Regulations, Laws and Guidelines Affecting Louisiana Dental Practices
The specific wording for Louisiana laws can be found at www.legis.state.la.us.(Information on laws and regulations is provided as a service to members of the Louisiana dental profession and is presented for informational purposes only. This information is not offered as legal advice, nor is it intended to be a substitute for legal advice. Although the LDA has made reasonable, diligent efforts to ensure the accuracy of the content herein and will update information as promptly as possible, laws and regulations cited in this section may occasionally change. The LDA makes no warranties as to content accuracy and is not responsible for any loss, actual or potential, resulting from reliance on this guide. If you have specific legal questions concerning your circumstances, please consult your own legal counsel. General questions about federal laws should be directed to the American Dental Association, and general questions about Louisiana laws should be directed to the appropriate state, parish or municipal authority.)
AED (LIMITATION OF LIABILITY)
Note: The degree of protection for providers actually afforded by this law has never been specifically tested in court.
ADVERSE REACTIONS
ADVERTISING
AMERICANS WITH DISABILITIES ACT
The law also prohibits discrimination in services, including dental care, to persons with physical or mental disabilities, which many courts have held to include HIV infection. Under the ADA, a person with a physical or mental impairment that substantially limits a major life activity is considered disabled, as well as a person wit a record of having such impairment and a person who is regarded as having such impairment.
The Americans with Disabilities Act also requires that places of public accommodation, including physicians’ and dentists’ offices, be accessible to persons with disabilities. With the advent of the internet, and of websites that businesses utilize to provide additional access to the public, the U.S. Department of Justice has taken the position that websites open to the public must also be accessible in various ways to persons with sight or hearing impairment. This interpretation may affect not only the websites of our members.
White Paper from the ADA on Website Accessibility
Alt Tags Sample
Video Captioning Sample
For more information on dentists’ obligations under the Act, call: U.S. Justice Department Information Line, 800-514-0301, ADA Technical Assistance, 800-949-4ADA, www.adata.org.
ANTIBIOTIC PROPHYLAXIS
- In most cases, endocarditis is not attributable to invasive procedures.
- Cardiac conditions are stratified into risk categories based on potential outcome if endocarditis develops.
- Procedures that cause bacteremia and for which prophylaxis is recommended are more clearly specified.
- An algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse.
- For oral/dental procedures, the initial amoxicillin dose is reduced to 2g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered.
ANTIBIOTICS, EFFECT ON ORAL CONTRACEPTIVES
ANTITRUST
ADA Antitrust Laws in Dentistry
ANY WILLING PROVIDER
BALANCED BILLING
CHEMICAL DEPENDENCY
CHILD ABUSE
CLAIMS APPEALS
CLEFT LIP / CLEFT PALATE INSURANCE COVERAGE
For more information on the benefits included with cleft lip or cleft palate insurance coverage, contact the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org.
CLOSING A DENTAL PRACTICE
CONSUMER CREDIT
CONTRACT ANALYSIS/REVIEW
DENTAL BENEFIT PLANS
DENTAL FAIRNESS ACT
- The health care services would be covered if provided by a person licensed to engage in the practice of medicine and surgery.
- The health care services can be lawfully performed within the scope of practice of a licensed dentist.
DENTAL HANDPIECE STERILIZATION & DISINFECTION
DENTAL SERVICE CONTRACTORS LAW
DENTIST-PATIENT RELATIONSHIPS (TERMINATION)
- Dental treatment in progress must either be completed so the patient’s health will not be jeopardized or the patient should be referred to another qualified dentist or specialist;
- Before terminating a dentist-patient relationship, a dentist should seek advice from an attorney and/or malpractice insurance carrier;
- To end this relationship, the dentist should send the patient a written notification via certified mail, return receipt requested. The notice to the patient should include the date the relationship will end (allowing reasonable notice), suggestions on how to find another dentist, an offer to forward the patient’s records to a new dentist, an offer to provide emergency care for a reasonable period of time, and a statement of the current status of care and future need for treatment; and
- AIDS or HIV positive diagnoses are typically not valid reasons for termination.
DOWNCODING
Additionally, if a procedure code change is made, the explanation of benefits (EOB) provided to the patient shall include the reason for the downcoding and citation of the dental service contractor's applicable policy. The EOB shall not state or infer that the code billed by the dentist or other healthcare provider was inappropriate unless there is clear evidence the code listed on the claim by the provider in no way related to the procedure performed. The EOB shall not state or infer that the healthcare provider's charge was excessive unless there is clear evidence the charge was substantially higher than the provider's regular fees. The third party payer shall disclose in its provider contracts, on its website, or both, the specific downcoding policies that the dental service contractor reasonably expects to be applied to the provider or provider's services on a routine basis as a matter of policy.
