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June 2009

President's Message: United we stand Dr. Anthony Wolf, D.C. Greetings Doctors, Unity has never been more important in this world we live in. Chiropractors in Indiana must constantly realize that our true strength comes as a result of unity. Each of us possesses our own uniqueness, yet we are all chiropractors and have a core understanding of the body’s ability to heal itself that unites us in this philosophy. HOWEVER, Chiropractic as we know it today will be slowly broken down by our adversaries and within our own profession, if we fail to take action in a unified manner. The ISCA is that Unity, the VOICE and STRENGTH of Chiropractic in Indiana. The position of Chiropractic in Indiana tomorrow is a direct result of the Actions of the ISCA and its members today. Norman Vincent Peale once stated, “The secret of life is not in what happens to you-rather what you do with what happens to you.” I am truly amazed and humbled by the commitment of our membership and our Board of Directors to continue to defend and strengthen this great profession! Our Spring Seminar was a great success in many ways! We had top notch speakers including our very own Drs. Jim Cox II and Chris Klaes. Drs. Klaes and Cox gave a very informative lecture on Medicare changes and a detailed account on Medicare Audits. We also launched a first ever “chiropractic summit panel” under the supervision of our Membership Committee Chair, Dr. Diane Vuotto. This was designed to allow a question and answer session for veteran and new ISCA members. We look forward to developing and enhancing this excellent concept to be held at each Spring Seminar.

Do not miss our Fall Convention as we have another excellent line up of speakers. Our conventions have always been a great opportunity to “catch up” with other doctors in the state, while completing our continuing education requirements in support of our state association. A significant portion of our revenue comes from our seminar attendance. The ISCA Executive Board, Board of Directors, Committee Chairs and Committee Members are volunteering their time and are working hard to connect Doctors across the state and develop new ideas to continue to strengthen the unity of the ISCA and its members. The Insurance Committee, under chair Dr. Peter Furno, is busy with issues concerning reimbursement rates, Medicare and Anthem audits, and Equal reimbursement for Chiropractic Spinal Manipulation compared to Osteopathic Manipulation. This committee is our members’ source for coding questions and reimbursement/denial issues. The Membership Committee, under chair Dr. Diane Vuotto, is currently developing “Brown Bag Lunches” that will offer a call in number for our members in which topics will be discussed in regards to important issues of the practice of chiropractic in Indiana. This will be a great opportunity for all members to ask questions and discuss issues with established, experienced Board Members. This teleconference call will be offered bi-monthly to our membership. Be sure to call in and contribute as we develop this concept. Contact the ISCA office for the next scheduled “Brown Bag Lunch”. The Website Committee will be continuously enhancing the ISCA website as a valuable tool for our members to frequently refer to. We will be initiating a communication format in which doctors can post questions to be answered by members of the ISCA. The website will also include various state laws affecting your practice and how to utilize these laws in dealing with insurance companies.

Inside This Issue President's Message.....................................................................................1 ISCA Board of Directors & Staff Info...................................................2 Executive Director's Message................................................................3 OIG Report on inappropriate medicare payments............................4 customer service: Rob Hart.....................................................................5 Federal trade commission protecting america's consumers......6 CoCSA to Offer Red Flag Course...........................................................7 Competitive sports in youth........................................................................8 St. Vincent Carmel Hospital Ad...................................................................9 ACA UPdate: E-Stim Remains covered service for bCBs Plans........11

June 2009

In Chiropractors volunteer as part of ISCA DC of the DAy.............11 AMA Joins Suit Claiming Wellpoint shorted physicians..................12 ACA comments on first draft of health Care REform Legislation..12 ACA responds to may OIG Report.........................................................13 Payment Processing ad...........................................................................14 Senate legislation introduced to expand chiro benefit...............14 ISCA Membership UPdate............................................................................15 ISCA Q&A...........................................................................................................15 ISCA fall conference Oct. 9-11, 2009................................................16 ISCA Classifieds......................................................................................18-19

ISCA Report

Indiana State chiropractic association Board of directors President Anthony Wolf, D.C. Indianapolis, IN 317.898.1100

District Seven Diane Vuotto, D.C. Indianapolis, IN 317.898.6989

District Three Jason Russell, D.C. Fort Wayne, IN 260.483.5588

District Directors

District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464

District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885

Second Vice-President Robert Tennant D.C. Shirley, IN 765.737.1117

District One Ron Daulton, Sr., D.C. Hammond, IN 219.932.8900

District Nine Nate Unterseher, D.C. Seymour, IN 812.524.2273

District Five David Frischman, D.C. Wabash, IN 260.563.8476

Secretary James Cox II, D.C. Fort Wayne, IN 260.484.1964

District Two Gerard Hofferth, D.C. South Bend, IN 574.256.1008

Alternate Directors at Large

District Six David Davis, D.C. Winchester, IN 765.584.3665

Treasurer Chris Bryan, D.C. South Bend, IN 574.259.3355

District Three George Joachim, D.C. Fort Wayne, IN 260.492.8811

Immediate Past President Duane Binder, D.C. Clinton, IN 765.832.7777

District Four G. Lyman Shaw, D.C. Brownsburg, IN 317.852.3870

Past President Representative Mick Gallagher, D.C. Indianapolis, IN 317.571.1480

District Five Derek Dyer, D.C. Huntington, In 260.356.1616

Directors at Large

District Six Matt Howard, D.C. Muncie, IN 765.254.9481

First Vice-President Peter Furno, D.C. Zionsville, IN 317.338.6464

Ted Freidline, D.C. Salem, IN 812.883.1444

Lewis Myers, D.C. Valparaiso, IN 219.464.4444 Michael Phelps, D.C. Martinsville, IN 765.342.2208

James Galyen, D.C. Scottsburg, IN 812.752.6202 C.C. Paprocki, D.C. Greenwood, IN 317.535.7507 John Volbers, D.C. Indianapolis, IN 317.299.3330 Alternate District Directors District One Chris Hayes, D.C. Crown Point, IN 219.661.8680 District Two Bill Garl, D.C. Bremen, IN 574.546.1111

District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 District Nine John Krawchinson D.C. Seymour, IN 812.524.2273 Alternates: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate Directors at Large are nominated by the Directors at Large and then must be approved by the Board of Directors. The District Director Alternates are recommended by the District Directors and approved by the board.

Indiana State chiropractic association staff & Info

Patricia McGuffey Executive Director

Stephanie Higgins Director of Events

Patrick Russell Association Manager

Stacy Quasebarth Director of Communications

Tom Johnson, CPA Chief Finanical Officer

Connie Vickery Governmental Affairs

Debra Scott, IOM Vice President of Operations

John Livengood Governmental Affairs

ISCA Report

Krista Rader Education 200 S. Meridian St., Suite 350 Indianapolis, IN 46225 317.673.4245 phone 317.673.4210 fax

June 2009

The Public Relations Committee is compiling survey results from our member survey conducted at the Spring Seminar. This committee will be concerned with direction and public relations efforts to advance the image of chiropractic to the public, various Medical Professionals and Lawmakers. The Legislative Committee will continue to focus on potential bills that would harm the practice of chiropractic in Indiana, but more importantly institute proactive legislation such as the Assignment of Benefits Bill, which gained much momentum this year. AOB protects the Doctor’s rights to be directly reimbursed when out of network. The Speaker/Convention Committee, under chair Dr. Sheila Wilson, is constantly at work to improve our continuing education experience. I do not need to remind you that these are difficult times, but they are also days filled with unique opportunities. The demand for chiropractic care has never been greater. In the May issue of Consumer Reports, a research article revealed that more people were satisfied with their chiropractor than any other health professional.

