THE AVERAGE # OF REFERRALS?
Choose Your Specialty
435.590.7763
CALIFORNIA
Dental Referral Guidelines and Regulations
Doctor to Doctor / Patient to Doctor
QUICK SUMMARY
By Dr. Rob
REFERRALS SIMPLIFIED
- SPECIALIST: Increase captured referrals by 17%.
- GENERAL: Status updates on all patient referrals. (FREE)
-
PATIENT: Receive the treatment they need
CALIFORNIA STATE REFERRAL GUIDELINES
https://www.cda.org/news-events/use-caution-with-patient-referral-loyalty-programs
Use caution with patient referral, loyalty programs
There are many advertising options for dental practices to use as a way to keep current patients and bring new patients in. One way dentists can do this is through a patient loyalty program where patients earn “points” in exchange for gift cards or other rewards for keeping appointments, brushing and flossing regularly, etc. Dentists participating in such a program must make sure they are staying within the guidelines of the law and CDA ethical standards, however.
The CDA Judicial Council reminds dentists that problems arise in a patient loyalty program when points are earned and prizes are given for patient referrals. Under the California Business and Professions Code Section 650, dentists cannot offer or accept anything of value as compensation or inducement for the referral of a patient.
“When you offer loyalty programs to your patients, or work with a company that helps you with your marketing and runs a program like this for you, you should know that it is OK to offer prizes for things such as good brushing habits or making all of their appointments on time. But when you include a third party into the equation that is benefitting financially for referrals, it goes against Section 650 and you could be in violation,” said Alma Clark, DDS, chair of the CDA Judicial Council.
In a 2013 legal opinion, the Legal Division of the California State Department of Consumer Affairs (DCA) determined that “fee splitting” was not in the best interest of the patient (mainly as it relates to “social couponing services”). Fee splitting occurs when a third party (individual or company) is compensated for helping bring in a new patient.
“While there are many reasons the DCA is against this practice, the main reason is that you want a patient to go to a dentist because they provide the best care, not because it was part of an incentive,” Clark said.
A violation is punishable upon a first conviction by imprisonment in a county jail for not more than one year, or by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or by a fine not exceeding $50,000, or by both that imprisonment and fine. A second or subsequent conviction is punishable by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or by that imprisonment and a fine of $50,000.
Social couponing companies typically provide a dentist the option to send out daily deals to bring new patients in the door. Dentists must make sure they are abiding by Business and Professions Code Section 650 here as well and not offering anything of value as compensation or inducement for a specific referral of patients.
“In other words, if you are using a social couponing website as part of your marketing, you cannot give the company a percentage of the profit gained from that particular daily deal because that would be considered fee splitting,” Clark said.
Dentists can still use social couponing companies if they are paying a flat rate (either monthly or yearly) and are not paying per individual referral. The prohibition against fee splitting is not applicable to marketing via group advertising or referral services that do not base their fees on the number of referrals or amount of professional fees paid by the patient to the dentist.
With the loyalty programs and social couponing issues discussed above, dentists should be aware that, similar to the prohibition in Section 650, CDA Code of Ethics Section 11 and the related Advisory Opinion 11.A.1. also prohibit split-fees in advertising and marketing services.
‘Daily deal’ website recommendations
Dentists interested in advertising free cleanings, whitenings, etc. to patients should be mindful of California Code of Regulations Section 1051, which covers advertising discounts and truth in advertising details. CDA recommends that dentists using “daily deal” websites make sure the ads are not false or misleading in any material respect (see Section 6 of the CDA Code of Ethics). The ad should contain all of the information patients would need to properly evaluate the deal and make an informed choice about the provider and the service.
From a legal standpoint, members should watch for several red flags, including:
Dentists may not offer gifts, discounts or anything of value as compensation or inducement for patient referrals (but it is acceptable to provide something to the actual new patient).
For more information, review the CDA Code of Ethics.Section 650. (Amended by Stats. 2009, Ch. 140, Sec. 2.)
Cite as: Cal. Bus. & Prof. Code §650.
Section 650. (Amended by Stats. 2009, Ch. 140, Sec. 2.)
Cite as: Cal. Bus. & Prof. Code §650.
(a)Except as provided in Chapter 2.3 (commencing with Section 1400) of Division 2 of the Health and Safety Code, the offer, delivery, receipt, or acceptance by any person licensed under this division or the Chiropractic Initiative Act of any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers to any person, irrespective of any membership, proprietary interest, or coownership in or with any person to whom these patients, clients, or customers are referred is unlawful.
ADA REFERRAL GUIDELINES
http://www.ada.org/en/~/media/ADA/Member%20Center/FIles/referring_guidelines
DOCTOR TO DOCTOR REFERRALS
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.
BLOG
DSO: Referring In-House, is it legal?
Paper Referrals are Killing Your Practice
Your State Referral Regulations
Rewarding Patient Referrals will cost you big!
