Professional Chiropractic Conduct in Texas: Clinical and Financial Records
Written by Chris G. Dalrymple D.C., F.I.C.C.   
Thursday, July 05, 2018 05:13 PM

The phrase “If it isn’t written, it wasn’t done” is repeated so commonly that it seems crazy to question it. The TBCE has implemented rules that require much of what we do be documented.

Patient and billing records shall be maintained.

Rule 77.8, item (f) makes is clear that “Licensees shall maintain patient and billing records … . A licensee's patient records shall support all diagnoses, treatments, and billing. Records shall be timely, dated, accurate, legible, and signed or initialed by the licensee or the person providing treatment.”  That documentation of patient records support “all diagnoses, treatments, and billing” is a legal requirement of the chiropractic profession in Texas.  

Patient documentation shall contain...

Item (g) of that same rule states that doctors of chiropractic are “required…to perform an appropriate history and exam based on the nature of the presenting problem described by the patient and in accordance with accepted documentation guidelines.” See the rule itself for a listing of these accepted documentation guidelines.  Except for some non-therapeutic types of interactions, also required by item (h) are patient history;  “description of symptomatology or wellness care”;  examination findings, including imaging and laboratory records when clinically indicated; diagnosis; prognosis;  assessment(s); treatment plan;  treatment provided or recommended; and periodic reassessment(s) when appropriate, at a minimum of once per calendar year.

Item (i) notes that the patient records for “all subsequent visits shall include” an updated history that includes a review of the chief complaint(s), changes, if any, since the last visit.  Also required are “a physical exam of the area involved in the diagnosis”, and "an assessment of any change in the patient’s condition since last visit."  Finally, subsequent therapeutic visits shall include a treatment that includes documentation of treatment given, the patient’s response, and any changes in treatment plan or planned referrals if indicated.

Who is responsible? 

The rule notes that “all licensed chiropractors shall observe and comply with all documentation laws pertaining to health care providers under state and federal law.”  EVERY licensee practicing in any facility “is equally responsible for compliance” with these documentation laws.  In addition, rule 77.11 requires that “Licensees shall employ their best good faith efforts to provide information and facilitate understanding to enable the patient to make an informed choice … [and] shall allow the patient to make his or her own determination on such treatment.

This code of ethics also notes that licensees should willingly seek consultation with other health care professionals, shall not discriminate as to which patients they choose to serve, and shall conduct themselves as members of a learned profession and as members of the greater healthcare community dedicated to the promotion of health. As such, licensees should collaborate and cooperate with other health care professionals to protect and enhance the health of the public with the goals of reducing morbidity, increasing functional capacity, increasing the longevity of the U.S. population and reducing health care costs. Licensees shall recognize their obligation to help others acquire knowledge and skill in the practice of the profession, and shall maintain the highest standards of scholarship, education and training in the accurate and full dissemination of information and ideas.

How long should these records be kept?

Rule 77.8 instructs us regarding the maintenance of our patients’ chiropractic records.  “An adequate chiropractic record…for each patient shall be maintained for a minimum of six years from the date of last treatment,” until the patient reaches 21 or six years from the last treatment whichever is longer, or as mandated by other state or federal regulations.  The rule also notes that “chiropractic records that relate to any civil, criminal or administrative proceeding shall not be destroyed until the proceeding has been finally resolved.

What is included in the financial records?

Regarding financial records, rule 77.3 requires that licensees shall “at patient’s request on the date of providing goods or services to a patient, make available…a receipt or summary of the full amount of the licensee’s charges for that day. … in any written, printed or digital form reasonably calculated to notify the patient.

Rule 77.12 notes that a licensee “may accept prepayment for services planned but not yet delivered, but … The plan must be cancellable by either party at any time for any reason without penalty of any kind to the patient.  Upon cancellation of the plan the patient shall receive a complete refund of all fees paid on a pro rata basis of the number of treatments provided compared to total treatments contracted.  The plan must provide for a limited, defined number of visits.  The patient’s file must contain the proposed treatment plan, including enumeration of all aspects of evaluation, management, and treatment planned to therapeutically benefit the patient.… The patient’s financial file must contain documents outlining any necessary procedures for refunding unused payment amounts… The treatment plan in such cases where prepayment is contracted must contain beginning and ending dates and a breakdown of the proposed treatment frequency. A contract for services and consent of treatment document must be maintained in the patient’s file that specifies the condition for which the treatment plan is formulated." If other “hard goods” are to be used during the proposed treatment plan, the documents must state whether these items are included in the gross treatment costs or if they constitute a separate and distinct service or fee.”

What is fraud and healthcare fraud?

These, and other rules of the TBCE, are implemented to curtail fraud, which rule 77.10 defines as “an intentional misrepresentation where the following conditions are present: (1) there must be a cause of deception;  (2) the act or acts must show an intentional misrepresentation of fact; and  (3) the provider must stand to gain financially from the deception and misrepresentation."  The rule further defines health care fraud as “wantonly misleading or misrepresenting patient treatment circumstances or any other dynamic of the healthcare industry, resulting in any type of financial gain for the doctor, patient, or any other third party or entity.

Review rules 77.3 through 77.12 and plan to ensure that your records are in keeping with the legal requirements of the chiropractic profession in Texas. 

The Texas Chiropractic Association (TCA) works to enhance public access to and education about chiropractic practice. This article is a conversational presentation of some of the rules pertaining to patient records found in the Texas Board of Chiropractic Examiners (TBCE) rules.  These rules, just as other governmental regulations are the law.  You are directed to Chapter 77 of the rules of the Texas Board of Chiropractic Examiners for the actual rules.  This article is merely an educational summary of a portion of Chapter 77.

Source:$ext.ViewTAC?tac_view=4&ti=22&pt=3&ch=77&rl=Y     Rules 77.3, 77.8, 77.10, 77.11, 77.12