The ISCA has total faith, confidence and belief in chiropractic and I know that we as its current ambassadors can all move up one level and carry this profession to its rightful place in America’s healthcare system. I would like to end with the following poem, written by S. Marlin Edges to remind us all to move to the next level! “When I walk to the edge Of all the light I have And take that step into The darkness of the unknown I believe One of two things will happen There will be something solid For me to stand on Or I will be taught to fly!” Yours in chiropractic, Anthony C. Wolf, D.C., F.I.C.C.

Executive Director's Message Patricia McGuffey

The Regular Session of the Indiana General Assembly adjourned April 29th. However, the Legislature did not pass the biennial budget that is mandated by the Constitution. Consequently, the Governor called for a Special Session (SS) which convened June 11. Senate Republican leadership and the Governor have indicated they want the SS limited to passing the budget. However the House Democrats have introduced two additional pieces of legislation concerning the Capitol Improvement Board bailout and a delay in the auditing of the FSSA modernization contract. As you know, ISCA was successful in the Regular Session in securing language in the budget to allow for Chiropractic services in the Healthy Indiana Program (HIP) program. Since the budget failed, ISCA has been successful in having language included in SS HB1001 (budget bill) that not only allows for chiropractic services in HIP but also indicates reimbursement must be on the same basis as physicians. It will be difficult in light of the State’s economic climate to keep the provision since it has not been supported by the Administration. However, there is no reason why Chiropractors should be discriminated against in services they can provide in the HIP program. HIP patients deserve to have access to Chiropractic services as well as regular insurance patients. This prohibition violates the law that established the HIP program and we will continue to fight for that inclusion!

provider or they will be committing insurance fraud. It specifies that the print must be large and the address and all information must be clear so the patient will clearly understand where the benefit check should be mailed. In addition, the legislation required the Department of Insurance to research if there really is a cost for implementing full AOB legislation. Full AOB legislation would require insurance companies to honor the patient’s wishes on where the benefits should be sent. We are confident that the research will prove that there are no costs to implementing full AOB legislation. This will enable the ISCA to successfully pursue full AOB legislation in the 2010 legislative Session. I want to sincerely thank our members who have done a yeomen’s job in the 2009 Session by contacting legislators regarding our important legislation. With your help we have been able to advance important legislative issues and prevent onerous ones from being passed. The legislative process requires teamwork and I appreciate ISCA’s first rate team. In closing, I want to request that all of you support YOUR ISCA by continuing your membership, contributing to BACKPAC and continuing to support ISCA’s conferences, golf outings, seminars, etc. Without your support, the ISCA would not be able to continue to represent the chiropractic profession or provide services needed by all our chiropractic members. Thanks for making our work possible. Please let me know if the ISCA staff or ISCA board can ever be of service to you in your practice. Thanks for your support.

ISCA’s other legislative priority was to pass legislation that would allow for Assignment of Benefits (AOB). We were successful in passing HEA 1300 that requires insurance companies to notify patients that their benefits check must be sent to the health care

June 2009

ISCA Report

OIG Report on Inappropriate Medicare Payments for Chiropractic Services By David Elliott Jose, Esq.

In May 2009, the Office of Inspector General (OIG) issued a report entitled, “Inappropriate Medicare Payments for Chiropractic Services”. This was based upon a study of a random sample of claims for chiropractic services in 2006. The report includes very useful information that can be of assistance for chiropractors (and all health care providers) in seeking to comply with Medicare billing and documentation requirements and avoid audit and repayment penalties. The report begins with the audit premise that Medicare pays only for medically necessary chiropractic services, which are limited to active/corrective manual manipulations of the spine to correct subluxations. OIG has performed previous investigations of Medicare billing practices by chiropractors, and finds in this report that some of its previous concerns are still present. As a result, it is reasonable to anticipate that the Center for Medicare and Medicaid Services (CMS) will implement some changes to its documentation and billing requirements, and it is also probable that CMS will enhance its retrospective audits of chiropractors. The OIG began its investigation by identifying a sample of situations where more than 12 claims had been submitted from the same chiropractor for treatment of an individual patient. For each treatment episode, the medical records were reviewed to identify whether the treatment reflected active/corrective treatment or maintenance therapy, the extent to which the chiropractors were supporting their use of the AT modifier with proper documentation, and the extent to which the claims were coded properly. The OIG concluded that Medicare inappropriately paid $178 million (out of a total amount paid of $466 million) for chiropractic services that medical reviewers determined to be maintenance therapy, miscoded, or undocumented. Those inappropriately paid claims represented 47% of all allowed chiropractic claims that met the study criteria. One important finding from the report is the OIG’s contention that it is hard to determine if a service represents active/ corrective treatment as opposed to maintenance therapy using a single claim. As a result, they are recommending that CMS auditors in the future look at multiple claims in order to better detect and distinguish between active/corrective treatment versus maintenance therapy. This prompted the OIG to recommend that chiropractors enhance their documentation for each claim in order to identify the start of a new treatment episode so as to substantiate that on-going treatment is serving an active/corrective purpose as opposed to a maintenance purpose.

The report also notes that there were many deficiencies associated with treatment plans. Treatment plans are an important element in determining whether the treatment is active/corrective and achieving specified goals. Many of the treatment plans lacked treatment goals, and a number lacked objective measures or recommended levels of care. The report states that the mean number of claims between the initial visit and the first visit determined to be maintenance therapy was 14, with the median number being 9 claims. Furthermore, 78% of those treatment episodes that became maintenance therapy did so by the 20th visit, and 100% were considered maintenance beyond the 24th visit. Thus, visits beyond 10 or 12 following an initial visit for a new treatment episode should be very carefully scrutinized. The OIG is recommending that CMS take steps to impose greater documentation requirements on chiropractors, while also enhancing retrospective audit oversight of chiropractic claims since there are so many errors noted by OIG’s medical reviewers. One enhanced step recommended by the report is to increase the use of prepayment review of claims from chiropractors who repeatedly failed to meet documentation requirements. This Report, and the follow-up responses from CMS, reveal a heightened scrutiny for chiropractors and their Medicare claims. Clearly CMS believes that there are a high percentage of inappropriately paid claims representing a significant dollar amount to be recovered. This reinforces the importance for chiropractors to enhance the specificity and completeness of one’s service documentation, with a constant eye on including information revealing the start of a new treatment episode, the active/corrective treatment being pursued, and the connection of that treatment to a treatment plan and treatment goals. This report was issued at a time of growing scrutiny for claims by Medicare and Medicaid as well as by commercial payors. New initiatives are being considered and implemented for retrospective audits, and it is incumbent upon providers to establish and maintain rigorous compliance plans that assure proper billing that can be defended against retrospective oversight. If you have any questions regarding the OIG report or such retrospective audit activity, you may contact David E. Jose at (317) 238-6211 or Each situation is different, but all situations can be best addressed by anticipating such audit scrutiny and implementing policies and procedures that can help prepare for and respond to such audit inquiries. Material contained herein is not to be considered legal advice to any particular person. Each person's circumstances are unique and must be evaluated individually. Competent legal counsel should be sought before taking any action in reliance upon the information contained in this article. The contents of this article may not be reproduced or distributed without the express written consent of Krieg DeVault LLP.

(Editor's Note: See Page 13 for ACA rebuttal of OIG Report.)

