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@@@ CCLE Review Worksheet (by evelynmmm + Me) ~ DONE

Terms in this set (75)

Who determines if treatment is excessive?
Local Chiropractors.

The administration of treatment or use of diagnostic procedures which are clearly excessive as determined by customary practice & standards of local community of licensees.

Determined by the community of fellow licensees.

Excessive treatment is considered unprofessional conduct for a chiropractor.
What is excessive treatment?
• Treatment beyond what is reasonable/necessary or within standard of care

• Failure to document necessity (conduct a thorough exam, diagnose condition, implement a treatment plan, & conduct follow-up exams to assess progress)
If you are guilty of excessive treatment, this falls under _____.
Unprofessional Conduct
Elder abuse
Causes or permits infliction of physical pain or mental suffering under circumstances or conditions not likely to produce great bodily harm or death.

Willfully causes or permits an elder to suffer.
Unjustifiable physical pain or mental suffering.

Embezzlement.

Willfully threatens to commit a crime which will result in death or great bodily injury.
Known or suspected causes of abuse of elder or dependent adult (6).
Physical
Abandonment
Abduction
Isolation
Financial
Neglect
Punishment of failure to report elder abuse?
If no great harm came to the patient, it is a misdemeanor, 6 months in jail, $1000 fine.

If the abuse results in bodily harm & death it is a felony. 1 year in jail, $5000 fine
Who do you report elder abuse to?
Local law enforcement agency or adult protective services.
What are common violations that chiropractors treat beyond their scope of practice?
1) Performing surgical procedures
2) Furnishing/prescribing controlled substances
3) Claiming to treat/cure cancer
A chiropractor may use laser as long as it is _____, it is used for _____, all manufacture _____ are followed and they comply with all _____.
A chiropractor may use (FDA) approved laser if it is used for purposes other than treatment consistent with section 302 & product's FDA approval or clearance, all manufacturer's specified guidelines are followed and they comply with all state & federal laws governing the use of lasers in clinical settings.
Chiropractic scope of practice (5)
1) Manipulate bone, joints, muscles and connective tissue.

2) As part of a course of chiropractic treatment, may use all necessary mechanical, hygienic, sanitary measures incident to the care of the body in the course of chiropractic manipulations and/or adjustments.

3) may treat any condition, disease, or injury in any patient, including a pregnant woman, and may diagnose, so long as such treatment or diagnosis is done in a manner consistent with chiropractic methods and techniques

4) may employ the use of vitamins, food supplements, foods for special dietary use, or proprietary medicines, so long as such substances are not included in material medica.

5) may make use of X-ray and thermography equipment for the purposes of diagnosis but not for the purposes of treatment. A duly licensed chiropractor may make use of diagnostic ultrasound equipment for the purposes of neuromuscular skeletal diagnosis.
Unlicensed Individual
any person, including a student or graduate of a chiropractic institution, who does not hold a valid California chiropractic license. An exemption is hereby created for student doctors participating in board approved preceptorship programs.
You find out that a D.C. is billing insurance companies illegally.

What do you do? What is this infraction?
Call the board!

"The issuance and disposition of a citation shall be reported to other chiropractic boards and other regulatory agencies."

INSURANCE FRAUD
Types of insurance fraud.
• Double billing
• Billing for service not rendered
• Upcoding
• Excessive treatment
If you are guilty of insurance fraud this falls under the laws of _____.
Unprofessional conduct.
How long do you have to transfer shares from someone who has been disqualified from the corporation?
90 days or 3 months

"Becomes a disqualified person as defined in Section 13401(d) of the Corporations Code, for a period exceeding ninety (90) days, his or her shares shall be transferred to a licensed person or to the issuing chiropractic corporation, on such terms as are agreed upon. Such transfer shall occur not later than six (6) months after any such death and not later than ninety (90) days after the date he or she becomes a disqualified person."
What is the scope of an unlicensed person in a chiropractic office?
Can take history; perform exams where no diagnosis or analysis is required.
Also can mark on x-ray; develop x-ray and apply PT modalities.

(They cannot diagnose, analyze, heart or lung auscultation, positioning for x-ray, can't write a discharge paper, or adjust)
Who can you transfer your corporation share to?
Only licensed chiropractors can own shares in a chiropractic corporation.
Physical therapy must be used _____.
Physical therapy must be used in conjunction with chiropractic treatment.
A 42 male has acute cervical, arm and shoulder pain.

