March 2009
President's Message Dr. Anthony Wolf, D.C. ISCA: An Inside Look at An Association of Members Greetings Doctors, I feel that as an ISCA Member we are all entitled and should be genuinely interested in the direction of our Association. The ISCA is an organization that is controlled entirely by its members. The Board of Directors is governed by our own bylaws which in turn guides the decisions we make by a majority of the board. There are no individual decisions made for any one person’s gain. The Executive Director’s role is to offer guidance with the final decision to be made by the Board of Directors with a majority vote after careful discussion. Individual committees have been developed to handle concerns relative to the many issues that pertain to our profession. If any ISCA member has a question, suggestion or concern, please contact the ISCA so that we can work with best suited committee chair to address your concern. This will help streamline your inquiry for a faster, more accurate response. For general association questions, please feel free to call the ISCA office, our Executive Director, or always feel free to contact me directly. I am very proud of the progress of the ISCA committees. Each committee chair reports to the Executive Board and Board of Directors to make decisions on issues impacting the practice of chiropractic in Indiana. The ISCA is Frugal with Our Money The Finance Committee under the guidance of our Treasurer, Dr. Chris Bryan, carefully scrutinizes every penny we spend. Dr. Bryan personally signs every check and keeps a close watch on the bank account. Tom Johnson, the Chief Financial Officer at LMV Consulting has done an excellent job transferring our accounts from our past association management group. The Executive Committee and Board of Directors are given an up to date comprehensive account analysis at every meeting. This report includes expense/income comparisons to past years as well as a future budget in every category. As a member, you can be assured that 100% of your dues go directly into chiropractic matters that affect your ability to practice chiropractic in Indiana. As your President, I am confident that the current Board of Directors and Committee Members are volunteering their time to simply serve this great profession. We have a lot of intelligent minds within our
membership. We are aware of the challenges that face us including the insurance industry and the physical therapists. The Board of Directors and our members must be poised to react to things that happen to our profession, but more importantly we must be proactive to always be a step ahead of what is coming. We must be able and willing to adapt and change with the times, but NEVER forget the very purpose of our profession. The promotion of chiropractic will always be the number one priority of the ISCA. We will promote the philosophy of natural healthcare through correction of the vertebral subluxation to restore wellness from within. Each of us has our own variation of how we practice including the techniques we use. As professionals we have varying opinions. As an organization it is imperative that we focus on the 95% of what we agree on rather than the 5% we disagree on. FOCUS ON BEING PROACTIVE The Public Relations and Long Range Planning Committee is working on developing a comprehensive plan to promote chiropractic to the public. A survey will be conducted of our members to determine our course of action. Please be sure to complete the survey. INSURANCE REIMBURSEMENT The ISCA Insurance Committee under the guidance of ISCA First Vice President, Dr. Peter Furno, is constantly at work negotiating reimbursement rates and helping ISCA members with various insurance concerns including audit issues. As an association, we must continue to “fight the good fight” with current insurance issues, but we must also be aware of the trend. As chiropractors we must be ready to move toward cash/insurance practices as insurance companies continue to decrease our reimbursement. How can the ISCA help its members with this transition? The ISCA membership is a “pool” of talent! ISCA members need to link with each other to share ideas with other members in their district and throughout the state. The ISCA Membership Committee, under the guidance of Dr. Diane Vuotto, is developing a mentor program. Each district will have their own mentor to assist new doctors as they start their practices. Don’t miss the ISCA Spring Seminar! At this spring seminar, we will have a first ever panel discussion of successful Indiana doctors for a question and answer session, Saturday April 18 from 6PM-7PM.
Inside This Issue President's Message.....................................................................................1 ISCA Board of Directors & Staff Info...................................................2 Executive Director's Message................................................................3 Chiropractic and the economy..............................................................4 Lilly ledbetter fair pay act of 2009 signed into law........................4 Important new restrictive covenant decision......................................5 Increasing number of children receiving PED.chiro care............6 'Automating' appeals: Get the reimbursements you deserve........6 mark your calendar for back talk!........................................................7 How-To: anthem on-line inquiries..............................................................7
March 2009
truth in advertising.....................................................................................8 One Day; One voice; one mission!.............................................................8 Chiropractic suited for primary care..............................................9 imaging for low back pain..................................................................10 Dr. Tennant's ACA update........................................................................11 ISCA Legislative update..............................................................................13 New ABn Mandatory on march 1.........................................................14 Dr. Wolf's rebuttal to assignment of benefits..................................15 ISCA spring conference april 17-19, 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 Drtony6900@aol.com
District Seven Diane Vuotto, D.C. Indianapolis, IN 317.898.6989 vuottojd@comcast.net
District Three Jason Russell Fort Wayne, IN 260.483.5588 jdrussell10@hotmail.com
District Directors
District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 Flopper1968@hotmail.com
District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885 gtdlf@netcapade.com
Second Vice-President Robert Tennant D.C. Shirley, IN 765.737.1117 doct@hrtc.net
District One Ron Daulton, Sr., D.C. Hammond, IN 219.932.8900 reddcdr@comcast.com
District Nine Nate Unterseher, D.C. Seymour, IN 812.524.2273 drn8@live.com
District Five David Frischman Wabash, IN 260.563.8476 ccincpc@comcast.net
Secretary James Cox II, D.C. Fort Wayne, IN 260.484.1964 Cox.chiropractic@verizon.net
District Two Gerard Hofferth, D.C. South Bend, IN 574.256.1008 drhof@aol.com
Alternate Directors at Large
District Six David Davis, D.C. Winchester, IN 765.584.3665 drddd@aol.com
Treasurer Chris Bryan, D.C. South Bend, IN 574.259.3355 cwbdc@aol.com
District Three George Joachim, D.C. Fort Wayne, IN 260.492.8811 drgeorge@aaronchiro.com
Immediate Past President Duane Binder, D.C. Clinton, IN 765.832.7777 Dbinder326@aol.com
District Four G. Lyman Shaw, D.C. Brownsburg, IN 317.852.3870 glshaw@juno.com
Past President Representative Mick Gallagher, D.C. Indianapolis, IN 317.571.1480 MGalla6425@aol.com
District Five Derek Dyer, D.C. Huntington, In 260.356.1616 drderekdyer@gmail.com
Directors at Large
District Six Matt Howard Muncie, IN 765.254.9481 info@howardchiro.com
First Vice-President Peter Furno, D.C. Zionsville, IN 317.338.6464 pfurno@sbcglobal.net
Ted Freidline Salem, IN 812.883.1444 Sp9dr@comcast.net
Lewis Myers, D.C. Valparaiso, IN 219.464.4444 lew.myers@gmail.com Michael Phelps, D.C. Martinsville, IN 765.342.2208 mchiro@reliable-net.net
James Galyen Scottsburg, IN 812.752.6202 iubigpig@msn.com C.C. Paprocki, D.C. Greenwood, IN 317.535.7507 John Volbers, D.C. Indianapolis, IN 317.299.3330 ecchiro@cs.com Alternate District Directors District One Chris Hayes Crown Point, IN 219.661.8680 hayesfamilydc@hotmail.com District Two Bill Garl Bremen, IN 574.546.1111 w.garl@comcast.com
District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 indysportdoc@iquest.net District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 drshaun@newburghchiro.com 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 pmcguffey@LMVconsulting.com
Stephanie Higgins Director of Events shiggins@LMVconsulting.com
Patrick Russell Membership Services prussell@LMVconsulting.com
Lane Velayo Association Manager lvelayo@LMVconsulting.com
Stacy Quasebarth Director of Communications squasebarth@LMVconsulting.com
Krista Rader Education krader@LMVconsulting.com
Tom Johnson, CPA Chief Finanical Officer tjohnson@LMVconsulting.com
Connie Vickery Governmental Affairs cvickery@LMVconsulting.com
Debra Scott, IOM Vice President of Operations dscott@LMVconsulting.com
John Livengood Governmental Affairs jlivengood@LMVconsulting.com
ISCA Report
200 S. Meridian St., Suite 350 Indianapolis, IN 46225 info@indianastatechiros.org www.indianastatechiros.org 317.673.4245 phone 317.673.4210 fax
March 2009
President's Message continued.... All ISCA members are encouraged to attend! Keep yourself on the cutting edge. Don’t try to reinvent the wheel. The Speaker Committee Chair, Dr. Sheila Wilson, has lined up some great speakers including our own talent with Dr. Jim Cox II. I encourage you to meet your district director, executive director and myself. Stay connected, that is what we are here for. It is a privilege and a blessing to serve this great profession. Dr. Anthony Wolf
Executive Director's Message Patricia McGuffey
The 2009 Session of the Indiana General Assembly convened on Wednesday, Jan. 7th. This is the long Session and Legislators must pass a biennium budget and adjourn by April 29th. February 25th was the deadline for bills to pass the legislative chamber where they were introduced and move on to the other chamber where they must be heard and voted on. I reviewed more than 700 bills filed for consideration in the House and more than 600 measures in the Senate to determine those of interest to ISCA. ISCA’s legislative committee determined which bills are a priority and those we will monitor. One of ISCA’s two priorities was in SB 75 and HB 1086, Assignment of Benefits. The bills would have required insurance companies to honor assignment of benefits requests from patients who choose to go to an out of network Chiropractor. Some Chiropractors choose to leave the insurance PPO network due to poor payment, an insurer’s unsound medical policy or administrative burden. Some insurance companies are refusing to honor patient’s requests for benefits to be assigned to the Chiropractor’s office. Insurance companies that refuse to honor assignment requests are attempting to use the patient as a pawn. SB 75 and HB 1086 would have required an insurer to comply with its insured’s wishes. The bills were stringently opposed by insurance companies, unions, the Governor’s office and the business community. Unfortunately, after passing out of the House Insurance committee, HB 1086 was not called down for a vote by House Insurance Committee Chairman Rep. Craig Fry because of the Union opposition. In the Senate, SB 75 passed out of the Health & Provider Services Committee and had a floor vote of 25 for and 24 against our AOB legislation. Consequently it failed to pass due to a lack of a constitutional majority. This is better than we have done in previous years in the Senate. This issue will be back.
