Demystifying OSHA Inspections

2017 Alliance sponsor feature article

By Debra Gordick, Mediator/Government Liaison for Total Medical Compliance

An OSHA inspection can be a scary experience. One reason is that they are always a surprise. You are going about your day as usual and suddenly you have an inspector at the front desk. Another reason is that you don’t know what to expect or what to do. Being informed about the process before it happens can help you focus and minimize the impact of an inspection.

How does your practice get chosen by OSHA to be inspected?

The most usual way for your practice to be inspected is that an employee, ex-employee or patient has reported you to OSHA for violations of OSHA regulations. This is called a “for cause” inspection. If it was a current employee who reported a true regulation offense then you will be inspected. OSHA takes that type of report very seriously. They are aware that sometimes an ex-employee may be angry and lashing out. If, in their judgment, that is the case OSHA may send you a letter asking for details and an explanation instead of inspecting. Receiving a letter does not mean you can dismiss the issue. You have a limited time to answer. If you do not answer the letter or do not answer it to OSHA’s satisfaction, they will show up to inspect. They will not give you advance notice and you cannot stop them from inspecting. A “for cause” inspection is usually limited in scope to the area or areas reported. They can expand the scope if they notice something wrong during their inspection. It is important not to volunteer information to an inspector unless they ask a question. Something as innocuous as “we have an excellent training program” requires them to expand their scope to your training program.

The second kind of inspection is a “random” inspection. Every year OSHA has a schedule. First they inspect reported violations. Then they generate a random sampling from their computers of business types that are closely watched. Types of businesses on this permanent rotation tend to be high risk for employee injury and death like construction, manufacturing, mining and farming. This list is a compilation of a federal list and, if your state has its own OSHA program, a state list. North Carolina has a strong state program. If they finish all inspections on high risk businesses, OSHA will look at the computer generated list of business types that have not been inspected for awhile. Unlike the “for cause” inspections, random inspections are full scope. The inspectors will look at all areas of regulations.

What are the steps of an OSHA Inspection?

  1. SELECTION
  2. PHYSICAL INSPECTION
  3. CLOSING MEETING
  4. CITATION LETTER
  5. ABATEMENT
  6. INFORMAL CONFERENCE
  7. SETTLEMENT
  8. FORMAL HEARING

What happens during the actual inspection?

When OSHA decides to inspect your practice the inspector(s) will show up at your door without notice. Get a business card. Ask the inspector to have a seat in the lobby while you notify management and the OSHA Officer. We recommend delaying the inspector no longer than twenty minutes. Additionally, you cannot refuse inspection. They will leave just long enough to get a warrant and the police. The only time we’ve seen an inspection delayed was when the office was not actually open for business and just a small staff was present doing paperwork.

Use your time wisely. Walk-through your office to spot and correct any problems that can be handled quickly such as replace a full sharps container or secure gas cylinders the delivery service missed that day. Grab a camera or camera phone. Greet the inspector. The inspector is going to ask for information about your business such as tax ID # and unemployment insurance #. You should be told if this is a random inspection or you were reported. If that information isn’t volunteered, you should ask. They can tell you what you were reported for but not who reported you. An inspection can take from one hour to multiple days with an average of 3-4 hours. A “for cause” inspection should be shorter and focused on the reported violation(s). The inspector is going to do the following:

  • Ask to see your documentation. This can, and likely will, include your policy and procedure manual, reports of any injuries or illnesses, Hepatitis B vaccination records and training records.
  • Walk through you practice and inspect various areas. (Remember that under HIPAA regulations the inspector cannot enter an occupied treatment room without you getting permission from the patient beforehand.) Never leave an inspector unescorted.
  • Take pictures. Ask them what they are photographing and why.
  • Ask you or other employees questions on how something is handled. (OSHA inspections are performance-based which means that what you are doing should match what your policies and procedures state.)

The inspector may want to talk to employees without management present. This is allowed.

Things you can do during the inspection to minimize citations and lower fines:

  1. Always be polite and courteous. The inspector is just doing their job. Also, you get a 15% reduction in fines for being “cooperative and courteous.”
  2. Take a picture of anything the inspector does for your records.
  3. If asked for something you don’t know the answer to, ask for clarification. It is easier to stop a citation from being written than to get it removed later.
  4. Always answer truthfully but do not volunteer information. By law they must inspect any area you bring up.
  5. At no point should an inspector ask for money. Report this to OSHA immediately. This person is most likely a scam artist.

