Labels Matter When Surveyors Come Knocking at the Door

I realize we just covered Medicare enrollment issues a few weeks ago, but we are getting inundated with enrollment questions, problems, and most importantly, clients who are facing sanctions.

A couple of weeks ago, durable medical equipment (DME) validation surveyors showed up at a location in a large health system. The lead surveyor asked to speak with a manager. The receptionist grabbed someone and brought them out.  

The surveyors asked for the individual’s name. They then examined the organization’s 855B enrollment form to see whether the individual was listed as a managing employee. She wasn’t.

The surveyors asserted that that omission provided grounds to terminate the health system’s DME enrollment. The good news is that the surveyors were merely using the threat to make a point.

But that threat is quite terrifying, particularly because we have had several clients confront actual disenrollment for issues like this.  

Part of the problem here is semantics.

Every location has someone who is the “fixer:” the person who, in the event of trouble, everyone knows to seek out. When someone asks to talk to the manager, they are generally asking for the person with the most authority who is present at the moment.

The 855B form only requires disclosures of people who manage the entire business. There are many people in the world who are “managers” without managing the entire business. The professional who oversees the front desk is most definitely a manager.

But that person is not managing the operations of the entire clinic. So, one of our practice tips is to try to avoid using the word “manager” when speaking with surveyors about individuals working at enrolled practice locations, so you aren’t relying on the surveyor to recognize that nuance. 

The term “supervisor” is a great replacement synonym. You are not required to record “supervisors” on the 855B. To minimize the risk that you will be threatened with program termination, you will likely want to either massively overreport people on your 855B form or train people to try not to use the term “manager.” The problem with simply overreporting is that you are also required to report all changes to an individual’s status.

Unless you are going to do a great job of keeping up with employee turnover, overreporting creates its own set of challenges. My colleagues and I are so worried about wacky revocations and terminations that we are going to focus our June webinar on that topic alone. You can register for that here.   

The bottom line is that in life, quoting They Might Be Giants, singing “you’re not the boss of me now,” is generally not the best advice, but what may get you in trouble for being insubordinate in most situations may actually help you avoid a payment revocation.

One way to lower the risk of retroactive loss of enrollment is to avoid characterizing people as the boss.