ISCA Report

June 2009

Customer Service By Rob Hart - Hart Consulting

Let’s imagine that you are one of several chiropractic doctors practicing within a mile of each other on the same street (and you probably are) and further pretend that a prospective new patient is trying to decide which one of you he should see (and one probably is), why should he choose you over the others? What makes you different, special or unique? The answer might be that you are not unique, but hopefully you will choose to change that. The marketing term that is used to describe the characteristics that separate you from your competitors is called your unique selling proposition, or USP. For some doctors, their USP could be the ability to speak another language such as Spanish, certainly a useful trait in our modern society. Others might have learned a specialized technique or have specialized equipment. Still other doctors might be the only female in their area and therefore unique. As you can see, in some cases, your USP is something you have no control over such as your gender; but in others, you can consciously develop a USP based on a perceived need in the community. Permit me to offer a suggestion for the perfect unique selling proposition – customer service. I recognize that you might be thinking that you already offer great customer service, but that’s not what I am talking about. I’m talking about incredible, fantastic, beyond belief customer service, the kind of customer service that creates intensely loyal patients. Let’s look at a couple of real life examples in other industries. Think about what a tough job selling shoes on the internet would be, you’d be nuts to try. The customer can’t try them on to see how they look and feel and the shoes you sell are the same models and brands available in every shoe store in every mall in America. Enter Zappos, an online shoe retailer that has solved the problem by becoming better known for its customer service than for the shoes it sells. The Zappos solution is to offer fast, free shipping and free returns. When you order a pair of shoes from Zappos, the order is shipped in as little as 8 minutes from when it was placed. Further, without even telling the customer, they ship their orders overnight so the customer is amazed when they receive their shoes the next day. Zappos had 1 billion dollars in gross sales in 2008, representing a 20% increase over the previous year. To learn more about the Zappos revolutionary customer service, to read an article in the May 2009 issue of Inc. Magazine or online at Southwest Airlines is renowned for their effective brand of superior customer service. A combination of low fares, in-flight humor and putting employees first, translates to an airline that is the largest domestic carrier in the United States as measured by number of passengers carried. Most significantly, Southwest has posted a profit for 36 consecutive years at a time when many of their competitors have been busy filing bankruptcy. Possibly the most revolutionary aspect of Southwest’s customer service philosophy is their decision to put the customer second. They believe that their employees come first and that if they can keep their

June 2009

employees happy those employees will pass that contentment along to their customers. Demonstrating this philosophy Herb Kelleher, the founder and first Chairman of the airline, once wrote the following reply to the last of many complaining letters from a long standing difficult passenger. “Dear Mrs. ‘Crabapple’, we will miss you. Love, Herb.” He actually “fired” the passenger, because she was hassling his employees – what a concept. To learn more about Southwest Airline’s brand of customer service, read the book, “Nuts!” by Kevin and Jackie Freiberg. Costco is a value priced, no frills warehouse style retailer, so it would seem that customer service would be a difficult proposition for them. However, their entire customer service policy is successfully distilled into 3 points. • Membership: We will refund your membership fee in full at any time if you are dissatisfied. • Merchandise: We guarantee your satisfaction on every product we sell, with a full refund. • Merchandise Exceptions: Televisions, projectors, computers, cameras, camcorders, iPOD/MP3 players and cellular phones must be returned within 90 days of purchase for a refund. The policy is simple and straight forward and I can personally attest to their willingness to accept returns as I have availed myself of that opportunity numerous times. One purchase in particular, a carpet cleaning machine that has seen much use as we have raised our family, has been returned many times when a part breaks or something stops working. It doesn’t seem to matter how old the unit is, they take it back and issue a refund each time. It is also interesting to note that Costco has recently been called to task by Wall Street for not being sensitive to their shareholders because even though they continue to earn a healthy profit, they pay their employees 42% more than Sam’s Club employees and won’t mark up their merchandise as high as the industry standard. This is a bad thing? So enough with the examples, what about your practice? How can you create a “WOW” factor with your customer service? Unfortunately, there is no simple answer to that question. The answer will differ based on your location, your personality, and what kind of practice you want to create. Do you want the “Sax Fifth Avenue” practice, where the countertops are granite, the faucets gold plated, the patients pampered and where money is not an object? Or, do you envision the “Costco” practice where the staff is helpful, the bathrooms are clean and the prices are low? You cannot please all of the people all of the time. Some patients will like a downhome, comfortable style, and some a glass and chrome professional style. One thing is for certain, great customer service requires more than lip service – it requires hard work. It requires creating systems and commitment to ensure that it continues beyond the motivating staff meeting that you have after reading this article. Are you willing to fire a staff person because she won’t look up and smile when a patient enters the office? If you are serious about this, you may have to.

ISCA Report


Rob HART: Customer Service Continued... What follows are some simple ideas to get the discussion going in your office. Some should be done by every single office regardless of the brand of customer service that they choose and others not. Good luck setting yourself apart from the other chiropractors in your area with your USP. •

Genuinely love and care for your patients and their health.

Smile and greet every patient by name.

Be on time for your patient’s appointment. If you have an emergency and are running late, let them know, apologize and give them the option of waiting or rescheduling.

When a patient experiences a significant event in their lives, write a note acknowledging that event. This lets them know you listen and you care. (Deaths, graduations, promotions, all-star team, good grades, etc.)

listening options. •

Make sure the office is clean.

Make sure the office smells nice.

Decorate the office in something other than a dark paneled 70’s style, unless you are going for that groovy feel.

Consider an interesting theme for each adjusting room. Don’t be afraid to show some personality.

Offer options for kids when they come in. A separate room? A toy corner?

Offer drinks and snacks.

Offer reading material in the reception area that is less than 6 months old.

Always call the patient after their first adjustment.

Play music appropriate to your office, or offer individual

Provide reserved parking close to the office door.

Federal Trade Commission Protecting America's Consumers

FTC Will Grant Three-Month Delay of Enforcement of ‘Red Flags’ Rule Requiring Creditors and Financial Institutions to Adopt Identity Theft Prevention Programs The Federal Trade Commission will delay enforcement of the new “Red Flags Rule” until August 1, 2009, to give creditors and financial institutions more time to develop and implement written identity theft prevention programs. For entities that have a low risk of identity theft, such as businesses that know their customers personally, the Commission will soon release a template to help them comply with the law. Today’s announcement does not affect other federal agencies’ enforcement of the original November 1, 2008 compliance deadline for institutions subject to their oversight. “Given the ongoing debate about whether Congress wrote this provision too broadly, delaying enforcement of the Red Flags Rule will allow industries and associations to share guidance with their members, provide low-risk entities an opportunity to use the template in developing their programs, and give Congress time to consider the issue further,” FTC Chairman Jon Leibowitz said. The Fair and Accurate Credit Transactions Act of 2003 (FACTA) directed financial regulatory agencies, including the FTC, to promulgate rules requiring “creditors” and “financial institutions” with covered accounts to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft. FACTA’s definition of “creditor” applies to any entity that regularly extends or renews credit – or arranges for others to do so – and includes all entities that regularly permit deferred payments for goods or services. Accepting credit cards as a form of payment does not, by itself, make an entity a creditor. Some examples of creditors are finance companies; automobile dealers that provide or arrange financing; mortgage brokers; utility companies; telecommunications companies; non-profit and government entities that defer payment for goods or services; and

businesses that provide services and bill later, including many lawyers, doctors, and other professionals. “Financial institutions” include entities that offer accounts that enable consumers to write checks or make payments to third parties through other means, such as other negotiable instruments or telephone transfers. During outreach efforts last year, the FTC staff learned that some industries and entities within the agency’s jurisdiction were uncertain about their coverage under the Red Flags Rule. During this time, FTC staff developed and published materials to help explain what types of entities are covered, and how they might develop their identity theft prevention programs. Among these materials were an alert on the Rule’s requirements,, and a Web site with more resources to help covered entities design and implement identity theft prevention programs, redflagsrule. The compliance template will be available on this Web site. The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,500 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s Web site provides free information on a variety of consumer topics. MEDIA CONTACT: Office of Public Affairs 202-326-2180 (Red Flags Deadline Extension)

ISCA Report

June 2009

DOI Helps North Carolinians Recover $10 Million in 2008

Cocsa to offer Red Flag Course

2008 Call Center Stats, Trends Released The Congress of Chiropractic State Associations along with the help of Pennsylvania Chiropractic Association now have a RED FLAG course to offer the Chiropractic Profession. With the expertise of Veratad Consulting, a unique course has been approved to assist you in providing an excellent tool for your doctors and their staff. As of today, there is a website where you can enroll in the course. As an ISCA Member you may use a special discount code for the course that will bring the price down from $299 to $99. To obtain the password, you must call the ISCA directly to confirm your membership status – (317) 673-4245.