March 2009
In addition, SB 87 was an AOB bill that would have allowed AOB for emergency services but would have excluded Chiropractors and a number of other providers. We worked successfully to kill this legislation that would have excluded and thus discriminated against DCs. ISCA’s other priority legislative proposal is HB 1726, a bill that would put Chiropractic services in the HIP program, the State’s insurance program for the uninsured. As you recall when the legislation passed last year, language was passed in the statute that mandated the HIP program follow regular insurance laws that do not discriminate against Chiropractors. However, when the State promulgated the rule to implement HIP, they excluded Chiropractors. ISCA was able to get the Rule amended to allow Chiropractors to be in the program but they will not allow manipulations to be reimbursed, only physical therapy and other general services. HB 1726 passed out of the House with a vote of 88-10 and has now been assigned to the Senate Health & Provider Services Committee. ISCA also worked with Legislators to get Chiropractic services in HIP language placed in the budget bill, HB 1001. Since the Governor’s office is strongly opposing this effort, we will have to work hard to make sure the Republican Senate does not take the language out of the budget as well as kill HB 1726. We are following numerous other legislative proposals on ISCA’s behalf. The bills include Medicaid, insurance, and various health and business proposals to name a few. You may contact me if you would like to see a list of all the bills that LMV follows on your behalf, my e-mail is pmcguffey@lmvconsulting.com. In addition, you may find out information on the Indiana General Assembly Web site. Through www.legislative.IN.gov, you can watch or listen to General Assembly sessions, obtain legislator contact information, search bills and resolutions, research Indiana laws and more! Go to that web site or the Capwiz link at http://capwiz.com/la or ISCA’s web site www.indianastatechiros.org where you can get a link to these web sites to locate contact information for your legislators. It is important for you to contact them to support ISCA’s legislation. It is very clear that we have to be ever diligent in our efforts to protect the chiropractic profession in the legislature. LMV works tirelessly on your behalf. However, we can only be successful with your help by contacting your legislators and giving money to ISCA’s BACKPAC that gives money to legislators that support Chiropractic. Please develop a strong relationship with both your Senator and Representative. In addition, please write a check today to ISCA’s BACKPAC. Without your support, it will be impossible to successfully defend the chiropractic profession. Remember we want to serve our members by answering your practice questions, providing up to date information and education through newsletters, conferences and e-mails. Please get involved, volunteer for a Committee, recruit a new member and help to make our ISCA the strongest and best organization possible. I look forward to seeing you all at our Spring Conference. It is important that you show your support for ISCA by attending and letting us hear what we can do to serve you better. Thanks for all you do for the ISCA.
ISCA Report
Chiropractic and the Economy By Rob Hart - Hart Consulting
It was just before 5:00 in the morning and I was standing in the brightly lit bedroom of a quadriplegic man that I barely knew. I realized that I had subconsciously moved as far away from the bed where he lay and was leaning against the back wall as I watched his assistant perform several tasks that I will leave to your imagination, but which included bathing and dressing him. Newly married and attending Arizona State University, I had responded to an offer to assist this gentleman in exchange for free rent on a small home. However at that moment, I wondered what I had gotten myself into. Later, after the initial training session had concluded, I asked the assistant why he hadn’t warned me in advance regarding the nature of my responsibilities. His response was, “If I had described what you would have to do, you wouldn’t have shown up.” Fortunately, despite my initial discomfort, I ended up working for David Beebe for several years and received much more from him than free rent. On those early mornings, David taught me many things that have stuck with me, including how to make the most of your life when you are thrown that proverbial curveball. David was originally paralyzed while swimming in Chesapeake Bay at the age of 20. When I met him, he was in his 50s and self-employed as a successful accountant. He didn’t feel sorry for himself and he didn’t dwell on what might have been. Rather, he spoke of his opportunities and how fortunate he was to have survived a spinal injury and the bedsores that followed in a day when treatment options were limited. Another lesson, which I didn’t fully appreciate at the time, I will call the parable of the soap. One morning as I was preparing to bathe him, I found that the soap was reduced to a sliver and basically unusable. I asked him where I could find a new bar and he told me, but added that I should save the old bar and when I was finished with the new soap that morning I should press the old bar to the back of the new. I’m sure that I had a puzzled expression until he explained that his mother had lived through the Great Depression and has taught him to never waste anything. My wife is sure that I am nuts, but to this day I always press the old bar to the back of the new. Today we find ourselves in uncertain economic times. As if changes in the insurance industry weren’t challenging enough, we face wider problems in the national and even global financial markets. We see mortgage companies and banks failing at an unprecedented rate and foreclosures at an all time high. How will this affect us? I am not sure; my crystal ball is cloudy today. First, I know that other than exercising our right to vote for those we feel will help us out of this mess, we can’t control the economy. Second, I know that people in pain tend to see help; therefore, there will always be a need for chiropractic care. Third, I know that although the economy is outside of our control, we can control how we respond to it.
I believe that based on what I have observed so far, most chiropractors will choose to respond in one of two ways. Some will hunker down in a defensive posture and accept the decline in their practice as inevitable. They will find comfort in complaining about how bad things are and console themselves that there is nothing they can do about it. They will throw great “pity parties” inviting all that they know to attend, because misery truly loves company. While others, hopefully a majority will choose to see the opportunities. They will sharpen their systems and procedures to increase their efficiency. They will buy gently used office furniture or equipment at a cut-rate price to spruce up their facility. They will increase their efforts to educate their patients and be more diligent in asking for referrals. They will squeeze the metaphorical bars of soap together, becoming less wasteful and as a consequence reducing their overhead. Clearly the lessons that David Beebe taught me all those years ago could apply to your practice today. David couldn’t change what had happened to him – the accident couldn’t be undone – no matter how badly he wanted a different outcome, he was still paralyzed. But David took the cards that he had been dealt and he played the best hand he could. I’m sure that he had his moments of depression and doubt and so will you. But ultimately, against great odds, he prevailed and so can you. Rob Hart is the founder and owner of Hart Consulting.
Lilly Ledbetter Fair Pay Act of 2009 – Signed into Law Source: Chiropractic Economics
On January 29, 2009, President Obama signed into law the Lilly Ledbetter Fair Pay Act of 2009 (FPA). In response to the United States’ Supreme Court case, Ledbetter v. Goodyear Tire and Rubber Co., Congress passed the FPA to protect the rights of individuals who are subject to unlawful pay discrimination based on sex, race, color, national origin, age, religion, or disability. By amending Title VII of the Civil Rights Act (Title VII) and the Age Discrimination in Employment Act (ADEA) and modifying the operation of the Americans with Disabilities Act of 1990 (ADA) and the Rehabilitation Act of 1973, the FPA codifies that “a discriminatory compensation decision or other practice occurs each time compensation is paid pursuant to the discriminatory compensation decision or other practice.” Therefore, the 180-day time limit (and in some cases, 300-day) to file a claim for discriminatory pay practices now restarts each time an employee receives a paycheck based on the discriminatory decision or practice.
ISCA Report
March 2009
Important New Restrictive Covenant Decision by Indiana Court of Appeals By David Elliott Jose, Esq.
