Alabama State Regulations Simplified By Dr. Rob
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435.767.1102
ALABAMA
Dental Referral Guidelines and Regulations
Doctor to Doctor / Patient to Doctor
STATE REGULATIONS SIMPLIFIED
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ALABAMA STATE REFERRAL GUIDELINES
§ 34-9-18. Grounds for disciplinary action.
(a) The board may invoke disciplinary action as outlined in subsection (b) hereof whenever it shall be established to the satisfaction of the board, after hearing as hereinafter provided, that any dentist, dental hygienist, or expanded duty dental assistant has been guilty of the following:
..........(9) Is guilty of division of fees, or agreeing to split or divide the fee received for dental service with any person for bringing or referring a patient without the knowledge of the patient or his or her legal representative, except the division of fees between dentists practicing in a partnership and sharing professional fees, or in the case of one licensed dentist employing another.
Commentary by Dr. Rob
1. Does this mean that if the person knows that you are splitting the fee, then it is ok?)
2. So basically, you can’t split or divide fees with “any person” except in situations where a dentist employs another dentist.
34-9-19.1. Advertising- Dental referral service; requirements; prohibitions; penalties
(a) For purposes of this section, the following words shall have the following meanings: (1) ADVERTISEMENT. Information communicated in a manner designed to attract public attention to a referral service, participating dentist, or a practice of dentistry. (2) DENTAL REFERRAL SERVICE. A person, firm, partnership, association, corporation, agent, or employee of any of the foregoing that engages in any business or service for profit that in whole or in part includes the referral or recommendation of persons to a dentist for any form of dental care or treatment. (3) DENTIST. Any person licensed to practice dentistry or any entity authorized by law which is formed for the purpose of practicing dentistry. 29 (4) FALSE, FRAUDULENT, MISLEADING, OR DECEPTIVE STATEMENT. A statement or claim having one or more of the following characteristics: a. One that contains a misrepresentation of fact. b. One that is likely to mislead or deceive because in context it makes only a partial disclosure of relevant facts. c. One that is intended or is likely to create a false or unjustified expectation of favorable results. d. One that implies unusual superior dental ability. e. One that contains other representations or implications that in reasonable probability will cause an ordinary and prudent person to misunderstand or be deceived. (5) PARTICIPATING DENTIST. A dentist who has paid a fee to the dental referral service in order to be included on its referral service. (b) A dental referral service shall not participate in the advertising of or operate a dental referral service unless all of the following conditions are met:
(1) The patient referrals by the dental referral service result from patient-initiated responses to the service's advertising.
(2) The dental referral service discloses to any prospective patient who makes contact with the service that the participating dentists have paid a fee for participation in the service.
(3) The dental referral service does not impose a fee on the participating dentists dependent on the number of referrals or amount of professional fees paid by the patient to the dentist.
(4) Participating dentists charge no more than their usual and customary fees to any patient referred. (5) The dental referral service registers with the Board of Dental Examiners of Alabama providing all the following information: a. Name. b. Street address. c. Mailing address. d. Telephone number. e. Name of registered agent or person responsible for the operation of the dental referral service. f. Listing of other states where the dental referral service is registered. g. A copy of the standard form contract that regulates its relationship with participating dentists. (c) Participating dentists shall not enter into a contract or other form or agreement to accept for dental care or treatment a person referred or recommended for the care or treatment by a dental referral service unless the dental referral service meets all the requirements of this section. (d) A dental referral service that advertises shall include in each advertisement in legible or audible language, or both, a disclaimer containing all the following statements or information that: (1) The participating dentist of the dental referral service is a dentist who has paid a fee to participate in the service. 30 (2) The advertisement is paid for by participating dentists. (3) No representation is made about the quality of the dental services to be performed or the expertise of the participating dentists. (4) Participating dentists are not more or less qualified than dentists who are not participating in the service. (e) Dental referral service advertisements shall not do any of the following: (1) Advertise or solicit patients in a manner that contains a false, fraudulent, misleading, or deceptive statement in any material respect.