Is it permissible to do a passive (meaning no adjustments) PT modality?
Yes, only if that patient can't tolerate adjustments, but subsequent manipulation is in the treatment plan.
If a D.C. exhibits some unprofessional behavior, and the behavior is noted to the Board, what will the board do?
The D.C. will be examined by one or more licensed psychiatrist.

"When reasonable cause exists that a person holding a license is mentally ill to the extent that it may affect his ability to conduct the practice authorized by such license, the board may order the license holder to be examined by one or more physicians specializing in psychiatry designated by the board."
What is an example of gross negligence?
A patient whom is clearly depended (infant, elderly or physically impaired) is unsupervised & falls off a treatment table.
Unprofessional conduct includes: A-W (7)
(a) Gross negligence;
(b) Repeated negligent acts;
(c) Incompetence;
(d) excessive treatment
(e) Any conduct which has endangered or is likely to endanger the public;
(f) The administering to oneself, of any controlled substance on the job.
(g) Conviction of a crime which is substantially related to the qualifications, functions or duties of a chiropractor;
(h) Conviction of any offense, involving moral turpitude, dishonesty, physical violence or corruption.
(i) The conviction of more than one misdemeanor or any felony involving the use, consumption, or self-administration of any dangerous drug or alcoholic beverage, or any combination of those substances.
(j) The violation of any of the provisions of law regulating the dispensing or administration of narcotics, dangerous drugs, or controlled substances;
(k) The commission of any act involving moral turpitude, dishonesty, or corruption, whether the act is committed in the course of the individual's activities as a license holder, or otherwise;
(l) Knowingly making or signing any certificate or other document relating to the practice of chiropractic which falsely represents the existence or nonexistence of a state of facts;
(m) Violating the Act or the regulations adopted by the board thereunder;
(n) Making or giving any false statement or information in connection with the application for issuance of a license;
(o) Impersonating an applicant
(p) False advertising
(q) fraud or misrepresentation;
(r) the unauthorized disclosure of any information about a patient revealed or discovered during the course of examination or treatment;
(s) The employment or use of persons known as cappers or steerers to obtain business;
(t) The offering, delivering, receiving or accepting of any rebate, refund, commission, preference, patronage, dividend, discount or other consideration as compensation or inducement for referring patients to any person;
(u) Participation in information or referral bureaus which do not comply with section 317.1 of the regulations;
(v) Entering into an agreement to waive, abrogate, or rebate the deductible and/or co-payment amounts of any insurance policy by forgiving any or all of any patient's obligation for payment thereunder,
(w) Not referring a patient to a physician and surgeon or other licensed health care provider who can provide the appropriate management of a patient's physical or mental condition,
(x) The offer, advertisement, or substitution of a spinal manipulation for vaccination.
If you are convicted of crimes this falls under the laws of _____.

What are common crimes included?
unprofessional conduct

CONVICTION OF A CRIME(S)
• Theft
• Domestic violence
• DUI
• Vandalism
• Possession or use of any illicit drugs
• Practicing while impaired
• Prescription medication abuse
Common infractions of false advertising?
• Sensational claims
• No "D.C." after chiropractor's name
• Fraud/misrepresentation

Unprofessional conduct
How long must you keep patients records?
5 years from the date of last treatment.

"Each licensed chiropractor is required to maintain all active and inactive chiropractic patient records for five years from the date of the doctor's last treatment of the patient unless state or federal laws require a longer period of retention."
How long must you keep the records of a minor?
At least 1 year after their 18th birthday (unless needed to keep for 5 necessary years of last treatment)
How long do you have to get patient copies of their records when the patient requested in writing?
15 days

Unprofessional conduct if not followed.
How long do you have to allow a patient to inspect their file after a written request for an active file is received?
Within 5 working days during business hours after the receipt of the written request.
How long do you have to prepare a file for inspection by the board?
If the file is active, it must be available immediately.

If the file is inactive, 10 days.
How long do you have to fix a billing issue (ex: overbilling) without infraction?
30 days.

"In the event an error occurs which results in an overbilling, the licensee must promptly make reimbursement of the overbilling whether or not the licensee is in any way compensated for such reimbursement by his employer, agent or any other individual or business entity responsible for such error. Failure by the licensee, within 30 days after discovery or notification of an error which resulted in an overbilling, to make full reimbursement constitutes unprofessional conduct."
Where does the responsibility fall to catch an overbilling mistake?
the chiropractor

(not the Office Manager, Insurance Company or Patient)

"Each licensed chiropractor is required to ensure accurate billing of his or her chiropractic services whether or not such chiropractor is an employee of any business entity, whether corporate or individual, and whether or not billing for such services is accomplished by an individual or business entity other than the licensee.
How long does a D.C. have to notify the board that they are practicing?
30 days
How long does a D.C. have to notify the board of a name change?
10 days
How many hours of CE are required each year?
24 hours.

