Pay adjustments per patient

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Re: Pay adjustments per patient

Postby sleepprofessional » Sat May 09, 2015 10:54 pm

Sorry, but it is a violation of FEDERAL law. Federal law trumps State law in all 50 States. But, please continue to fail to pay your non-exempt employees an HOURLY rate AND track their hours; otherwise, your employees won't be able to collect a judgment against your company in FEDERAL court. But, like I said, keep doing what you're doing...kinda like the sleep labs that keep using non-credentialed techs to do sleep studies on Medicare patients. Remember, if you want clarification on Federal labor laws you need to call the U.S. Department of Labor...not the State Department of Labor. If you will PM the name and location of your sleep lab to me, I will gladly arrange proof for you that you are violating Federal law. Whadda ya say?
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Re: Pay adjustments per patient

Postby somnonaut » Sun May 10, 2015 6:12 am

NC must be a Right to Work....for free state. Yeah see how that whole "unions suck" thing comes back to bite everyone in the ass.
Gotta love irony.
http://www.nrtw.org/right-work-states-north-carolina
Can you say unconstitutional law?
So, now it is against the law to ASSOCIATE with other groups.
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Re: Pay adjustments per patient

Postby tiredjohnny1 » Sun May 10, 2015 12:23 pm

I don't like many of the pay arrangements in the sleep field. However, Sleepprofessional shows up occasionally, states how people are breaking federal law, cites an entire document and not specific statutes, then when responses are posted that show clearly he is inaccurate, he continues to believe what he believes. (We wont even address his comment about nonregistered techs, as we've discussed that before.) Well that's to be expected on the internet I guess.

Ok, after reading all 64 pages of the document cited, and of course without being a lawyer, basically my take on all these arrangements where pay can change is that there should be a standardized method of computation and everyone should get paid minimum wage and overtime.

As an example lets say a sleep tech makes $25 p/hour and works 40 hours p/week (4-10 hour shifts) with an expectation that the tech will normally have 2 patients per shift. Now the employer wants to reduce pay by $50 if only 1 patient or perhaps pay an extra $50 for 3 patients.
1. Track employee hours and change the 'regular rate' to: $15 p/hour. So every paycheck shows a regular rate of $600 p/week (40 hours x $15 p/hour).
2. Pay a 'premium rate': Each patient: $5 p/hour. This equates to $50 p/night p/patient. (Or bonus $50 p/patient.)
So the tech makes a nightly regular pay of $150. Then he additionally also always makes the 1 patient 'premium rate' of $50, totally $200 p/night, or $20 p/hour. If he has 2 patients he will make $250 p/night, or $25 p/hour. If he has 3 patients he will make $300 p/night, or $30 p/hour.

Sum it all up: assign a 'regular rate' that doesn't change. Keep track of all hours worked. Alterations in pay based on # of patients should be separate transactions (premium rate, bonus, etc.). You should be able to explain to any federal auditors your methodology, that you pay a regular rate and then a premium or bonus, not that you subtract or add from a regular rate based on workload. And if you pay your nightly techs as 1099 workers, well then there is no help for you if you are audited, although that is not the DOL but the IRS that will be asking the questions and you will lose.
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Re: Pay adjustments per patient