The Indiana Court of Appeals recently issued a very important decision, which could have a significant impact on business relationships among health care professionals. The decision related to a restrictive covenant for two cardiovascular surgeons practicing in Terre Haute. The two surgeons were part of a group that had its principal office in Indianapolis and a second office in Terre Haute. In this decision, the Indiana Court of Appeals held that the noncompetition agreement was not binding on the two surgeons in Terre Haute when they departed from the group. There are several peculiar facts in this case, and the decision reflects the impact that some of those unusual facts may have had on the Court of Appeals. This column cannot highlight all of the key facts, which is necessary for a proper evaluation of the decision. Briefly, the two Terre Haute cardiovascular surgeons joined the group in 1994. After a period of a few years, they became shareholders in the group. The surgeons’ initial employment agreements contained a noncompetition agreement, and a similar restrictive covenant was imposed through a shareholder’s agreement when they became shareholders in the professional corporation in 1999. Eventually, the relationship between the two surgeons and the group deteriorated, in part due to a sharp conflict that they had with a third cardiovascular surgeon located in the Terre Haute office. As a result, the two surgeons terminated their relationship with the group in December 1999 (one was terminated by the group, and the other terminated her relationship in response). Following an initial series of litigation developments, the case remained fairly dormant until late 2007, when the trial court ultimately held a brief hearing and granted summary judgment for the two surgeons. The trial court ruled that the noncompetition agreement could not be enforced by the group. The Court of Appeals noted that non-competition agreements are justified because they protect the investment and goodwill of the employer. It should be noted that they have been applied in medical practice settings in Indiana on several occasions. In the past, the Indiana courts have noted that noncompetition agreements in the medical field should be given careful scrutiny, but this has not significantly altered the analysis that would be applied in any business setting. However, in this case, the careful scrutiny resulted in a favorable decision for the departing physicians. The first test applied in analyzing a situation is whether the agreement is wider than necessary for the protection of the employer’s legitimate interest. This focuses on the time or duration of the restriction, the geographic service area covered
March 2009
by the restriction, and the range of services forbidden by the noncompetition agreement. In this case, the Court of Appeals found that the restriction for three years, 50 miles, and thoracic/vascular/cardio-vascular surgical services was not unduly broad, and was therefore enforceable. The second test related to the effect that the noncompetition agreement would have upon the employees (and former shareholders). In this situation, the departed physicians were able to find alternative work arrangements, although they ultimately left the area, so the Court determined that the noncompetition burdens were not unreasonable and could be enforced. The third and critical test related to whether enforcement of the noncompetition agreement would be contrary to the declared public policy of Indiana’s constitution, its legislature or the judiciary. The Court of Appeals specifically focused on whether enforcement of the noncompetition agreements would have a negative impact on the public because of a lack of suitable alternatives for cardiovascular surgery in the Terre Haute area. The departed physicians provided numerous affidavits from other physicians in the service area. Those other physicians stated in their affidavits that there were no reasonable or adequate alternatives for such care in the area, claiming that allowing the departed physicians to remain practicing in the area would be in the area patients’ best interest. The practice provided no conflicting evidence to respond to or refute the multiple affidavits from the medical community. As a result, the Court of Appeals held that enforcement of the noncompetition restrictions would be contrary to the patients’ best interests and therefore contrary to public policy. There are several factual and procedural factors that influenced the Court of Appeals’ reasoning and decision. However, this is an important decision because of the forceful reliance upon the “public policy” factor. It will have an important impact for employers and business partners seeking to impose noncompetition provisions, as well as on individual professionals evaluating the enforceability of such provisions. This is an area that can be very fact sensitive, and is difficult to predict due to differing court interpretations as well as changes that have been occurring in recent years. We have several attorneys who follow these developments and advise employers, employees and business groups on these matters. If you have any questions, please contact David Jose at (317) 238-6211 or djose@kdlegal.com. 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. © 2009, Krieg DeVault LLP
ISCA Report
INCREASING NUMBER OF CHILDREN RECEIVE PEDIATRIC CHIROPRACTIC CARE
A growing number of parents are adding pediatric chiropractic care as an integrative component of their children’s health care regimen Survey data indicates that the percentage of chiropractic patients under 17 years of age has increased at least 8.5% since 1991, says the American Chiropractic Association. Further, a recent Centers for Disease Control and Prevention study indicated that nearly 3 percent of children in the United States were treated with chiropractic or osteopathic manipulation in 2007, making it the most common form of doctor-directed complementary or alternative medicine used by children. According to Elise Hewitt, DC, a Portland-area doctor of chiropractic and president of the American Chiropractic Association’s Pediatrics Council, chiropractic care isn’t just for adults. Infants and children can benefit from spinal manipulation and other forms of chiropractic care just as much as their parents and grandparents. “It’s very important that a child have both a pediatrician and a pediatric chiropractor. A pediatric chiropractor is not there to replace the role of the pediatrician,” says Dr. Hewitt. “The pediatrician provides medications when necessary and delivers care in times of serious illness and injury. A pediatric chiropractor is there for preventative wellness care and maintenance of the child’s
structure. The two are very complementary.” Studies are beginning to show that chiropractic can help children not only with typical back and neck pain complaints, but also with issues as varied as asthma, chronic ear infections, nursing difficulties, colic and bedwetting. Chiropractic spinal manipulation is a highly skilled treatment, and in the case of children, very gentle. Doctors of chiropractic— commonly referred to as chiropractors—practice a hands-on, drugfree approach to health care that includes patient examination, diagnosis and treatment. Following their undergraduate education, doctors of chiropractic obtain a four-year degree consisting of more than 4,500 hours of study and clinical experience. Pediatric specialists receive additional post-doctorate training. “The vast majority of parents report that their children enjoy their chiropractic adjustments and look forward to subsequent visits. They also report that their children experience a greater level of health while under regular chiropractic care,” Dr. Hewitt notes. The American Chiropractic Association (ACA)
‘Automating’ Appeals: Get the reimbursements you deserve by making insurance appeals second nature in your practice By: Andrew Slavik, DC
Nearly every day when the mail comes into my practice, we receive responses from insurers based on claims submitted. Unfortunately, these responses often include denials of services rendered. When I began practicing, I didn’t realize that I didn’t have to accept these denials as final determinations and, over time, I’ve learned the great importance of appealing denials. By appealing, I can draw attention to an insurer’s inappropriate claims processing. And it gives me an opportunity to receive reimbursement for services that the insurer did not initially pay – rather than just accept these denials as a write off. ACA also recognizes the importance of appealing denials. Furthermore, the association realizes that providers don’t have a lot of time to devote to drafting appeal letters for every denial received. To assist me and other doctors, ACA offers a number of template letters to quickly help appeal denials. For example, yesterday I received a denial for an evaluation and management service that I reported with a spinal manipulation. The patient I treated had reinjured herself running, and I needed to thoroughly re-examine her before providing treatment. Like other doctors, I was disappointed to see this denial come back from the insurer when I had taken the time to carefully evaluate the patient and determine the best course of care. I shared the denial with my office manager, who promptly logged onto ACA’s Web site at www.acatoday.org/appeals and downloaded the template appeal letter for denials of E/M services reported with CMT. Later that day, she left the letter on my desk along with the patient’s chart. I reviewed the patient’s chart and modified the appeal letter with some notes, which my office manager
incorporated into the final version that was sent to the insurer. She also set a reminder in our online appointment calendar to follow up on the appeal after 30 days. Three weeks after I submitted the appeal, I received a letter from the insurer indicating the claim had initially been processed incorrectly. I also received a check for payment of the evaluation. With properly guided staff, you too can survive an appeal by following the steps and implementing a protocol. If you are within your rights, and the insurer will not overturn the denial after an appeal, I suggest filing a complaint with your state insurance commissioner. By appealing, providers can send a strong message to insurers. We will not simply accept inappropriate processing of claims, and we will not provide services to our patients for free just because of a faulty claims-processing system. Review ACA’s template appeal letters today, and work with your staff to develop a quick and easy process to appeal denials. Protocol for Filing an Appeal 1. Identify non-payment of a claim or procedure (doctor or staff) 2. Identify the reason for non-payment, and have staff follow up with the insurer to verify the reason for denial, if it is not evident. 3. Decide if the reason is administrative, insurance company policy or clinical in nature. 4. Determine if the reason can be handled by your office or if the patient, a chiropractic organization, insurance regulators or your attorney need to be active in the process. 5. File the appropriate appeal using template letters.
ISCA Report
March 2009
Mark Your Calendar!
BACK TALK Comprehensive Concepts in the Diagnosis and Treatment of Spinal Disorders According to the North American Spine Society, one out of three Americans suffers from back pain. Back pain continues to be one of the most common reasons patients seek medical care. To address this ongoing need, join us for the 3rd annual spine symposium. This spine symposium will provide the latest information for the diagnosis and treatment of spinal disorders, injuries and abnormalities.
Date: September 11 & 12, 2009 Location: University Place Conference Center & Hotel 850 W. Michigan Street | Indianapolis, IN 46202 For more information, visit www.indianaspinegroup.com or call (866) 947-7463.
CE Credits sponsored by Logan College of Chiropractic.
Spinal Diagnostics & Therapeutics Kevin E. Macadaeg, M.D. | Jonathan P. Gentile, M.D. | John W. Arbuckle, M.D. Spine Surgery Rick C. Sasso, M.D. | Kenneth L. Renkens, M.D. | Thomas M. Reilly, M.D. | Paul E. Kraemer, M.D.
How to apply for a User name and password for Anthem On-line inquiries Note: This application is only for In-Network Providers
• Using your web browser, go to www.anthem.com • On the left side of your screen you will see the following: • Visitors • Members • Brokers & Producers • Providers • Employers • Click on Providers to shade it a darker blue. • In the center of the screen there is a phrase “To enter site, Click here”. Underneath that phrase you must select the state you are a provider in, then click Enter just below that. • A new screen appears. • On the left upper portion of the screen it states – Not registered? Register Now. Click on the register now. • You will need: Federal ID #, Anthem PIN #, Individual NPI #, Group NPI # (if applicable) and all pertinent information about the Doctor/clinic. If you want your front desk CA, Insurance clerk, etc. to have access to the information on line, set them up also at this time. Once you have completed the application, they will mail your user name and temporary password to you with instructions on how to reset your password. You may then begin using Anthem.com to check benefits, check on claims, send messages regarding errors on claims, etc.