After the inspection is over, the inspector will have a Closing Meeting to cover the preliminary findings. This meeting can happen immediately after the inspection or can be scheduled for a future date. At the Closing Meeting the inspector will meet with the OSHA Officer (and management if you request it) to go over all issues noted during the inspection. This list of issues is not the official citation list as it may include issues that are noted but so minor that they will not end up on the official list. Feel free to ask questions and to volunteer information that could prove you have addressed the issue. Start fixing the problems identified immediately.

What happens after the inspection?

After the Closing Meeting the inspector will return to their office and write up their results. They may call you to get follow up information. Once the report is written it is submitted to their manager. The manager will review the report and create an official citation letter listing each issue, the regulation that was involved and the amount of the fine for each citation. This letter will include information on your rights to contest the OSHA citations and your responsibilities to post the results for your employees and the dates by which you are required to fix the problems identified. This letter will be sent to you usually within two weeks of the Closing Meeting.

OSHA divides citations into “Serious” and “Non-Serious” categories. Non-Serious violations usually are not fined but can be minimally fined. OSHA increased their fines in August 2016 and again on 1/13/17. Each Serious violation starts at $12,675. There is a series of fine reductions which are available.

  • 60% for small businesses
  • 15% off if you were “courteous and cooperative
  • 10% if you have an OSHA program in place.

However, if OSHA notes that this is a repeated violation from a previous inspection or if they determine that it is a “willful” violation the fine starts at $126,749.

You will then have to submit a form (included in your citation letter) back to OSHA to prove that you have fixed the problems listed within the timeframe allotted. This is called Abatement. Abatement should include a short explanation, supporting documents or even pictures if necessary. You can request an extension if necessary. Failure to abate the citations by the stated date can result in a fine of $12,675.

You also have the right to contest the citations. The first step of this process is to request an Informal Conference with the manager/supervisor who sent you the citation letter. This meeting must be asked for within the timeframe listed (usually 15 days of receipt of the citation letter). It can usually be conducted by phone. It is your chance to state your reasons for removing or reducing citations and/or fines. You ask for this even if you don’t have any explanation but “we’re sorry and we fixed it”. OSHA cannot increase the citations or fines and you do not get on a black list. You can usually get some reduction in fines just by asking.

After the Informal Conference, OSHA will send a Settlement Letter to you. This will list what changes they are willing to make. You then have a limited time to decide whether to accept the settlement, sign it, return it and pay any remaining fines or you can choose to move to the next and final phase, the Formal Hearing.

If you do not accept the Settlement you have only one last recourse. You can request a Formal Hearing. This meeting will be in person before an administrative judge in Raleigh. This step should only be taken if you believe OSHA has violated regulations or if you have a legal reason that you did not violate a regulation. You are allowed to bring a lawyer and your consultant. OSHA will have their lawyers there. Results are final.

On a final note, your best protection from OSHA citations is a strong and continuing OSHA program. You need to understand what is expected from your business. Your program should include policies, procedures, strong documentation, good records, current SDS, annual review of safety devices for sharps, and thorough training.

Debra Gordick is the Mediator/Government Liaison for Total Medical Compliance. TMC is a private consulting company providing affordable turnkey programs and seminars for health care providers allowing them to achieve and maintain compliance with government safety and privacy regulations such as HIPAA, OSHA and Infection Control. A TMC consultant works in partnership with the safety and privacy officers at your location to ensure all aspects of the regulations are addressed. TMC services include on-site employee training, customized compliance manuals, office inspections, and ongoing client support through bi-monthly newsletters and a fully staffed Call Center. Information on seminar schedules and products can be found on the TMC web site, http://www.TotalMedicalCompliance.com.

For additional information call 888-862-6742 or email Service@totalmedicalcompliance.com

 

Palmetto GBA E-mail Update: Monday, July 17, 2017

Claims Payment/Processing Issues Log Webcast: July 26
Palmetto GBA will host a Part B Claims Payment/Processing Issues Log (CPIL) webcast on July 26, 2017 at 10 am, ET. This 60-minute Webcast is designed to provide an overview of the CPIL available on the Part B Palmetto GBA website and will include a question and answer period for questions related to accessing and using the CPIL. This webcast will include: how to access the CPIL, types of issues included on the log, and how to sign up for email notification of an individual CPIL updates. Please plan to attend.

