A community of 30,000 US Transcriptionist serving Medical Transcription Industry

I JUST DON'T GET IT....VENTING - Alice

Posted: Mar 02, 2010

How can an MTSO which whom an MT has an actual contract suddenly decide to impose new rules, penalties and fines without actually negotiating a new contract? Is this really legal?

This is in response to the new HITECH law, but I think that HITECH is just a scapegoat that the company is using to do what they always wanted to do. I don't want to mention the name of the MTSO because I am too scared to do so at this point, and I have not made any HIPAA errors that I am aware of, but the company that I am referring to seems to think that MTs are like like chess pawns, meant to be manipulated at whatever whim the MTSO's client mandates. That's right, the MTSO's client tells the MTSO how to treat its ICs. One error, and that pay period's paycheck will be adversely affected, with a limit on how many reports you are allowed to do per day along with a reduction in your line rate. Too bad if you are an MT who is already making pennies and having a hard time making ends meet. If you are not perfect, be prepared to starve.

All I can say is, Goodbye MT, hello Wal-Mart. I've just reached my limit.

I know who this is! - ??

[ In Reply To ..]
I know exactly who you are talking about without you even saying. It is ridiculous.

Reply - Alice

[ In Reply To ..]
Thank you for your response. It is good to not feel alone in my disgust. I'm actually wondering why more MTs/ICs of that company have not been here recently to make comments.

I predict that, someday, an MT with the time and money (?) will be burned by an MTSO and will file a lawsuit against an MTSO and/or the MTSO's client for imposing fines and penalties on the MT when not enough information was provided to the MT, causing the MT to make an honest mistake at choosing a cc name from a pull-down list that sounded like the one that the dictating clinician was saying. In such a case, I think that the client should be responsible for providing sound-alike name lists to MTs.

Perhaps this will also bring lawsuits by MTs who have been held responsible to be almost perfect while dictating clinicians are oftentimes totally careless. I'm curious as to how a jury would interpret such a case.

This same MTSO announced that they had provided full contact information on MTs to the client. We are no longer known to the client by IDs, but they have our "full" contact information. I can only imagine what they are expecting to do with that information. In the same paragraph, it was mentioned that a patient would be able to file a lawsuit, so my conclusions were fairly straightforward.

Apparently, the MTSO and client thinks that they, the client facility and dictating clinicians, are totally exempt from any responsibility.

Something you should probably - know about this situation

[ In Reply To ..]
The link below is to an article entitled "HIPAA Audit: The 42 Questions HHS Might Ask". The article describes an actual audit and really should have been entitled "The 42 Questions (Or More) that HHS DOES Ask".

If you read the list of questions carefully, you'll see that this audit demands detailed information about virtually any system that houses or processes PHI as well as the people who have access (even terminated employees!). For instance, here's one question:

"Please provide a list of outsourced individuals and contractors with access to ePHI data, if applicable. Please include a copy of the contract for these individuals."

If you have any idea what it takes to answer some of these questions (hours of work - or more), you'll understand that hospitals can't afford to wait until an audit is sprung on them. They have to have this information in hand well in advance (and many probably are creating separate databases just to house all of this information). More cost of doing business when the government gets involved!

Anyway, I thought you should be aware that the client undoubtedly demanded this information from your MTSO.

However, neither HIPAA nor HITECH is a legal justification for changing the terms of your IC contract unilaterally UNLESS the terms of your original contract specifically grant or reserve that right for the MTSO - and I am not even sure that such a term would be considered enforceable at court as it would essentially render the other terms of the contract void on a couple of different grounds. An enforceable term would call for the original contract (or certain of its terms) to be vacated entirely with a right to negotiate new terms, this being optional to both parties.

So we really have two issues here. The client is justified in gathering specific information about systems and people entrusted with their PHI, whether in-house or outsourced. This only makes sense, really. The hospital collects all kinds of other information as well - merely to be able to deal with audits of other kinds, accreditation, etc., etc, etc.

However, the MTSO is not justified in unilaterally altering the terms of your contract on the grounds of "legal necessity" (like HITECH), etc. The contract must be renegotiated.

"42 Questions" link - sorry for the omission

[ In Reply To ..]
Copy and paste this:

http://www.computerworld.com/s/article/9025253/HIPAA_audit_The_42_questions_HHS_might_ask

or click link below...

