Delegating Services

Who can provide services to patients other than the doctor?

Delegating services depends on several factors: where you practice, the type of ancillary personnel working in your practice, and whether you are submitting billing to a third-party payer.

So many rules! Let’s simplify delegating services with real practice examples.

You’ve adjusted the last patient of the morning, but he/she is receiving some electric muscle stimulation. You have a lunch appointment. Can you leave?

Most states require you to be present when your staff is working “incident to” your license. You must be on the premises when the work is being performed. However, in states that certify Chiropractic Assistants (CA) to perform certain, specific therapies, there is no problem, especially if you are planning to bill to a third-party payer. The provider’s name on Line 31 of the 1500 claim form for billing indicates that they oversaw and directed the treatment. For most chiropractors, the safest strategy is to stay put until all aspects of patient care are completed.

Your reception room is overflowing, and you’re backed up. Is it okay for your Chiropractic Assistant (CA) to share the results of a new patient’s posture examination?

Maybe. And sort of. CAs can share educational materials and information such as reading a computer printout. A properly trained CA can assist with information gathering, taking vital signs, and reviewing paperwork for completeness. Reviewing automated printouts such as the results of a foot scan can be taught to a CA. What is critical is that a CA, or any other unlicensed person, cannot be involved in health care decision-making, including diagnosis or treatment, without written direction and without being under the supervision of the DC.

Your staff massage therapist is seeing the last patient of the day. Can you leave?

Your massage therapist is licensed, so what this really hinges upon is whether he or she is your employee or an independent contractor—and, even if they are an employee, whether you intend to bill under your billing name and NPI number.

In some states, licensed massage therapists can bill under their own name and provider number, even as an independent contractor. So, if the patient’s insurance was not being billed for the service, and the massage therapist (whether employee or not) is considered fully responsible for the treatment, you might be just fine skating out the door.

Your Certified Athletic Trainer (ATC) is overseeing a patient’s rehab in the therapy room after the chiropractic treatment. Should you stay?

Again, it depends on the nature of the billing status, the licensure of your trainer, and the rules of your chiropractic board of examiners. In certain states, ATCs can be credentialed just like massage or physical therapists and can submit billing under their own NPI number. If the patient is paying cash, then it depends on the supervision requirements of your state. Not sure? Check-in with your board, and perhaps his/her board, for all the rules, and include them in your compliance manual.

Delegating services to unlicensed or licensed individuals within a practice is often misunderstood by health professionals nationwide. The requirements set by the state where you practice determine who is allowed to provide services under the direction of the licensed doctor. There are also circumstances that dictate what can and cannot be delegated, such as individual provider agreements. Usually, your state law is the final authority for decisions about delegation, but you should be aware that provider contracts can be more stringent than a state rule.

Bottom line?

Operating without a complete understanding of your state and contract rules is a risky proposition. Know the rules about delegating services before allowing services rendered by others to take place in your practice—especially in your absence.

Dr. Colleen Auchenbach graduated with a Doctor of Chiropractic from Cleveland University Kansas City in December of 1998 and enjoyed practicing for over 20 years. Her interest in Medical Compliance began when she earned the 100-hour Insurance Consultant/Peer Review certification from Logan University in 2015. She has been a certified Medical Compliance Specialist-Physician since 2016 and a Certified Professional Medical Auditor since 2022. Dr. Auchenbach joined the excellent team at KMC University as a Specialist in 2020, and as a part of this dedicated team is determined to bring you accurate, current, and reliable information. You may reach her by email at info@kmcuniversity.com or by calling (855) 832-6562.