Postby sleepprofessional » Sun May 10, 2015 1:21 pm

Although tiredjohnny is often wrong about Federal laws and regulations he finally seemed to get it on this one a little..at the end. FLSA requires record keeping of actual hours worked and one and one-half times the employee's regular hourly pay-rate for all hours worked in excess of 40 hours per week.
If you pay a tech "per shift" you simply are failing to meet these requirements. Again, it appears that some are confusing State law as being the same as Federal law. Federal law trumps State law. If you are in doubt about your situation you can call any one of the local U.S. Department of Labor Enforcement Offices closest to where you live; or if you are an affected employee contact a local attorney who practices labor law and the attorney will represent you in a lawsuit as FLSA mandates that (if your employer is violating FLSA) your employer must also pay YOUR attorney's fees and costs.
Also, paying a sleep tech who routinely works at your sleep lab as a 1099 is a FLSA violation and subject to the same fines and penalties.
As far as tiredjohnny's reference to non-credentialed sleep techs being used to perform sleep tests on Medicare patients, google search the case of American Sleep Medicine. The sleep tech who blew the whistle on ASM was paid $2.6 million by the Feds for reporting ASM for using non-credentialed techs.
In short, if you are a tech who works at a lab that is violating Federal law...report them. If you are unsure of the process for filing a complaint, feel free to PM me and I will put you in touch with the right Federal agencies.
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Re: Pay adjustments per patient

Postby sleepprofessional » Sun May 10, 2015 1:29 pm

Tiredjohnny was wrong again when he stated I don't cite specific laws. If you look at my original post several months ago, you will see that I cited "29 United States Code, Chapter 8, Title 29". Must be tired indeed johnny...and wrong. Get some sleep my friend johnny. Remember excessive tiredness has been clinically demonstrated to result in excessive errors.
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Re: Pay adjustments per patient

Postby tiredjohnny1 » Sun May 10, 2015 3:35 pm

sleepprofessional wrote:Tiredjohnny was wrong again when he stated I don't cite specific laws. If you look at my original post several months ago, you will see that I cited "29 United States Code, Chapter 8, Title 29". Must be tired indeed johnny...and wrong. Get some sleep my friend johnny. Remember excessive tiredness has been clinically demonstrated to result in excessive errors.


Apologize for the wording...should have written he does not cite 'relevant section(s) of a statute'....As I did mention however, citing an entire statute that is a 64 page document is fairly useless. A specific section/reference that is a direct correlation to the issue is much more useful.
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Re: Pay adjustments per patient

Postby tiredjohnny1 » Sun May 10, 2015 3:37 pm

sleepprofessional wrote:Although tiredjohnny is often wrong about Federal laws and regulations

This is again an inaccuracy. My record on binarysleep would prove this statement false. I am rarely if ever inaccurate, as anything I write pertaining to law/regulations are completely researched/documented. I have spent thousands of dollars of my own money getting legal advice from a board-certified healthcare attorney so that I don't do or tell others to do illegal or unnecessary things.

sleepprofessional wrote: Also, paying a sleep tech who routinely works at your sleep lab as a 1099 is a FLSA violation and subject to the same fines and penalties.

This is an example of why I wrote that Sleepprofesssional posts inaccuracies on this forum. I wrote that nightly techs cannot be 1099 workers. I did not write a 'sleep tech' (This implies that the rule applies to ALL techs who routinely work at a lab). A sleep tech who only scores, chooses what days he works, and is not directly managed is very likely a 1099 worker.


sleepprofessional wrote: As far as tiredjohnny's reference to non-credentialed sleep techs being used to perform sleep tests on Medicare patients, google search the case of American Sleep Medicine. The sleep tech who blew the whistle on ASM was paid $2.6 million by the Feds for reporting ASM for using non-credentialed techs.
In short, if you are a tech who works at a lab that is violating Federal law..port them. If you are unsure of the process for filing a complaint, feel free to PM me and I will put you in touch with the right Federal agencies.


Again, inaccuracies. 1. He wrote that non-credentialed techs cannot run Medicare patients. That may or may not be true. The only federal tech credentialing requirement is in the setting of an IDTF. In the setting of an IDTF, Chapter 42 of the Federal Register Section 410.33(c) states that a tech must be licensed or if no licensing is available, the technologist must be certified by an appropriate national credentialing board. So there are no federal requirements for techs running studies on Medicare patients in any other setting (hospital, doctors office, etc.) A local Part B contractor may require those credentials in other settings however. It may be that most states require credentialed techs to run Medicare studies, but it is inaccurate to claim that in all states and all settings a tech has to be registered to run a Medicare study.