Insurance Commissioner Wayne Goodwin released the 2008 statistics for the Department of Insurance's Consumer Services Division, which handles consumer inquiries and complaints about insurance-related issues. In 2008 the Consumer Services Division handled some 90,000 calls and processed 8,200 written complaints from the public. Through these calls and complaints, the Department was able to help citizens recover $10 million from insurance companies. "I already knew that our employees in Consumer Services worked hard and stayed busy," said Commissioner Goodwin. "But to see the numbers in front of me and know that they put $10 million back into the wallets of North Carolinians makes me even more proud to be a part of DOI."

The directions for the website tutorial are listed below and there is also a video you can click on for step by step instructions. The site is live and the RED FLAG Course has already been pre-viewed by about 50 chiropractors and the feedback has been VERY positive. This Course provides an overview of the Red Flag Rule, What to do about it and tools for implementation in your office.

The $10 million worth of recoveries stem from complaints filed with the Consumer Services Division. When a person files a formal complaint, the Department contacts the insurance company on the consumer's behalf. The company then has seven days to review the complaint and respond. In many cases, the insurance company realizes a mistake and will settle the dispute directly with the consumer. This sum is on top of the $5.8 million recovered by the Department's Investigations Division during their insurance fraud cases for 2008.

Remember the deadline for the Compliance of the Red Flag rule is August 1, 2009.

The most common types of insurance involved in the complaints were:

Taking the COCSA sponsored Red Flag course can be done in six easy steps.

Life and health insurance: group health (46%); individual health (24%); and life insurance (22%)


Property and casualty insurance: auto (63%) and homeowners (16%)

The course takes about 45 minutes to complete.

2. 3.


5. 6.

First, contact the ISCA for a member’s only discount code so that you will receive a 67% reduction and obtain the course for only $99. With your discount code in hand, go to the COCSA site at www. Let’s get registered! Click the “New User” link located in the upper right hand corner. Enter your e-mail address, make-up a password and complete the basic registration information. You will know that you are registered when you see your e-mail address in the upper right corner of the screen. Let’s pick the course. Click “Course Catalog” on the left side of the page and you will see the course listed at the non-member price of $299. Insert the discount code below the course and click “Apply Discount Code.” The fee will change to $99. Now check the small “Enroll” box to the right of the course and then click the yellow “Enroll Now” button. Fill in your credit card information on our encrypted and secure page. Click the “Purchase Course” button and the course will start.

Finally, click the FAQ button on the left side of the page if you log out early or need to resume the course.

June 2009

The most common reasons for filing a complaint were claimsrelated, including claim denial, claim delay and unsatisfactory settlement (meaning the insurance company didn't pay enough). "Now more than ever, every dollar counts," said Commissioner Goodwin. "I want the public to know that if they have questions or problems with their insurance companies - for example if their insurance company isn't paying claims in a timely manner - they should call the Department of Insurance. We are here to help." For all Indiana doctors that would like to file a complaint please do so through the Indiana Department of Insurance. Complaint forms can be accessed through their website or through the links below. Indiana Department of Insurance Attn: Consumer Services Division 311 W. Washington Street Indianapolis, IN 46204-2787 Fax: 317-234-2103 Phone: 317-232-2395 Website:

ISCA Report

Competitive Sports in Youth May Predispose to Disk Degeneration But Are Degenerative Disks Causative of Low Back Pain? By Warren Hammer, MS, DC, DABCO

In a recent study, it was found that athletes who trained from youth were more likely to have degenerative disks (DD) compared to nonathletes. Comparing sports such as baseball, swimming, basketball, Kendo, soccer, and running, continuous competitive baseball and swimming were the most associated with DD. All of the participants in the above sports significantly experienced more low back pain than non-athletes in the study. Consideration of gender and obesity did not change the statistics, although some studies have shown that while height or weight does not affect DD, obesity does. It was thought that particular sports resulted in greater DD based on different postures and actions specific to each sport. Studies have shown that weight-lifters and soccer players have increased DD compared to shooters and DD is significantly more common in male elite gymnasts than in non-athletes. It was thought that baseball players and swimmers experienced more DD due to the frequent rotations of the trunk, but no signs of accelerated DD have appeared in competitive runners or runners and cross-country skiers at the recreational level. There is a major question about all these studies. Are degenerated disks causative of low back pain? In the cervical spine, if degenerative disease is a cause of pain, it should be more frequent at older ages than 49, which is the peak time of incidence. Degenerative changes on cervical MRI do not correlate with neck pain, since these findings are commonly found in asymptomatic people. A study was performed to determine if lumbar disc degeneration, diagnosed in young patients with low back pain using MRI, could predict chronic pain, disc herniation, or functional disability after 17 years of follow-up. In this study, early DD in adolescent patients with low back pain predicted the evolution of enhanced DD and herniation in adulthood, but was not associated with severe low back pain or increased frequency of spinal surgery. Another study demonstrated that individuals with disc degeneration soon after the phase of rapid physical growth not only have an increased risk of recurrent low back pain at this age, but also a long-term risk of recurrent pain up to early adulthood. In another pertinent study, 67 asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. Seven years later, they were sent a questionnaire about the status of their back regarding pain. Fifty responded and a repeat MRI was performed for 31 of these subjects. Two neuroradiologists and one orthopedic spine surgeon interpreted the original and repeat scans in a blinded fashion, independent of clinical information. Of the 50 subjects who returned the questionnaire, 29 (58 percent) had no back pain. Low back pain developed in 21 subjects during the seven-year study period. The 1989 scans of these subjects demonstrated normal findings in 12, a herniated disc in five, stenosis in three, and moderate disc degeneration in one. Eight individuals had radiating leg pain; four with normal findings on the original scans, two with prior spinal stenosis, one with a prior disc protrusion, and one with a prior a disc extrusion. In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans. It was concluded that the findings on magnetic resonance scans were not predictive of the development or duration of low back pain. Individuals with the longest duration of low back pain did not have the greatest degree of anatomical abnormality on the original (1989) scans. It is apparent that if there are motor and sensory signs and pain along a particular dermatome below the knee, a positive MRI with associated disc findings is probably relevant. Otherwise, a DD in the lumbar spine, as in the cervical spine, is not necessarily relevant. Source: Dynamic Chiropractic Volume 27, Number 13

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ISCA Report

June 2009


Because back problems DON’T ALWAYS SHOW UP


The Open Upright MRI

At St.Vincent Carmel Hospital

Standing, sitting, bending, or lying down. The Upright MRI at St.Vincent Carmel is a multiposition tool for joints, spine, instability of the foot and pelvic prolapse that delivers vastly improved diagnostics. Enabling diagnosis of patient weight bearing issues, it lets you view your patients in the situations that actually produce their pain. With conventional tubular MRIs you may be forced to surmise. The Upright MRI eliminates the guesswork. Your patients will benefit too. Not only does the Upright MRI provide higher levels of comfort for everyone, it’s also a great relief to those who are claustrophobic. Better imaging for you. Greater ease for your patients. The Upright MRI at St.Vincent Carmel. Call (317) 338-3224 to schedule.

