Record Keeping and Ethics FAQs

Do we have to keep paper prescription pads?

Medicaid still requires that paper prescriptions be submitted to the pharmacy. In addition, all controlled substances are required to be on a paper prescription. (DEA Practitioners Manual Section 5, 856 IAC 1-34-1)

 

What are allowable charges for duplication of records?

Your office may charge cost-based fees for the duplication of records. Fees are limited to those outlined in 760 IAC 1-71-3, Copying Fees for Medical Records:

 

    • First 10 page copies: $1 per page; no per-page charge is allowed for the first 10 pages if a labor fee is charged
    • Pages 11 through 50 copies: 50 cents per page
    • Pages 51 and higher copies: 25 cents per page
    • Labor fee: $20
    • Actual costs of mailing
    • An additional $10 may be charged if the request is for copies to be provided within two working days
    • Certification of medical records: $20

 

Dentists may not charge for the time spent locating, searching for or retrieving records. (IC 16-39-9)

 

Am I required to provide Hepatitis B immunizations for office employees?

Dental health employers are required to offer HBV vaccine within 10 days of beginning employment, or if staff request it later, providing they have never received the vaccine before. This is mandated by the Bloodborne Pathogens Standard.

 

What is the deadline for obtaining an amalgam separator?

July 14, 2020. With few exceptions, dental offices must have an amalgam separator in place by that time.

 

How often does our x-ray machine need to be recertified?

Your machine must be recertified every 36 months by a radiation health specialist who is on staff or approved by the Indiana State Department of Health.

 

What do I need to know about advertising rules?

Guidelines are generally common sense. Advertising should be truthful. Don’t misuse the word ‘free’ or advertise services for which you are not trained or certified. Testimonials should be from actual patients and not deceptive or misleading.

 

Can I advertise that I accept Medicaid?

Yes, but do not use state or federal government logos or symbols in your advertising or on your website, as this implies endorsement by these agencies. Discounts or incentives related to Medicaid are strictly forbidden and can result in having your dental license revoked.

 

In addition, do not advertise routine waivers of Medicaid co-pays. While these waivers are allowed on an individual basis, advertising them is not allowed because it may unduly influence a patient’s choice of dentist based on the co-pay waivers.

 

How often must staff receive OSHA training?

Annually. Technically the requirement is for staff who treat patients directly, but training may be useful for all staff in the office since they may unexpectedly come into contact with bloodborne pathogens in the course of interacting with patients in a non-clinical setting. (29 CFR 1910)

 

What do I do if I have a complaint against an insurance company?

The Indiana Department of Insurance maintains a complaint process on its website. Both providers and patients may complain about an insurance company at www.in.gov/idoi/2961.htm. You can also get in contact with IDA’s Director of Professional Services Ed Rosenbaum.

 

Can our office sell dental-related products?

Yes, but there are multiple issues to consider. Have an attorney review any sales contracts or agreements with the manufacturer or supplier. Also check with an accountant to discuss laws and procedures for collecting and remitting state sales tax on items.

 

If you lease your office, check with your landlord to make sure there are no provisions against selling merchandise. You might be surprised by restrictions set in place to prevent competition with other tenants in the same shopping center. For example, if a pharmacy is located in the same building, other offices may be prohibited from selling health, hygiene and beauty aids.

 

Lastly, keep in mind that you could be included in a lawsuit if the product(s) you sell turn out to be defective. Check with your insurance advisor about product liability coverage.

 

How long should we keep records?

You are required to keep patient records for seven years, x-rays for five years. It is recommended that you keep children’s records until seven years after the child becomes an adult. Some attorneys and professional liability carriers have even longer recommendations for certain types of procedures or for certain specialties within dentistry. Ask your liability carrier and legal counselor for advice. (IC 16-39-7)

 

Do we have to allow a service animal in the operatory?

Yes. Under the Americans With Disabilities Act, a dental office must allow service animals into all areas of the facility where the patient must go. You may inquire whether the animal is a trained service animal and not merely a pet, but you may not ask for official certification for the animal. You also may not ask about the nature of the patient’s disability or why he or she needs the animal. You may not charge extra fees for the animal or treat the patient differently from other patients.

 

Are we required to provide interpreters for hearing impaired patients?

Yes. Under the Americans With Disabilities Act, a dental office must provide and pay for a sign language interpreter. You may not pass the cost to the patient or ask the patient’s family member to interpret for free.

 

Because your office is paying for the services of the interpreter, the patient cannot insist that you use a specific interpreter. If you find the cost of the patient’s preferred interpreter too high, you can research lower cost options through local agencies, religious organizations, social service offices or Easter Seals chapters.

 

Are we required to provide interpreters for patients with poor English skills?

The issue of interpreters for foreign languages is more of a grey area. You may have to provide interpreters if you accept Medicaid (even if the patient in question is not on Medicaid) or if your office receives financial assistance through the U.S. Department of Health and Human Services.

 

Even if you are not legally required to provide an interpreter, doing so can show tremendous goodwill toward your patients and immigrants in your community. As with sign language interpreters, check with local religious organizations or cultural clubs to inquire about affordable interpreter services.

 

What are the HIPAA requirements for electronic records?

You must annually audit your HIPAA policies and practices. The HIPAA Security Rule requires that dental practices conduct a written risk assessment and to update the risk assessment as necessary to maintain security safeguards and to protect electronic patient data.

 

What are the rules for protecting patient information?

Your office should take reasonable, common sense steps to protect patient charts and information. Avoid leaving paper charts where others can read the content. Keep charts filed and out of plain sight. Keep computer monitors displaying patient data facing away from the public, and use password-protected screen savers if there’s a chance that the computer will be unattended during office hours. Avoid discussing or asking patients sensitive questions where others can hear the conversation.

 

Can we ask a patient if he or she has HIV or other infectious diseases?

Yes, but only with the intent of providing the best patient care. Asking this question of certain patients but not others, or using this information to deny or restrict treatment could lead to a discrimination claim against you.

 

How can we recognize drug-seeking patients?

Warning signs include inappropriate clothing (slovenly dress or overly formal), strange behavior, exceptional knowledge of controlled substances, exaggerated or multiple medical symptoms and physical signs of drug abuse such as track marks.

 

Drug-seeking patients are also evident in their stories or scheduling habits. They may insist on being seen right away or being the last appointment of the day. They may claim to be traveling from out of town or say that their controlled drug prescription has been lost and needs to be replaced. They often claim to be allergic to non-narcotic painkillers. They may refuse to give the name of their regular practitioner, or claim to have been a patient of a dentist who has recently died or closed a practice.

 

Lastly, dentists are highly encouraged to check a patient’s prescription history via Indiana INSPECT before prescribing a controlled substance.

 

How often should patients be asked to update their health history forms?

There is no specific law regulating updates, so patient history information should be updated and noted in charts as regularly as your office deems appropriate. A patient should be asked at each visit whether there have been changes to his or her medical history since the last visit, including changes in medications and dietary supplements.

 

 

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