Professional Responsibilities

Professional advertising is regulated by the New Jersey State Board of Dentistry.  The regulations are very specific and comprehensive therefore dentists are urged to review the advertising regulations before any advertisement is published. 

            The State Board may require licensees to substantiate the truthfulness of any objective assertion or representation set forth in an advertisement, and the use of advertisements deemed to be false or misleading can lead to the imposition of disciplinary penalties.  The advertising regulation imposes specific requirements in connection with offers of discounts, fee reductions or free services, and imposes particular requirements for advertising as a general dentist or specialist.  A licensee is presumed by the Board to have approved the contact of all advertisement and therefore hears responsibility for its compliance will all relevant regulations.

Emailing Patient Information

Dentists may prepare and maintain patient records on a personal or other computer provided that such record-keeping complies with all State Board of Dentistry regulations.  Among other standards, the regulations require quarterly back-up of all computerized patient records, and a permanent audit trail to ensure that deletions and revisions of a record are recorded. 

As described in detail in a regulation adopted by the State Board, dentists must complete forty (40) hours of continuing education (CE) in approved subject areas in order to renew their dental licenses, with modifications for recent graduates, residents and individuals licensed in the 2^nd year of the biennial period.  The required hours must be completed within the two-year period immediately preceding license renewal.  CE can be satisfied by attending educational and scientific courses, teaching, giving presentations, and writing original scientific papers and essays.  One hour of the CE requirement will be waived for each patient treated under the Donated Dental Service program, up to a maximum of three hours during any biennial period.  A maximum of seven continuing education credits completed by a licensee in excess of the forty (40) credit hours may be credited to the subsequent biennial registration period.  No more than seven hours of CE credit will be recognized during any biennial period for courses in practice management/managed care.  Distance learning or electronic medium courses are subject to a maximum of twenty (20) hours per biennial period.  Such courses must include a written post-test, and the test must be retained by the licensee.  Members are cautioned to ensure that courses have been approved by the State Board.  Records evidencing attendance at and successful completion of continuing education credits must be retained for two full biennial periods from the date of completion of the CE activity.  The State Board periodically conducts random audits.  CLICK HERE for the complete continuing education regulation NJAC 13:30-5.1.

Effective July 18, 2016, the New Jersey State Board of Dentistry adopted a regulation that requires each dental office, facility, dental clinic or institution at which there is patient contact to: “1. Have a written protocol for managing medical or dental emergencies; 2. Have equipment to maintain adult and pediatric airways; 3. Have an ambu bag (bag-valve-mask resuscitator); and 4. Ensure that all staff are trained upon hire, and at least annually thereafter, to implement the emergency protocol.”  

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NJDA has developed sample emergency protocols that members can use or adapt as needed. 

Sample Protocol with Fillable Assignment Sheet

HIPAA is a federal law that was passed in 1996 and covers a wide range of issues, including assuring portability of health insurance; mandating a fraud and abuse control program; creating Medical Savings Accounts; and, making entities accountable for the security and privacy of protected health information.

All “covered entities,” defined to include any provider of medical or other health care service or supply who transmits health information in electronic form, must comply with the Administrative Simplification provisions.  Put simply, any dentist that does not submit electronic claims need not comply with any portion of the Administrative Simplification provisions, which include:

• Privacy
• Standard Electronic Health Care Transactions and Code Sets
• Employer Identifier Standard
• Security Standards
• National Provider Identifier

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Under the HIPAA administrative simplification rules, all dentists who are covered entities must apply for a National Provider Identifier (NPI). 

Notice of Privacy Practices in dental offices must be posted and given to new patients.  Sample documents are available at HealthIT.gov. 

The ADA and NJDA have been very involved in educating members about the various provisions of HIPAA and assisting in compliance efforts.  ADA has developed several HIPAA resources specifically for dentists.  

Emailing Patient Information: A Resource for Dental Practices

With respect to protected health information transmitted to it by any NJDA member dentist, the NJDA has signed a Business Associate agreement in which it has agreed to treat such information in compliance with HIPAA. See also: Health & Humans Services Website

The Association supports a confidential program for dentists with drug or alcohol abuse problems.  The Professional Assistance Program of New Jersey is staffed by professionals with significant experience in this area to provide education, counseling, evaluation, treatment planning and advocacy for licensed healthcare professionals.  The program is utilized as a resource by the New Jersey State Board of Dentistry as well.

There are no automatic exemptions from jury duty for dentists or other licensed professionals. Staff members must be provided time off when called for jury duty but do not have to be paid. 

The National Practitioner Data Bank (NPDB), which began operation on September 1, 1990, is a national repository of adverse or disciplinary actions taken against physicians, dentists and other health care practitioners.  It was intended to improve the quality of health care by encouraging State Licensing Boards, professional societies, hospitals, and other health care entities to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history. 