DRUG LICENSE REGISTRATION
After completing your application, return it along with a $20 check to the above address. You should also include a copy of your dental license which shows the date of expiration. You will then be assigned a Controlled Dangerous Substances (CDS) number. You should then request a copy of Form 224 (Form 224a for renewals) from the Federal Drug Enforcement Administration. Forms are available online at www.deadiversion.usdoj.gov.
Return the form to the DEA with the $390 registration fee. For more registration information, contact the DEA field office:
Registration Unit of the U. S. Department of Justice
Federal Drug Enforcement Administration
3838 North Causeway Blvd., Suite 1800
Three Lakeway Center
Metairie, LA 70002
504-840-1063 or 888-514-7302
For general information, call the DEA at 800-882-9539.
ELECTRONIC HEALTH RECORDS (EHR)
There is *no federal deadline* for adoption of Electronic Health Records (EHRs) by dentists who do not submit claims to Medicare. However, Medicare eligible professionals will have a payment adjustment in their Medicare reimbursement for failure to implement “meaningful use” of EHRs starting in 2015. Eligible professionals may begin participating in the Medicare EHR incentive program as early as 2011, and the program ends in 2016.
The Medicare and Medicaid program aspects of HITECH may not affect most dentists because many dentists do not provide Medicare-covered services or meet the Medicaid incentive program patient-volume threshold. However, dentists should not ignore other aspects of HITECH, especially those parts concerning Privacy, Security, and the Breach Notification Rule.
Louisiana has already started a Medicaid EHR Incentive Program in which eligible medical professionals and hospitals can receive incentive payments for adopting, implementing or upgrading certified EHR technology during their first year of participation, and can earn payments for up to five subsequent years for demonstrating meaningful use of EHR.
EMERGENCY CARE: The Good Samaritan Law
EMPLOYEE HIRING
Employers must have federal and state tax identification numbers to report employee wages and to remit payroll taxes. For your Federal Employer Identification Number (EIN), call: Internal Revenue Service (IRS) at 800-829-1040 or www.irs.gov.
Information on a state employer identification number is available at: LA Department of Revenue and Taxation, 225-219-7318, www.rev.state.la.us.
EMPLOYER POSTER REQUIREMENTS
State and federal laws require employers to display certain posters. Below is a list of state-required posters distributed by the Louisiana Department of Labor, available at any statewide Job Service Office:
- Notice to Workers regarding Unemployment Insurance Benefits (LDET-ES 74)
- Louisiana Minor Labor Law Placard (if employing anyone age 17 or younger)
- Notice of Compliance to Employees
- Sickle Cell Anemia (If employing 15 or more people), Civil Rights Bureau, Department of Social Services, 225-342-2700
- Smoking
- Out-of-State Motor Vehicles
- Fair Employment and Age Discrimination
The federal government requires the following posters:
- Minimum Wage, WH Publication 1088 (required for all businesses subject to the Fair Labor Standards Act). Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting www.dol.gov.
- Employee Polygraph Protection Act. Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting www.dol.gov.
- Job Safety and Health Protection, OSHA 2203. Obtain this poster from the Federal OSHA Office by calling 225-389-0474.
- Family and Medical Leave Act, WH Publication 1420 (for employers with 50 or more employees). Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting www.dol.gov.
- Equal Employment Opportunity (for employers with 20 or more employees). Obtain this poster from the EEOC office by calling 800-669-3362 or visiting www.dol.gov.
- Genetic Information and Privacy. For more information on posters required by state and federal law, visit http://www.laworks.net/Downloads/Downloads_Posters.asp.
EXTERNAL REVIEW
Many states who have this external review process also include dental insurance claims as eligible for this review process, but not Louisiana. In fact, Louisiana Medicaid coverage already allows for independent reviews on dental and medical claims. However, private insurance does not include dentists.
FEE SPLITTING
Louisiana State Board of Dentistry
One Canal Place, Suite 2680
365 Canal Street
New Orleans, LA 70130
504-568-8574
www.lsbd.org
FREEDOM OF CHOICE
GENERAL ANESTHESIA: HEALTH PLAN COVERAGE
Insurers may apply the following restrictions:
- Coverage to include only procedures performed by dentists who have hospital privileges.
- Coverage to include only procedures performed by pediatric dentistry specialists or fully accredited specialists in a recognized dental specialty for which hospital privileges are granted.
- Prior authorization required in the same manner as for other covered medical conditions.
