Tips for verifying overtime
With all of the paperwork and record keeping handled in a home health agency, none is more important to employees and more frustrating to managers than keeping track of time worked for hourly employees.
The January 2002 decision by the U.S. District Court for the Northern District of Ohio at Cleve-land that ruled against a home health agency that paid a nurse a combination of per-visit fees and hourly wages has caused many home health agencies to review their pay practices.1 As different approaches to paying staff are evaluated, managers who opt to pay hourly wages with overtime for work more than 40 hours per week are looking for the best way to document and verify time worked. (See Hospital Home Health, April 2002, p. 39.)
First of all, overtime for home health is defined as any time greater than 40 hours in a seven-day pay period, says Liz Pearson, Esq., president of Pearson and Bernard, a law firm in Covington, KY, that represents home health agencies. "Your pay period doesn’t have to run Sunday through Saturday," Pearson explains. "You can define it as Monday through Sunday, if that works best for your business." This differs from many hospitals that have two-week pay periods and 80 hours worked, she adds.
Making sure your field staff understand when the day begins and ends also is important, says Pearson. The workday begins upon arrival at the first patient’s home or the office, if the clinician starts the day there, she explains. From that first visit or stop at the office, all travel time to the next visit counts as work time, she adds.
The workday ends at the completion of the last patient visit or a stop by the office, if required, Pearson says. "The workday does not include the travel time from the employee’s home to the first visit or the time from the last visit to the employee’s home.
"Within the workday, a specified amount of unpaid time, usually one hour, must be allowed for the employee’s mealtime, she adds.
It is important to make sure employees understand that overtime is hours worked and has nothing to do with productivity levels, explains Renee Korb, CPA, a home health consultant in Indianapolis. If a clinician is very productive and able to make more visits in a workday than other clinicians, that is rewarded with bonuses or salary increases, she adds.
When employees are responsible for tracking their own time, there may be questions raised about the accuracy of hours reported, says Korb. One way to verify hours and locations of work is a telephony system, she suggests. The telephony vendor can provide the home health agency with an 800-number for clinicians to call when they arrive at the patient’s home and when they depart the home. (See list of resources at the end of this article.)
The telephony system can identify the number from which the call is made and match it to the patient’s telephone number that is programmed into the system, Korb explains. Because the clinician’s schedule is also entered in the system, a follow-up report that lists the clinician’s schedule, time of arrival, and time of departure can be used to compare to the employee’s report of hours worked, she says.
Many agencies also are using telephony systems to collect information on activities performed during the visit at the same time the clinician makes the departure call, Korb says. (See HHH, July 2001, p. 73.)
"Three years ago, we implemented a telephony system for our aides, and we are planning to expand it to our nurses and other staff members," says Sharon Chilcoate, MSW, LCSW, director of home health services for Reid Hospital and Healthcare Services in Richmond, IN. "Our aides call upon arrival and upon completion of the visit," she says. The aides use the telephone to key in the tasks that were completed when they make the departure call, she says.
Chilcoate’s agency tries to avoid overtime by scheduling field staff carefully. "Standard productivity for our nurses is six visits per day and we do schedule geographically to make it easy for them to get from one patient home to another," explains Chilcoate. "We also offer patients the option of visits on the weekend, and we have nurses who work weekends only," she adds. This does decrease the number of visits that Monday-through-Friday nurses may need to squeeze in, she says.
"We monitor overtime carefully, and if one person seems to report more overtime than is typical, we take a look at the schedule and ask the person to come in to talk with us," Chilcoate says.
Part of counseling an employee who routinely reports overtime might be to go with the employee on several visits, Korb says. "If one person is taking a significantly longer time to do the same job as other people, it might mean the employee needs additional training related to specific activities," she says.
Other reasons may include unusually heavy traffic at the time of day the employee is traveling a certain route, or even a temporary detour due to road construction, she adds. When you discover an overtime variance, the key is not to jump the gun, she says. Following counseling and re-training if necessary, monitor the time to see if there is an improvement. "If there is no improvement, you have an employee who can’t do the job and should be fired," Korb adds.
If you don’t choose to use telephony to track employees, be sure to have the paper or electronic documentation to verify hours worked, Pearson suggests.
"Document travel time separately from patient visit time, and document all time the clinician completed paperwork, even if the paperwork is completed at the nurse’s home," she says.
Pearson does point out that clinicians taking paperwork home may be a practice that needs to be reviewed in light of the Health Insurance Portability and Accountability Act. (See Hospital Home Health, June 2002, p. 61.)
You can verify visits and activities performed during a visit by making a telephone call to the patient following the scheduled time for the visit, Korb suggests. "This can be part of your quality improvement initiative, gather patient satisfaction information at the same time you verify the visit," she says.
If you do plan to make telephony a part of your home health agency’s effort to collect accurate data on time worked as well as visits made, be sure to inform your patients, Chilcoate suggests. "We were concerned at first that patients would be uncomfortable with our employees using their telephones," she admits.
That did not present a problem once the system was explained to patients, she adds. "We now include an explanation of the system in all of our admission packets."
Prepare for unusual circumstances in which a telephone may not be available in a patient’s home, Chilcoate says. "We just ask employees to call as soon as they get to a working phone and let us know why the call could not be made from the patient’s home."
"I am convinced that telephony is the way to go," Korb points out. "With vendors offering systems that interface with scheduling, billing, and payroll, life for home health managers can be simplified."
[For more information about tracking and verifying overtime, contact:
- Sharon Chilcoate, MSW, LCSW, Director of Home Health Services, Reid Hospital and Healthcare Services, 1401 Chester Blvd., Richmond, IN 47374. Telephone: (765) 983-3157. E-mail: firstname.lastname@example.org.
- Renee Korb, CPA, Consultant, 627 N. Pennsylvania St., Indianapolis, IN 46204. Telephone: (317) 387-7375. E-mail: email@example.com.
- Liz Pearson, Esq., President, Pearson and Bernard, 1224 Highway Ave., Covington, KY 41011. Telephone: (859) 655-3700. E-mail: firstname.lastname@example.org.
The following vendors offer telephony systems for home health:
- Santrax, 26 Harbor Park Drive, Port Washington, NY 11050. Telephone: (800) 544-7263; (516) 484-4400; or (718) 628-2277. Fax: (516) 484-6084. Web site: www.santrax.com.
- CareWatch, 5555 Oakbrook Parkway, Suite 330, Norcross, GA 30093. Telephone: (866) 869-4953 or (770) 409-9084. Web site: www.carewatch.com.
- LoginSoft, 4510 Daly Drive, Suite 300, Chantilly, VA 20151. Telephone: (703) 788-4900. Web site: www.loginsoft.com.]
1. Wendy Elwell v. University Hospital Home Health Care Services, No.-98-02472, U.S. Court of Appeals for the Sixth Circuit (Jan. 11, 2002).