            The Data Bank collects information on malpractice payments (interpreted as including refunds made by corporate checks in response to a written request), adverse actions on licensure  clinical privileges, and professional society memberships, and controlled substance registrations, and exclusions from participation in Medicare and other federal health care programs.  All “health care entities”, such as licensing boards, professional societies and hospitals must report and may receive reports from the Data Bank.

            A “medical malpractice payment” as interpreted by the U.S. Department of Health and Human Services (HHS), is an exchange of money resulting from a written demand for payment, based on the provision of or failure to provide health care services.  The fact that a payment qualifies as a “medical malpractice payment” as that term is interpreted by HHS, does not of itself mean that malpractice has occurred in the legal sense.  If a dentist refunds fees to a patient from a personal checking account based on a written request, he/she does not have to report to the Data Bank; however, if a dentist is incorporated, payments made on the corporate account will be considered payments made by an entity and are reportable by the corporation.  Professional liability insurance companies must report all payments made on behalf of the dentist.

            The New Jersey State Board of Dentistry periodically receives copies of any reports made to the Data Bank as to any reported matters involving dentists licensed to practice in New Jersey.

In order to document and maintain a record of the incidence of cancer in New Jersey, state law requires dentists (among other health care practitioners) who diagnose or treat tumorous or precancerous diseases to report each case to the State Cancer Registry, which is maintained by the New Jersey Department of Health and Senior Services.  Reporting may be performed by contacting a hospital tumor registrar – even for non-hospitalized cases.

A large number of complaints received by the State Board each year are made as a consequence of efforts to collect fees when either the patient was unhappy with the dental service or there is a dispute about the amount charged.

            If a dentist is contacted by the State Board regarding a patient complaint, a response should be made within the time specified unless an extension of time is requested.  Complaints should always be taken seriously.  Legal counsel at NJDA is available to assist members in assessing the seriousness of a complaint and in fashioning a written response.  Simply call headquarters and ask to speak with an attorney.  When a dentist is required to appear before the State Board and in other cases where legal representation is indicated, the NJDA will refer to lawyers who regularly appear before the State Board and are viewed by its members and deputy attorneys general as being effective and competent.  If the Board eventually determines that a complaint is valid, it may require restitution to the patient, but it may also decide to require remedial coursework, civil penalties and/or costs of investigation.  In the most serious cases, a license could be suspended or revoked.  The State Board must report to the National Practitioner Data Bank any licensure action taken against a dentist.

Emailing Patient Information

A detailed patient records regulation can be found on the New Jersey State Board of Dentistry website under Laws and Regulations and then Regulations.  A licensee should be familiar with this entire section and it should be checked periodically as changes are made by the State Board.

            A contemporaneous, permanent record must be prepared and maintained by a licensee for each person seeking or receiving dental services, regardless of whether any treatment is actually rendered or whether any fee is charged.  A record need not be prepared and maintained in connection with screenings.

            At a minimum, patient records must include (1) the name, address and date of birth of the patient and, if a minor, the name of the parent or guardian; (2) the patient’s medical history; (3) a record of results of a clinical examination where appropriate or an indication of the patient’s chief complaint; (4) a diagnosis and treatment plan, which shall also include the material treatment risks and clinically acceptable alternatives and costs relative to the treatment that is recommended and/or rendered; (5) the dates of each patient visit and a description of the treatment or services rendered at each visit; (6) a description of all radiographs taken and diagnostic models made properly identified with the patient’s name and date; (7) the date and a description of any medications prescribed, dispensed or sold including the dosage or a copy of any written prescription; (8) Copies of any prescriptions to laboratories for dental prostheses; (9) complete financial records, including an itemized statement of the amount billed to and received on the patient’s account from the patient or a third party payer and copies of all insurance claim forms; (10) payment vouchers received from third party payers; (11) a record of any recommendations or referrals for treatment or consultation by a specialist, including those which were refused by the patient; and (12) the name of the dentist of record.

            The entire patient record including all radiographs and insurance claim forms, must be maintained for at least seven (7) years from the date of the last entry in the record, except that diagnostic and study models used for definitive treatment need be maintained only for at least three years from the date the model is made.  Working models may, but need not, be maintained.

            Patient records must accurately reflect the treatment or services rendered.  They should never be altered.  Whenever additional information is added to a record, it should always be clearly dated.  In all circumstances, the person who made the entry should be identified. 