GENERAL SUPERVISION OF THE DENTAL HYGIENIST
1. The enabling statute must be placed under La. R.S. 37:766.
La. R.S. 37:766 Hygienists, employment; operations limited
A. Any Louisiana licensed dentist of good standing, public institution, or school authority may employ a licensed hygienist who may perform such duties as may be authorized by the board. A registered dental hygienist may operate under a licensed Louisiana dentist’s direct or general supervision as those terms are defined in the Louisiana Administrative Code (Title 46 - Professional and Occupational Standards - Part XXXIII Dental Health Professionals-Rule 108). The licensed hygienist shall be responsible for providing notification to the board of the name and location of his employer.
2. The following rules have been suggested.
**B. Under general supervision, a dental hygienist may provide to patients of record, for not more than five (5) consecutive business days, all dental hygiene services (except local anesthesia and root planing which must be under direct supervision) if all of the following conditions are satisfied:
(1) The dental hygienist has at least three (3) years, or an equivalent amount of experience, in the practice of dental hygiene;
(2) The dental hygienist has current CPR certification and complies with the established protocols for emergencies which the supervising dentist has established;
(3) The supervising dentist has examined the patient of record not more than nine (9) months prior to the date that the dental hygienist provides the dental hygiene services;
(4) The dental hygienist provides dental hygiene services to the patient of record in accordance with a written treatment protocol prescribed by the supervising dentist for the patient;
(5) The patient of record is notified in advance of the appointment that the supervising dentist will be absent from the location;
(6) No licensed dental hygienist, under general supervision, may delegate or supervise any dental hygiene duties for an expanded duty dental assistant; and,
(7) The dentist is responsible for all actions of the dental hygienist during treatment of patients under general supervision.
B. The following limitations also apply to the practice of dental hygiene under general supervision:
(1) No entity other than a public institution or school supervised by a Louisiana licensed dentist, or an office owned by a dentist or group of dentists licensed in Louisiana, may employ dental hygienists to provide treatment for patients of record under general supervision.
(2) No duly licensed and registered dentist shall supervise more than two (2) dental hygienists under general supervision at any one time.
(3) No duly licensed and registered dentist shall supervise a dental hygienist for more than five (5) consecutive business days or for more than twenty total (20)* days in any calendar year.
(4) No patient can be seen twice consecutively under general supervision.
(5) An examination fee must not be charged if a patient is seen under general supervision.
(6) No person shall practice dental hygiene in a manner which is separate or independent from a supervising dentist, or establish or maintain an office or a practice that is primarily devoted to providing dental hygiene services.
HAZARDOUS WASTE DISPOSAL AND TRANSPORTATION
Except for small quantities, potentially infectious medical wastes can be transported off the site where they were generated only by transporters permitted by the State Health Officer. Small quantity generators, including dentists’ offices, may transport small quantities of properly packaged and labeled wastes to approved large quantity generators, permitted storage facilities, or permitted treatment facilities without meeting the requirements for transport and treatment that large quantity generators must meet. Transportation of potentially infectious waste (except by small quantity generators) is governed by Section 27:023 of the regulations.
To avoid violating federal regulations and facing severe penalties, call: Department of Environmental Quality, 225-765-0355, www.deq.state.la.us.
HIPAA (Health Insurance Portability and Accountability Act)
This federal law restricts the use of patient information and imposes standards for electronic transmission of health information. Dentists who utilize electronic transactions in their practices must comply with the provisions of HIPAA. Members may purchase a HIPAA Privacy Kit through the ADA by calling (800) 621-8099, and other HIPAA compliance tips can be found at http://www.ada.org/en/publications/ada-catalog/complete-hipaa-compliance-kit
The U.S. Department of Health and Human Services (HHS) protects the health of all Americans and provides essential human services, especially for those least able to help themselves. HHS Office for Civil Rights offers the following HIPAA guidance for health care professionals:
HHS Office for Civil Rights, Uses and Disclosures for Treatment, Payment, and Health Care Operations:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html
HHS Office for Civil Rights, Minimum Necessary Requirement:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/minimum-necessary-requirement/index.html
HHS Office for Civil Rights, Business Associates:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/business-associates/index.html
HIV/HBV (INFECTIOUS DISEASES)
HIV Informed Consent Form
Louisiana Department of Health and Hospitals
Office of Public Health – HIV/AIDS Program
234 Loyola Avenue, 5th Floor
New Orleans, LA 70112
504-568-7474
hivweb@dhh.state.la.us
https://ldh.la.gov/page/928
HIV Test Result Disclosure
- the purpose of the disclosure;
- the patient’s right to review the health care provider’s privacy notice; and
- an explanation of the process by which the patient may revoke or request restrictions on the consent to disclosure.