2. For running studies on any Medicare patients in the IDTF I specifically wrote 'non-registered,' not 'non-credentialed.' The Federal Register did not specifically state what defines 'certified' or 'national credentialing board.' There is no national coverage determination for Part B that states tech requirements that I can currently find. Absent that, the local determination coverage documents apply. In Florida, Sleepprofessional's states, the LCD indicates that non-registered techs are 'credentialed' by virtue of the sleep labs accreditation. It further provides specific direction about non-registered techs. "Unregistered technologists and technicians....must be supervised by a registered technologist." LCD29949

I don't believe I have ever posted inaccuracies when it comes to these issues, but as I've written in the past, contact a healthcare attorney, because as you can read, inaccuracies are sometimes posted here.
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Re: Pay adjustments per patient

Postby sleepprofessional » Mon May 11, 2015 2:35 pm

For further definitive guidance about the wage and hour status for sleep techs read the the U.S. Department of Labor Wage & Hour Division Fact Sheet #170: Technologists and Technicians and the Part 541 Exemptions Under the Fair Labor Standards Act, which states "Technologists and technicians do not meet these requirements for the learned professional exemption".
Yes, always seek guidance from the U.S. Department of Labor for guidance on wage issues, and from the U.S. Department of Health and Human Services Office of the Inspector General regarding settled issues regarding technician credentialling requirements. Because, yes, being the internet, some people will repeatedly post their erroneous opinions rather than fact.
But, if you are a non-credentialed tech working at a sleep lab where you are assigned to perform sleep studies on Medicare patients, google "American Sleep Medicine Medicare Fraud" and read about Daniel Purnell receiving $2.6 million dollars for blowing the whistle about that very issue at ASM.
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Re: Pay adjustments per patient

Postby sleepprofessional » Mon May 11, 2015 3:17 pm

As for credentialing, in Florida, LCD 29949 applies to all non-IDTF sleep labs "including sleep clinics that are part of a physician's office".
As for technician credentials it clearly states, "Sleep technicians or technologists attending PSG or sleep studies affiliated with HST must have appropriate personnel certification. Examples of certification of certification in PSG and sleep technology for technologists are: (1) RPSGT, (2) R.EEG.T, (3) CRT-SDS, (4) RRT-SDS."
Again, notice the phrase "must have appropriate personnel certifications". Furthermore, the case law established by the U.S. Attorney's Office for the Middle District of Florida is clear on the issue that a lab being accredited does not confer any personnel certification on the the personnel performing the sleep test. Perhaps, tiredjihnny, management at American Sleep Medicine (based in Florida) read your previous posts and followed your guidance...which is why they had to pay $15 million dollars to the Federal government ($2.6 million went to the tech who blew the whistle). So, please, if you work at tiredjohnny's sleep lab, and you perform sleep studies on Medicare patients and you do not have a recognized credential in sleep technology, PM me and I will put you in touch with a law office that handles these fraud cases.
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Re: Pay adjustments per patient

Postby somnonaut » Mon May 11, 2015 3:41 pm

sleepprofessional wrote:So, please, if you work at tiredjohnny's sleep lab, and you perform sleep studies on Medicare patients and you do not have a recognized credential in sleep technology, PM me and I will put you in touch with a law office that handles these fraud cases.


Only for Florida? Do you have a listing of ALL 50 states CMS guidelines and what restrictions they place on labs in terms of credentialing of staff? That would be a starting point to help get the ball rolling on making unscrupulous labs to atone.

Possible column headings:
State; Lab type: Hosp, Doc, IDTF; credential required y/n; Example of credential type offered? (list);
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Re: Pay adjustments per patient

Postby tiredjohnny1 » Mon May 11, 2015 7:32 pm

sleepprofessional wrote:As for credentialing, in Florida, LCD 29949 applies to all non-IDTF sleep labs "including sleep clinics that are part of a physician's office".

