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peer review

Peer Review, Collections and Complaints ... Oh My!

Defense attorney Jenn Herlihy has noticed several types of board allegations are becoming more common. Here are her recommendations to help you reduce the chance of a board complaint being filed against you.

In my experience, billing complaints, online marketing complaints, audits (most recently Medicare) and complaints based on peer review are of increasingly concern for D.C.s:

Collection agencies. More board complaints against D.C.s are being triggered due to the actions of their hired collections agencies. You need to know what these agencies are saying and doing on your behalf. Otherwise, it may lead to a board complaint against you! I recommend you find out what the agency will be communicating with your patients, e.g., the initial contact letter and any follow-up correspondence for nonpayment. Keep copies of these documents in your files.

Outside billing. If you don’t do in-house billing and provide a signature or signature stamp, which I do not recommend, you need to review bills for accuracy. At minimum, review a random sample at regular intervals. Further, know the codes for billing. The biggest mistake seems to come with the initial and re-evaluation codes. These are “complexity” based, not “time” based.

Payment discounts. If you have a “prepay discount” package or similar plan, check your state’s board guidelines to determine if it’s appropriate. If so, have a documented policy that is clear to the patient. It needs to be fair and followed to the letter of the agreement.

Online marketing. Although programs such as Groupon look like great marketing opportunities on the surface, the problem is that the company shares in the sales. Thus, most states consider these offers to be fee-splitting, and therefore, illegal.

Medicare payments. Providers are now being audited on past records, so even if your system is now compliant, you could receive repayment requests.

Peer review. Many states consider conducting a peer review as practicing chiropractic. Some states go as far as mandating licensure and limiting the percentage of your practice devoted to this activity. Review the regulations and adhere to any expert requirements for your state.

5 More Tips to Protect Your Practice

  1. Regulatory updates. You can find links to every state’s board regulations on (click on the “Directory” tab). Review these and determine when the information was last updated. The amount of practical information varies by state, but some states even let you ask specific questions of the board. You especially want to know your board’s policy on:
  • Recordkeeping and retention
  • Informed consent forms
  • Which therapeutic modalities are allowed (by whom and what must be documented)
  • Any requirement for staff credentialing
  • CE credits for licensing renewal requirements
  1. Internet. A chiropractor must be extremely careful about what they place into the public arena. Many times, a complaint of inappropriate conduct will include questionable content on a web page. A good rule of thumb is to keep all Internet-based materials professional. Further, train your staff on the potential of HIPAA violations resulting from innocent or inadvertent postings.
  2. Boundary violations. Many patient complaints center on perceived (or real) boundary violations. The lines become further blurred if there was a relationship, even a consensual one. A chiropractor who wants to date a patient must end the professional relationship, refer that patient to another practitioner, and then wait a substantial length of time before seeing him or her socially. Some states may provide a time requirement. Regardless, the doctor/patient relationship must end, and the referral must be made and documented.
  3. Advertising and marketing. Make sure you represent yourself and your practice pursuant to the regulations of your state. Only offer permissible services and be clear about your credentials—sometimes patients will claim they thought they were being treated by an M.D. Unclear language implying warranties or guarantees is very difficult to overcome with boards. Do not solicit outside of board regulations, particularly in auto and personal injury cases.
  4. Facility compliance. Many states have regulations for the chiropractic facility that require a separate facility license. This becomes more likely if it is not a solo practice or if other professionals (e.g., a physical therapy group) share the space. If so, consider hiring a professional to make sure that you and your practice are compliant.

If you implement the above tips, you will be in a better position to protect yourself from any adverse action before a board or in court. In the event of a complaint, audit or malpractice claim, remember to contact NCMIC immediately to verify your coverage and to assist you in any response.

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