March 2009
Indiana Spine Group
Tennessee Department of Insurance and Commerce Prohibits Discrimination Against DCs In a Jan. 29 bulletin, the Tennessee Department of Insurance and Commerce clarified for all licensed health insurers that Tennessee regulations mandate that any policy that pays for a treatment of a condition by a physician, must pay for the treatment of that condition by a chiropractor. The bulletin also indicated that “insurers should be prepared to reimburse those services rendered by a chiropractic physician to the same extent as it would reimburse services by a medical physician for treatment of the same condition.” Additionally, the bulletin indicated that higher copayments and deductibles cannot be required for services rendered by doctors of chiropractic. ACA commends doctors in Tennessee for meeting with the Department of Insurance. Their actions ensured the rightful enforcement of Tennessee insurance regulations, protected the scope of practice of doctors of chiropractic, and ended chiropractic discrimination. - ACA TODAY
ISCA Report
Truth in Advertising Inflating your professional degrees and expertise is never ethical By: Stephen Perle, DC, MSare
“Doctors of chiropractic should exercise utmost care that advertising is truthful and accurate in representing the doctor’s professional qualifications and degree of competence. Advertising should not exploit the vulnerability of patients, should not be misleading and should conform to all governmental jurisdictional rules and regulations in connection with professional advertising.” -Tenet Xi, ACA Code of Ethics Hyperbole in advertising seems to be the rule of thumb. One need only watch TV, listen to the radio or read printed and electronic media to see examples of over the top advertisements. However, as doctors of chiropractic, we must uphold a higher standard. If there is one word to describe the minimum criterion for an ethical advertisement, it is truthfulness. If you believe that something is the truth, but in fact it isn’t, that is not a lie. Nevertheless, without telling a lie, you can be held morally responsible for misleading the public by using an untruth in advertisement. For example, recent decisions regarding the advertising of spinal decompression by the Oregon Board of Chiropractic Examiners state that one cannot rely on the statements of manufacturers to ensure the validity of any claims. The onus is on the doctor to confirm the accuracy of any statements that he or she makes in advertising.
physiological chiropractic. Most states do not allow DCs to say they are board certified just because they hold a license to practice chiropractic. Likewise, people may say that they have a diplomate in XYZ, earned from some chiropractic college; however, as with all ACA-recognized diplomats and certifications, they took their training at the college but the diplomate came from the XYZ board. Make sure that any claims of expertise you make can be documented. With no advanced training, you cannot claim superiority over your chiropractic peers. I have seen advertisements in which doctors claim expertise in treating conditions that their state licensing regulations specifically prohibit them from treating. While padding your resume might help get you a job, not only is it unethical, but it can get you in trouble with regulatory boards and can even become an issue in a malpractice suit. Any advertisement that attempts to play upon the fears of patients is problematic, as well. A very common ploy is ads featuring “danger sings” or “killer sublaxations.” These ads are intended to exploit the fears of the general public and are not acceptable. It is ethical to educate people within an advertisement as long as the ad does not seek to inflate their fears over the potential dangers of their symptoms.
Keep in mind that the rules of the game are different for business and healthcare providers. The goal of business people is to maximize their profits, while our pre-eminent job is to provide health benefits to patients. Again, the higher the standard of conduct is expected of healthcare providers.
Finally, please be sure to review the laws and regulations in your own state regarding advertising. Violating these rules is inherently unethical. Some states have specific regulations that are the written in common language (not legalise) for both doctors and patients to review. A good example is New York’s regulation on unprofessional conduct.
I have seen many ads in which doctors claim some degree, or qualification, that in fact does not exist. For example, I have often seen people state that they are board certified in
Dr. Perle is a professor of clinical sciences at the University of Bridgeport College of Chiropractic, where he has taught an ethics course for more than 15 years.
ONE DAY; ONE VOICE; ONE MISSION! Chiropractors Worldwide Take Action To Educate Their Communities Face-to-Face Thursday, May 14, 2009, chiropractors and chiropractic students worldwide will take to the streets of their communities to talk face-to-face with 100 people each about the benefits of chiropractic care to celebrate the launch of International Face-to-Face Chiropractic Education Day (IFF-CED). This campaign is designed for chiropractors to communicate the BIG IDEA of chiropractic. The campaign launch comes as a result of studies that show that our population is severely under educated about the benefits of chiropractic! They believe 1000 chiropractors committed to educating their communities face-to-face will profoundly affect the lives of countless individuals. One Day; One Voice; One Mission instills the vision of the chiropractic BIG IDEA. Mark A. Kostow, D.C. is the founder of DC DOORS and the creator of International Face-to-Face Chiropractic Education Day (IFF-CED). Dr. Kostow has unmatched experience in face-to-face marketing of chiropractic. He has visited an average of 100 homes weekly for the past six years. “My professional life’s mission is to teach chiropractors how effective face-to-face marketing is for helping people receive chiropractic care.” Mark A. Kostow, D.C. For more information and registration for International Face-to-Face Chiropractic Education Day, contact 866-375-6786.
ISCA Report
March 2009
Chiropractic Suited for Primary Care? By Nicolas Campos, DC, CCSP
According to a recent survey in the Journal of the American Medical Association, the number of graduating medical students planning on working in primary care has dropped to 2 percent. This number is down from the already low 9 percent reported in a similar survey in 1991. Why is this decrease in primary care physicians important for chiropractors? Because as the public’s options dwindle with regard to primary care, DCs should expect more “nonchiropractic cases” to enter their offices over the next few years. As they do, chiropractors should be perfectly positioned to assist in, if not take over, the role of gatekeepers for a changing American health care system. I fully expect this article to rekindle the chiropractor as primary care physician debate. I remember this controversy from when I was in college. One group of students – the philosophically principled – felt that primary care, as discussed in the modern medical context, is not chiropractic at all, but the practice of medicine. They felt any movement in that direction would be an abandonment of the principles on which our illustrious profession was founded. Chiropractic is, and has always been the detection and correction of spinal subluxations, they say. Leave the medical doctoring to its own profession, including all forms of medical diagnosis. As such, seeing the chiropractor as primary care physician is a moot point.
Yes, some chiropractors will argue it’s about educating the public on our true role as spinal health experts – that we correct spinal subluxations and leave the medical conditions to medical doctors. To those who believe this, I pose this question: Do you really think the public understands how to differentiate between spinal and organic conditions? If they did, what the heck would they need us for? This brings to mind a recent experience I had in my office. Early one morning in July, we received a call from Mary, who was concerned because her son, Jim, was suffering from “terrible neck pain and headaches.” My office manager assured her that we would take good care of him. When the 25-year-old Jim came in, he appeared languid. He said he had a terrible headache and “sore” neck, and asked if I could just give him “a quick adjustment.” Upon questioning, I learned that Jim had been knocked unconscious by a thug at a Hollywood nightclub the week before. He disclosed that he was “out for 10 minutes,” and that he had swallowed copious amounts of his own blood, on which he nearly choked. He had regained consciousness, opted out of an ER visit, and been taken home by his friends, whereupon he passed out until the next morning. He reported feeling lethargic, vomiting every day, having excruciating headaches, and losing 15 pounds (unconfirmed) due to a loss of appetite.
The other group of students – the “let’s enter the mainstream health care market and serve the most people” faction – saw the chiropractor as primary care physician option simply as a no-brainer. Why wouldn’t we want to have the broadest scope possible, to help as many people as we can, and to embed ourselves in a potentially lucrative financial position? To this group, it made sense to study all the academic courses in college, regardless of whether they were chiropractically or medically oriented, and to also use all the tools learned in those courses to provide adequate patient care.
I immediately sent Jim via cab to the radiology center in my area for a CT scan. I knew he would be getting top-notch scans there and that they would send him over to the ER if necessary. It appeared to me that he had some intracranial bleeding going on, which would make sense considering his recent trauma and presenting complaints. Turns out he had a subarachnoid hematoma. Jim was immediately sent to USC Medical Center for further evaluation and emergency surgery. He is now recovering beautifully from his injuries and should be able to resume a normal life within a few months.
So, who’s right? Interestingly, both groups are, to a degree. The principled faction is absolutely correct: We must maintain our unique identity. We are not medical doctors; we operate from an entirely different premise. We treat people naturally, without drugs, without surgery, to facilitate the innate healing powers of the body. No matter whether you are a pain doctor or a wellness doctor, or a combination thereof, the major premise by which you practice your craft is that the body heals itself; and as a chiropractor, you help it along through this process by administering an adjustment. (I personally do not care what language each individual doctor uses to describe this process.)
Here is the gist of the story: Despite what some chiropractors think, we do not always get to choose our patients. People often call with what they think is one problem – a sore neck and terrible headache, for example – and yet may have something entirely different. It is our responsibility as doctors to differentiate between musculoskeletal pain and more severe maladies. Our patients rely on us to help them with their health problems; if nothing else, to direct them to the appropriate place to find appropriate help.
