The second rung of the ROPE (Rule Overload Prevention and Elimination) Ladder deals with teaching your systems — and the “Rules” that shape your systems — in a way that both conveys knowledge as well as motivation and enthusiasm. But this can't happen without properly written policies and procedures taught in a way that fits an employee's position or level of responsibility.
Writing Well
Write policies and procedures in a way that makes training easier. When policies affect reimbursement requirements, HIPAA (Health Insurance Portability and Accountability Act) or other rules, they should be crafted with an eye not only toward daily use as a compliance reference but also as a training device. The policy manual is what employees refer to daily, so it should also become their source training document.
Effective policies have two components: a policy statement followed by procedural instructions. As an example, let's look at charges to patients for copying their records. An effective policy might look like this:
Policy: Records Copying Fees — State law permits us to charge patients a fee for copies of their records up to certain limits, plus sales tax and postage as applicable. Section 164.524 of the HIPAA Privacy Regulation states that a patient may be charged a reasonable, cost-based fee for copies of medical records plus postage. It does not specify a maximum authorized charge.
Procedure: Records Copying Fees — In light of these rules, we have adopted the following procedure: When a patient requests a copy of his or her record, we will charge 65 cents per page for the first 30 pages and 50 cents for every page over 30.
If the records are not on site and must be retrieved from storage, a $15 clerical fee will be charged. The patient will be given a completed copy of the records invoice form attached to this policy and will be asked for payment in advance. Requests for exceptions to this policy must be referred to the privacy officer.
This is an effective policy for training purposes because it explains the underlying mandates in clear terms and establishes the validity of the rationale behind the policy statement. It tells staff exactly how to handle patient requests for medical records.
Tailored Training
Tailor training to your audience. Remember that the ROPE system only requires training appropriate to an employee's position or level of responsibility. Employees should be trained in functional groups so that they are neither over-trained nor under-trained. And while each employee may get a copy of the entire policy manual, only those policies applicable to an employee's position need be covered. (Of course, personnel should be encouraged to explore any of your privacy policies if they are curious.)
Conversely, ensure that everyone who may work with financial information or protected health information receive appropriate training, from top leadership down to part-time staff and volunteers. In some cases it may be prudent to include contractors and business associates in certain sessions.
Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. He is also a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting, and the author of the Home Care Compliance Answer Book. He can be reached via e-mail at ncaesar@healthlawcenter.com, or by telephone at 864/676-9075.
The ROPE Ladder
Rung 1: Articulate the way you want things to run, and note how they run now. Then, tweak your systems as necessary to comply with “The Rules.”
Rung 2: Teach your operating systems to your employees.
Rung 3: Implement a clear and simple method for dealing with problems — identify them, report them, investigate them and fix them.
Rung 4: Give your compliance staff resources to help them keep up-to-date with internal and external changes that may sometimes require you to refine your operating systems.
Rung 5: Monitor your operating systems to make sure they continue to run as you intended.
