Why do “No Out of Pocket Expense” deals (NOOPE) violate the law? Why do “No Out of Pocket Expense” (NOOPE) deals violate insurance contracts? What information is an insurance company supposed to provide when it rejects a claim? What should I tell patients when their EOB states their care not “medically necessary? What is a “reasonable explanation” when an insurer denies payment? Can I refuse to give my patients a copy of their records if they have an unpaid balance? Does an insurance company have to honor my lien? If the insurance company mails us a check that reimburses us for only a portion of a claim, are we giving up our rights to collect the balance of the claim if we cash the check? If I deposit the check the doctor receives from the insurance company, are we giving up our right to fight the reduction of our charges? Are we giving up any of our rights if we deposit an insurer’s check? Can a lien against a patient be enforced? How long does an insurance company have to pay a claim? On September 1, 2001 the law changed regarding how long an insurance company has to pay a claim. What are the new requirements? What can we do if an insurer is late paying a claim? Why do we need antitrust laws? Can I discuss pricing with my colleagues? Can I discuss managed care agreements with my colleagues? May I collect data on prices charged by other chiropractors or medical doctors? May I discuss prices with other chiropractors? May I distribute price lists for chiropractors in my area? Can the WCA give me advice on my pricing? Can my colleagues and I boycott a managed care company? Can I share negative information about a managed care organization? May I attend a meeting to discuss managed care with my colleagues? Am I OK if others doctors discuss managed care but I do not say anything? Can I ask another doctor to negotiate a managed care agreement for me? Several of us are considering a merger. Should we take any special antitrust precautions? I am thinking of starting my own PPO. Is this something a person can do by themselves? Can the WCA recommend whether I should join a particular managed care company? II have a question on pricing or managed care. What should I do? Can I merge staffs or purchasing activities without violating antitrust law? What business practices are illegal under state and federal antitrust laws? Should I get an attorney if a complaint is filed against me? How does the state investigate complaints made against me? I have more than 40 CE hours, may I transfer the excess to the next licensure period? May I count CE hours I am required to take as discipline as part of my 40 hr. requirement? What is the best way to respond if a complaint is brought against me? How does the state know if I take all of the required CE? Can the state discipline me if I do not pay child support or taxes? What does it mean to practice with “reasonable skill and safety? What is an example of practicing outside my training, education, or experience? What does it mean to practice outside my scope of practice? What is an example of practicing in an unhealthy or unsafe manner? How do I prove that I attended 40 hours of continuing education? What does the state consider to be a competent exam? Can someone practice under my license? What types of programs does the examining board approve for credit? Can you give me an example of improper sexual contact with a patient? What does it mean for someone to impersonate a chiropractor? Can I refuse care to someone because of his or her race, religion, sex or color? Can you provide a practical example of fraud? How long does it take from the time a complaint is filed until it is resolved? Can I refuse to give a patient their records for any reason? Can you provide a practical example of misrepresentation? What does the state mean when they say I cannot practice in an “impaired” state? What does it mean to falsify patient records? Can you supply some practical guidance against falsifying records? How do I know what the state interprets as the ordinary standard of care? It is against the law for a chiropractor to knowingly provide false information to the board or its representative. Can you give me some practical advice? Must I report disciplinary action against me in another state? What does it mean to provide reasonable supervision over my employees? Must I report a criminal conviction to the board? What is a crime substantially related to chiropractic? It is against the law for a chiropractor to violate a law, or aid or abet the violation of any law substantially related to the practice of chiropractic. What does this mean? If I violate a law, does it automatically mean I will lose my license? May a chiropractor share ownership of their practice with other health care providers? May I count any continuing education program as part of my 40 hour CE requirement? May a chiropractor sign a child’s sports physical certificate? May a chiropractor sign a cross bow hunting permit? Can a parent refuse to have their child immunized? Is it a violation of the law to reveal patient information? Can chiropractors in Wisconsin use homeopathy? How does the state define excessive treatment? Why does it take the state so long to resolve complaints? How long do I have to keep my records? Is it a violation of the law to sign an agreement that contains obsolete CPT codes? Can I be bound to standards set by the American Medical Association? Can a managed care company use different conversion factors for MDs? Is it a violation of the law if a managed care plan does not have female providers on its panel? Who do the HIPAA rules apply to? What does this regulation do? Why are these rules necessary? If a billing service prepares my billing, will I have to comply with these rules? Can I rely on my software vendor to automatically comply with the law? Why is the government insisting on these rules? Are electronic claims the only things covered by HIPAA? Our state already has privacy laws. Does HIPAA preempt them? Can we use our own form that simplify HIPAA? Does HIPAA apply to me if I do not file claims electronically? Are IME doctors covered by HIPAA? When my we disclose patient information? Must