docs said they had a pay structure which included chart review and documentation. Apparently many of them didn't meet a specific metric for the year before unbeknownst to them and they were fined A LOT of money. I hope this is not a new trend.

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From a management perspective, you can't bill for the encounter. This leads to a reasonableness issue. We have a similar issue with attendings. Since the inpatient encounter can't be billed until the D/C summary is done, once its more than 30 days old, they contract it out and bill the cost to the attending. So here it depends on the cost. If you are talking 1000 late charts, this is not unreasonable. On the other hand if this is for one chart its not. We monitor late charts closely and our standard is chart completion within 48 hours. From a finance and liability standard having open charts is not acceptable. 

So how many charts are we talking about? Also, you said its not in your contract. Are you sure? $4500 is real money. I would take the contract to a labor lawyer for review. If its not kosher, a letter from the lawyer will likely make them cave. 

 

Dave

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As a self-employed clinician, if I don't get my charts done and billed in a timely manner, I don't get paid. Mind you, I have a year to submit correct charts, but why get behind in the first place if you can avoid it? Absent any contractual issues, the risks from delayed documentation as I see it are...

1) Delayed referrals. Can't send the referral without the relevant chart note.
2) Delayed payments. Can't bill the encounter without the relevant chart note.
3) Accuracy. Poor memory means more risk of recall errors, which are liabilities for malpractice, fraud, and the like.

So, it's not just about money, although it is about money, it's about good patient care.

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On 5/8/2024 at 11:25 PM, iconic said:

I have seen providers sit on charts for days to weeks and I personally don't get it; if I don't get my chart down the same day - I will have very little recollection of the visit to get it done later

Working like a dog, overworked due to staffing issues, burnt out, not held accountable for timely completion... 

But yes, always best to complete same day. 

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1) If you live and work in MN, non-competes may actually be illegal/ invalid. Check with an attorney.

2) If you're salaried, the extra time you put in to work on charts after you're done seeing patients basically affects you the same way a fine or a reduced wage would anyway. Of course, it doesn't enrich the company other than in the abstract sense that you're giving them extra labor outside normal working hours, so it's harder for them to put on the balance sheet.

3) A company will have a big problem billing for services any later than 30 days after the encounter date. I often have charts that are not closed after a couple of business days, but it's never more than 2 calendar weeks/ 10 business days. (They would prefer 48 hours and so would I, but it's rare they will pay me to chart during work hours and not also see patients, so it is what it is.)

It seems like whatever process they have for review by the billing and coding people takes a while, so it benefits them to have your charts closed asap. That's fine, but penalizing you in this way is a dumb strategy. If you can find a new job, it would be a nice way to make sure their dumb strategy backfires. 

All that being said, if you have any significant number of charts still open close to a month after the fact, something is clearly wrong and needs to get figured out.

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7 hours ago, Febrifuge said:

 

7 hours ago, Febrifuge said:

it's rare they will pay me to chart during work hours and not also see patients, so it is what it is

7 hours ago, Febrifuge said:

that being said, if you have any significant number of charts still open close to a month after the fact, something is clearly wrong and needs to get figured out.

Great points you make. I used these ones in particular to negotiate getting a scribe.

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