Yes I wrote that LCDs in many states require credentialing of techs in non-IDTF settings. Florida is one of those states. Sleepprofessional restated what I already wrote.

sleepprofessional wrote:As for technician credentials it clearly states, "Sleep technicians or technologists attending PSG or sleep studies affiliated with HST must have appropriate personnel certification. Examples of certification of certification in PSG and sleep technology for technologists are: (1) RPSGT, (2) R.EEG.T, (3) CRT-SDS, (4) RRT-SDS." Again, notice the phrase "must have appropriate personnel certifications".

Yes that is a list of examples. Immediately after that list is this:

"Credentialing must be provided by nationally recognized credentialing organizations such as:
• Board of Registered Polysomnographic Technologists (BRPT) that provides (RPSGT) credential; OR
• American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET) that provides R. EEG T.) – Polysomnography credential;OR
• Performed in a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM), or Accreditation Commission for Health Care (ACHC), or Joint Commission; OR• American Board of Sleep Medicine (ABSM) that provides credentialing in sleep technology;OR
• National Board for Respiratory Care, Inc. (NBRC) that provides specialty examination for respiratory therapists performing sleep disorders testing and therapeutic intervention (CRT-SDS and RRT-SDS)

All technologists and technicians conducting sleep testing who are not registered by the BRPT, ABRET, ABSM, NBRC or other accepted certification body, must be affiliated with an AASM or ACHC accredited sleep facility or Joint Commission accredited sleep facility (a Joint Commission accredited sleep laboratory). Unregistered technologists and technicians must maintain appropriate training and supervision, and, be supervised by a registered and licensed technologist, where license is required by state law."

Ok. Am I missing something???????? Unregistered techs can work at accredited labs as long as they are supervised. Anyone can read it for themselves. Here is the link to the LCD: http://medicare.fcso.com/Fee_lookup/LCD ... ?id=L29949

sleepprofessional wrote: Furthermore, the case law established by the U.S. Attorney's Office for the Middle District of Florida is clear on the issue that a lab being accredited does not confer any personnel certification on the the personnel performing the sleep test.

Please cite a source. The AMS case was brought before the Western District of Kentucky. Although AMS is headquartered in Florida and has many labs in Florida, no action was brought by Florida as far as I can tell. The only case I could find in the Middle District of Florida is the Nichols case. If that is the case being referred to, that is absurd. Their techs were ex-strip club employees who had no personal degrees or credentials and never received training in performing sleep studies. They were obviously not qualified or credentialed due to their personal lack of training. Their affiliation with an accredited lab was never mentioned because that was irrelevant, as they were personally not qualified due to lack of appropriate training, nor were they supervised.

sleepprofessional wrote: Perhaps, tiredjihnny, management at American Sleep Medicine (based in Florida) read your previous posts and followed your guidance...which is why they had to pay $15 million dollars to the Federal government ($2.6 million went to the tech who blew the whistle).

As I've often written, if someone has questions about what is appropriate consult a healthcare attorney. I did that and I also emailed and received written guidance on the matter from FCSO, the part B administrator in Florida, for clarification.

sleepprofessional wrote:
So, please, if you work at tiredjohnny's sleep lab, and you perform sleep studies on Medicare patients and you do not have a recognized credential in sleep technology, PM me and I will put you in touch with a law office that handles these fraud cases.

For the record, I personally believe that sleep studies, regardless of insurance, should be performed by RPSGT or RRT-SDS only. As far as my lab, the techs are registered so studies are performed by registered techs no matter the insurance. I personally don't think its right that Medicare studies can be performed by unregistered techs, I just hate inaccuracies flooding this board.
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Re: Pay adjustments per patient

Postby tiredjohnny1 » Mon May 11, 2015 7:42 pm

somnonaut wrote:
sleepprofessional wrote:So, please, if you work at tiredjohnny's sleep lab, and you perform sleep studies on Medicare patients and you do not have a recognized credential in sleep technology, PM me and I will put you in touch with a law office that handles these fraud cases.


