• Internal Revenue Service (IRS) records for the clinic; • State franchise tax documents; and • Medicare and Medicaid provider enrollment applications and supplementary federal submissions showing to whom claims under these programs are assigned, paid, or payable.
TMB may require additional documentation to determine
clinic ownership. The clinic’s proposed medical director and all physician owners must contact the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Da- tabank at
www.npdb-hipdb.hrsa.gov to search for their names and submit all information they find to TMB. Applicants must indicate the queries are for pain management clinic certifica- tion. The pain management clinic registration form is at www
.tmb.state.tx.us/professionals/physicians/licensed/PMClini cRegistrationForm-9-18-12.pdf. Ms. Robinson says the board may deny applications if the
physician owner has a restricted license or a felony criminal record, or has been disciplined by the board for past nonthera- peutic prescribing violations.
AVOIDING DISCIPLINE A January article in Becker’s Hospital Review discusses the mea- sures physicians can take to avoid medical board discipline for legitimate controlled substance prescribing. “Overprescribing and Medical Board Enforcement: How to
Avoid Discipline,” by Los Angeles attorneys Nicholas Jurkowitz and Farooq Mir, warns physicians that it is easier for medical boards to monitor the prescriptions they’re writing for their patients. They refer to the Texas Prescription Monitoring Pro- gram (PMP), which tracks Schedule II through Schedule V pre- scription drug dispensing. (Read “Small Problems, Big Impact,” Texas Medicine, December 2012, pages 41–44.) The medical board can check PMP to examine a physician’s
controlled substance prescribing patterns and access patients’ controlled substance prescription information. Ms. Robinson says TMB queries the database each time it receives a com- plaint against a physician for nontherapeutic prescribing. “That helps us assess whether there is a reason to believe the physician is engaged in nontherapeutic prescribing.” Mr. Jurkowitz and Mr. Mir recommend physicians register
with databases that generate prescription information and allow them to access regular reports of patients’ prescription drug history. They also advise physicians to conduct thorough patient examinations and to make detailed documentation in patient charts. TPS Executive Director Krista Crockett says she expects
Senator Williams to file two bills pertaining to pain manage- ment this legislative session. She said one piece of legislation would likely put into statute possible changes to TMB pain management clinic rules. She anticipated another bill would enhance the PMP drug- monitoring database by making it easier to use. At press time, the bills hadn’t been filed, and Ms. Crockett couldn’t comment on the exact provisions of the legislation. Should physicians find themselves in the medical board’s
22 TEXAS MEDICINE April 2013
crosshairs, Mr. Jurkowitz and Mr. Mir say proper documenta- tion that justifies prescribing practices is essential. “In maintaining proper documentation, the physician should
keep a record of all drugs dispensed in the office and all pre- scriptions filled out, detailed descriptions of the tests or ex- aminations performed, and detailed descriptions of the pain or symptoms of the patient,” they wrote.
DUE DILIGENCE ESSENTIAL San Antonio attorney Mike Kreager says physicians should do their homework before purchasing or assuming management of any existing medical practice so they know what they’re get- ting into. The due diligence process allows physicians to obtain underlying information about a practice that reveals potential legal claims against them. Mr. Kreager recommends that physicians:
• Review public filings with the Texas Secretary of State’s Office for ownership and financial information about the practice.
• Search county records to determine whether the practice has been sued.
• Request at least three years of financial statements to exam- ine profits and losses.
• Review the practice’s past three years of IRS tax returns. • Review the practice’s general ledger to determine payment patterns and see ongoing vendor contracts that may need to be honored or terminated.
• Interview existing employees to unearth any problems the seller may not have revealed.
• Review payer contracts and payer mix. • Review the practice’s procedures to comply with workers’ compensation rules on pain management and ask the Texas Workforce Commission about any complaints against the practice.
• Check with TMB on any pending or resolved patient com- plaints or agency investigations.
• Check NPDB to learn if any physicians in the practice have liability settlements or patient complaints against them.
• Contact the Texas Health and Human Services Commis- sion Office of Inspector General to make sure Medicare and Medicaid have not excluded any of the physicians in the practice.
Mr. Kreager says a thorough due diligence process takes
from two weeks to a month. He advises physicians to use a team approach that involves a certified public accountant to evaluate financial information, an attorney to assess litigation risk, and either an experienced practice administrator or a consulting group to review coding, documentation, and bill- ing practices, recordkeeping, and other management matters. TMA Practice Consulting offers customized coding and doc- umentation reviews and chart audits. For information, contact TMA Practice Consulting by telephone at (800) 523-8776 or by email at
practice.consulting@
texmed.org. All services are available for a fee based on a practice’s needs.
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