HIV Positive Dentists
Under the American Dental Association’s Principles of Ethics and Code of Professional Conduct, any dentist who becomes impaired in any way is urged to seek medical advice and treatment from a qualified professional and to limit his/her practice activities to areas that will not endanger patients or dental staff. For more information, contact:
Louisiana State Board of Dentistry
1201 North Third Street
Suite G-136
Baton Rouge, Louisiana 70802
225-219-7330
www.lsbd.org
ICD-10 DIAGNOSIS CODES
Beginning October 1, 2015, any provider billing a CPT code is required to use ICD-10 diagnosis codes. (This primarily affects oral surgeons and dentists who perform reconstructions following accidents, surgeries, cancer, etc. and bill using medical (CPT) codes to Bayou Health.)
Dentists billing CDT codes will not be required to use ICD-10 codes when filing a claim with MCNA or Fee-For-Service (FFS). Currently recipients that reside in an Intermediate Care Facility for the Developmentally Disabled continue to receive dental services via FFS, with claims paid by Molina.
Dentists who bill procedure codes that require a diagnosis code must use ICD-10 when billing for both Bayou Health and FFS members. The Bayou Health 2.0 contract (effective 2/1/15) provides coverage for surgical dental services. Therefore any medically necessary oral surgery or reconstructive dental surgery claim using CPT codes should be submitted to the respective health plan if the member is enrolled in Bayou Health. For those that are not enrolled in a Bayou Health plan, surgical claims utilizing CPT codes should continue to be sent to Molina.
The links below were placed on the Louisiana Medicaid website with additional information regarding the ICD-10 transition.
9/18/15 ICD-10 Testing Information Update: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_Testing_Information_Update_9-18-15.pdf
9/15/15 ICD-10 Information Update: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_Information_Update_9-10-15.pdf
9/10/15 ICD 10 Q&A: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_QA_9-10-15.pdf
8/7/15 ICD-10 Implementation Webinar Presentation: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_Implementation_Webinar_8-7-15.pdf
7/6/15 ICD-10 Outreach: http://www.lamedicaid.com/provweb1/default.htm
INFECTION CONTROL
- Wearing gloves, masks and protective eyewear.
- Washing hands before and after each treatment.
- Changing gloves after each patient.
- Disposing of needles and other sharp items in special containers.
- Properly disposing of waste items and contaminated material.
The CDC publication Recommended Infection-Control Practices for Dentistry is included in the booklet published by the Louisiana State Board of Dentistry and may be ordered or accessed online through the Centers for Disease Control - Division of Oral Health, 770-488-6054, or 888-CDC-FACT (232-3228) for automated information or www.cdc.gov.
The LA State Board of Dentistry infection control checklist
INFORMED CONSENT
Under Louisiana Revised Statute 40:1299.131, a dentist must receive consent for any dental treatment after the patient has been informed in general terms of the nature and purpose of the dental treatment and the risks of death, brain damage, quadriplegia, paraplegia, loss or loss of function of an organ or limb, or disfiguring scars associated with specific dental treatment. The patient must be given an opportunity to ask questions about the treatment and have them answered satisfactorily. The dentist has the responsibility of obtaining written informed consent of a patient, but this responsibility may be delegated to a lay or professional employee of a hospital or dental office. For more information, contact your malpractice insurer carrier or the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org.
Fortress Insurance Company is a professional liability company created by dentists, for dentists. Fortress has developed a comprehensive risk management program uniquely designed for the dental office. Fortress has provided sample informed consent documents for LDA members. Their goal is to educate dentists and their staff about current risk management techniques that enhance patient care and help reduce liability exposure. To learn more about how Fortress Insurance Company can protect you and your practice, email Stormy Blair at Brown & Brown at Stormy.Blair@bbrown.com.
INSURANCE
- Major Medical
- Business Overhead Expense
- Personal Accident
- Term life
- Disability Income
- In-Hospital Indemnity
- Medicare Supplement
- Long Term Care
INSURANCE ID CARDS
JURY DUTY
LIMITED LIABILITY FOR PROVIDERS OF FREE CARE
In addition, either at the time of the initial screening or at the time health care services are provided, the clinic or provider must give the patient written notice of the limitation of liability and conspicuously post a similar notice of the limitation of liability for patients to see.
More detailed information is available in the LDA information sheet, Limited Liability for Gratuitous Provision of Health Care Services. To obtain a copy, contact the LDA at 800-388-6642, 225-926-1986 or email info@ladental.org.
MATE ACT
Sec. 1263 of the spending bill Congress passed in December 2022 requires controlled substance prescribers to complete 8 hours of one-time training on safe controlled substance prescribing as a condition of receiving or renewing a DEA registration. The statutory language was taken from a separate bill, called the Medication Access and Training Expansion Act (or MATE Act).The federal training requirement applies to any licensed Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) who requires a DEA registration to prescribe controlled substances (Schedules II, III, IV, and V). Those who do not need a DEA registration are not affected.