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June 2009

4/27/2009 12:30:14 PM

ISCA Report


Legislation would end insurance discrimination against those who live with pre-existing or chronic illness During a conference call with reporters, Senator John D. (Jay) Rockefeller IV (D-W.Va.), Chairman of the Senate Finance Subcommittee on Health Care, and Congressman Joe Courtney (D-Conn.), Member of the House Education and Labor Committee, announced the introduction of the Pre-existing Condition Patient Protection Act that would end insurance discrimination against those who live with preexisting or chronic illness. “We have 133 million Americans living with chronic illness – insurance companies should no longer be allowed to reap profits by denying care to sick Americans,” said Senator Rockefeller. “We as a nation can no longer stand by and continue to allow this practice to occur. These medical services are not optional, and most times, they are not affordable without insurance. Our system is broken—which is why we must eliminate the ability of insurers to deny coverage for pre-existing conditions in every single market. The time for serious action is now.” “It is wrong and impractical to commit ourselves to health care reform without addressing the faulty and ill-advised pre-existing condition exclusion,” stated Congressman Courtney. “This discriminatory practice prevents millions of hardworking Americans from changing or finding new jobs and in this economy that is just plain wrong. Senator Rockefeller and I agree that it is time for the most advanced nation in the world to have a world-class health care system that is fair and affordable.” Background The Pre-existing Condition Patient Protection Act will eliminate pre-existing condition exclusions in all insurance markets, a major step forward for the 133 million Americans living with at least one chronic condition. Eliminating pre-existing condition exclusions is a priority of the Obama Administration and Senator Rockefeller and Congressman Courtney plan to work closely with President Obama to enact this vital legislation. Insurance market reform must be a central part of comprehensive health reform. Both Senator Rockefeller and Congressman Courtney believe that all individuals should have access to comprehensive, meaningful, and affordable health insurance coverage—and this legislation is a critical component of achieving that goal. Summary of the legislation •

The Pre-existing Condition Patient Protection Act is a bill to protect consumers excluded from receiving health insurance coverage due to a “pre-existing condition.”

The Pre-existing Condition Patient Protection Act would require the Secretary of Health and Human Services to submit a report to Congress on the extent of adverse selection (i.e. which happens when less healthy people disproportionately enroll in a risk pool) that occurs because insurers can no longer exclude patients with pre-existing conditions. This report must include data from private insurers on the characteristics of their insured population. This new reporting requirement would provide transparency on the true mix of patients and patient claims experience among private insurers; and

Require the Government Accountability Office to submit a report to Congress addressing the impact of this legislation on reducing the number of uninsured and underinsured, as well as its effect on the affordability of health insurance coverage. This is meant to highlight both the positive impact this new policy will have on making coverage more accessible for individuals with chronic conditions, but also recognize that without further regulatory changes, coverage may not be affordable for these individuals.

The Pre-existing Condition Patient Protection Act of 2009 has been endorsed by twenty-two organizations, including: American Autoimmune Related Diseases Association; American Heart Association/American Stroke Association; Association of Black Cardiologists, Inc.; Association of Community Cancer Centers; Breast Cancer Network of Strength; Children’s Cause for Cancer Advocacy; Congenital Heart; Information Network; Dermatology Nurses’ Association; First Focus; International Myeloma Foundation; Lung Cancer Alliance; Lupus Foundation of America; Mended Little Hearts; National Association of Pediatric Nurse Practitioners; National Patient Advocate Foundation; Oncology Nursing Society; Ovarian Cancer National Alliance; Pediatric Stroke Network, Inc.; Sarcoma Foundation of America; Sudden Cardiac Arrest Association; The Leukemia & Lymphoma Society; and The Wellness Community.


ISCA Report

June 2009

ACA UPdate: E-Stim Remains Covered Service for BCBS Plans By: Dr. Robert Tennant, D.C. - ISCA Second Vice President

In early March, ACA began to receive member reports that a number of Blue Cross Blue Shield (BCBS) plans would no longer cover electrical stimulation and certain types of traction. The BCBS plans that were reported to be affected were all those operated by the Health Care Service Corporation which includes the BCBS plans of Oklahoma, New Mexico, Texas and Illinois. While reports that this change affected all of these plans, written notification regarding the policy changes was released only by BCBSOK. The ACA has been working with our contacts at the HCSC Blues plans to obtain confirmation as to whether these policies were going to be implemented by all HCSC plans. This week, we were notified that electrical stimulation remains a covered service under HCSC plans. Certain types of traction are not covered in accordance with the HCSC policy on non-covered physical therapy services. The ACA is working to obtain additional clarification on the types of traction that will not be covered. The information received from HCSC prompted ACA to contact BCBSOK because the information BCBSOK released is in conflict with both BCBSOK’s own website and the information obtained from HCSC. As soon as we have additional details from BCBSOK we will notify all members.

Indiana Chiropractors volunteer their Services at the Statehouse as part of the Indiana STate Chiropractic ASsociation's DC of the Day program INDIANAPLOIS, IN — Local Indiana chiropractors provided complimentary Chiropractic care to legislators, staff and policy makers as volunteers for the Indiana State Chiropractic Association’s (ISCA) Chiropractor of the Day program during the 2009 Legislative Session and were recently recognized by the Indiana State Senate. The Indiana State Senate passed Senate Resolution Ninety-Seven to express their sincere appreciation for “the invaluable contribution of the Chiropractor of the Day Program and to the chiropractors who have volunteered their services.” The volunteer chiropractors connected directly with legislators and gave them advice on their chiropractic needs and how to address them. This was also a great time for the chiropractors to educate legislators about issues that chiropractors and patients across Indiana face everyday. Wrapping up its 19th year in service, Chiropractor of the Day is a nationally recognized program that members of ISCA can take part in to meet legislators face to face and provide Chiropractic care free of charge. The doctors also get a chance to educate them about the costeffectiveness and efficacy of chiropractic. This service is offered every Tuesday and Thursday throughout the legislative session to all elected officials residing in the Statehouse, including: Supreme Court members, the Governor’s office, the Secretary of State’s office and many others. Participating chiropractors received a sealed copy of the Senate resolution as well a press release for their local newspapers. The Indiana State Chiropractic Association thanks its many volunteers for making the ISCA DC of the Day program a success! • Dr. Abraham Beaber - Hamilton County Chiropractic in Noblesville, IN • Dr. Chris Bryan - Bryan Chiropractic Center in Mishawaka, IN • Dr. Derek Dyer - Dyer Health & Wellness Center in Huntington, IN Please let us know if we missed your • Dr. Jeremy Ferris - Health Connections in Fishers, IN name, we will include it in the next newsletter. • Dr. Nathan Frasier - Frasier Chiropractic & Sports Clinic in Columbus, IN • Dr. Richard Hilton - New Palestine Chiropractic in New Palestine, IN Contact Patrick Russell to volunteer • Dr. Mark Jones - Jones Chiropractic & Maximum Health Clinic in Westfield, IN in 2010 as ISCA D.C. of the Day • Dr. Joseph Kielur - Mass Ave Chiropractic in Indianapolis, IN or call • Dr. Marcus McCray - Premier Sports Chiropractic in Carmel, IN 317-673-4245. • Dr. Donna McVay - McVay Family Chiropractic in Rockville, IN • Dr. Michael Phelps - Martinsville Chiropractic Center in Martinsville, IN • Dr. Noel Taylor - Columbus Chiropractic Offices in Columbus, IN • Dr. James Todd - Rushville Chiropractic Office in Rushville, IN • Dr. Nathan Unterseher - Jackson County Chiropractic Center in Seymour, IN • Dr. Diane Vuotto – Backpain Chiropractic Clinic in Indianapolis, IN • Dr. Anthony Wolf - East Washington Chiropractic in Indianapolis, IN • Dr. Jeffry Yoder - Meridian Chiropractic Clinic in Indianapolis, IN

June 2009

ISCA Report


AMA Joins Suit Claiming WellPoint Shorted Physicians By Peggy Peck, Executive Editor, MedPage Today.