You honestly don't get it... - MT4now

[ In Reply To ..]
It is unfortunate that you truly do not "understand" what is at stake for the BA (business associate), otherwise known as the MTSO in your post above. I think you do need to do some research into the New HITECH Act for your own education, which is actually the "hammer" of the old HIPAA law. You need to do your research so that you can see the penalties/fines that are going to be imposed on a BA if they are not compliant. I am an MT, not an MTSO, but have taken some courses to learn about the new HITECH Act so that I could understand exactly what it is. You also need to see things from the other side of the fence. I have been given an opportunity to do this and have a new understanding of why companies have to enforce polices, in particular QA policies, as not all MTs are - shall we say "working up to their ability" especially when there are no consequences involved with being lazy and not looking up words that are not easily heard, easier to leave a blank. Not caring about their work content as QA will look it over anyway. Policies have to be enforced unfortunately due to this and every company has those types of MTs. I am not saying that you, or everyone, is one of those types of MTs but they are the reasons why polices are in place. I always hold to my saying, "If you are doing the right thing, doing your work correctly, you have nothing to worry about." It is only the ones (MTs) that are taking the short cuts, not proofing their work, etc., just trying to make their money quickly any way they can without producing quality - are the ones who have something to worry about. Most MTSO's are running a pretty tight ship - meaning they are not getting much more per line from the covered entity than what they are paying you. Of course, there are those that are going to say, oh yes they are, but in all reality, they are not making a ton of money over and above what they are paying you in your line count. You have to consider all the expenses they have in running a business as well that they have to take into consideration when deciding how much they can pay on a certain account to make out such as equipment, servers, firewalls, virus scans - just the programs to run all of these accounts in themselves are a huge expense. The MTSO has many expenses running their business that have to be figured into their cost. I would say the MTSO's that are outsourcing to India and paying them a couple cents of line are making a killing but that is not what we are talking about here. That is a totally different subject. Bottom line here is, to run a business properly the business has to make money in order for us to have a job. There also have to be policies in place. The HITECH Act is here and it is real and cannot be ignored by any BA (Business Associate) or CE (Covered Entity). Those rules do trickle down to the IC/employees and everyone better comply as well or you can and will be imposed to the same fines as the BA's-MTSO's or CE's. The MTSO did not create that law, Obama did!! Blame him if you feel like blaming someone. Your BA (MTSO) is just as upset about the new rules as you are but if you look into it, protecting people's personal health information should be important to us all. That is really what the HITECH act is about. Stricter measures to protect that information from falling into the wrong hands. This new law has made a new huge expense for BA's and CE's in trying to be/stay compliant. It is just one more expense to add to their already long list of expenses. As far as penalties for making a mistake, I think a policy that requires MTs to have to achieve at least 98% is fair, after all it allows you some room for error - after all we are only human and we do make some mistakes. Basically, it is telling you that in a report that consists of 100 lines you are allowed to make a mistake(s) worth 2 points. That is fair. They are not saying you have to bee 100% all the time, but in thinking about being the patient, I would rather my chart be 100% - wouldn't you? You are supposed to be an expert in this field so should you produce documents below 98% accuracy?? The MTSO's are held to those standards from the CE (hospitals or whoever contracts with them) so when you fall bellow that percentage and the hospital or client calls the MTSO and says, "Hey, you have an MT that got a 96% accuracy on this report." What should the MTSO do, ignore it? After all, many MTSO's guarantee the quality of their work to the client in order to even be able to get a contract. If the work falls below 98% most often they are penalized on their end. Should the MTSO have to eat that cost because of an MT? If they did that all the time, you would not have ANY job because they would be out of business. It is alright to be frustrated and vent but you do need to understand some things before you accuse businesses of doing wrong to you. I know there are some out there that seem unfair and if that is the case, move on to one that is not. Be sure, however, that they are being unfair and not just running their business the way it has to be run in order to "have" a business. Again, I am not an MTSO, and I am sure there will be plenty who will accuse me of being one - whatever. Instead of that, some may want to actually try to read this as a helping tool in trying to understand the business in hope's of reducing your frustration in thinking that everyone is trying to do wrong to you. That is what this is truly meant to be. Take it for what it is worth!! :-)

Would you mind using paragraphs please? - Your post is practically illegible.

[ In Reply To ..]
Thanks.

The points you make beg the question that the "justification" for accuracy in our work has always been true, and was true when this original poster signed her original IC contract, when the terms of the arrangement were agreed upon. This has nothing to do with HIPAA.

What - did the MTSO just wake up to the need for accuracy, or the concomitant need to include quality-related provisions in the IC contract?

The time to incorporate terms related to work product expectations was when the original IC contract was executed. If the MTSO wants to add, delete, or revise the terms of the contract now, THEY MUST DO SO LEGALLY AND PROPERLY.