FAQ Mate Act
MEDICAL DEVICE EXCISE TAX
MEDICAL MALPRACTICE
According to Louisiana Revised Statues 9:5628, “no action for damages for injury of death against any physician, ... dentist, ... hospital duly licensed under the laws of this state, or community blood center or tissue bank as defined in R.S. 40:1299.41(A), whether based upon tort, or breach of contract, or otherwise, arising out of patient care shall be brought unless filed within one year from the date of the alleged act, omission or neglect, or within one year from the date of discovery of the alleged act, omission or neglect; however, even as to claims filed within one year from the date of such discovery, in all events such claims shall be filed at the latest within a period of three years from the date of the alleged act, omission or neglect.”
MEDICAL RECORDS
If treatment records are generated, maintained, or stored in digital format, copies may be requested to be provided in digital format and charged at the rate provided by this item; however, the charges for providing digital copies shall not exceed $100, including all postage and handling charges actually incurred. Also: x-rays, microfilm and electronic and imaging media, upon payment of reasonable reproduction costs and a handling charge of $20 for hospitals; $10 for other health care providers. If the patient X-rays and other imaging media are generated, maintained, or stored in digital format, copies may be requested to be provided in digital format and charged at the rate provided by this item; however, the charges for providing digital imaging media copies shall not exceed $200, including all postage and handling charges actually incurred. If requested, the health care provider shall provide the requestor, at no extra charge, a certification page setting forth the extent of the completeness of records on file. In the event a hospital record is not complete, the copy of the records furnished shall indicate, through a stamp, coversheet, or otherwise, the extent of completeness of the records. Each request for records submitted by the patient or other person authorized to request records pursuant to the provisions of this Subparagraph shall be subject to only one handling charge, and the health care provider shall not divide the separate requests for different types of records or X-rays, including but not limited to billing or invoice statements. The health care provider or person or legal entity providing records on behalf of the health care provider shall not charge any other fee which is not specifically authorized by the provisions of this Subparagraph, except for notary fees and fees for expedited requests as contracted by the parties.
The health care provider must comply with requests in at least 15 days. Any court-ordered records will require the health care provider to pay reasonable expenses and attorneys fees. Access to records may be denied only if the knowledge of the information would be harmful to the health or welfare of the patient or any other person.
Medical records should be retained for a minimum of six years from the date of last treatment. Graphic matter, images, x-ray films, and such data should be retained for three years from the date of last treatment, unless the patient requests a longer period in writing.
MEDICAL WASTE DISPOSAL
DHH Office of Public Health
Infectious Waste Program
6867 Bluebonnet Blvd.
Baton Rouge, LA 70810
225-763-5553
Sanitary Code on Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste
Pharmaceutical Waste Disposal in Louisiana
It should be noted that the LDA’s endorsed medical waste disposal service, Medical Waste Management (MWM), is locally owned and operated and thus does not have to contend with the same regulatory requirements as a larger company that operates in multiple states. As long as your office’s pharmaceutical waste does not include a Schedule 2 Narcotic or RCRA drugs, MWM can pick it up along with your other medical waste at no additional charge. In the case of Amalgam, a special bucket is needed due to its mercury content, and there is a one-time additional fee. Moreover, MWM can offer a limited, inexpensive pharmaceutical waste only option for those members who currently have long-term contracts with other companies for medical waste disposal but don’t wish to purchase second pricey contract from the same company. These are just a few ways that MWM can offer added value to LDA members.
If you are looking for an alternative to your current waste disposal service, or simply want to know more about your options, contact the MWM team at 985-373-6428 to discuss your situation. They’ll be happy to review all the possible options with you. You can also visit their website at www.medwastemgmt.net or contact Mark Grillo at Mark@medwastemgmt.net. MWM is endorsed by the LDA.
MEDICARE PART D
DATE CHANGE
The Center Medicare and Medicaid Services (CMS) will be extending to Jan. 1, 2016 the effective date by which dentists must have either enrolled or officially opted out of Medicare in order for prescriptions they write to be covered by Medicare Part D. This proposed rule would also require Part D plans to cover a "provisional supply" of up to 90 days of a medication prescribed by a doctor who has not enrolled or opted out. A Part D plan must notify the beneficiary in writing within three business days that the medication is being covered on a provisional basis because of the prescriber's current Medicare status. Part D plans must also make reasonable efforts to notify the prescriber. After covering the provisional supply and providing the notice to the beneficiary, the Part D plan will be required to reject future claims for the same medication for that beneficiary if the prescription is from the same prescriber.