Applies to:

  • JM Part B//General

North Carolina Part B Providers: Quality Payment Program (QPP) Webcast: July 25
North Carolina Part B providers, do you need help in being successful under the Quality Payment Program? Please join Alliant as we partner with Palmetto GBA on Tuesday, July 25th at 1:00 pm ET, for information concerning the Quality Payment Program. This webcast is intended for North Carolina Part B providers. The Quality Payment Program improves Medicare by helping practices focus on care quality and the one thing that matters most – making patients healthier. If you participate in Medicare Part B, the Quality Payment Program will provide new tools and resources to help you give your patients the best possible care. Please plan to attend.

Applies to:

  • JM Part B//General

Part B Top 10 Medical Review Denials Webcast: July 31
Please join Palmetto GBA on July 31, 2017, at 10:30 a.m. ET as we share the Top 10 Medical Review Denials and provide a better understanding of medical review denial reasons. During this 45 minute webcast, providers can expect to learn about: top medical review denials; edit effectiveness letter; denial documentation examples; medical necessity; and documentation tips. Please plan to attend.

Applies to:

  • JM Part B//General

Signature Log Can Be the Key
Do you have questions regarding the signature log? A signature log is a typed listing of the provider(s) identifying their name with a corresponding handwritten signature. This may be an individual log or a group log. A signature log may be used to establish signature identity as needed throughout the medical record documentation.

Applies to:

  • JM Part B//General
  • JM Part A//General
  • JM Home Health and Hospice//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices?
Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices? Be sure to check them out today!

Applies to:

  • JM Part B//General
  • JM Part B//Chiropractic
  • JM Part B//Physician
  • JM Part B//Primary Care

eServices makes it easy to monitor the use of your NPI!
eUtilization reports provide rendering providers and ordering and referring providers access to their personal data. Check them out today.

Applies to:

  • JM Part B//General
  • JM Part B//Physician
  • JM Part B//Primary Care

E/M Weekly Tip

E/M Weekly Tip: History Component ‘Unable to Obtain’
If you are unable to obtain the review of systems (ROS) and past, family and social history from the patient/source, the documentation must clearly describe the patient’s condition or other circumstance. Please share with appropriate staff.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Palmetto GBA Update – Proposed 2018 Policy and Payment Rate Changes

Hospital Outpatient, ASC: CMS Proposes 2018 Policy and Rate Changes

Proposed rule and Request for Information promote improvements to quality, accessibility, and affordability of care

On July 13, CMS issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility and innovation in the delivery of care.

The OPPS and ASC payment system are updated annually to include changes to payment policies, payment rates, and quality provisions for those Medicare patients who receive care at hospital outpatient departments or receive care at surgical centers. Among the provisions in this rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program. The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals. In addition, CMS is releasing within the proposed rule a Request for Information to welcome continued feedback on flexibilities and efficiencies in the Medicare program.

For More Information:

Physician Fee Schedule: CMS Proposes 2018 Payment and Policy Updates

Proposed rule & Request for Information provide flexibility, support strong patient-doctor relationships

On July 13, CMS issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in CY 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

The Physician Fee Schedule is updated annually to include changes to payment policies, payment rates, and quality provisions for services furnished to Medicare beneficiaries. This proposed rule would provide greater potential for payment system modernization and seeks public comment on reducing administrative burdens for providing patient care, including visits, care management, and telehealth services. The rule takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program. The rule encourages fairer competition between hospitals and physician practices by promoting greater payment alignment, and it would improve the payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders. In addition, the proposed rule makes additional proposals to implement the Center for Medicare and Medicaid Innovation’s Medicare Diabetes Prevention Program expanded model starting in 2018.

For More Information:

OCR FAQs on Section 1557 clarify member questions on language assistance requirements

Originally published in the July 12, 2017 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

The Office for Civil Rights (OCR) released FAQs on its final rule implementing Section 1557 of the Affordable Care Act that offer much needed clarification for covered medical group practices on language access requirements for individuals with limited English proficiency (LEP) stemming from a final rule implementing Section 1557 of the Affordable Care Act. Section 1557 builds on longstanding civil rights laws and provides additional nondiscrimination requirements for covered group practices, including posting taglines alerting LEP individuals to the availability of language assistance services. Notably, the FAQs clarify that the phone number displayed on each tagline should be your group practice’s phone number.

For more information about how to comply with Section 1557, download MGMA’s member resource entitled, “Section 1557: What Your Practice Needs to Know.”