Because chiropractic is unique, both in premise and in practice, our greatest contribution to the public health is to maintain this distinctiveness. As I’ve heard it said by others, and with which I fully agree, if the patient is looking for a medical doctor or physical therapist, they probably shouldn’t be walking into a chiropractor’s office. However, this does not mean that we should shirk our responsibility as doctors. We owe it to our clients to be well-versed in and cognizant of standard diagnostic procedures. People see chiropractors as doctors, so they enter chiropractic offices with concerns about their general health. They don’t give a hoot about the profession’s philosophical differences.
I understand that some chiropractors have a different focus. They are wellness doctors and emphasize optimal health through the removal of spinal subluxations. I get it, and I’m all for it. My point here, though, is that it takes very careful patient education to teach patients what one’s scope is. If you don’t do diagnosis, then you’d better tell your incoming patients so. And if you are still accepting pain cases, you might be contradicting your own principles. If you do accept pain patients and your focus (even if only a portion) is pain relief, then you absolutely must have basic diagnostic skills. Basic diagnostic skills encompass the ability to distinguish between chiropractic and nonchiropractic cases, understanding red flags and knowing when to refer.
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March 2009
ISCA Report
Chiropractic suit continued... This referral point should resonate with principled chiropractors, as it relates to what we’ve all learned as limitations of matter. As explained in Chiro Philosophy 101, if a person falls off a 10-story building, there isn’t much chiropractic can do for them. We can all agree, though, that patients do not always know the difference with some conditions, as leg pain with large, deep purple spots seems to some people like something a chiropractor should be able to treat. I have plenty of patients who trust me enough to bring their painful purple legs into my office. So, the original question is, should chiropractors position themselves as gatekeepers to tomorrow’s reformed health care system? My belief is a resounding yes. The reality is that medical doctors, for various reasons, are abandoning the post for greener and more lucrative pastures in specialization. The options available to fill the primary care niche are registered nurses and nurse practitioners, doctors of physical therapy (it’s coming!), foreign-trained medical doctors or chiropractors. Nurses are adequate, but in short supply; however, in no way are they better trained than chiropractors. Physical therapists are not yet doctors, and their education to this point is limited. I suspect that foreign-born MDs will increase over the next several years, as current reports list their numbers at 25 percent of the medical work force. With these four options in mind, it seems to me that the most likely scenario will include some combination of the four professions acting as primary health care gatekeepers. As chiropractic doctors, we should not let this opportunity slip us by. Our training and licensure put us in a perfect position to fill at least a partial role as primary care doctors.
I am certain that this notion will make some of the more traditionally minded, principled chiropractors very upset, for the reasons I have mentioned previously. I believe the reason for this is that I am suggesting change, and very few people adopt change without kicking and screaming along the way. However, I do not believe that those wishing to continue to practice in a traditional, wellness-based model should stop doing so. That type of focus is necessary and appreciated as an integral part of a holistic health care system, as long as incoming clients understand that distinction. But for those who wish to establish themselves more firmly in the mainstream health care arena, taking on the role of primary care gatekeeper will be essential to filling a very real void that is forming and will continue to grow as medical doctors increasingly leave behind their primary care practices. References 1.Hauer KE, Durning SJ, Kernan WN, et al. Factors associated with medical students’ career choices regarding internal medicine. JAMA2008;300(10):1154-64. 2.Schwartz MD, Linzer M, Babbott D, et al. Medical student interest in internal medicine. Initial report of the Society of General Internal Medicine Interest Group Survey on Factors Influencing Career Choice in Internal Medicine. Ann Intern Med, Jan. 1, 1991;114(1):6-15. 3.Migration Policy Institute Web site. Migration Information Source, U.S. in Focus, Foreign-Born Health-Care Workers in the United States. (www. migrationinformation.org/USFocus/display.cfm?ID=583).
Dr. Nicolas Campos graduated from U.C. Berkeley in 1994 with a degree in molecular and cell biology, and then attended Cleveland Chiropractic College Los Angeles, graduating in 2000. The author of Six Keys to Optimal Health, Dr. Campos practices in West Hollywood, Calif.
Imaging for low back pain without serious underlying conditions does not improve clinical outcomes Source: Ortho Supersite The routine use of radiography, MRI or CT scans in patients with low back pain but no indication of a serious underlying condition does not improve clinical outcomes, according to a recent study. In light of the findings, physicians should refrain from routine, immediate scanning unless they observe features of a serious underlying condition, Roger Chou, MD, of the Oregon Health and Science University in Portland, Ore., and colleagues reported in this week’s edition of The Lancet. Researchers performed a meta-analysis of randomized controlled trials that compared immediate back imaging - using either radiography, MRI or CT - with usual clinical care that does not involve immediate imaging. Investigators included six trials that involved more than 1,800 patients and reported a range of outcomes, including pain and function, quality of life, mental health, overall patient-reported improvement and patient satisfaction. The researchers identified no significant differences between immediate imaging and usual clinical care in their meta-analysis, according to a press release. “Rates of utilization of lumbar MRI are increasing, and implementation of diagnostic imaging guidelines for low back pain remains a challenge,” the researchers said in the press release. “However, clinicians are more likely to adhere to guideline recommendations about lumbar imaging now that these are supported by consistent evidence from higher-quality randomized controlled trials. “Patient expectations and preferences about imaging should also be addressed, because 80% of patients with low back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging,” they said in the press release. According to Chou, educational interventions could be effective for reducing the proportion of patients with low back pain who believe that routine imaging should be done. “We need to identify back pain assessment and educational strategies that meet patient expectations and increase satisfaction, while avoiding unnecessary imaging,” he said in the press release. Reference: Chou R, Fu R, Carrino JA, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009; 373(9662):463-472.
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ISCA Report
March 2009
ACA UPdate: ACA Defends the Scope of Practice of Doctors of Chiropractic By: Dr. Robert Tennant, D.C. - ISCA Second Vice President
Over the past year, ACA has received an increasing number of reports from members that certain self-funded employer plans are precluding doctors of chiropractic from performing spinal manipulation for their beneficiaries. In these instances, the health plans allow spinal manipulation to be performed only by MDs and DOs. As DCs are the most qualified provider to perform spinal manipulation, the ACA has aggressively pursued policy change with health plans who are implementing such policies. The ACA has advocated with Motorola, A.J. Gallagher, Grand Prarie Texas City Hall, and Shop Rite regarding their policies that disallowed DCs from performing manipulation and they were subsequently overturned. The ACA continues to fight for the right of DCs to perform spinal manipulation with WalMart, Fresnius Health, and PNC Bank. The ACA pursues with conviction all attempts made by insurers to limit the scope of practice of doctors of chiropractic. These infringements can be severe and threaten the very core of chiropractic practice. As is evident in their two-year pursuit of policy change with Motorola, the ACA will not stop advocating on behalf of our members when faced with obstacles to appropriate patient care.
NFL Great Jerry Rice Named F4CP Spokesman Jerry Rice, considered the greatest wide receiver in National Football League (NFL) history and one of the greatest players that ever played, now carries the ball for the chiropractic profession. The Foundation for Chiropractic Progress (F4CP) has enlisted Jerry Rice to speak on his use and support of the chiropractic profession. An advertising campaign featuring Jerry Rice began in the Dec. 15th issue of ESPN The Magazine on page 46. The magazine has a national circulation of more than 2 million.
Self Service
Did you know Medicare has a variety of different resources available to make your job easier? These resources are self-service tools that providers and their staff can use without assistance from Medicare. These include: •
The WPS Medicare Website: http://www.wpsmedicare.com
The full page ad of Jerry Rice includes positive statements on how chiropractic made a difference in making him one of the most feared wide receivers in history and later as a finalist with the popular “Dancing with the Stars” program.
•
The Centers for Medicare & Medicaid Services Website:
•
The Medicare Website for beneficiaries: www.medicare.gov
This ad is the beginning of a comprehensive public relations effort that is planned in the next couple of months to communicate Rice’s endorsement that will include placement in Sports Illustrated, USA Today, Men’s Fitness, and Women’s Health. It will also include a press release and video to the media, an advertorial that will be sent to 10,000 newspapers in the country, and a Public Service Announcement.