MEDICARE ADVANTAGE
In a conversation with CMS today we confirmed that “opting out” is not an option for any provider who treats patients in a Medicare Advantage plan and wishes their patients to receive the benefit from the MA plan. This is true whether the provider is in-network for the MA plan or not (for PPO-type MA plans). The MA organization is required to check the opt out list on a regular basis. Remember if a dentist has already opted out they can reverse their decision within 90 days.
We also confirmed that enrolling either using the 855I (full enrollment) or the 855O (ordering and referring provider) are valid options for a dentist treating patients with an MA plan.
If a non-contracted dentist enrolls in Medicare using the 855i this does not mean the dentist is now an MA plan participant i.e. in-network for the MA plan.
The video that ADA has on CPS continues to be the most accurate information we have on this topic (other than the change in date noted above) -- http://success.ada.org/en/practice/medicare/medicare/medicare-overview-video-tutorial
The ADA has a slew of information readily available on its website regarding the opt in/out deadline for Medicare. There is even a flow chart of sorts that should make it fairly easy for dentists to decide whether or not they should enroll. The info can all be accessed from:http://www.ada.org/en/member-center/member-benefits/legal-resources/publications-and-articles/reimbursement/medicare-enrollment-decision-tool-introduction-medicare-enrollment/medicare-enrollment-faq
NATIONAL PRACTITIONER DATA BANK
NATIONAL PROVIDER IDENTIFIER FOR HEALTH CARE PROVIDERS
The National Provider Identifier (NPI) is a unique, government-issued, standard identification number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices. The government has contracted with an external company for processing applications and developing these random 10-digit numbers for applicants. Applications to obtain an NPI began on May 23, 2005.
Anyone who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries and claim attachments, will be required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. The ADA encourages all dentists to apply for NPIs, particularly those using (or planning to use) electronic transactions.
The NPI has some advantages over identifiers now in use:
Once implemented across the health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic transactions.
Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan.
Introduces an important element of standardization to electronic transactions that should improve transaction acceptance rates.
However, the NPI does not do any of the following:
Replace the DEA number when required for prescribing controlled substances or other DEA-regulated activities.
Replace state-issued licenses and certifications verifying a provider's licensing or qualifications.
Replace Social Security Number, Individual Tax ID, or Employer ID for tax purposes.
Early application for and receipt of an NPI mean your practice will be ready to submit NPI data when requested by a patient’s health plan, a clearinghouse, your system vendor, or a fellow health care provider who needs it for billing purposes. It is very likely that plans will begin requesting NPIs prior to May 23, 2007, for electronic transactions. Even if a dentist does not use electronic transactions, it is quite likely that a health plan might require the dentist to use an NPI on paper claims.
Applying for an NPI is free and relatively easy: Visit https://nppes.cms.hhs.gov/NPPES/Welcome.do, read the instructions carefully, complete the questionnaire and submit your application. This takes about 20–30 minutes. After confirmation of your data’s receipt, you should receive your NPI via e-mail in one to five business days. A downloadable application form is also available. Download the application form, print, complete and mail per the instructions. The NPPES does not accept faxed applications. Processing of paper applications takes about 20 business days.
Network Leasing
Non-Covered Services Law in Louisiana
In the 2010 Legislative Session, the LDA sponsored a non-covered services bill. This bill said that no dental plan that is contracted for in this state may require that a dentist provide dental health care services to a covered person at a particular fee unless such services are covered services for which benefits are paid under a contract with such dentist. It also clarifies that a dental service contractor or insurer may offer a dentist optional agreements for participation in a dental plan in which a dentist may CHOOSE to participate either with or without a provision to provide discounts to covered persons for non-covered services. This law became effective January 1, 2011.
OSHA
The Bloodborne Pathogens Standard requires employers to formulate a written exposure control plan, identify workers with occupational exposure to blood and saliva, and specify protection and training for them. This plan should be reviewed and updated regularly and made available to employees. Guidelines for compliance with post-exposure requirements under this standard are available at http://www.ada.org/en/. Needle safety regulations added to the Bloodborne Pathogens Standard in 2001 have little impact on dental offices; dentists are not required to adopt new injection technologies unless they decide that a new device will be safe, effective, and appropriate for their practice.
The Hazard Communication Standard ensures that both employers and employees know about chemical hazards in the workplace and how to protect themselves through proper handling. Employers must maintain a library of Material Safety Data Sheets (MSDS) on all hazardous materials in the workplace, or have access to the appropriate MSDS in an emergency; check that hazardous materials are properly labeled; train employees to handle those materials; and make a written plan for your office available to employees.
Other OSHA standards and guidelines address fire extinguishers, fire exits, ergonomics, and other factors that could harm employees. Dental offices were exempted from certain OSHA record-keeping requirements that took effect in 2002 relative to sharps injuries, work-related injuries, and illnesses. However, OSHA and/or state agencies may still ask a dental office to keep certain injury records. If you receive a letter from OSHA stating that a formal or informal complaint has been received against your office, notify the LDA immediately.
