Neurology & Pain Management Coding Alert

Tip: Implement a grievance process to outline appropriate steps.

No employer is perfect, which means employee complaints are inevitable. Unhappy employees can put your practice under scrutiny from the Occupational Safety and Health Administration (OSHA), the HHS Office of Inspector General (OIG), or the U.S. Equal Employment Opportunity Commission (EEOC).

Stay ahead of the game by following these tips to developing a solid grievance policy — and stop problems before they start.

Understand Why Practices Need Policies

Many employee complaints are trivial (such as personality conflicts) and could be resolved with a policy. Other times, all employees want is an apology from management. Either way, disgruntled employees may unnecessarily file lawsuits or take complaints to state and federal officials if your practice doesn’t have a complaints policy that helps staff resolve problems internally.

“A grievance process is a must for a medical practice since it tells an employee how to report a grievance, or internal problem, who to report it to and how an investigation will be conducted and what outcome to expect,” says Catherine Brink, BS, CMM, CPC, CMSCS, president of NJ-based Healthcare Resource Management. “Without these policies and procedures, an employee can become a ‘whistleblower’ taking their complaint directly to the OIG or OSHA which can lead to further investigation by OIG or OSHA, fines, etc.”

Beware: If you have a grievance policy, make sure you follow it. If you don’t, you could be providing more ammunition for an angry employee.

Incorporate Instructions With the Process

Your grievance policy should specify how to report a concern and to whom it should be taken. According to Brink, you should put this information in your compliance plan as part of your written policies and procedures. You also want to include details about how the practice will investigate the issue and how it will be resolved.

“Of course, if the practice doesn’t have a compliance plan, then they need to have written policies and procedures for a grievance process,” Brink adds.

Consider including the following steps in your grievance process:

1. The employee delivers the complaint to the direct supervisor. The complaint should be made in writing within five days after the incident, give the name and address of person filing, and briefly describe the alleged action the employee’s complaining about.

2. The supervisor provides an initial determination and resolution. Frequently, policies stipulate that the supervisor should make the initial determination within a certain time frame, such as 10 days after receiving the complaint. This allows the supervisor time to investigate the complaint.

3. Often, the problem is resolved after the first step. If the supervisor doesn’t satisfactorily resolve the employee’s issue, the employee next requests a hearing with the vice president of human resources or the supervisor’s manager for final determination.

Most policies set a time frame for the final determination, such as 14 days after the complaint presentation. Experts recommend that the employer come down one way or another. The final determination is either that the complaint is valid or not valid.

“The timeframe should be spelled out in the grievance process —  i.e., employee has five days to put their grievance in writing after verbal communication to the supervisor — same for supervisor, say, 10 days,” Brink explains.

Clue In to Compliance Breaches

A staff member’s complaint may indicate you have a compliance problem that needs immediate attention. You want to be careful to take the allegation very seriously and fully investigate it. Give your compliance officer a heads up so she knows this is in the works and keep her apprised of the resolution and document everything.

“When it comes to [the] OIG, the practice should have the grievance policy in place in their practice compliance plan. For instance, a coder might find improper coding of practice procedures,” Brink explains. “Concerning OSHA, they are extremely particular about due diligence and documentation of written policies and procedures to comply with OSHA standards. Therefore, a practice should have policies and procedures in place for compliance with OSHA, i.e. handling of blood borne pathogens, OSHA employee training, etc.”

Protect Whistleblowers

 If an employee complains to a government agency such as OSHA or the OIG about a compliance problem -- such as sexual harassment or discrimination -- you must make sure she isn’t punished for issuing the complaint.

Train management to be especially careful about preventing any retaliatory actions -- such as shunning or termination -- that can trigger such additional problems as Equal Employment Opportunity Commission (EEOC) violations.