The MTSO can't have it both ways, you know. Either it's a contract that is binding on BOTH parties, or it is a contract that is binding on NEITHER party.

Of course, the underlying problem is that IC contracts - are really false agreements

[ In Reply To ..]
Most IC contracts are so "one-sided" that their enforceability is at least open to question, if not doubtful. For instance, in most of them, the MTSO undertakes or promises to do virtually nothing (for instance, to provide work!) other than to pay a certain line rate when work is performed. All of the other terms in the contract relate to what the MT promises to do.

Negotiation is not, as some believe, a necessary element for an enforceable contract. If you'll notice, there's no "negotiation" about an automobile purchase agreement in most cases, although you might be in good enough standing with the bank that that you can bargain a bit over the interest rate. Otherwise, it's a dense document filled with standard cast-iron terms that are utterly nonnegotiable. It's take it or leave it.

However, there must be informed agreement between the parties - a "meeting of the minds" - for a contract to be enforceable, and the signatures of the parties on the contract are not always unassailable evidence of such agreement.

De facto, there can be no agreement with respect to unilateral changes in the terms of the contract under most circumstances. However, it IS IMPORTANT TO RAISE OBJECTIONS TO SUCH CHANGES IMMEDIATELY, because continued performance under the revised terms might be CONSTRUED as agreement with them.

Get a life.. - MT4now

[ In Reply To ..]
What I posted was simply to help her, and maybe others, realize that maybe they need to do some research before they decide someone is doing something wrong to them - truly to relieve some frustration on their part. It was not to give them a lesson in English writing, grammar, etc. It is people like you who just sit out there waiting for someone to write a post so you can quick "proofread it" to criticize that are truly a waste of anyone's reading time on this board. Whether there were paragraphs or not - honestly! If you can't understand the meaning of the post - that is fine, as I am sure that you had no intenctions of getting anything out of the post in the first place. You were simply trying to be an "editor" which is why the whole post went over your head. Now, for the person who actually posted the very first post, it truly was to help you understand to relieve some frustration in hopes to make you realize that if someone is truly doing you wrong - you should move on!! Before people do make a move, however, you should weigh all issues. Sometimes a move is truly warranted; somtimes they are just an "angry moment" move that are sometimes regretted in the end. Oh no, I did not use paragraphs, someone quick call the "Mt Stars Editing Police!" LOL what a joke!! I am sure, however, this person will get the last word as I am not going to waste my time to go back and forth with her/him over his foolish subject anymore!! This will be MY last post. Go ahead and have the last word ..it is all yours. You know the old saying, give someone enough rope and they will hang themselves..........

Totally agree - Blueyes

[ In Reply To ..]
Totally agree, get over the "wanna be editor" attitude!! People should be able to relax here and not have to worry about being criticized for formatting errors and spelling, etc. You really do need a life!!

I didn't say it was an "error" - merely difficult to read.

[ In Reply To ..]
I thought I made my request very politely, saying both "please" and "thank you". I certainly had no intention of offending anyone.

I read your post very carefully - because I am interested in the subject matter

[ In Reply To ..]
And I too found it very difficult to read on the screen because of the dense text.

It had nothing whatsoever to do with the content of the post; simply the way it looks on the screen without being split into more readable paragraphs.

So no, it is NOT the editing police. If you have a desire to get your information out there, and it's good information to know, then it behooves you to put it in a form that is more easily readable.

All I can think is you must have a lot of rope... - Blueyes

[ In Reply To ..]

Reply - Alice

[ In Reply To ..]
Thank you for your reply. I do not disagree with anything that you wrote. However, I was not referring to a 98% QA rating. I was referring to a new policy in which an instant decrease in pay will be instituted for an entire pay period and being allowed only a few reports per day, if a wrong doc gets a cc based on a dictation by a mumbling dictator who cannot speak English, his native language. In other words, make one mistake, and your pay is affected. This has not happened to me, but it could because I am human and the provider lists provided by the client to the MTs for those who might receive copies is not complete.

Also, the client told the MTSO what penalties to apply to the ICs. The MTSO apparently cannot stand on its own feet, for whatever reason.

That was my major gripe. Second, of course, is the fact that the MTSO has made this ruling based on what the client wants, without benefit of conferring with MTs or making necessary contractual changes, which is a subject that another poster has addressed.

I'm aware of HIPAA and HITECH, just do not appreciate any MTSO doing things to us and about us, and then notifying us after the fact.

MT4Now - Nick

[ In Reply To ..]
Wow, could you please take a breath in all of that? In writing, it is known as pagination, you know, as in breaking things into paragraphs. I am sure what you say is valuable but the format is daunting and a turnoff.

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