•
The Centers for Medicare & Medicaid Services Secure
www.cms.hhs.gov
Network Access Portal (CSNAP), giving on-line claim status, eligibility, and more: www.medicareinfo.com •
Individuals Authorized Access to CMS Computer Serivces – Provider/Supplier Community (IACS-PC)
-Source: Foundation for Chiropractic Progress www.foundation4cp.com
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Medicare Remit Easy Print (MREP)
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Interactive Voice Response (IVR): www.wpsmedicare.com/ part_b/selfservice/ivr/pdf
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Visit the IsCA website for upcoming events and check out the new Rss Feed www.indianastatechiros.org
Computer-Based Trainings (CBTs) (available from CMS and WPS Medicare)
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The WPS Medicare Monthly Newsletter: The Communique
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E-mail news updates from CMS and WPS Medicare: The eNews Listserv
•
Medicare Learning Network: Educational resources available from CMS
March 2009
ISCA Report
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WellPoint pays to settle reimbursement probe By J.K. Wall, Indianapolis Business Journal staff - jwall@ibj.com Indianapolis-based WellPoint Inc. has agreed to pay $10 million to settle a New York probe into how the Indianapolis-based health insurer reimbursed customers for out-of-network services. WellPoint also agreed to stop using the Ingenix database of reimbursement rates that New York Attorney General Andrew Cuomo has called “defective and manipulated.” “WellPoint acknowledges the conflicts of interest in the Ingenix database, which the Attorney General’s investigation brought to light, and we support his office’s efforts to increase the transparency of health care costs,” Ken Goulet, the CEO of WellPoint’s commercial business, said in a statement. The Ingenix database, operated by Minnesota-based UnitedHealth Group, included reimbursement rates from numerous health insurers. Insurers referred to the database to set its reimbursement rates when one of its customers visited an “out-of-network” doctor - a physician who had not agreed to give discounts to the insurer’s customers. Cuomo will use fees paid by WellPoint and its peers to create and fund a not-for-profit database to replace Ingenix that will be accessible both to insurers and their customers. UnitedHealth said in January it would discontinue the database. WellPoint is the fourth major company to settle with Cuomo. A $10 million settlement by Philadelphia-based Cigna Corp., the fifth-largest U.S. health insurer, was announced yesterday. UnitedHealth, the nation’s biggest health insurer, settled for $50 million in an agreement announced last month. Connecticut-based Aetna Inc., the third-largest, agreed to pay $20 million. “WellPoint is committed to appropriately processing claims and fairly reimbursing health care providers for covered services under the terms of each member’s contract, while at the same time protecting our members and group customers against excessive charges by some non-participating providers,” Goulet added.
Incentives to promote the delivery of preventive care Preventative care is defined in 42 CFR 1003.101 to mean items and services that (i) are covered by Medicare or Medicaid, and (ii) are either pre-natal or post-natal well-baby services or are services described in the Guide to Clinical Preventive Services published by the U.S. Preventive Services Task Force (available online at http://odphp.osophs.dhhs.gov/pubs/guidecaps/). Such incentives may not be in the form of cash or cash equivalents and may not be disproportionate to the value of the preventive care provided. (See 42 CFR 1003.101; 65 FR 24400 and 24409.) Any practice permitted under an anti-kickback statute safe harbor at 42 CFR 1001.952. For example, anti-kick-back statute safe harbors exist for warranties; discounts; employee compensation; waivers of certain beneficiary coinsurance and deductible amounts; and increased coverage, reduced cost-sharing amounts, or reduced premium amounts offered by health plans. Waivers of co-payments amounts in excess of the minimum co-payment amounts under the Medicare hospital outpatient fee schedule. Inducement The Act bars the offering of remuneration to Medicare of Medicaid beneficiaries where the person offering the remuneration knows or should know that the remuneration is likely to influence the beneficiary to order or receive items or services from a particular provider. The “should know” standard is met if a provider acts with deliberate ignorance or reckless disregard. No proof of specific intent is required. (See 42 CFR 1003.101) The “inducement” element of the offense is met by any offer of valuable (i.e., not inexpensive) goods and services as part of a marketing or promotional activity, regardless of whether the marketing or promotional activity is active or passive. For example, even if a provider does not directly advertise or promote the availability of a benefit to beneficiaries, there may be indirect marketing or promotional efforts or informal channels of information dissemination, such as “word of mouth” promotion by practitioners or patient support groups. In addition, the OIG considers the provision of free goods or services to existing customers who have an ongoing relationship with the provider likely to influence those customers’ future purchases. Source: Northwestern Health Sciences University, www.nwhealth.edu
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ISCA Report
March 2009
ISCA Legislative update
By Dr. Anthony Wolf - Legislative Committee Chair The ISCA Legislative Committee has been very active on behalf of ISCA members. The committee meets every week to make important decisions on various bills that may be beneficial or detrimental to our profession. The committee members decide whether to support/ oppose or monitor nearly 100 bills that have been proposed this legislative session. Our Executive Director/Lobbyist attends all hearings and special meetings at the State House as well as individual meetings with legislators to closely monitor and voice our concerns on every bill that concerns the ISCA. She then reports the latest movement and negotiations of each bill to allow the Legislative Committee to decide on the appropriate action. When immediate action is necessary the ISCA grassroots efforts are CRITICAL to encourage your senators and representatives to support our issues. The elected officials need to hear from doctors and patients that live in their districts as these are the people they represent. Two major bills we are actively engaged in are Assignment of Benefits (AOB) and chiropractic inclusion in the Healthy Indiana Program (HIP). Assignment of Benefits is our own bill that originated with the ISCA four years ago. Although it has gained great support from all Health Professions, we face a strong opposition from the Insurance Industry, Unions, Manufacturer’s Association, and Chamber of Commerce. The ISCA Board of Directors and Legislative Committee feel that AOB is an important issue for DC’s practicing in Indiana because it mandates that insurance companies pay the Provider and not the patient for Out of Network services. As Doctors are getting “squeezed” by declining In Network reimbursements, there is an increasing urge to become an Out of Network provider. AOB also removes the burden of claims follow-up and EOB interpretation from the patient by allowing the provider to directly handle these issues. Currently, the HIP program does not include Chiropractic Manipulative Therapy. The ISCA Legislative Committee and Board of Directors feel this is an act of Discrimination on our profession as we are included in other Government Insurance programs such as Medicare and Medicaid. An Amendment to the Budget Bill has been added by the ISCA to allow CMT reimbursement under HIP. Each year there are numerous other bills that would have a severe negative impact on the practice of chiropractic in Indiana. This year is no different. The ISCA’s lobbyist and Executive Director is ready to act on our behalf in the event any of these bills are considered for a hearing. We are closely monitoring all bills for any amendments by the Physical Therapists in regards to direct access and spinal manipulation. Pat McGuffey has already been successful in removing language from a bill that would allow Physician Assistants to refer to Physical Therapists. The Legislative Committee felt this would leave the patient without a proper diagnosis as we felt PA’s and PT’s lack the proper training to diagnose. As ISCA members we are all called to act in any capacity we can to protect this profession. The Support of our members is critical to ensure future success. • Be Active in the Grassroots efforts when called upon • Invest in our BackPac (Remember this is an investment for a return, NOT a donation to a cause.) • Actively support your Senator and Representative in your area. • Create an open dialogue with your elected officials If you have any questions concerning our legislative issues, please do not hesitate to call the ISCA office at 317-673-4245 or call me directly at 317-690-0769. It is a privilege and a blessing to serve this Great Profession.
March 2009
ISCA Report
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Online Medicare Enrollment Available in 24 States, D.C.
Updated Health Savings Account Information for 2009 New Annual Contribution Levels for HSAs Announced A Health Savings Account (HSA) is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSAs enable account holders to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. HSAs were created by the Medicare bill signed into law by President Bush in December 2003. The IRS recently issued the maximum contribution levels for HSAs and out-of-pocket spending limits for High Deductible Health Plans that must be used in conjunction with HSAs. These amounts have been indexed for cost-of-living adjustments for 2009. The new levels are as follows: New Annual Contribution Levels for HSAs • For 2009, the maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000. • For family coverage, the maximum annual HAS contribution is $5,950. • Catch up contribution for individuals who are 55 or older is increased by statute to $1,000 for 2009 and all years going forward. • Individuals who are eligible individuals on the first day of the last month of the taxable year (December for most taxpayers) are allowed the full annual contribution (plus catch up contribution, if 55 or older by year end), regardless of the number of months the individual was an eligible individual in the year. For individuals who are no longer eligible individuals on that date, both the HSA contribution and catch up contribution apply pro rata based on the number of months of the year a taxpayer is an eligible individual. New Amounts for Out-of-Pocket Spending on HSA-Compatible HDHPs • For 2009, the maximum annual out-of-pocket amounts for HDHP self-coverage increase to $5,800 and the maximum annual out of pocket amount for HDHP family coverage is twice that, $11,600. Minimum Deductible Amounts for HSA-Compatible HDHPs • For 2009, the minimum deductible for HDHPs increases to $1,150 for self-only coverage and $2,300 for family coverage. • In addition, a fiscal year plan that satisfies the requirements for an HDHP on the first day of the first month of its fiscal year my apply that deductible for the entire fiscal year. For more on HSAs, including fact sheets, frequently asked questions and more visit www.ustreas.gov/offices/publicaffairs/hsa/
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Healthcare providers can now enroll in medicare and make important changes to their Medicare status from the convenience of their computers, thanks to the new Provider Enrollment, Chair and Ownership System (PECOS). Both Physician and non-physician practitioners in select states can use PECOs to enroll in Medicare, make changes in their enrollment status, view their Medicare enrollment information on file with Medicare, and check on the status of a Medicare enrollment application. This Internet-based system is capable of processing enrollment applications, updates and changes up to 50 percent faster than the paper-based system. Providers in the following states can use the PECOS system now: Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, West Virginia, Wisconsin, and the District of Columbia. All remaining states are expected to be included in the next two months. To access the PECOS system, visit: https://pecos.cms.hhs.gov/pecos/login.do
Chiropractic college news nhsu: undergrads on campus
NHSU will hold undergraduate courses on campus starting this month. Thanks to a new building addition and laboratory renovations, students in the undergraduate studies program will now attend class on the university’s Bloomington, Minn., campus rather than at Invers Hill Community College. There are approximately 900 students currently enrolled at NHSU in courses on a number of natural health care techniques, including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology.
