Legal Lesson of the Month: New Year’s Resolutions for Ambulance Providers

It’s that time of year again, when we all take a few minutes to reflect on the successes we’ve achieved and the failures we’ve somehow survived over the past 12 months; then we swear to do better this year. As you transition into 2019, we want to help you with a list of key resolutions for the administrative side of your ambulance service. These are the things that you might be able to do better—or maybe even for the first time—in 2019:

1. I will read my Medicare enrollment form.

This sounds a bit boring, but it’s a good idea. This document, called the 855B form, can be accessed online, and it contains all the information Medicare thinks is important to know about you and your company. Have you moved, have you opened or closed an alternative address (like a P.O. box), have you opened an additional location (maybe in a new zip code), or have key employees been replaced? If so, chances are your enrollment form is out of date and needs to be revised. If you catch it before Medicare does, you should be OK. If Medicare catches an error before you correct it, it could lead to the immediate and irreversible termination of your provider number.

2. I will review our contracts with other providers.

Yeah, I know, we started out with two snoozers, but hang with us. Reviewing your contracts is a very important resolution, and January is the time to do it. Contracts with facilities often have clauses that tie rates to annual adjustments or to Medicare rates that automatically adjust every January. If you’re not looking at them, they may be out of date. More important, your contracts could be out of compliance with antikickback laws, and the government is focusing more attention on the relationships between ambulance services and the facilities they serve. Contracts may also have renewal clauses that require actions at certain times—January is a good time to put those dates on your calendar! And make sure you get legal review of those contracts to verify they comply with state and federal laws.

3. I will read our employee handbook.

Seriously, do you know what’s in there—or, more important, what’s not in there? If so, you can skip this one. On the other hand, if you’re not sure, now is a good time to familiarize yourself with your policies and update your employee handbooks and manuals with the new policies constantly required by advances in technology and new rules/regulations. Make sure, too, that all your staff have read and reviewed the handbook.

4. I will go through new-employee training.

You don’t actually have to sit down and pretend to be a new employee; just go through the training materials and make sure they’re up to date and actually say what you want them to say. Are you communicating your expectations to new staff in a way they understand? Technology and rule changes require us to stay on our toes when it comes to training new hires, both in the field and in the office. While you’re at it, take a look at your exiting-employee practices and make sure you’re happy with those as well—it’s an important compliance function to identify any potential compliance and human resource issues, and staff members who are leaving are more likely to be candid about any concerns.

5. I will get a HIPAA checkup.

Yes, HIPAA, that five-letter acronym that sounds like a disease and, for a business, is 10 times worse than MRSA. HIPAA is the one area of potential liability that concerns us the most, since there can be so many possible violations of the rules in our everyday practice. Federal on-site and “desk” audits for HIPAA compliance are on the rise, and the fines can be huge. So check your policies and make sure your actual practices match up with them, update your security and operating software, and conduct your 2019 risk analysis and document the results. (We would have put this at No. 1, but admit it: If we’d done that, you would have quit reading by now!)

6. I will keep a calendar of license and other renewal dates.

Failure to ensure that all individual certifications and licenses are up to date is a cause of major slip-ups—and they are so preventable! We can’t tell you how many times we have had a client call with an emergency licensing issue, and the bad part is there’s nothing we can do to turn back a clock. Inadvertently allowing an EMS practitioner to function without proper certifications and licenses can result in paying money back to Medicare, as well as civil monetary penalties and state licensure suspensions. Get these items on your radar and carefully monitor all staff credentials. Begin the process of renewal at least a few weeks before you think you need to—trust us on that one.

7. I will activate a working compliance program.

If you already have a compliance program in place, good job! But keep in mind that compliance must be more than a policy or document. It needs to be living, breathing program, and everyone needs to know whom to go to with a compliance concern and whom the compliance officer is. The only thing worse than not having a policy is having one you don’t follow, so if your program is not up to date, your compliance officer has retired, your people don’t know the name of your compliance officer, or you have items that aren’t actively being addressed, now is the time to fix these deficiencies and implement a compliance program that works for you.

8. I will perform a pay practices audit.

EMS pay practices are complex, and with the increasing overtime issues (due in part to staffing shortages), you need to make sure your people are being paid correctly—break times, after-shift work, overtime, training time, and on-call time are areas where wage and hour law violations are common in EMS. Review your pay practice policies regularly and make sure the payroll company is managing these areas well. This is another area where getting good legal advice is important.

9. I will seriously address unlawful harassment and discrimination.

With the #metoo movement and the propensity for harassment issues to occur in EMS, you are much more vulnerable today to a complaint or lawsuit for not ensuring a harassment-free workplace. It is more important than ever to update your nonharassment and nondiscrimination policies and train frontline staff and leadership on the latest approaches to prevent and stop unlawful harassment, like bystander engagement strategies that get everyone involved in prevention and taking appropriate action when improper conduct occurs in the workplace.

10. I will make sure our people have strong mental health support.

EMS work is extremely stressful, and in many cases we have not paid enough attention to the emotional and mental health of our people. Adequate rest periods, resiliency training, counseling, employee-assistance programs, and critical incident debriefing are all things that need be part of the overall EMS workplace physical and mental health program. Having a healthy and resilient workforce in 2019 can improve not only job satisfaction, but patient satisfaction as well—and, as a side benefit, reduce complaints and lawsuits.

That’s not a long list, but they are must-do resolutions for your EMS administrative office. If anyone can think of a few others, please post a comment, and let’s discuss. Happy New Year!

Steve Wirth and G. Christopher Kelly are lawyers with Page, Wolfberg & Wirth LLC, a prominent Pennsylvania-based law firm with a focus on regulatory healthcare law as it relates to EMS and the ambulance industry. This article is not intended as legal advice. For more information e-mail the authors at swirth@pwwemslaw.com and ckelly@pwwemslaw.com.