How to keep out of trouble with the licensing board
by Steven Conway, DC, DACBOH, JD

I am a new doctor just starting out in practice. In college, my jurisprudence course seemed more like scare tactics rather than anything I would see in practice. What should I be concerned about?

Inexperienced doctors make mistakes. Often they do not know they are violating state laws until it is too late. Unfortunately, "not knowing" is not a valid defense. And the penalties for violations may extend beyond those that the chiropractic examining board levies, including denials from managed-care organizations to participate in their networks.

Complaints initiated at the state board level seem to fall into five basic areas:

1. Documentation,
2. Coding,
3. Boundaries,
4. Fee splitting/financial irregularities, and
5. Advertising.

DOCUMENTATION

Proper documentation is crucial to your practice to protect you against malpractice and paybacks demanded by insurance companies. (See "How to deal with the headaches of paybacks and takebacks" and "Recordkeeping for risk management".)

If you have poor documentation, you are left with no defense.

Many state statutes require a specific level of documentation for patient treatment. If you do not produce the necessary level or quality of documentation, your license could be in jeopardy.

CODING

Coding errors get practitioners in hot water. Even though books, manuals, and seminars are available as resources, doctors make mistakes in up-coding and miscoding.

Interestingly, it is usually poor documentation that creates an opportunity for an up-coding charge: The chiropractor codes and charges for a certain level of service. But when claims are reviewed for supporting evidence of the billed code, documentation is either absent or not at a level to support the code. The chiropractor is usually charged with fraudulent coding and unprofessional conduct.

Certain codes, such as mobile diagnostics, raise red flags to investigators. However, some E&M codes, such as 99205 (evaluation and management — comprehensive history and exam, complex decision making for severe problems), cause poblems. Some chiropractors use this code for every personal-injury (PI) auto accident initial exam, although their documentation for the PI claims is not different from other initial exams.

Code 99205 (and any other code) can be used — when conditions call for the treatment and documentation supports it.

BOUNDARIES

Violation of patient boundaries are covered in "The Dating Game," in Vol. 52, Issue 6, of Chiropractic Economics, which provided recommendations to avoid this fast track to trouble. Violating employee boundaries can also cause grave problems.

FEE SPLITTING / FINANCIAL IRREGULARITIES

Fee splitting and financial irregularities cover a large area. Two things to be leery about:

• Patients for a fee. Do not be enticed by "runners" who contact auto accident victims and send you new PI or WC patients for fee.

• Cheap rentals for mobile diagnostics. Room rentals for mobile diagnostics that do not reflect current standard lease rates may be seen as a front for kickbacks for patient referrals to the diagnostic companies.

Meet with a local attorney who is familiar with health law before undertaking any activity that falls into these categories.

ADVERTISING

The free exam may be a ticket to trouble. Medicare prohibits giving free services. And many states have regulations and statutes that bar free exams.

When free services are permitted, chiropractors often get into trouble in the transition from providing free services to services with charges associated with them. Unless the chiropractors have clear written policies that outline free and charged services, patients can be confused and angry when they receive a bill for services they assumed were free. And angry patients make complaints to the board.

Steven Conway, DC, DACBOH, JD, is a partner in True North Chiropractic Consultants LLC, which provides guidance and ethical solutions to the barriers found in chiropractic practices. He can be contacted through truenorthchiropracticconsultants.com or by e-mail at chirolaw@aol.com.

DISCLAIMER: This column is provided for educational purposes only. The accuracy or timeliness of the information presented is not warranted. The information is not presented as legal advice and no attorney-client relationship is established.