4 must be adjusting hours
How many CE hours can be CPR/BLS?
A licensee may earn up to a maximum of two (2) hours of continuing education credit in cardiopulmonary resuscitation, basic life support or use of an automated external defibrillator.
Can you reward patients to thank them for referrals?
No.

"The offering, delivering, receiving or accepting of any rebate, refund, commission, preference, patronage, dividend, discount or other consideration as compensation or inducement for referring patients to any person is unlawful"
What is the punishment for unlawful referral?
Charged with a misdemeanor.
Penalties of up to $5,000 for each offense.
Can you trade services with chiropractic treatment?
You can trade services legally as long as the value of the services are of equal value.
Can you make agreements with another Health Center to accept or refer patients?
Yes, only if that agreement contributes to the ability of the health center entity to maintain or increase the availability, or enhance the quality, of services provided to a medically underserved population served by the health center.
Can you refer someone to a clinic that you have a proprietary interest or co-ownership?
Yes.

"it shall be lawful for any person licensed under this division to refer a person to any clinic solely because the licensee has a proprietary interest or coownership in the clinic provided, however, that there is medical need for referral and that the licensee's earnings are not based on the number of referred patients. A licensee shall disclose the financial interest to the patient, or the parent or legal guardian of the patient, in writing, at the time of the referral or request for consultation.
Under what circumstances can you refer to a special interest licensee?
the licensee's regular practice is located where there is no alternative provider of the service within either 25 miles or 40 minutes traveling time.
How long do you have to begin referring elsewhere once another provider comes within 25 miles?
If an alternative provider the licensee shall cease referrals within 6 months of the time at which the licensee knew or should have known.
What circumstances are not considered "personal interest" circumstances that would violate a referral law?
when the licensee or his or her immediate family.

when the license owes a loan to the referred office, as long as the loan doesn't include referrals.

If the referee is your landlord.

If you own stocks that anyone could buy.

If you are selling them your practice.
If there are two or more shareholders in a chiropractic corporation and one of the shareholders: (1) Dies, or (2) Becomes a disqualified person for a period exceeding ninety (90) days, what happens to their shares? What is the time frame for both (1/2)?
The shares of a chiropractic corporation may be issued only to a licensed person and may be transferred only to a licensed person or to the issuing corporation.

Such transfer shall occur not later than six (6) months after any such death and not later than ninety (90) days after the date he or she becomes a disqualified person.
What information must be present in active patient files? (7)
Active and inactive chiropractic patient records must include all of the following:
(1) Patient's full name, date of birth, and social security number (if available);
(2) Patient gender, height and weight. An estimated height and weight is acceptable where the physical condition of the patient prevents actual measurement;
(3) Patient history, complaint, diagnosis/analysis, and treatment must be signed by the primary treating doctor. Thereafter, any treatment rendered by any other doctor must be signed or initialed by said doctor;
(4) Signature of patient;
(5) Date of each and every patient visit;
(6) All chiropractic X-rays, or evidence of the transfer of said X-rays;
(7) Signed written informed consent.
What must you do in order to advertise no co-payment or deductibles?
Notify the insurance company what you are doing each time in writing.

"Entering into an agreement to waive, abrogate, or rebate the deductible and/or co-payment amounts of any insurance policy by forgiving any or all of any patient's obligation for payment thereunder, when used as an advertising and/or marketing procedure, unless the insurer is notified in writing of the fact of such waiver, abrogation, rebate, or forgiveness in each such instance."
Can you get a temporary license to practice in CA if you are just here for vacation relief from a different state?
No

There are no temporary licenses.
Under what circumstances can you share lab results over the internet?
When the patient asks, or if they are:
-HIV positive
-positive for hepatitis
-positive for drug abuse
-biopsy results.
Before any lab results can be shared over the internet, what must the D.C. do?
Get the request to do so from the patient, and the D.C. must review the results of the labs.

"In the event that a health care professional arranges for the provision of the test results by internet posting or other electronic manner, the results shall be delivered to a patient in a reasonable time period, but only after the results have been reviewed by the health care professional."
Informed consent must be in what 2 forms?