I put restrictions on the health care information my staff has access to? When must I limit a CAs access to records? What if I decide to take my chances and not comply? Are consent forms required under the HIPAA rules? Once a patient has signed an authorization is it good forever? Does HIPAA limit the information I can give to another doctor? Can I send patient information to the WCA when we are having a problem? How does HIPAA affect contracts that I have with my associate(s)? How does HIPAA change a doctor’s practice? When must I provide a patient with a copy of my privacy notice? What if there is an emergency and the patient is not capable of giving their consent? How can I prove that I am complying with HIPAA? What if my patient refuses to sign my HIPAA forms? Does HIPAA limit what can be sent to an insurance company? Can my patient decide they do not want me to send records to an insurer? What do I do if I find mistakes on my HIPAA forms? When can I send records without the patient’s consent? Can I just use the statute as my HIPAA notice? Can I send a newsletter with advertising to my patients? What type of authorization form must my patient sign? Am I allowed to use a blanket phrase like “all marketing activities” or must I be specific? What information must my marketing authorization include? What must I do when a patient complains about any of my policies or procedures? Do I send patient records to anyone who requests them? Must patients be given copies of their HIPAA forms? Are there limits on information to attorneys, insurers, or third parties? Can a patient restrict who we send their information to? How does HIPAA restrict my marketing? What specific elements must be in the privacy notice that we provide to patients? Must all patient information go to their home? What must we do to terminate our agreement to a disclosure restriction? Must there be a person in charge of our privacy policies and procedures? When must we revise our notice? When must health plans give notices to their patients? What internal protections do I have to provide for patient records within my office? Must we have an office HIPAA policy? What documentation is required for the records that are available for inspection or copying by my patients? What rights do my patients have to see information in their file? Does a patient have the right to make changes to their records? What are my responsibilities if I deny a patient’s request to amend their records? May we charge a fee for the records we provide to our patients? What are my responsibilities for documenting the name of the individual that has responsibility for receiving or processing requests for amendments by my patients? What rights do my patients have to know where their records have been sent? May I charge a patient when they ask me for an accounting of where their records have been sent? Must I keep track of where patient records were sent? What impact does HIPAA have on billing? What are my responsibilities if an employee does not follow our privacy policies? What are my obligations if I find that our privacy policies and/or procedures are not being followed? Can an insurance company waive HIPAA rules? May I treat a person that will not sign our HIPAA forms? Who is covered by privacy laws? By what date must I comply with the electronic standards portion of the rule? If I use a billing service or clearinghouse, am I responsible for making sure their software is compliant? What members of my staff are required to have privacy training? Must I comply with HIPAA if I do use a fax or computer? What resources are the billing and coding standards based on? Does HIPAA apply to me if I only receive payments electronically? Does HIPAA aplly to me if I only use the web to check on the status of claims? Does HIPAA apply to me if I only send questions about a patient on the web? Can we set up an appointment without having HIPAA forms signed? Does HIPAA restrict consultations with other providers? Must we verify a patient’s signature on the HIPAA forms? Must a revocation of an authorization be in writing? Am I responsible for a managed care companies HIPAA compliance? How are we to determine the minimum amount of patient information that may be sent? Must all conversations about a patient be done privately? Must I remodel my office to be HIPAA compliant? Do the privacy rules allow parents the right to see their children’s medical records? What insurance laws or rules is the insurance commissioner supposed to enforce? What is an example of an insurer that does not respond promptly to a policy question? When is it a violation of the law when an insurer delays a claims investigation? Is it a violation of the law for an insurer to tell a patient why they have denied payment? Is it a violation of the law for an insurer to misrepresent the patient’s benefits? Is it a violation of the law for the insurer not to provide claim forms? Is it a violation of the law for an insurer to continuously deny liability for a claim? If a patient has first party coverage, must an insurer offer to settle their claim? Is it a violation of the law for an insurer does not tell an insured about their appeals process? Must an insurance company offer their insureds arbitration? Is an insurer required to have enough staff to handle claims on a timely basis? Can in insurer use leverage on one claim to get a patient to settle on another? Is it a violation of the law if an insurer refuses to investigate a claim? Is an insurance company required to settle a claim for which they are liable? Why doesn’t the insurance commissioner more aggressively defend patients that are taken advantage of by their insurance companies? How much may we charge to attorneys that request our records? Does a separate charge apply to each record request? Is it a violation of the law for an insurer to make a person take them to court to get a fair settlement? What information must an attorney give me with their request for a copy of the patient’s records? Can we bill if our doctor does not keep clinical records? Does a patient have the right to continue their insurance when they leave a job? May I continue COBRA if