MLN Connects for Thursday, July 13, 2017

News & Announcements

  • New Medicare Cards with New Numbers: 3 Changes You May Need to Make
  • QRDA III Implementation Guide Available
  • Quality Payment Program: View Recent Webinar Recordings
  • Hospital Discharge Notices
  • IPPS Hospitals: FY 2014 S-10 Revisions
  • Recognizing National HIV Testing Day

Provider Compliance

  • OIG Video: Reporting Fraud to the Office of the Inspector General

Claims, Pricers & Codes

  • ICD-10-CM Errata Available

Upcoming Events

  • Revised Interpretive Guidance for Nursing Homes and New Survey Process Call — July 25
  • ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26
  • IRF Quality Reporting Program Refresher Training Webinar — August 15
  • Comparative Billing Report on Drugs of Abuse Testing Webinar — August 23

Medicare Learning Network Publications & Multimedia

  • CLIA Webcast: Audio Recording and Transcript — New
  • Appeals Call: Audio Recording and Transcript — New
  • Acute Care Hospital Inpatient Prospective Payment System Booklet — Reminder
  • Skilled Nursing Facility Prospective Payment System Booklet — Reminder
  • Ambulatory Surgical Center Fee Schedule Fact Sheet — Reminder
  • Ambulance Fee Schedule Fact Sheet — Reminder
  • Health Professional Shortage Area Physician Bonus Program Fact Sheet — Reminder
  • Suite of Products & Resources for Billers & Coders Educational Tool — Reminder

Tune in to UHC On Air

2017 Alliance Sponsor Feature Article by UnitedHealthcare

We are introducing UHC On Air — your source for live and on-demand video broadcasts created specifically for UnitedHealthcare care providers. This innovative new tool features video broadcasts on topics relevant to you,

  • Ask and Advocate Sessions
  • Claims Processing and Payment
  • Provider Training and Orientation
  • Behavioral Health Issues
  • Reform and Regulations
  • Accountable Care Tools and Programs

UHC On Air is designed with you in mind. Benefits include:

  • Education: specialty programming to meet your organization’s unique needs.
  • Training: review processes and procedures to ensure your staff and administrators are compliant.
  • Engagement: hear directly from UHC experts, share feedback, earn CEUs, and ask questions in real-time.
  • Communication: be the first to know what’s new in your market

Easy access:

  • Log in to Link and select the UHC On Air button.
  • To access Link, sign in to UnitedHealthcareOnline.com using your Optum ID. If you aren’t registered for UnitedHealthcareOnline.com and Link, please go to UnitedHealthcareOnline.com and select New User in the top right corner.
  • In order to view your programs, complete the one-time profile form by providing your State, Specialty and Tax ID in order for UHC On Air to personalize content that is most relevant to you. Select your state-specific channel to see your local programming. After selecting your state-specific channel, you’ll see videos categorized by plan type. Select the UHC News Now channel to watch national UnitedHealthcare information, related to Medicare, Medicaid, Military & Veterans, and Commercial benefit plans, programs and services.

As a valued UHC partner, your engagement helps us serve you better. UHC On Air is designed to allow partners like you to provide insight into questions, concerns, and issues within the provider community.

Help us create programming you want to watch. Have a topic or idea? Our experts want to hear from you.

For more information or help with accessing UHC On Air contact your local UnitedHealthcare Hospital and Facility Advocate or the Carolinas Provider Relations General Mailbox at Carolinasprteam@uhc.com.

MLN Connects Newsletter: Thursday, July 6, 2017

News & Announcements

  • ESRD: Proposed 2018 Policy and Payment Rate Changes
  • ESRD QIP: Prepare for the PY 2018 Preview Period
  • QPP: New Resources to Help Clinicians Participate in MIPS
  • QPP: New Webpage for Clinicians in Small, Rural, or Underserved Areas
  • Open Payments Program Posts 2016 Financial Data

Provider Compliance

  • Chiropractic Services: High Improper Payment Rate within Medicare FFS Part B

Upcoming Events

  • ESRD QIP: Reviewing Your Facility’s PY 2018 Performance Data Call — July 10
  • Creating and Verifying Your National Provider Identifier Call — July 12
  • Assessing Your Ability to Support Patient Self-Management Webinar — July 19
  • ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26

Medicare Learning Network Publications & Multimedia

  • Modernized National Plan and Provider Enumeration System MLN Matters Article — New
  • Infection Control: Hand Hygiene Video — New
  • PECOS for Provider and Supplier Organizations Booklet — Reminder
  • Medicare Vision Services Fact Sheet — Reminder
  • Mass Immunizers and Roster Billing Booklet — Reminder