The ADA has developed a Regulatory Compliance Manual and training resources with all necessary information for dental professionals’ compliance with OSHA standards. To order these materials, visit www.adacatalog.org or call 1-800-947-4746. OSHA regulations are modified frequently, and LDA members are urged to contact the U.S. Department of Labor with specific questions about current OSHA standards. You may obtain a copy of current OSHA standards from:
U. S. Department of Labor
OSHA Publications Office
Post Office Box 37535
Washington, DC 20013-7535
800-321-OSHA
www.osha.gov
OSHA CONSULTATION SERVICE
OSHA Consultations Office
1001 North 23rd Street, Room 230
P.O. Box 94094
Baton Rouge, LA 70804-9094
225-342-9601
OWNERSHIP OF DECEASED OR DISABLED DENTIST’S PRACTICE
PATIENTS’ COMPENSATION FUND
PEER REVIEW IMMUNITY
PRE-EXISTING CONDITIONS LAW
PRESCRIPTIONS
PROVIDER CREDENTIALING
RADIOGRAPH EQUIPMENT REGISTRATION
To request permit form DRC-6:
Department of Environmental Quality
Licensing and Registration Section
P.O. Box 4312
Baton Rouge, LA 70821
225-219-3041
Download directly from the DEQ website at https://deq.louisiana.gov/resources/category/radiation-forms-guides-and-information
LDEQ Website: http://deq.louisiana.gov/
RECORD RETENTION
REQUIRED COVERAGE FOR CLEFT PALATE, PEDIATRIC HOSPITAL ANESTHESIA AND TMJ
RETIRED VOLUNTEER DENTAL LICENSE
SALES TAX EXEMPTION ON DENTAL MATERIALS
Because the LDA lobbied for expanded sales tax exemption that passed in 2002, many dental supplies are exempt from sales tax, thus saving practices thousands of dollars. The LDA also pursued and received a Revenue Ruling from the La. Department of Revenue in November 2004 regarding sales tax exemption. Louisiana grants a sales and use tax exemption on dental devices that are used exclusively by a patient or administered exclusively to a patient during health care treatment. On November 15, 2004, the Louisiana Department of Revenue and Taxation issued Revenue Ruling No. 04-008, which clarifies the department’s interpretation of an expanded sales tax exemption on dental devices. As a result, most Louisiana dentists are paying significantly less in sales taxes than they did before that date.
On October 8, 2019, the Louisiana Department of Revenue issued an updated publication that shows the applicable sales tax rates on all manner of items that either are, or have been at some time recently, exempt or excluded from state sales tax. The document shows the applicable rates as they have changed due to various legislative efforts to address the State’s budget shortfalls beginning 7/1/2013 and extending to 6/30/25, when many of the current exemptions are set to expire. The publication can be found at: http://revenue.louisiana.gov/Publications/R-1002(10-19)FINAL%20combined.pdf.
The applicability of the exemption for dental devices in the various periods of time covered in the publication can be found on page 13 about halfway down the page. The statutory citation is La. R.S. 47:305(D)(1)(t). As you can see, the exemption has been fully applicable since 7/1/18 and will remain so through 6/30/25. (It is likely and LDA will certainly lobby for amending the sales tax statutes again before that time to extend the exemption.)
For vendors to determine exactly which items qualify for the exemption under the statute, they should refer to the following Revenue Ruling issued by the State of Louisiana Department of Revenue: http://revenue.louisiana.gov/LawsPolicies/RR04008.pdf
In order to file a claim for refund for taxes paid to a dental supply company on items that are exempt,1. Fill out Form R-20127-L (claim for refund of overpayment). You can get a copy of this form from the LDA or by going to http://www.rev.state.la.us/ and clicking on forms. It can also be found at http://www.revenue.louisiana.gov/taxforms/20127(11_13)F.pdf.
2. You can also call the Sales Tax Division of the Department of Revenue (225-219-2270).
3. You can fill out the form online or print it out and mail it to: Office Audit Division (Dept. of Revenue), P.O. Box 66362, Baton Rouge, La 70896-6362.
SHARPS DISPOSAL BY MAIL
- Used sharps mailed through USPS must be sent first class or priority mail and must bear the international biohazard symbol;
- Used sharps must be properly packaged in authorized containers and accompanied by a manifest;
- Dentists should indicate on any container used to mail sharps the container manufacturer’s name, USPS authorization number, and container ID number or model number; and
- Containers must be securely sealed before mailing; liquid content may not exceed 50 ml; they must contain sufficient absorbent material; and they shall not exceed 35 pounds. Primary burden for compliance rests with manufacturers and distributors of mailing kits.