New ABN Mandatory on March 1 The deadline for transitioning to the new Advanced Beneficiary Notice (ABN) is approaching fast. The Centers for Medicare and Medicaid Services (CMS) requires all Medicare providers to use the new form beginning March 1. Among other changes, the new form may not be used for non-covered services, or anything that is NOT spinal CMT (CPT codes 98940, 98941, 98942). This includes exams, modalities, X-Rays, labs, etc. The new ABN will also eliminate the need for the previous Notice of Exclusion from Medicare Benefits (NEMB) form, which was considered optional by CMS.
ISCA Report
March 2009
IBJ staff
Rebuttal to Assignment of Benefits article IBJ February 2-8 2009 page 23A Assignment of Benefits (AOB) Setting the Record Straight By: Dr. Anthony C. Wolf, D.C. - ISCA President
Attention all Employers, Employees and Citizens of Indiana The Insurance Industry and Chamber of Commerce are providing misleading and untruthful statements to Employers and their insured members about Assignment of Benefits. The following comments in this article are backed by research and are truthful. However, the contract is not explained to the employer and employee noting that the insurance company will not honor assignment of benefits, when the employee chooses an out of network provider. Your article failed to mention the extreme burden placed on patients receiving the Explanation of Benefits that accompanies the check. A patient, untrained in insurance matters, has no idea of proper claims payment. How does an individual patient follow up on a low payment, or non-payment (denial) according to his/her contract with the insurance company? How can a patient know if the insurance company was correct to deny payment for “not medically necessary” services, when in fact the doctor can prove the services were medically necessary. How can a patient know what are “reasonable and customary” fees? What about a Medicare crossover to a secondary insurance in a timely fashion to avoid non-payment for time filing limits? With AOB- the doctor’s trained staff will handle these issues. Without AOB-the patient is on their own. Insurers and their allies claim healthcare costs would spiral our of control with AOB is false. Fact: An AOB Law would NOT increase healthcare costs. AOB only allows the patient to direct where the payment and explanation of benefits are to be sent. There is no mention in the bill of how much the patient or insurance company must pay. The patient also can always choose whether or not to go to an out of network doctor. Fact: Insurance companies pay out-of-network services at the same rate as in-network services. AOB does not increase balance billing to patients. It would be the same as it is currently. The patient can choose to go out of network and to be responsible for balance billing, or the patient can choose an in network doctor to avoid balance billing. Tony Feltz and Anthem can still “wring out” whatever they want to from in-network providers. Fact: AOB would not change this. Mike Ripley of the Chamber of Commerce implies that AOB would “harm” the networks. There is no evidence of this in states with AOB laws. Fact: Other insurance companies honoring AOB for out of network providers show NO evidence that this harms their Networks. Fact: Of the 22 states that have Assignment of Benefits Laws, more than ½ have lower insurance premiums when compared to Indiana. AOB Laws do not increase insurance premiums to Employers and Employees. We need to recognize the truth and pass AOB to honor the patient’s request to simply send the check to the provider. Employers and Employees may contact the ISCA directly to answer any questions they may have about Assignment of Benefits. Respectfully, Anthony C. Wolf, D.C. Indiana State Chiropractic Association President
March 2009
ISCA Report
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2009 Spring Conference
April 17-19, 2009 Radisson Airport
2500 S. High School Rd. Indianapolis, IN 46241 Friday April 17 (5:30 - 9:30pm) 4 Hour Risk Management Session Informed Consent & Professional Boundaries Anna K. Allen, RN, MSN, CLNC NCMIC policy holders receive a discount on their premiums by attending 8 hours of sessions presented by their speakers. Saturday April 18 (8am - 12pm) 4 Hour CA Medicare Session James M Cox II, D.C., LAC. Dr Cox will present the following topics to the chiropractic assistants: medically necessary documentation, who the Medicare carrier is for Indiana, what an ABN is, how to use the new ABN, what is the difference between participating and nonparticipating providers, the fee differences, covered medicare charges vs noncovered services, what you must bill to medicare and what changes are happening in 2009. In addition, Dr. Chris Klaes will present a first hand experience of medicare audits from beginning to end and how to win your appeals! Saturday April 18: 4 Hour Sessions (8am - 12pm) The Pathophysiology, Evaluation, and Management of Headache (2PM - 6PM) Practice Clinical Nutrition Scott D. Banks, D.C. Dr. Scott D. Banks’ entertaining, up-to-the-minute programs blend theory with practice. His forum is open and relaxed, and his humor and literary background make him a commonly requested speaker. Doctors will leave Dr. Banks’ program with an increased understanding of the pathophysiology and an up-to-date literature review. NCMIC policy holders receive a discount on their premiums by attending 8 hours of sessions presented by their speakers. Saturday April 18 (6PM -7pm) location: Vendor area 1 Hour Summit: Maintaining & Building Your Practice In A Tough Economic Environment Join ISCA in this peer led summit focusing on the current economic picture and how it affects your practice. This is an idea sharing session with panelists and session participants sharing their thoughts on the current economic picture as well as ideas on what every practice can do to withstand the pressure. Don’t miss out on this one of a kind event.
Sunday April 19 (8am - 12pm) Pediatrics: Full Spine Adjusting Techniques and Treatment Protocols for Common Pediatric Conditions Elise G. Hewitt, D.C., CST, DICCP Hotel Information: Radisson airport 2500 S. High School Rd. Indianapolis, IN 46241 Room rate: $99 / Room block ends 3/18/09. Reservations: (800) 333-3333. Reference “ISCA Spring Conf.” or “Indiana State Chiropractic Association” when calling. Join us for the ISCA Membership Meeting during Saturday’s Luncheon: April 18, 12pm - 1:30pm Get an update from the leadership of ISCA and see where your state association is heading. Pat McGuffey will provide valuable insight into the legislative issues that are affecting the industry and Dr. Tony Wolf will provide a brief overview of where the Association is and its goals for 2009. isca dinner gala : Saturday, April 18 Ticket included with purchase of 8 hour or 12 hour sessions. Additional tickets can be purchased for $60 each. Enjoy the company of fellow chiropractors, their spouses and ISCA guests at this Black Tie (optional) Gala. This affair is a great way to network with others in your profession from throughout the state and enjoy a wonderful evening after Saturday’s Spring Conference sessions have concluded. The ISCA Gala will include dinner and entertainment for the evening.
EARLY BIRD REGISTRATION ENDS MARCH 27! Register online at www.indianastatechiros.org!
I S CA ’ s E c o n o mi c S t im u l u s Pl a n Non-Members: Join today and get $30.00 off the ISCA Member rate for the Spring Conference. Members: Bringing more than one person to the conference has its rewards! Bring yourself and an Associate and receive $30.00 off per registration. Bring a total of 3 or more (including yourself) and take $40.00 off each registration. Unfortunately this is not valid on CA registrations.
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Register online at www.indianastatechiros.org! 2009 Indiana State Chiropractic Association Spring Conference Registration Form Please indicate if you will attend the luncheon and dinner gala, 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 Saturday Luncheon & Membership Meeting YES____ NO____ I will attend the ISCA Dinner Gala YES____ NO____ (included with purchase of 8 or 12 hour package)
Registration Type
Package A 12 Hour Session
Package B 8 Hour Session
Package C 4 Hour Session
Package D: CA $89 Package f: Lunch Ticket $30
After Mar. 27 -------
Adv. -------
After Mar. 27 -------
$400
$230
$280
After Adv. Mar. 27 ------------$145 $195
3. Member (in good standing).... $400 4. Member (in arrears)................. $515
$450
$270
$320
$165
$215
$565
$310
$360
$210
$260
5. Non-Member............................. $535
$585
$330
$380
$230
$280
Adv. 1. Platinum.......... complimentary -------2. Gold & Silver.............................. $350
Package E: Guest*/Student $75 (included with 8 &12 hour sessions)
Package g: Additional Dinner Gala Ticket $60 (1 included with 8 or 12 hr sessions) *non DC Guest
*Members shall only be eligible for all membership benefits, including Spring 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 Spring Conference free of charge but registration is still required. Contact Name Clinic Name Address
City
Phone (
State
)
registration type (Example: 1, 2, 3)
Registrant Name
Fax (
Zip )
packages
(Example: A, D, G)
Amount
$ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ Total $__________
Payment Information
Amex
Visa
Mastercard
Check (Make Payable to ISCA)
Cardholder:______________________________________________ Card #:__________________________________________________ Exp.______________
3 digit security #:_________________ Signature:__________________________________________________
Questions? Call 1.317.673.4245, or e-mail info@indianastatechiros.org / Refunds at 90% until April 3. No refunds after April 3.