Only for Florida? Do you have a listing of ALL 50 states CMS guidelines and what restrictions they place on labs in terms of credentialing of staff? That would be a starting point to help get the ball rolling on making unscrupulous labs to atone.

Possible column headings:
State; Lab type: Hosp, Doc, IDTF; credential required y/n; Example of credential type offered? (list);


Can get started here if someone has a question about their own state:

http://www.cms.gov/medicare-coverage-da ... A%3d%3d&=&
Click on 'Local Coverage Documents'
Select Your 'Geographic Region' (your state)
Enter CPT Code 95811
Click on 'Search By Type'
Once the results are displayed, in the column 'Expand ID' click on the + (plus sign).
Click on the LCD that applies to Part B
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Re: Pay adjustments per patient

Postby tiredjohnny1 » Mon May 11, 2015 8:01 pm

sleepprofessional wrote:For further definitive guidance about the wage and hour status for sleep techs read the the U.S. Department of Labor Wage & Hour Division Fact Sheet #170: Technologists and Technicians and the Part 541 Exemptions Under the Fair Labor Standards Act, which states "Technologists and technicians do not meet these requirements for the learned professional exemption".
Yes, always seek guidance from the U.S. Department of Labor for guidance on wage issues, and from the U.S. Department of Health and Human Services Office of the Inspector General regarding settled issues regarding technician credentialling requirements. Because, yes, being the internet, some people will repeatedly post their erroneous opinions rather than fact.

Yes the exemption being referred to is for exempt vs. non-exempt employees as it relates learned professionals. Most night techs will not qualify as exempt employees, that is, paid a salary. However, scoring techs and managers may qualify for salary (exempt status) under one of the other exemptions.
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Re: Pay adjustments per patient

Postby #42dreamweaver » Wed May 13, 2015 1:05 pm

I don't know bout y'all, but I love a "who's heated tubing is bigger" contest on Binarysleep. :lol:
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Re: Pay adjustments per patient

Postby somnonaut » Wed May 13, 2015 11:33 pm

So what do you all think of this hoo ha from NYS Entire Polysomnograhpy CMS guidelines:

"For all non-hospital based facilities, the facility must have on file documentation that it is in compliance with the criteria set by the American Sleep Disorders Association, the American Academy of Sleep Medicine or the Accreditation Commission for Health Care, Inc. Failure to supply such documentation may result in denial of the claim. Medicare does not cover sleep studies performed in mobile sleep laboratories.

The sleep laboratory or testing facility must be affiliated with a hospital or be under the direction and control of a physician (MD/DO), even though the diagnostic test may be performed in the absence of direct physician supervision. The laboratory physician director must be/have:

Board-certified in sleep medicine (ABSM, i.e., Diplomate of, or board-eligible for, the American Board of Sleep Medicine; or
A diplomate or board-eligible for an American Board of Medical Specialties (ABMS) approved board; or
Completed residency or fellowship training by an ABMS member board and has completed all the requirements for subspecialty certification in sleep medicine except the examination itself, and only until the time of reporting of the first examination for which the physician is eligible; or
An active staff member of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM), the Accreditation Commission for Health Care, Inc. or The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

HST scoring must be performed by an individual certified by the Board of Registered Polysomnographic Technologists as a Registered Polysomnographic Technologist (RPSGT), or equivalent, or by a polysomnographic technician under the supervision of a RPSGT, or equivalent. RPSGTs and polysomnographic technicians must meet the standards for such individuals promulgated by the American Academy of Sleep Medicine Standards for Accreditation of Laboratories for Sleep Related Breathing Disorders, or by the Accreditation Commission for Health Care, Inc. Standards for Accreditation for Sleep Programs and be licensed or certified by the state in which they practice, if such licensure or certification exists. The laboratory physician must review the entire raw data recording for every patient studied. "
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