(2) Publish or circulate, directly or indirectly, any false, fraudulent, misleading, or deceptive statement as to the skill or methods of practice of any participating dentist. (3) Contain a statement or make a recommendation that the dental referral service provides referrals to the most qualified dentists or dental practices. (4) Contain a review process or a screening. (5) Contain qualifications or information verification that misleads the public into thinking a participating dentist has obtained special recognition or joined a selective group of licensed dentists by being a participating dentist in the dental referral service. (f) A violation of Sections 34-9-15, 34-9-19, 34-9-28, or this section, including, but not limited to, advertising in any manner which is false, fraudulent, misleading, or deceptive, shall subject a participating dentist to possible administrative disciplinary actions outlined in Section 34-9-18, after notice and hearing by the Board of Dental Examiners of Alabama and the opportunity for judicial review as provided in this article
ADA REFERRAL GUIDELINES
http://www.ada.org/en/~/media/ADA/Member%20Center/FIles/referring_guidelines
Pre Referral Communication Between Referring Dentist and Specialist or Consulting
Dentist:
Both practitioners should discuss the referral treatment period and the return of the
patient to the referring dentist. This arrangement may be enhanced by an exchange of
business cards, referral forms and patient instructional materials. Availability for
emergency treatment during the referral period should be discussed.
Post Referral Communication Between the Specialist or Consulting Dentist and the
Referring Dentist:
Communication between professionals is essential. Patients should receive clear,
consistent information about their dental problems and treatment from all dental
professionals. Mixed messages can confuse and frustrate patients. The following steps
can facilitate the communication process:
- Initial report from specialist or consulting dentist indicating the preliminary
diagnosis and anticipated treatment
- Progress reports as necessary, if treatment is extended over a
considerable period of time
- Final report, including factors that may alter the future course of therapy or
affect the relationship between the referring dentist and the patient.
- Diagnostic quality copies or duplicates of radiographic or digital images
taken by specialist or consulting dentist
- Return of any pertinent documents or forms provided by the referring
dentist
2.B. CONSULTATION AND REFERRAL.
Dentists shall be obliged to seek consultation, if possible, whenever the welfare of
patients will be safeguarded or advanced by utilizing those who have special skills,
knowledge, and experience. When patients visit or are referred to specialists or
consulting dentists for consultation:
1. The specialists or consulting dentists upon completion of their care shall return the
patient, unless the patient expressly reveals a different preference, to the referring
dentist, or, if none, to the dentist of record for future care.
2. The specialists shall be obliged when there is no referring dentist and upon a
completion of their treatment to inform patients when there is a need for further
dental care.
4.E. REBATES AND SPLIT FEES.
Dentists shall not accept or tender “rebates” or “split fees.”
ADVISORY OPINION
4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES.
The prohibition against a dentist’s accepting or tendering rebates or split fees
applies to business dealings between dentists and any third party, not just other
dentists. Thus, a dentist who pays for advertising or marketing services by
sharing a specified portion of the professional fees collected from prospective or
actual patients with the vendor providing the advertising or marketing services
is engaged in fee splitting. The prohibition against fee splitting is also applicable
to the marketing of dental treatments or procedures via “social coupons” if
the business arrangement between the dentist and the concern providing the
marketing services for that treatment or those procedures allows the issuing
company to collect the fee from the prospective patient, retain a defined
percentage or portion of the revenue collected as payment for the coupon
marketing service provided to the dentist and remit to the dentist the remainder
of the amount collected.
Dentists should also be aware that the laws or regulations in their jurisdictions
may contain provisions that impact the division of revenue collected from
prospective patients between a dentist and a third party to pay for advertising
or marketing services.
5.F.4. REFERRAL SERVICES.
There are two basic types of referral services for dental care: not-for-profit and
the commercial. The not-for-profit is commonly organized by dental societies or
community services. It is open to all qualified practitioners in the area served. A fee
is sometimes charged the practitioner to be listed with the service. A fee for such
referral services is for the purpose of covering the expenses of the service and
has no relation to the number of patients referred. In contrast, some commercial
referral services restrict access to the referral service to a limited number of
dentists in a particular geographic area. Prospective patients calling the service may
be referred to a single subscribing dentist in the geographic area and the respective
dentist billed for each patient referred. Commercial referral services often advertise
to the public stressing that there is no charge for use of the service and the patient
may not be informed of the referral fee paid by the dentist. There is a connotation
to such advertisements that the referral that is being made is in the nature of a
public service. A dentist is allowed to pay for any advertising permitted by the
Code, but is generally not permitted to make payments to another person or entity
for the referral of a patient for professional services. While the particular facts and
circumstances relating to an individual commercial referral service will vary, the
council believes that the aspects outlined above for commercial referral services
violate the Code in that it constitutes advertising which is false or misleading in a
material respect and violates the prohibitions in the Code against fee splitting.
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