            Upon receipt of a written request from a patient or the patient’s authorized representative and within fourteen (14) days thereof, legible copies of the patient record including, if requested, duplicates of models and copies of radiographs, must be furnished to the patient or an authorized representative or a dentist.  A licensee may require any unpaid balance for diagnostic services be paid prior to release of the records.  However, where treatment of a patient whose dental expenses are paid through Medicaid is discontinued by the dentist prior to completion of the treatment, no charge for the records may be made or payment required.  In addition, no charge can be made for a copy of the patient’s record when the dentist has affirmatively terminated the patient from the practice.  To the extent that a record is illegible or prepared in a language other than English, the dentist must provide a typed or written transcription and/or translation at no additional cost to the patient.

            The charge for reproduction of records can be no greater than $1.00 per page or $100.00 for the entire record, whichever is less.  If the record requested is less than 10 pages, the dentist may charge up to $10.00 to cover postage and the miscellaneous costs associated with retrieval of the record. 

            A reasonable fee may also be charged for reproduction of radiographs or any other material within a patient record which cannot be routinely copied or duplicated on a commercial duplicating machine.  The fee for a set of up to nine radiographs cannot be more than $15.00 and not more than $30 for a set of up to 18 radiographs.  The fee for duplication of a panorex shall not exceed $30.

Peer review is a voluntary, non-punitive alternative dispute resolution mechanism administered by the NJDA.  In those instances in which the quality or appropriateness of dental treatment is at issue, a patient can submit the matter to peer review.  Teams of volunteer member dentists hear each complaint.  Each party must sign a consent form, indicating his/her willingness to cooperate with the peer review committee and accept its decision as binding and enforceable under New Jersey law.  By signing the consent, form, both parties waive their rights to have the dispute settled in a court of law.  If the committee finds in favor of the patient, the dentist may be directed to adjust or redo the treatment, provided the patient is willing to return.  If not, the committee may direct the dentist to return all or a portion of the fees paid for the treatment.  In no event will the refund be greater than the total fees paid.  Peer review refunds are not reportable to the National Practitioner Data Bank. 

Peer Review and Request for Mediation

Although the law generally permits parties to contract freely, releases and covenants not to sue are likely to provide only marginal protection against negligence or malpractice actions in most cases.  The terms “release” and “covenant not to sue” are sometimes used interchangeably and often used incorrectly.  Generally speaking, a “release” discharges an already existing claim while a “covenant not to sue” involves a promise to not assert in the future a claim which either presently exists or may arise.  Most courts that considered the issue have held that an agreement which gives up a right to sue a doctor for future negligence or malpractice is void because it violates public policy.

            As to past negligence or malpractice, courts have held that a release may be enforced provided it communicates in clear, unmistakable and explicit language that a liability claim for negligence and malpractice is being waived.  Since agreements that release doctors from liability for their negligence or malpractice are disfavored by the courts, the courts will carefully examine the totality of circumstances surrounding the release and will strictly construe the release against the party relying upon it to avoid liability.  The courts will explore, among other factors, the signer’s education and business experience, whether the payment made in exchange for the waiver was fair and equitable under the circumstances, whether the signer was represented by counsel, whether the signer knew or should have known his or her rights upon execution of the release, whether the signer had adequate time for reflection and deliberation, whether the signer understood the nature and scope of the release, whether there was an opportunity for negotiation and whether there was evidence of fraud, duress or undue influence.  In addition, the courts will weigh whether the enforcement of the agreement would be against the public interest and will consider any other equitable factors that bear upon the issue.

            Agreements which purport to grant an exemption from or limitation of liability for gross negligence or deliberate misconduct, no matter how clearly expressed, are wholly void.  Moreover, a release would not prevent the releasor from making a complaint to the New Jersey State Board of Dentistry, and would not prevent the State Board from taking action.  See a sample release/refund form.

Any person having reasonable cause to believe that a child has been subjected to abuse must immediately contact the State Central Registry in the Department of Children and Families at 1-877-652-2873. The report should contain, where possible, the names and addresses of the child and his parent, guardian, or other person having custody and control of the child and, if known, the child’s age, the nature and possible extent of the child’s injuries, abuse or maltreatment, and any other information that the person believes may be helpful with respect to the child abuse and the identity of the perpetrator. Immunity from liability is extended to a person who makes a report in good faith. Further, a person who has reasonable cause to believe that an act of child abuse has been committed but fails to report it is a disorderly person. 

Any person who believes that there has been a violation of the New Jersey Insurance Fraud Prevention Act must notify the Office of Insurance Fraud Prosecutor (OIFP) immediately after discovery of the alleged violation and send to that Office, upon a form and in the manner prescribed by the Commissioner of the Department of Banking and Insurance, the information requested by the Division. Upon filing a report or furnishing information in good faith without malice, a person will not be subject to civil liability for libel, violation of privacy or otherwise. 