I am hired by a new employer? When must an insurer notify an insured about their continuation of coverage rights? How long does a terminated employee have to make a decision about continuing group coverage or converting to an individual policy? Are continuation or conversion rights available if a group policy terminates because a chiropractor goes out of business? What happens if we change insurance companies or change our benefits while an exemployee is on continuation? Must we provide employees with notice if we change insurers? What is the “Health Insurance Risk-Sharing Plan (HIRSP)”? Is it necessary to make reminder calls to patients about their appointments? Can I give free adjustments to patients in exchange for a referral? Is telemarketing a good thing for chiropractors to use? How does a cash practice eliminate the need for narrative reports? Are there malpractice implications for a cash practice? Are we required to send anyone a written notice when we change our prices? Can we offer a discount for “payment on the same day of service”? Can a doctor offer lower prices to a patient with insurance who pays for their services immediately and files their own insurance claim? Can a doctor offer a plan in which the patient makes a monthly payment and an individual or a family receives unlimited chiropractic care? What is the proper way to give a same day payment discount? Can a doctor offer lower prices to patients without insurance who cannot immediately pay for their services? Can insurance companies arbitrarily determine UCR rates? Can we waive co-pays or deductibles to be competitive? What do I do if an attorney signs my lien or a fee protection agreement but then gives the settlement check to the patient before paying my balance due? We have patients that do not have insurance. May we offer them a discount? Must we take back the same day discount if the patient delays their payment? Can we compensate for low prices by using higher level E/M or CPT codes? May we offer extended payment plans? Is a doctor allowed to have more than one price list? Are there any special laws we have to follow before we offer financing to our patients? Can we offer payment plans tied to when a patient is paid? Does the state publish suggested notification language for a late charge? Once a late charge has been added to a patient’s account, do they have the right to take as long as they want to pay their balance? Why would a patient complain or sue us if we overlook the late charge law and allow them to continue to add to their account even when it is past due? What is the maximum amount we may add to a patient’s account as a late charge? We set an interest rate below 12%. May we raise the rate? What are the major differences between finance and late charges? What is the potential problem when a doctor offers a “cash discount”? Are there any special requirements before we add finance charges? May finance or late charges be charged to a patient with an overdue worker’s compensation account? Does the state require us to have anything in writing before we charge interest or finance charges? May we add a late fee to the patient’s bill without notifying them? Does a monthly statement that include interest charges meet the states disclosure law? May we add interest to overdue personal injury cases? What are the requirements for a credit application? What is the purpose of a “Marital Agreement Notice”? Can I give the patient a receipt for “list price” when they received a discount? How do we know if an insurer calculated UCR correctly? How do we challenge a UCR decision? Are there penalties for doctors that violate the interest/finance charge laws? If I deposit the check the doctor receives from the insurance company, are we giving up our right to fight the reduction of our charges? Should we be intimidated when an insurer tells the patient not to pay more than the reimbursed amount? How do we enforce our policy that discounts may only given if the patient pays on time? Am I required to have a written job description for every person that works in my practice? My spouse works in my office in an unpaid capacity. Does she need a job description? How do I replace an employee without forewarning her/him of my decision? Are there any special rules for hiring a 16 year old? What is an independent contractor? If we use a bi-weekly pay period, can we pay our employees overtime pay for working in excess of 80 hours per pay period rather than for over 40 hours per week? If an employee works unauthorized overtime, must I pay for those hours? Should independent contractors have written agreements that spell out their relationship? What are the risks of hiring independent contractors? What are the benefits of hiring independent contractors? Are there any circumstances where I am exempt from paying overtime? Can I force employees to use “comp time” instead of paying overtime? Must we give our employees meal or rest breaks during a work shift? What is the “test” the IRS uses to determine if a chiropractor is an independent contractor? Can a CT do more than a trained CA? Should a CA give and explain all supports and supplements given to a patient? As long as they are supervised by a chiropractor, may a CA do anything the doctor requests? Under what circumstances may I delegate work to a CA? In additional to educational requirements do I have other responsibilities before work can be delegated to a CA? How do we define a week for overtime purposes? Are there any restrictions on the number of hours that you can schedule an adult to work? How often must we pay our employees? We have an employee who moved and did not tell us her new address. Then she left a voice message quitting her job. How are we supposed to pay her within the 31 day rule? Are we allowed to require our employees to wear uniforms? Can we require our employees to take a lie detector test? How long must we keep our salary records? Is it proper for a CA to give a doctor advice on the type of person to hire? What are the rights of employees that feel they have been improperly denied overtime pay?
locate a chiropractor | program information | membership | contact| home
