Health Law for Chiropractors

Starting your own chiropractic practice is an exciting way to take the practice of medicine and your future into your own hands. What sets opening a new chiropractic practice apart from other entrepreneurial endeavors are the expansive, and often difficult to understand regulations which all chiropractors are bound by. Opening a new practice requires many steps to be carefully considered before taking action. Each possible choice has potentially far-reaching consequences which can include tax implications, liability, governance, and compliance issues. Our team leads chiropractors confidently through the entire process of opening a new practice.

Buying and selling a chiropractic practice is a complex process for all parties involved. It is important to remember that each transaction is unique and requires a hands-on approach from an attorney that knows the intricacies of operating and advising a chiropractic practice. Be aware that there are many practical, legal, and financial considerations that must be taken into account when deciding to buy or sell a practice.

  • Drafting, reviewing and negotiating purchase agreements
  • Drafting and reviewing lease agreements
  • Reviewing contracts in place
  • Due Diligence Preparation and Review
  • Ensuring physician compliance with regulations
  • Ensuring compliance with current marketing materials
  • Evaluating current and future risks
  • Determining if stock or asset purchase is best for the transaction
  • Reviewing current medical & billing documentation
  • Letter of Intent
  • Payment considerations and structures
  • Transition Plan

Within the ever-expanding healthcare field many chiropractors are integrating their practices to better equip themselves to provide the best patient care possible by adding additional services, which include but are not limited to physical therapy, massage therapy, regenerative medicine, wellness, acupuncture, and other physician specialties to their practice. To become an effective integrated practice, the most important step is to create a clear vision of the mission and purpose of the business, and ensure that compliance can be achieved by ensuring you can answer the following questions:

  1. Are there any applicable supervision requirements
  2. Do I need a special license
  3. Can additional service providers be a 1099 or W2
  4. Are there restrictions on how additional service providers can be compensated
  5. Are their regulations on how referrals can be made or accepted within the practice
  6. Will third-party payors allow me to add other specialties to my provider agreement
  7. Are there additional marketing regulations that must now be followed
  8. Do I need to open a subsidiary or additional entity?
  9. Does the Florida Patient Brokering Act, Anti-Kickback Statute or Stark Law Apply?
  10. Are there any Safe Harbor exceptions that will allow me to compliantly operate my practice?

Deciding whether to buy or lease a chiropractice office location is huge, since real estate costs are typically the second highest expense behind payroll. Understanding this medical real estate landscape demands market knowledge specifically as it pertains to chiropractors. Leasing medical office space requires many creative long-term options for renewal and expansion as a hedge against diminishing supply and rising costs. Knowing and understanding the market, the options and strategically crafting medical office lease and purchase agreements are key to helping any practice’s bottom line.

Chiropractors are facing greater scrutiny from payors in the form of denied claims, payment suspensions, and audits. Once notice is received for any issue related to the revenue cycle you have the opportunity to review your compliance, negotiate any errors, and avoid sanctions. In order to do this your billing, coding, and medical staff will work with our team of attorneys to fully diagnose and prepare for follow-up activity before a response or appeal is submitted. We regularly work with chiropractic practices to provide guidance and support on the following:

  • In/Out of network reimbursement disputes
  • Managed care contract disputes
  • Audits & Investigations
  • Recoupment Demands
  • Corrective Action Plans
  • Negotiating Letters of Protection
  • Prepayment reviews
  • Payment suspension rebuttal
  • ZPIC/UPIC Audits
  • Policies & Procedures Development & Implementation
  • Denied claims, False claims or Over-utilization representation

Any successful chiropractic practice is built on patient base retention. In today’s market chiropractors market their services in many different forms which include the internet, Groupon, radio advertisements, Facebook ads, speaking engagements, and health fairs. However, chiropractors must remain vigilant about compliance with the marketing regulations that apply to them. It is essential to understand the practical application of all state, federal, administrative, and third-party payor regulations and guidelines. In Florida, for instance, advertising violations are one of the top licensing investigations that occur which can result in severe fines, penalties, and disciplinary actions due to marketing that is found to be deceptive, misleading, or part of any illegal payment structure.