Dentists, like all state citizens, are required to pay either sales or use tax on all non-exempt purchases.  The State Division of Taxation periodically conducts random audits to ensure that all required taxes have been remitted properly.  Accordingly, members should request all vendors and suppliers to charge sales tax and show payment of such on all invoices where appropriate.   If sales tax is not charged, members must pay a use tax and must file such on either a quarterly or annual basis, depending upon volume of purchases.  A list of exempt and non-exempt items follows (this list may not be complete.  If you have a question regarding a specific item, you should contact the New Jersey Department of Taxation):

TAXABLE	EXEMPT
Office Supplies	Allow, Composite & Other Filling Material
Syringes	Dentures, Teeth
Mirrors	Denture Crowns, Reline & Repair
Film	Fillings: Gold, Platinum, Silver
Towels	Inlays
Sponges	Bridges
Cups	Cavity Liners
Compo Strips	Cements
Drills & Bits	Lining Pastes
Cotton Gauze, Pellets, Sponges	Anesthetics
Spit Sinks	Oxygen
Trays & Covers	Items for Resale to Patients
Tape	Braces
Floss and Threaders	Reusable Workwear
Hand Tools	Surgical Gloves
Chairs	Surgical Masks, Face Shields
Gas Dispensing Equipment	Medicines
Die Stones	Sutures
Office Equipment	Fluoride Paste
Office Equipment Repairs	Pins & Posts (Tooth Reconstruction)
Sharpeners	Orthodontic Appliances If Transferred to Patient
Alginate Impression materials	Surgical Soaps & Lotions (If Medicated)
Wax Bites	Labor on Capital Improvement to Real Property
Plaster
Toothpaste
Lamps
X-ray Machines, Films, Mounts
X-ray Machine Related Products
Paper Bibs
Tooth Brushes (Not Resold)
Crown Forms
Surgical Instruments
Operative Instruments
Endodontic Instruments
Tooth Polishing Cups & Brushes
Burs, Rotary Grinding & Polishing Instruments
Sterilization Solutions
Sterilization Pouches & Bags
Containers for Syringe/Needle Disposal

Emergency Protocol
Informed Consent General Dentistry
Sample Exposure Control Plan
Sample letter for overdue payments
Sample Letter termination of plan
Sample Nondiscrimination Notice
Sample Tagline Limited English Proficiency
Sharps Injury Log
Release_Refund sample
Sample Written Work Order Allowing General Supervision in Dental Office

An abandonment occurs when a dentist fails to provide dental services to a patient when treatment or other services is still needed in a case for which the dentist has assumed responsibility and from which the dentist has not been properly relieved.  The determination as to whether the notice was sufficient and the opportunity to secure another dentist was reasonable is fact sensitive and will be decided on a case-by-case basis.  Whenever feasible, if the dentist is in the middle of a treatment plan or at a critical stage of treatment, the particular aspect of the treatment plan or treatment should be completed so that the patient is placed in a stable condition and his/her oral health is not jeopardized.  If a dentist determines that he or she cannot provide needed specialized treatment, a referral of the patient to a specialist does not constitute abandonment.

            Clearly, there are situations in which a dentist may properly terminate a dentist-patient relationship without liability.  For example, a termination may be justified when a patient is nasty and abusive, repeatedly misses appointments, fails to satisfy payment obligations or is regularly uncooperative and obstinately refuses to follow the treatment prescribed.

            To reduce the likelihood that a complaint for abandonment will be made in court or submitted to the New Jersey State Board of Dentistry, or that related allegations for dental malpractice or breach of contract will be asserted, it would be prudent to consider the following suggestions:

            (1) The dentist should send the patient a letter simultaneously by certified mail, return receipt request and by regular mail, spelling out the reasons why the dentist is terminating the dentist-patient relationship.  A copy should be placed in the patient file.  Remember, under the law, a dentist cannot terminate a dentist-patient relationship for any unlawful or discriminatory reason relating to age, race, sex, religion, ethnic origin, handicap or illness, including HIV or AIDS.

            (2) The letter should advise the patient of the patient’s oral health condition and the need for continued care.  It should also specify, as appropriate, that failure to receive continued care could result in permanent, irreversible damage to the patient’s dental or general health.

            (3) The letter should also inform the patient that service will continue to be provided for thirty (30) days if there is an emergency condition which cannot safely wait for alternative care.

            (4) Finally, the letter should inform the patient that copies of the patient record including, if requested, duplicates of models and copies of radiographs, will be furnished by the dentist to the patient or to a designated dentist or other authorized representative within fourteen (14) days of a written request to do so by the patient or the patient’s legal guardian.  No charge can be made for the copy of the record.