TBCE TEN: Guidelines for DC’s Considering Employment
Written by Editor   
Tuesday, August 08, 2017 01:08 PM

The TBCE is implementing changes pursuant to recently passed legislation that will impact DC’s working within non-DC owned facilities. As of September 1, 2017, the TBCE will no longer register facilities. This means that facility owners will not be required to renew/register a facility, report ownership interests and otherwise keep their information current with the agency. The TBCE, however, maintains the authority and responsibility to regulate all aspects of chiropractic services within a facility, including billing for services and the maintenance of patient records. With this in mind, the TBCE offers the following ten guidelines for DC’s who are considering potential employment within a facility and entering into related business agreements.

When considering employment:

1. Check references of potential employer and the other associate doctors in the clinic.  Ask the employer for at least three (3) references to provide background information in support of ethical business practices and professional behavior. Review a potential employer’s website to assess whether it is in compliance with TBCE rules and Texas scope of practice; TAC Rule §77.2 Publicity.

2. Check the TBCE website. Whether a licensed DC or not, a potential employer may have a history of violations, including prior revocation of facility registration, which record is kept by the TBCE. Click the “Consumers” tab to access the Professional Profiling System for the record of a prior facility owner or licensed DC.

3.  Check additional resources for criminal history. You can also check the county/district court civil and criminal records in various counties for filings and final judgments against a potential employer. http://www.dallascounty.org/districtclerk/records-faqs.html 

4.  Personally inspect the facility for general appearance, cleanliness, and atmosphere. Consider the morale, friendliness, and professionalism of staff and other associate doctors. A DC’s license is susceptible to disciplinary action for treating in a clinic with unsanitary or other unsafe, prohibited conditions; TAC Rule §78.1(4).

5. Employment Agreement. Consider your rights and responsibilities when entering into an employment agreement. You should have the right to audit all billing associated with your NPI number and/or billing submitted on your behalf for the patients you have treated. Submission of correct billing is the responsibility of the licensed DC, as it is the DC who will be called before the Board for substantiated complaints regarding incorrect billing.

6 .Obtain legal advice.  The expense for sound legal advice when considering entering into an employment contract is worth peace of mind, as well as avoidance of fines, suspensions, and other disciplinary action against your license.

7. Protect Your NPI Number. Your NPI number is as important as your Social Security number. Each DC must have a personal NPI number. The clinic or company that employs you should only use your personal NPI number when billing for services that you have provided. A clinic/company may also have its own group NPI number for billing, in which case both numbers should be included on the claim form. Upon leaving a clinic or company, it is the DC’s responsibility to contact each insurance carrier to inform of the effective date of leaving. This further protects the DC’s NPI number from potential fraudulent use in billing. Also note: All DC’s must notify TBCE within 30 days of changing addresses to practice chiropractic in another location or clinic; TAC Rule §75.1

8. Miscoding. If a facility owner or billing personnel up-codes or otherwise alters the codes a DC recorded on a superbill or travel sheet, it remains the DC who is legally liable with the Board and other authorities for the miscoding. Make sure you are the one coding your services and that your codes are not altered by the billing department. An associate doctor should be knowledgeable in the coding and documentation requirements by TBCE, Federal, commercial and third party payers.

9. Medicare Enrollment. An associate doctor cannot treat any Medicare or commercial insurance (Blue Cross/Blue Shield, Aetna, etc.) patients without first becoming credentialed/enrolled as a provider. The clinic/company that employs the associate doctor should assist employees in the enrollment process if they are accepting Medicare & commercial insurance patients. The Medicare enrollment process can take 90-180 days to complete. A non-credentialed associate doctor may treat cash patients and most auto accident cases without restrictions. It is fraudulent to bill for services provided for Medicare patients or commercial insurance coverage under another DC’s NPI number.

10. Be knowledgeable with HIPAA rules and regulations. There are several CE courses that address HIPPA requirements for health care professionals. This includes HB 300 which is required by Texas. See https://www.hipaatraining.com/hipaa-and-texas-hb300-training. Attestation should be completed within 60 days of new employment in any clinic/company and renewed every 2 years. Ask the employer who their HIPAA compliance officer is and to view the HIPAA and OIG compliance manuals, including their risk analysis assessment for the practice. A well-run health clinic will have these in order.

Source: Texas Board of Chiropractic Examiners