435.590.7763
WASHINGTON
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
WASHINGTON STATE REFERRAL GUIDELINES
Dr. Barrick, I was forwarded your email for response.
I’m unaware of any dental laws in Washington state related to patient referrals. There is a state anti-rebating law, RCW 19.68 associated rebating by and to health practitioners.
http://app.leg.wa.gov/rcw/default.aspx?cite=19.68
I believe that the American Dental Association does have some guidelines associated to referrals for dentists.
There is a dental law RCW 18.32.533 that prohibits dentists from abrogating copayments.
http://app.leg.wa.gov/RCW/default.aspx?cite=18.32.533
Please let me know if you have additional questions.
Jennifer Santiago, Program Manager
Dental Quality Assurance Commission
Phone # 360-236-4893
There seems to be a lot of confusion as to how it can be done ethically. I have been asked if a dentist can promote new patient referrals by offering current patients such things as gift cards or account credits for each new patient they refer.
So, how can we ethically reward our patients for their kind referrals?
Let’s look at how our ADA Principles of Ethics and Code of Professional Conduct addresses it. Section 5.F.4. REFERRAL SERVICES speaks to this topic:
“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.”
In addition, Section 4.E. REBATES AND SPLIT FEES notes,
“Dentists shall not accept or tender ’rebates’ or ’split fees.’”
A split fee occurs when you offer to return a portion of the fee you collect to the referral source. A rebate is essentially the same thing. A discount on future fees, credit on their account, or cash back to the referring party would also apply.
There are also the following Washington state laws that deal with rebates and split fees:
RCW 19.68.010: It shall be unlawful for any person, firm, corporation or association…. to pay, or offer to pay … to any person licensed by the state of Washington to engage in the practice of …dentistry, …and it shall be unlawful for such person to request, receive or allow, directly or indirectly, a rebate, refund, commission, unearned discount or profit by means of a credit or other valuable consideration in connection with the referral of patients to any person, firm, corporation or association…. Any person violating this section is guilty of a misdemeanor.
RCW 19.68.020: The acceptance directly or indirectly by any person so licensed of any rebate, refund, commission, unearned discount, or profit by means of a credit or other valuable consideration whether in the form of money or otherwise, as compensation for referring patients to any person, firm, corporation or association as set forth in RCW 19.68.030, constitutes unprofessional conduct.
RCW 19.68.030: The license of any person so licensed may be revoked or suspended if he or she has directly or indirectly requested, received, or participated in the division, transference, assignment, rebate, splitting, or refunding of a fee for, or has directly or indirectly requested, received, or profited by means of a credit or other valuable consideration as a commission, discount, or gratuity in connection with the furnishing of medical, surgical, or dental care…
Now that we have the legal and ethical guidance for how to proceed, it should be noted that there is no ethical prohibition on rewarding a patient for a referral. A thank-you note with a nominal gift card would not, in itself, violate our Code. However, problems could arise if you were to offer a reward or credit up front to anyone who refers a new patient. An example would be a sign in your office or on your Facebook site offering $100 for each new patient that people send your way. Another example might be a contest with a trip to Hawaii for the person who refers the most new patients. The difference between these examples and the simple thank-you is that the thank-you is a spontaneous gesture, not contingent on the referral; whereas, the others involve an upfront offer with the intent to exchange patient referrals for a reward. From a legal perspective, a thank-you gift of a large amount might be construed as a rebate; so, consultation with your legal advisor would be prudent if you have any concerns.
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.
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