What is the violation for not acquiring consent?
(a) A licensed doctor of chiropractic shall verbally and in writing inform each patient of the material risks of proposed care. "Material" shall be defined as a procedure inherently involving known risk of serious bodily harm. The chiropractor shall obtain the patient's written informed consent prior to initiating clinical care. The signed written consent shall become part of the patient's record.
(b) A violation of this section constitutes unprofessional conduct and may subject the licensee to disciplinary action.
What is the punishment for false advertising?
(a) Suspension of said licensee's right to practice in this State for a period not exceeding one (1) year.

(b) Placing said licensee upon probation.

(c) Taking such other action, excepting the revocation of said licensee's license, in relation to disciplining said licensee as the board in its discretion may deem proper.
What is the appropriate amount of supervision required for unlicensed individuals?
If the unlicensed individual is performing PT and stretching - 50% supervision is required.

When the individual conducts standard neurological, orthopedic, physical and chiropractic examination- 100% immediate and direct supervision of a licensed D.C.
How often are re-evaluations required on patients?
Every 30 days
Who can obtain the records of an incapacitated patient?
If the patient has previously designated a representative to make health care decisions on his or her behalf the designated individual also has the right to authorize (or object to) the release of the patient's information to the extent necessary for the agent to fulfill his or her duties as agent.

If there is no designated representative, conservator, or family members available, the records may be disclosed to a physician on record.
What is the penalty for fraudulent worker's compensation?
"Workers' compensation fraud may be punished by imprisonment in county jail for over 1 year, or in a state prison for 2 to 5 years.

A fine may also be imposed not exceeding $150,000, or double the amount of the fraud, whichever is greater"
What is required in an evaluation?
History, analysis and diagnosis.

X-Ray & adjustment are excessive.
A patient was receiving worker's compensation for a low back injury. The patient fell down at the front pouch because it was very slippery and re-injured their low back. Who is responsible for the payment?
If the severity of LBP is less or same as before, it will be for Worker's Compensation since it is still the same region. If the severity is more than before, or if a different region is involved, it will be a patients responsibility.
What is the liability if an unlicensed person causes patient injury/damage ?
$10,000
How do you determine that a worker's compensation case is closed?
No continuation of symptom, no more disability.

Follow the guidelines of the Medical Treatment Utilization Schedule.
Are there laws in place referring to Physicians obtaining patient chiropractic records?
"The request to transfer medical records is considered a matter of "professional courtesy" and is not covered by law. No statutes cover record transfers and there is no set protocol for transferring records between providers. Generally, physicians will transfer records without charging a fee; however, some doctors do charge a fee associated with copying and mailing the paperwork. Physicians will require a patient to sign a records release form to transfer records."
Are patients entitled to their records?
"The patient or patient's representative is entitled to copies of all or any portion of his or her records that he or she has a right to inspect, upon written request to the chiropractor.

The chiropractor may charge a fee to defray the cost of copying, not to exceed 25 cents per page or 50 cents per page for records that are copied from microfilm, along with reasonable clerical costs. By law, a patient's records are defined as records relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient. Chiropractors must provide patients with copies within 15 days of receipt of the request.
How do you get a malpractice policy for a chiropractic corporation?
All shareholders of the corporation shall be jointly and severally liable for all claims established against the corporation by its patients up to the minimum amounts of at least $50,000 multiplied by the number of employed licensed persons.

The maximum limit of liability per policy year of at least $150,000 multiplied by the number of such employees, provided that the maximum coverage shall not be required to exceed $150,000 for each claim and $450,000 for all claims during the policy year.
Can you charge a patient for an information handout on exercises?
No, you can charge for extra time spent with the patient going over exercises and additional health explanation.
What is one circumstance where you would re-xray a patient?
Only if the original film is overexposed or is insufficient at visualizing a necessary structure.
What are the laws pertaining to the display of a license?
Each person holding a license shall display a current active license ( NOT A COPY) in a conspicuous place in the licensee's principal office or primary place of practice.

For satellite offices, display an official certificate of satellite office.

Never display a license that is not current and active.
When must you renew your license by?
Yearly by the end of your birthday month.
When must you renew your license by?
yearly, before the last day of the month of your birthday.
If you suspect child abuse who must you notify?
Local Law Enforcement
Any office being represented in a referral bureau may only represent what percent of the bureau?
20%
What is the punishment for using D.C. without a license?
$100-$750.

Using Dr w/o DC is unprofessional conduct.
What is the fee to renew a license
$313
What is the license application fee?
$371
What is the corporation certificate registration application fee?
$186
Failure to make an appropriate/ necessary referral is what type of unprofessional conduct?
Negligence/ Incompetence
What is the fine for a fraudulent diploma
$2000-$6000
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