A class-action lawsuit led by the AMA alleged that the nation's largest health insurer, WellPoint, used a flawed database to undercut payments to physicians. The suit, brought by the American Medical Association, four state medical societies, and two California doctors, charges that WellPoint based payment rates for nonparticipating or out-of-network physicians on skewed data from a fundamentally flawed database. Earlier this year UnitedHealth Group, which owns Ingenix, the database at the center of the WellPoint case, agreed to pay $350 million to settle a class-action suit initiated in 2000 by the AMA and state medical societies in New York and Missouri. ( See: Exposure of UnitedHealth Database Flaws Prompts More Insurer Settlements) The $350 million settlement came on top of a $50 million payment to New York State that ended an investigation by New York Attorney General Andrew Cuomo's office. (See: Usual-andCustomary Database Overhaul Promised in Insurer Settlement) The New York investigation showed that Ingenix had systematically understated usual-and-customary fees by up to 28% in some locations.

According to the complaint filed in the U.S. District Court for the Central District of California, Ingenix arrived at the lower rates by averaging "charges from both physicians and other healthcare providers that are not medical doctors," a scheme that would guarantee lower rates. In a prepared statement, AMA President Nancy H. Nielsen, M.D., said, "Physicians will not tolerate an apparent conspiracy that allows health insurers to play by their own rules without regard to patients, or the legitimate costs required to care for them." Last month, The AMA filed similar class-action lawsuits against Aetna Health and CIGNA. In addition to the AMA and the medical societies of California, Connecticut, Georgia, and North Carolina, Stephen D. Henry, M.D., a Pasadena private-practice internist specializing in HIV treatment, and James G. Schwendig, M.D., a trauma surgeon from La Jolla, are individual plaintiffs in the suit. SOURCE: PracticeManagement/Medicolegal/13435

ACA Comments on First Draft of Health Care Reform Legislation The American Chiropractic Association (ACA) obtained, on June 5th, a draft bill designed by Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Committee on Health, Education, Labor and Pensions (HELP). This opening salvo is the first of many pieces of health care reform legislation that will be debated in the coming months within the U.S. Senate and House of Representatives. The ACA Board of Governors discussed the draft June 6 during a previously scheduled meeting. The ACA government relations department is carefully reviewing the bill. According to ACA's government relations staff, the bill, titled the "American Health Choices Act," would direct individuals and businesses to obtain health care insurance. The draft contains language creating a federally-sponsored "public plan" that would compete with private insurers. The public plan aspect of the legislation is troublesome to Republicans, many of which have declared that a public plan would wipe out current private insurance; however, the public plan option recently gained approval by the Obama administration. Other major provisions in the draft bill include: • Providers and hospitals that serve patients under the new public plan would be paid 10 percent above current Medicare rates. • Premiums will cover most of the costs associated with the public plan.

12 14

• •

New insurance exchanges called "Gateways" would be created to enable individuals to shop for insurance, similar to how consumers shop for air fares on Internet travel sites. Federal subsidies for mid- to low-income families to purchase insurance.

The bill does not include specific language regarding physician status or services that would be available under the public plan. Instead, a new "Medical Advisory Council" would decide a schedule of services considered "essential health care benefits." Each year, the council would issue new recommendations, which would take effect automatically unless rejected by Congress. The HELP Committee is scheduled to address the bill the week of June 15. The other Senate committee of jurisdiction, Finance, is looking to address health care reform sometime later in June. The House of Representatives is planning to address health care reform throughout the summer and pass a bill before the August recess. ACA urges all doctors of chiropractic to continue to contact their legislators in Washington and demand that chiropractic interests are protected in any health care reform plan developed on Capitol Hill. Doctors of chiropractic and state associations are also strongly encouraged to enlist their patients and other chiropractic supporters in the ChiroVoice advocacy network.

ISCA Report

June 2009

American Chiropractic Association Responds to May OIG Report The American Chiropractic Association (ACA) refuted the findings and recommendations outlined in a May 2009 report released by the Department of Health and Human Services Office of the Inspector General (OIG), noting the methods used by the OIG may have resulted in an overestimate of inappropriate claims. The recently released OIG Report, based on a sampling of claims data from 2006, concluded that Medicare inappropriately paid $178 million in chiropractic claims for services considered maintenance therapy, miscoded, or undocumented. In commenting on the report, ACA said the OIG’s decision to restrict data collection to only those episodes of chiropractic care resulting in claims of more than 12 visits by the same doctor, likely skewed the data pool by focusing on a subpopulation previously identified to be more problematic. As a point of comparison, an OIG report released in 2005 investigated data collected from a global sample of claims. “Based solely on this report, it is wrong to conclude that the services rendered by doctors of chiropractic to Medicare beneficiaries are unnecessary or inappropriate,” said ACA President Glenn Manceaux, DC. “It is the opinion of the ACA that the report in question is at best fatally flawed due to its reliance on distorted and misrepresented data.” In addition, ACA’s response expressed concern regarding the standards used to determine whether submitted files contained “complete” documentation, as well as the amount of training provided to medical reviewers who were charged with analyzing each claim. To better asses the report’s findings, ACA has submitted a Freedom of Information Act request for copies of the protocols, training tools, and credentialing standards used by medical reviewers. “While we support serious-minded efforts to ensure that funds within the Medicare program are spent as efficiently as possible, we will not stand idle and watch as data is twisted in an effort to discredit the thousands of doctors of chiropractic across the nation that help millions of Medicare patients every year,” Dr. Manceaux said.

Following a 2005 report, in which the OIG was highly critical of the chiropractic profession’s participation in the Medicare program, a coalition of chiropractic organizations, including the ACA, launched a multi-faceted action plan to address the problems surrounding documentation and improper use of maintenance care. Since its formation in 2005, the coalition has accomplished the following actions: The ACA made its documentation manual available to the profession at cost over the course of two years. In addition, ACA developed and launched a free educational webinar that provides doctors of chiropractic with tools and information to improve their Medicare documentation. The Association of Chiropractic Colleges tightened up documentation standards requirements in chiropractic educational institutions, placing added emphasis on Medicare requirements. The Federation of Chiropractic Licensing Boards encouraged member boards to require hours in documentation for re-licensure, and the Congress of Chiropractic State Associations encouraged member associations to emphasize Medicare and documentation educational seminars. All four organizations met with the Centers for Medicare and Medicaid Services (CMS) to discuss documentation requirements and attended a presentation by CMS contractors regarding medical review standards for chiropractic claims. ACA leaders feel the profession has made significant progress since the aforementioned initiatives were implemented in 2006. “The impact of our proactive actions is most certainly not reflected in this recent OIG report because the window of time between the release of the 2005 report and the start of the data collection in 2006 did not allow sufficient time for meaningful change,” said ACA Chairman John Gentile, DC. ACA plans to share its full response with Capitol Hill. The association strongly encourages all doctors of chiropractic to work to improve their documentation and understanding of the Medicare program. Resources are available on ACA’s Web site at www. For more information and to view ACA’s full response to the 2009 OIG Report, visit

Save the DAte! ISCA Golf Outing September 24, 2009 Trophy Club Golf Course 3875 N. St. Rd. 52 Lebanon, IN 46052 June 2009

ISCA Report


FREEPAYMENTPROCESSINGSOFTWARE… PROVIDERPROCESSINGannouncesthearrivaloftheTrinitySystem;allowingyoutogetridof thosecreditcardmachinesyoumaybeleasingandpossiblyeliminate$30+/monthforthe phoneline(s)attachedtothem.Yougainsecurity,fasterfunding,oneͲtouchreporting, accountingsoftwareintegration,instantandrecurringbillingoptions,paymentviayour website,emailinvoicing,andmore–alldesignedtohelpeliminatebillingandlower processingcostsͲguaranteed! TheTrinitySystem’scredit/debittransactionsarehandledviaaspecialpartnershipwith PayJunctionandaspartofournewReferralProgram,thefirst25practicestomentionthisadwillreceivethissoftware freeofcharge($570value).TherearenosetͲupfeesorhiddencost.YoucanevenusetheTrinitysystematyour location(s)for30days,riskfree!!! the PayJunction software has literally changed our lives at the office. now instead of spending hours, literally 4 plus hours twice a month entering in monthly transactions for patient's recurrent billing, now the PayJunction software does it without any time spent in our office. this has freed up our staff and made our collections more consistent and easier for the patient's because they don't need to be giving us their credit card each month to swipe or manually enter. – Dr. Jen Depice, Willow Grove, PA


