Being called before the board can have a dramatic effect on your professional reputation and the future of your practice. Here are some allegations and determinations that warrant the attention of every dentist with regard to billing, electronic documentation and board requests.

Posted in Malpractice Insurance on Thursday, November 10, 2016

Did you know that stipulation agreements as the result of a board inquiry or action are public information? In fact, as part of the underwriting process, insurance carriers will usually review state dental board websites to determine if any actions have been initiated or concluded regarding your practice. 

As you may guess, being called before the board can have a dramatic effect on both your professional reputation and the future of your practice.

In a recent stipulation agreement, the doctor in question had several issues with which the board took exception, finding his actions violating the dental practice act for that state. Among the issues were allegations and determinations which warrant the attention of every dentist with regard to billing, electronic documentation and board requests. 

The findings of the dental board in this case concluded that:

• The dentist in question failed to formulate and implement policies related to billing.
• As a practice owner, the dentist failed to take steps to ensure the practice billed in accordance with treatment provided.
• The practice in question billed for multiple procedures which were not rendered.
• The dentist failed to take steps to investigate billings when information presented would have alerted him to billing errors.
• The dentist used default templates as part of their documentation, but failed to detect and correct erroneous default templates.
• The dentist failed to provide the board with the entire records pursuant to subpoenas and requests.

In light of this situation, you should take some time to review your practices in regards to billing, templates and investigations.

Billing

While billing might be a task that is delegated to a staff member at your practice, board actions clearly illustrate that you, as the practice owner and dentist, are responsible for formulating and implementing policies related to billing.

Additionally, if you are notified of irregularities, it is your responsibility to investigate them.

For more information on dental fraud and abuse in this area, take a look at Dental Economics article, Dental Healthcare Fraud and Abuse.

Templates

With regard to using templates in electronic health records, they are designed to make your life easier. However, board actions have revealed that templates should be used as a starting point for your practice and not as the final documentation.

Chart notes should accurately document the individual treatment rendered to the patient. For legal defense, the universally accepted position is that if it is not documented, it did not happen.

At PSIC, we advocate that the more clearly you document your assessment, treatment and treatment plan, the better we are able to defend you when or if a claim should arise.

Even when using a template, be sure that your notes are complete, timely and an accurate reflection of the services you provided.

Board Investigations

When it comes to dealing with the board, it is best to get the PSIC team involved. Remember, the licensing board is there to protect the consumer, not the dentist.

If the board contacts you and it is not regarding your license renewal, there is a good chance that it is an investigation. If this happens, you should contact us immediately. Even if you are not sure whether the situation is an actual claim or a licensing board investigation, call the PSIC Claims Department at 1-800-640-6504.

Our professional claim representatives will help you determine the best course of action, and your coverage will not be jeopardized by placing the call.

Under these circumstances, the PSIC team may help you use your coverage to its fullest advantage or point you to resources of which you may not be aware. In the case of a board investigation, you will need the experience of an attorney who is familiar with licensing board investigations.

To find out more about the PSIC Dental Claims Services, visit the Claims Services portion of our website.