I have been observing the Enforcement Committee of the TBCE these past several months and have reported to you previously the kinds of infractions and errors that have been occuring and how to insure that you avoid them.  My interest is less in bringing you the "gory details" but rather in sharing the simple preventions that can help to prevent infractions in the first place.

From the February meeting I came away with the observation that DOCTORS, WHEN THE TBCE SAYS RESPOND IN WRITING, this means respond in writing.  Some never respond, some respond ONLY by phone conversation.  WRITTEN RESPONSE MEANS WRITTEN RESPONSE doctors.  Make the time to craft your written response and return it in a timely manner.  Some members of the TBCE are entertaining the idea of making "non-response" a greater category (read this "more expensive fine") and one that will be reported to federal databases.  Some level of violations are not reportable to the federal database of violators, and other levels are.  Some members are entertaining making some violations "more reportable" to the federal databases.

Another significant observation concerned one violation that included, but did not center upon, an unregistered facility in the doctor's home.  The point being here, doctors, is that if you treat a "significant" number of patients at home or in a facility other than your primary facility, you may wish to take the time to register it as a facility rather than risk the violation of operating a non-registered facility.  This particular case seemed to indicate that the doctor in question routinely saw weekend patients at his home.  The point is, just use caution.

Another fairly regular violation heard by the committee is for failure to renew a license, or a facility registration.  It is common to hear "the office manager was supposed to renew it."  Dr. Larry Montgomery provided a most apt analogy.  Dr.  Do you allow your "office manager" to manage, have control of, and have access to your check book?  Then why do you rely upon an "office manager" to control, manage, and have access to whether or not you have a legal access to practice health care?  The point being, doctors, it is YOUR RESPONSIBILITY to see that YOUR license is renewed, that your facility registration is renewed.  Don't allow staff to have "control of the checkbook".

The TBCE's enforcement committee continues to be concerned with documentation and coding.  They routinely are taking note of a "wrong code", or an "inappropriate code" or "not enough time was spent to warrant a level of coding".  Be aware of what the CPT codes call for and be prepared to defend WHY a particular code was used.  Some in government will want to know.

The TBCE also is making use of a new format regarding enforcement committee procedures.  Here is MY understanding of how it will work.  I will acknowledge first of all that my description MAY not be "legally accurate" so use my understanding as a guide and do your own homework.  The TBCE Enforcement Committee desires to keep the privacy of the accused and the complainant to as small a number as possible so that sensitivities are preserved.  With such in mind the committee as a whole will review a case and make a determination of a "range" of settlements that may be acceptable to the committee..."from A to D, but not C" kind of agreement.

One member of the committee, one staff member, and one legal representative as well as the complainant and/or the accused will then meet informally and review the particulars of the case and the committee member will negotiate a settlement within the parameters agreed to by the committee.  If the parties agree, the committee will vote upon the settlement and pass their recommendation to the whole board.  If the parties involved can not agree, or if they desire to be heard by the whole committee, they may refuse to settle and bring it before the whole committee.

The purpose of this is supposed to protect the privacy of the complainant and the accused in that full and open meetings will not be required as they currently are for a full committee meeting.  The hope is that it will streamline the enforcement process.   A fear is that single committee members will be negotiating settlements and accused may not be fully aware of the full procedures available to them choosing to take the first settlement offered. 

If I am in error in my understanding I will certainly report it to you as soon as possible.  This new procedure first went into effect at the March meeting and it seemed that proceedings moved faster, but time will tell.

Some observations from the March meeting include: Make sure to "only use chiropractic manipulation codes" and not to use "osteopathic manipulation codes" has had been done in decades past for some consider this "fraud".  Further I observed that the committee is primarily using your case records to reconstruct the care given.  BE SURE YOUR RECORDS PROVIDED TO THE TBCE FULLY REFLECT THE STORY of what you did and did not do.  Be sure that your coding is accurate or report the error and take action to correct it.  It is this author's impression that the TBCE Enforcement Committee desires to match coding and billing to case records.

Another observation of this committee was subtly stated when a member stated that "the enforcement committee looks for violations."   This caught my attention because historically it has been my observation that the committee looked "at" violations in order to render a judgment and come to a resolution.  It seems now that the enforcement committee WILL TAKE WHAT YOU SUBMIT AND LOOK FOR VIOLATIONS.  Use suitable caution in providing your written response doctor.

And here is a repetition of one of the most common violations I observed: 

DON'T USE THE WORD DOCTOR OR DR. IF YOU DON'T HAVE A LEGAL LICENSE IN YOUR POSSESSION. 

Just because you have a diploma that MAKES you a doctor does not ENTITLE you to use the term doctor.  It's kind of like the federal and state government--just because the federal government through Medicare SAYS you provide a physician level service, and just because state law SAYS that you provide and bill a physician level service, and just because a state attorney general SAYS that "physician" is a descriptor and not a title doesn't mean that you can CALL yourself a physician. 

The word "physician" is looked upon as at "title" granted only to medical practitioners.  The word "doctor" is looked upon as a "title" granted ONLY to those LICENSED as such.  Just because your school say's you are one doesn't make you one.  Hey, it's the government.  It doesn't HAVE to make sense.

The next enforcement committee meetings will be April 13, May 11, June 15, an July 13, 2010.  I'll keep you posted.