Senate Legislation Introduced to Expand Chiropractic Benefit Within VA Health Care System The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) commended Sen. Patty Murray, D-Wash., for introducing legislation in the U.S. Senate designed to fully integrate chiropractic as a covered service within the Department of Veterans Affairs (VA) health care system. The bill, S.1204, specifically requires the VA to have a doctor of chiropractic on staff at all VA medical facilities by 2012. The legislation was introduced June 8. “The ACA and ACC applaud the work of Sen. Murray as she continues to advance causes that positively impact our nation’s veterans,” said ACA President Glenn Manceaux, DC. “Because the VA continues to drag its feet on this issue, American veterans who suffer from chronic and disabling pain remain unable to access the essential services of a doctor of chiropractic.” ACC President Frank Nicchi, DC, MS, noted, “We are very pleased that Sen. Murray recognizes the value and necessity of full access to chiropractic care by our nation’s veterans.” Sen. Murray is a recognized champion for veterans throughout the country. She is the daughter of a disabled World War II veteran and is the first woman to serve on the Senate Veterans Affairs Committee. A companion bill, HR 1017, was introduced in February by Rep. Bob Filner, D-Calif.


Through previous congressional action, chiropractic care is now available at 32 VA facilities across the country; however, in the more than 120 facilities without a doctor of chiropractic on staff, the chiropractic care benefit Congress authorized for America’s veterans remains virtually non-existent. Detroit, Denver, and Chicago are a few examples of major metropolitan areas without a doctor of chiropractic available at the local VA medical facility. According to ACA Vice President of Government Relations John Falardeau, without a congressional directive, further expansion to VA facilities will be on a case-by-case basis and will be excruciatingly slow. The ACA believes that integrating chiropractic treatment into the VA health care system would not only be cost-effective, it would also speed the recovery of many of the veterans returning from current operations in Iraq and Afghanistan. A January 2009 report from the Veterans Health Administration indicates that over 49 percent of veterans returning from the Middle East and Southwest Asia who have sought VA health care were treated for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for the report. S.1204 has been referred to the Senate Committee on Veterans’ Affairs. Contact your Senators and urge them to cosponsor S.1204. If you have questions or would like more information, please contact

ISCA Report

June 2009

ISCA Membership update NEW ISCA MEMBERS Trent L. Phillips Thomas G. Drach Devon T. McGillem Joseph P. Busch Shahnaz Sabeti Ryan P. Porterfield Russell E.Mead Vesta E. Guest Liza M. Schuck Bryan S. Bingham

Gold Members Michael Gallagher Steven C. Mangas Gary R. Billingsley Robert C. Prather Michael A. Toney Robert P. Maddox John S. Wagner Benoit O. Choiniere Marian F. Klaes-Lanham Chris J. Klaes Diane Vuotto

Platinum Members Duane Binder Anthony C. Wolf Robert J. Krause Robert W. Foster Robert W. Tennant Calvin E. Finch David S. Dyer KennethAckles Christopher Nunier Stacey S. Conrad Charles R. Solano James M. Cox, II

Indiana state chiropractic association Q&A Queston: What can a doctor legally charge for copies of medical records? Maximum copy charges are defined in the following Indiana law: IC 16-39-9 Chapter 9. Charges Permitted for Providing Copies of Medical Records IC 16-39-9-1 Chapter exemptions Sec. 1. This chapter does not apply to x-rays covered by either of the following: (1) IC 16-39-1-2. (2) IC 16-39-7-2. As added by P.L.102-1994, SEC.9. IC 16-39-9-2 Maximum copying fees Sec. 2. A provider may not charge a person for making and providing copies of medical records an amount greater than provided in this chapter. As added by P.L.102-1994, SEC.9. IC 16-39-9-3 Copying fees Sec. 3. (a) A provider may collect a charge of twenty-five cents ($0.25) per page for making and providing copies of medical records. If the provider collects a labor charge under subsection (b), the provider may not charge for making and providing copies of the first ten (10) pages of a medical record under this subsection. (b) A provider may collect a fifteen dollar ($15) labor charge in addition to the per page charge collected under subsection (a). (c) A provider may collect actual postage costs in addition to the charges collected under subsections (a) and (b). (d) If the person requesting the copies requests that the copies be provided within two (2) working days, and the provider provides the copies within two (2) working days, the provider may collect a fee of ten dollars ($10) in addition to the charges collected under subsections (a) through (c).

June 2009

As added by P.L.102-1994, SEC.9. Amended by P.L.78-2004, SEC.24. IC 16-39-9-4 Cost adjustments by department Sec. 4. (a) As used in this section, "department" refers to the department of insurance created by IC 27-1-1-1. (b) Notwithstanding sections 1 and 2 of this chapter, the department may adopt rules under IC 4-22-2 to adjust the amounts that may be charged for copying records under this chapter. In adopting rules under this section, the department shall consider the following factors relating to the costs of copying medical records: (1) The following labor costs: (A) Verification of requests. (B) Logging requests. (C) Retrieval. (D) Copying. (E) Refiling. (2) Software costs for logging requests. (3) Expense costs for copying. (4) Capital costs for copying. (5) Billing and bad debt expenses. (6) Space costs. If you have any questions you would like answered in the next newsletter, please feel free to contact Patrick Russell with the ISCA at 317-673-4252 or

ISCA Report


2009 fall Conference October 9-11, 2009

Hilton North Indianapolis 8181 N. Shadeland Ave. Indpls, IN 46250

Fall Speaker Preview: More to come! NGS Medicare Coding & Compliance Dr. Steven Troyanovich - Structural Rehabilitation / Sponsored by Footlevelers Mark Sullivan - Laws Affecting Chiropractic in Indiana



ISCA Report

June 2009

isca Fall conference 2009 registration form

Return to: ISCA 200 S. Meridian St, Suite 350 Indianapolis, IN 46225 or by Fax: 317.673.4210 ISCA Fall Conference | October 9-11, 2009 | Hilton North 8181 N. Shadeland Ave. Indpls, IN 46250 Please indicate if you will attend the luncheon and After Hours Reception to assure we provide sufficient meals for all attendees. Additional lunches may be purchased for guests at $30.00 each. Attendance to lectures is by badge only, including spouses.

I will attend the ISCA After Hours Reception YES____ NO____ (included with purchase of 8 or 12 hour sessions)

Package B 8 Hour Session

Package C 4 Hour Session

After Adv. Sept. 18 1. Platinum.......... complimentary -------------2. Gold & Silver.............................. $350 $400

After Adv. Sept. 18 ------------$230


After Package f: Lunch Ticket $30 Adv. Sept. 18 (included with 8 &12 hour sessions) ------------Package g: Additional After Hours $145 $195

3. Member (in good standing).... $400 4. Member (in arrears)................. $515











5. Non-Member............................. $535






Registration Type

Package A 12 Hour Session

Package D: CA $89 Package E: Guest*/Student $75

Reception Ticket $30 (included with all packages)

(1 included with 8 or 12 hr sessions) *non DC Guest

*Members shall only be eligible for all membership benefits, including Fall Conference registration prices, if they are in “good standing.” The ISCA’s By Laws state the following, “a member shall not be in ‘good standing’ when his or her dues are more than two (2) quarters in arrears. ‘Good standing’ will be determined at the time registration is received in the ISCA office or by the assistant secretary.”