For more information, visit www.usps.com.
SILENT PPOs
STATE BOARD OF DENTISTRY
Louisiana State Board of Dentistry
One Canal Place, Suite 2680
365 Canal Street
New Orleans, LA 70130
504-568-8574
www.lsbd.org
TAX CREDIT FOR DENTISTS PARTICIPATING IN MEDICAID
Louisiana Revised Standard 47:297
H.(1) The tax determined as provided in this Part shall be reduced by the lesser of the tax due or five thousand dollars per taxable year up to a maximum of five years for each taxpayer meeting all of the following criteria.
(2) The taxpayer shall:
(a) Be a certified medical doctor (M.D.) possessing an unrestricted license from this state to practice medicine, or be a dentist licensed by this state to practice dentistry.
(b) If a certified medical doctor, establish and maintain, after July 1, 1991, the primary office of his practice within twenty miles of a community hospital not owned predominantly by other physicians, and both the office and the hospital shall be located more than twenty miles from the nearest incorporated city with a population in excess of thirty thousand persons, provided that the medical doctor shall have relocated from outside of the service area of the community hospital.
(c) If a dentist, establish and maintain, after July 1, 2002, the primary office of his practice within a parish or other geographic area in the state designated as a Dental Health Professional Shortage Area (HPSA) by the U.S. Department of Health and Human Services' Bureau of Primary Health Care, Division of Shortage Designation (DSD) as per Section 332 of the Public Health Service Act. Subject to the limits of Paragraph (3) of this Subsection, the provisions of this Subsection will continue to be available to the dentist if the Dental HPSA designation is withdrawn after the practice is established at that location.
(d) Agree to practice under the conditions set forth herein for a period of not less than three years. The tax reduction provided herein shall continue to be available for two additional years if the remaining conditions of this Subsection continue to be met.
(e) Accept Medicaid and Medicare payments for services rendered.
(3) The provisions of this Subsection shall be available to a physician or dentist for only one relocation and only for a maximum of five years. In the event that the physician or dentist ceases to comply with these provisions within the three-year period, all taxes reduced hereunder shall be subject to recapture pursuant to rules promulgated by the department
(This information was found on the Department of Health and Hospitals Web site at http://new.dhh.louisiana.gov/index.cfm/page/796)
UNIQUE PHYSICIAN IDENTIFICATION NUMBER
Medicare Services
Post Office Box 83860
Baton Rouge, LA 70884-3860
225-231-2133
UNEMPLOYMENT COMPENSATION
- Prepare detailed job descriptions;
- Hold effective job interviews;
- Establish a written hiring agreement; and
- Establish a written disciplinary system and termination procedure.
Employers are also required to file federal unemployment tax returns annually. For more information, contact: Internal Revenue Center, Memphis, TN 37501, 800-829-1040 or http://www.irs.gov/.
USUAL AND CUSTOMARY FEE DISCLOSURE
- The frequency of fee data update to determine maximum allowance;
- A specific description of the method used to determine usual and customary fee, including geographical information and the percentile used to determine the maximum allowable benefit.
VOLUNTEERISM OR INDIGENT CARE LIMITATION OF LIABILITY
In order for there to be immunity from professional liability (except for gross negligence or willful/wanton misconduct) when a health care provider renders free care, three criteria must be met:
- The care must be provided in, or arranged through, a non-profit community clinic (as defined in the statute).
- Prior to the patient receiving care, the clinic must conduct a financial screening to determine that the patient is eligible to receive free care, including screening to determine whether the patient is eligible or enrolled in a public entitlement program (e.g., Medicaid, Medicare, etc.) that provides health care benefits.
- The patient must be informed in writing, either in a document handed to him/her or via a notice posted prominently at the location where the screening takes place, that he/she may not have the same legal recourse for anything that goes wrong in the course of receiving free health care.
WORKERS’ COMPENSATION
- Workers’ compensation insurer;
- Self-insurance;
- Group self-insurance.
Failure to provide for workers’ compensation in one of the above ways can subject an employer to a fine of up to $10,000, imprisonment for up to one year, or both.
Additionally, employers must post a notice of compliance in a convenient and conspicuous place, which sets forth certain rights and responsibilities of injured employees. If the employer fails to post the notice, the time for giving notice of the injury shall be extended to 12 months from the date of injury. For a copy of the poster, visit www.laworks.net or contact:
State of Louisiana
Office of Workers’ Compensation
P.O. Box 94040
Baton Rouge, LA 70808-9040
225-342-7555
To obtain workers’ compensation insurance coverage, contact your local independent insurance agent.