 

  • Rules and Regulations
  • Commission Structures for Marketers
  • Marketing Employment Contracts
  • Third Party Marketing Company Agreements
  • Federal Trade Commission Regulations
  • Reviewing current marketing material
  • Discussing how the practice will be marketed
  • Third Party Marketers and False Claim liability
  • Website
  • Social Media & Digital Content
  • Patient Consent & HIPAA
  • Online Reviews

Everything that chiropractors want to do is regulated by state and federal laws in addition to payor requirements. We make sure our clients know what the regulatory compliance obstacles are and how to succeed as a chiropractic practice in this landscape. Our firm regularly counsels clients on regulatory compliance with Federal and State Anti-Kickback statutes (Patient Brokering Act) and we provide in-depth guidance and analysis to healthcare providers on issues arising out of federal and state self-referral laws. Whether you require a brief explanation or full-blown analysis and legal opinion we will guide you by helping you determine the most appropriate and effective manner in which to proceed by providing sensible solutions to your compliance needs. Areas of compliance every chiropractor should be aware of include the following:

  • Anti Kickback Statute
  • Stark
  • Safe Harbor Exceptions
  • State Licensing Board
  • Records Requests
  • Audits
  • Contracts
  • Informed Consent
  • HIPAA
  • Board of Chiropractic Medicine Regulations
  • Florida Patient Brokering Act

Many chiropractic and integrated practices are don’t have the luxury of an in-house legal department, which leaves them handling many legal issues without proper guidance. Practices who do not have an in-house legal department can utilize the services of our firm to provide cost-effective and practical advice and day-to-day legal services regarding various personnel and labor issues.

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Articles from Our Team

By: Zach Simpson

Over the years I have come to grasp that ABNs although very useful are quite difficult to implement appropriately for chiropractic practices. My goal for this article is to help practices understand how often ABNs should actually be signed by their Medicare beneficiary patients. A question I am typically asked about ABNs is when should a patient sign a new one? Many offices have the misconception that a new ABN should be signed by Medicare beneficiaries at the beginning of each year which is not the case. Read on.

By: Zach Simpson

A question that I am frequently asked is do I actually need a Massage Establishment License for my chiropractic practice? The answer is it depends on the employment status of licensed massage therapist, and whose patients the massage therapist is treating.

Chapter 480, Florida Statutes, regulates the practice of massage therapy in Florida. Pursuant to this law, the facility where massage therapy is administered must be licensed separately as a massage establishment license unless it is the residence or office of the client. Read on.

By: Zach Simpson

As the country reopens in light of COVID-19 many patients are beginning to feel safe to return to practices for services. In an effort to generate additional business to make up for lost revenue many practices have turned to internet-based marketing programs, such as Groupon to help attract new patients. Such sites provide a platform for discounted services, in exchange for a fee to refer patients to those businesses. While every state and business is different, chiropractors need to be aware of the implications of working with such sites while accepting federal health care insurance reimbursements, and the marketing requirements that still must be adhered to that often go overlooked. Read on.

By: Zach Simpson

What follows is a very common scenario that helps demonstrate why proper documentation is essential in all personal injury cases, and what steps can be taken to ensure proper documentation occurs from the very beginning. Typically, following a car accident or slip and fall, a patient will present to the ER with complaints of “neck pain” only. However, the next day the patient might wake up with mid-back, and low back pain that radiates down the right leg, in addition to the original neck pain. The pain does not go away and gets worse, so they decide to make an appointment to come see their chiropractor. Read on.

By: Jeff Cohen

Inspired by many medical integration consultants and coaching organizations, chiropractors have vigorously pursued medically integrating their practices in the past handful of years.  Led by both the desire to provide effective healthcare solutions and to capture more of the healthcare dollar that their patients are already spending (elsewhere), chiropractors are smart to consider it…slowly! Read on.

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How we Help

Whether its navigating the increasingly complex providers contracts, assisting with chiropractic audits and appeals, or fighting payment suspensions and contract terminations, The Florida Healthcare Law Firm is uniquely positioned to help your chiropractic practice with all of its health law and compliance needs.

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