Platinum members of the ISCA may attend the Fall Conference free of charge but registration is still required. Contact Name Address

Clinic Name City


Phone (



Fax (

registration type (Example: 1, 2, 3)

Registrant Name

Zip )


(Example: A, D, G)


$ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ Total $__________

Payment Information




Check (Make Payable to ISCA)

Cardholder:______________________________________________ Card #:__________________________________________________ Exp.______________

3 digit security #:_________________ Signature:__________________________________________________

Questions? Call 1.317.673.4245, or e-mail / Refunds at 90% until Sept. 25. No refunds after Sept. 25.

Register online at! June 2009

ISCA Report


Indiana State chiropractic association classifieds PRACTICES FOR SALE Nice office on NW side of Indianapolis for sale. Good mix of PI and Insurance. Office has new equipment including, Kodak Digital CR x-ray processor with 37" LCD TV for viewing x-rays, X-ray machine, Back Project's ATM-2, 1 Hydro-massage table, 4 Intersegmental traction tables. Drop adjusting table. Necksys and Synergy low tech rehab, 2 exam rooms, open adjusting/ rehab area. Office has been established 16 months and sees around 400 patient visits per month on a 3 1/2 day week. Office markets well and is in a very visible location. This office is NICE!! Call 317-4647530 or email Posted 05/27/09 (M) Excellent Opportunity for a Chiropractor in a newer 2,000 sq ft , state of the art clinic located in beautiful Fishers, Indiana. This turn key office is ready to go for a nominal amount. The current DC/Owner is looking to downsize. If you have excellent credit the current owner is willing to transfer office and equipment lease over to you. Equipment includes Cervical/Lumbar Decompression, Digital X-ray, Cold Laser Therapy, Hill Flexion Distraction Tables, Open Bay Physiotherapy. and more! Call (317) 607-0464 or email: if interested in learning more. Visit www. to learn more about the fantastic demographics and location. Posted 05/27/09 (NM) Beautiful Southern Indiana University Town: Priced over $200k below appraised value! Northwest: Doctor collected $960K+ this year! West Central: Practice is 60% from referrals. Collections $317K+. Call Professional Practice Advisors, Inc. 800.863.9373 Posted 04/15/09 (NM) Perfect for a new practitioner or an established chiropractor looking for a satellite location. Located in an upscale area. Established practice with an excellent reputation. Several fully equipped therapy rooms. Owner runs office as part time but has almost 300 active clients. Unlimited growth potential. Contact 317-2552620 or Posted 04/03/09 (NM)


Crawfordsville- long established, very stable diversified practice consistently collecting over $200k. Great location, very nice building, great staff, and wonderful community. Home to Wabash College, Nucor Steel, Alcoa, RR Donnelly, and more! Ideal for investor as this is a satellite office with associate in place and well trained staff. Price for quick sell at: $150K A/R included. Call (812)240-2411 or email me at Posted 3/20/08 (M) Indiana - Porter County - Chicagoland. Great practice, a 18 year old well-established chiropractic practice. General diversified practice, fully equipped, modalities, lowtech rehab, x-ray, nutrition, cox. Excellent opportunity. Motivated seller. Transition included. Email: Posted 3/16/09 (M) Associates Available Seeking Part-time Associate Position. I am available on Tuesdays and Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. References available. Email me at or contact me at my office. Dr. Chris Whiteman (765) 864-1877. Posted 5/18/09 (M) Recent graduate of National is looking for position in Indianapolis. Trained in Diversified, ART, Graston, KT, Thompson and Activator. Extensive background in rehab, PT and nutrition/internal medicine. Energetic, highly-motivated and reliable chiropractor looking for opportunity to learn from an experienced chiropractor. Call Dr. Shelley Coughlin at 815-483-3336 or email Posted 4/22/09 (M) Associates Wanted Associates Wanted! We are looking for 2 associate positions. Candidates must be self starters, energetic, and willing to learn. Positions are in northwest Indiana and Indianapolis. Please email resumes- No calls please Posted 4/3/09 (M)

ISCA Report

Palmer graduate seeking independent contractor/associate for 2 Indianapolis clinics – Speedway & new state of the art clinic opening in Fishers/Noblesville approximately in December 2006 with the opportunity to operate one of the clinics on your own. Techniques used are Palmer Package, Diversified, Thompson, Flexion Distraction & Activator but willing to accept other techniques. Looking for someone that is eager to grow with the practice. New office will include cold laser therapy, lumbar decompression, massage & acupuncture. Both clinics accept most insurance. Large percentage of patient base is personal injury. Salary would be negotiable depending on the situation. Fax resume to 317-299-0017 or e-mail

Vacation Doctors Vacation, Maternity Leave, Seminar Fillin, Etc. Palmer graduate, 20+ years of experience, licensed in Indiana, NCMIC insured. Proficient in multiple techniques; diversified, activator, soft tissue, drop, flexion/distraction, basic. Able to travel statewide. Excellent adjusting & people skills. Call Dr. Guest - 317-462-0022 or email Posted 6/8/09 (M) Fill-in/Vacation relief Doctor! Licensed in Indiana & Kentucky, Multiple techniques, $400.00 a day. Contact Bill Overstreet, D.C. (765) 480-6283 or Posted 5/27/09 (NM) Do you want a day off? Available Tuesdays and/or Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. $400 a day base fee. References available. Email me at or contact me at my office. Dr. Chris Whiteman (765)8641877. Posted 4/28/09 (M) 1989 Logan Grad available for full or half day fill-in. Diversified, Gonstead, NIMMO, Logan Basic, Graston Technique and Impulse Adjusting. minkischiropractic@ or 317-388-1118. Posted 12/04/08 (NM)

June 2009

Indiana State chiropractic association classifieds Equipment For Sale

Post a Classified Ad

-X-Ray Unit and Processor - Fisher 300/125 xray unit with 14 x 17 cassette holder and Alphatek Cold Water Processor . 7x17, 14x17 and 8x10 cassettes included $6000 OBO. Contact Dr. Bob Graham 616-5307474 or Posted 05/04/09 (NM)

ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. Non-members may place ads for $25 per ad per printed issue.

Mobile Lead Barrier 30" X 72" with 8" X 10" window $650.00. Contact or 574-546-3435. Posted 05/01/09 (M) Complete Bennett X-Ray Room Equipment & Accessories (processor needs motor)14x17 high frequency autotech, asking $6700.00; 4-Tier X-Ray File Shelves, $175.00; Petecto Scales, $75.00; X-Ray Copier, $175.00; 2 3-Panel Screens, $125.00, 2 Standard Therapy Tables (Walnut Finish), $275.00. Call Dr. Jim Ebler at 812-397-2981. Pictures can be emailed to interested parties. Posted 4/22/09 (NM) Hands Free Ultra Sound Machine, and a Rehab Exercise Machine for Back/Hip. All in great condition. Call SpinalAid at 317-2724100. Posted 4/15/09 (M) "Presenting Acute Cervical Spine Injuries in Court" slide presentation by Robert A. Ballard,D.C. ($100 + shipping): The "DU-LER" range of motion system,($100 + shipping): email for contact. Posted 3/09/09 (M)

ISCA Report: Quarterly Member Printed Newsletter Deadlines are for ads to be included in the printed version of the ISCA Report Classified ads will also be posted online until the next issue’s deadline. March Issue Ad Submission Deadline Feb 25 June Issue Ad Submission Deadline May 25 September Issue Ad Submission Deadline August 25 December Issue Ad Submission Deadline November 25 To place a classified ad visit us online at or call 317.673.4245.

Insight Millennium Second Generation Subluxation Station. Great for documenting progress of patient and for evaluating children. $4500 OBO; Zenith II Hi-Lo with drop pelvic and breakaway abdominal piece. $2500; Amrex therapeutic low volt unit, $500; E-mail or call 219-798-6410. Posted 1/08/09 (NM)

June 2009

ISCA Report


ISCA Report

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ISCA Summer Newsletter 2009  
ISCA Summer Newsletter 2009  

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