Register online at www.indianastatechiros.org! March 2009
ISCA Report
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Indiana State chiropractic association classifieds PRACTICES FOR SALE NDIANA - Great Buy-In Opportunity! Make $100K your first year with annual increases. Full practice ownership through sweat equity. Looking for a motivated doctor to take on this great opportunity. Includes practice management (coaching) and tremendous Seller assistance in transition of the practice. Professional Practice Advisors, Inc. 800.863.9373 www. practiceadvisors.com Posted 12/01/08 INDIANA FISHERS, IN - Great practice, doctor has health issues and must sell ASAP. Make offer, priced below market. Transition included. Contact for a two page “fact sheet”. Dr. Tom Morgan VolumeDC@aol.com, 770 748-6084. www. VolumePractice.com. Posted 11/18/08 Practice for sale in Lawrenceburg, Indiana. 10 year old well-established practice in a rapidly growing area. $250,000 gross in 2007 on 3 days per week. General diversified practice, fully equipped, modalities, low-tech rehab, x-ray. Excellent opportunity. Practice has great growth potential. Motivated seller. Contact Dr. Mike at 513-544-2699. Posted 10/24/08 WESTERN INDIANA 12 year family practice collecting $148,016.00. Dr take home before taxes $95,191.00. Open 3-1/2 days. 4,283 total visits. 7,000 total patient draw. This is a strong agricultural rural region. A peaceful, “Andy of Mayberry”, strong family values community. Will sacrifice for $99,950.00 Pix on web! 100% financing O.A.C. Call (928) 282-8434. Posted 10/21/08 WEST CENTRAL INDIANA PRACTICE AND RETIRE as a multi-millionaire, as we are doing. Since 1976 has operated as a two doctor clinic. Professional three thousand sq ft. office in high traffic growth location. Diversified, P.T., nutrition, x-ray, Cox, and A.K. practice. Practice, building, and equipment professionally appraised at $600,000. Call 812-243-2248 for financial details. Posted 9/30/08 Established, profitable 10 year old Chiropractic Practice located in upscale SW Fort Wayne, Indiana. Excellent practice facility utilizing hands on adjusting, active and passive rehab and nutrition. Will consider sale of building along with practice if appropriate. This is an excellent opportunity for a motivated individual who wants to relocate or begin solo practice. This can also be a highly effective satellite practice. If you are interested, inquiries can be directed to chiro4sale46804@gmail.com. Posted 9/22/08
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A growing well established chiropractic practice located close to Ft. Wayne, IN. Beautiful, well equipped clinic with space to expand. The real estate has an attached live in space or could be used as a rental. Priced well below the market with an extremely low overhead in a delightful town. This is a must see opportunity for a serious doctor, or perhaps a second location for a multiple practice; call now (260)568-2129 or email haftagottagetto@hotmail.com. Posted 9/22/08 MD/DC/PT practices for sell. GI 1.4M in '07. 2.5 years established. Northwest Indiana. Further details upon request by email, drbenc@msn.com. Posted 8/5/08 Wayne and White counties and East Central, IN. Call The Paragon Group at (800) 582-1812 or visit our website http://www.eparagongroup.com. Posted 7/09/08
Associates Available Preceptorship Wanted – Energetic, reliable female intern is looking to preceptor with a motivated chiropractor in the Indianapolis area from Jan-April 2009. I recently completed a 4-week preceptorship at a VA clinic where I adjusted patients every day. I graduate from National in April 2009 and want to enhance my clinic experience by assisting a busy clinic while I gain from your experience. Call Shelley at 815483-3336 or email shelleycoughlin@student. nuhs.edu. Posted 10/16/08 (M)
Associates Wanted Associate Chiropractor wanted for large functional chiropractic office in Indianapolis. We are looking for a progressive doctor who enjoys treating a variety of patient types including personal injury, sports and physical medicine, and rehabilitation. Candidate should have excellent communication, evaluation, and writing skills. Knowledge of or willingness to learn Atlas Orthogonal Technique a must. Indiana license required. Participation in Medicare and Anthem are a plus. Competitive compensation package for the right candidate. Please email CV to rprather@indy.rr.com. Posted 1/21/09 (M) Busy Chiropractic office in NW Indiana looking for tandem chiropractor. Must use Thompson Leg Check Analysis. Fax resume to (219) 836-2344 or email to: info@trimbolichiro.net Posted 1/15/09 (M)
ISCA Report
Associates Wanted - Rapidly expanding Practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic, ambitious doctor is a must. Must be proficient in Cox Technique, Palmer Diversified Technique and Thomas Technique. Salary and profit share of clinic are offered. Send resume to Dr. Danielle Kauffman 7620 E.109th Ave, Crown Point, IN 46307 or E-mail to chirodan@comcast.net. Posted 1/08/09 (M) Associate wanted for Indianapolis area multidisciplinary clinic. Associate will perform exams, x-rays, adjust and document in office. You will be trained in new patient procurement. Please send resume to drspine26@yahoo.com or call 317-496-2530 if line is busy please call back. First year Salary $48-52k+bonus. Posted 1/07/09 (M) Logan Basic/Activator Practitioner wanted to work in multi-specialty chiropractic office in Indianapolis, Indiana. I pay 40% of collections on any patient you treat in our office. I pay your rent, phone, internet, and utilities. I also purchase your x-ray film, pay the lease on the new high frequency x-ray machine and buy your business cards. You will have your own adjusting room and my staff files your insurance claims. We are an in-network (PPO) provider for Anthem Blue Cross, Aetna, Cigna, Sagamore and a participating provider with Medicare. Hamilton County is one of the fastest growing counties in the country with one of the lowest cost of living indexes. Three letters of recommendation from Logan faculty is required for consideration. Please send your resume and cover letter to palachiro@sbcglobal.net. Or mail to Dr. Shawn Pala, 14701 Cumberland road, suite 350, Noblesville, Indiana 46060. Visit our website: www.palachiropractic.com. Posted 11/18/08 Associate doctor for Indianapolis clinic. We pay for malpractice through NCMIC and your continuing education. We work a 3 1/2 day week. 28 hours and NO Fridays! A 3 day weekend every weekend! Competitive salary plus bonus after 6 months. Call Dr. Terry Tolle 317-496-2530. Posted 9/16/08 Excellent opportunity at an established chiropractic office of 20 years in small town in southern Indiana. Work independently but benefit from successful 3 affiliated clinic's shared expertise. Email resume to tenaxinc@fuse.net. Posted 8/15/08
March 2009
Indiana State chiropractic association classifieds Vacation Doctors
Equipment For Sale
1989 Logan Grad available for full or half day fill-in. Diversified, Gonstead, NIMMO, Logan Basic, Graston Technique and Impulse Adjusting. minkischiropractic@gmail.com or 317-388-1118. Posted 12/04/08 (NM)
"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 lyonschiro@verizon.net for contact. Posted 3/09/09 (M)
Vacation Doctor - Palmer Graduate, 27 years experience, excellent adjusting and people skills. Multiple techniques including Activator and Cox. $300 a day base fee. References available. Dr. Dan Grotzinger 317-826-8106. Posted 11/25/08 Well Skilled, personable, efficient in patient care. Proficient in various techniques, inc. Proadjuster. Licensed from 1994. Exp:Bus.Owner/Associate/ Vac fill-in. Available for temp.or permanent work. For more information please contact 765683-0845 or katsan7@yahoo.com Kathleen Sanderford, D.C. Posted 7/17/08 Licensed doctor to cover your practice. Over 10 years experience. Excellent adjusting skills, Many references. Call Dr. Flynn at (317) 580-1145 Licensed doctor to cover your practice. 8 years of experience, available state wide. References available. Call Dr. Reynold at (309) 269-0317 Stable chiropractic office in NW Indiana seeks reliable vacation doctor for 1 week both in October and February. Prefer Palmer grad. Must know Palmer Package, Activator, Cox, and Nimmo Trigger-Point Therapy. Prefer confident doctor who is not afraid to spend some quality time with each patient to educate and treat them. Pay is negotiable. May open up to a weekly part-time position for the right doctor. Call 219661-8680 (ask for one of the doctors) or e-mail chirocouple@hotmail.com Palmer graduate, 25 years experience, excellent adjusting and people skills. References available. Call Dr. Grotzinger (317) 585-4808 Maternity leave, vacations, seminars. Indiana licensed, NCMIC insured, Logan graduate. Efficient in Diversified, Drop, Pro-Adjuster, Activator, Flexion/Distraction, Basic. Able to work state wide. Many refrences. Call Dr. Amy Roache at 317.496.0299 or email dr_amyroache@hotmail.com Indiana and Kentucky licenses, OUM insured, multiple techniques, $400 per day. Call Bill Overstreet (765) 480-6283 or email bojostreet@hotmail.com
March 2009
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 mihajlo62@hotmail.com or call 219-798-6410. Posted 1/08/09 (NM) Equipment For Sale - '03'Intelect Legend Stim Model 4S: $300.00 / '07'ERGOWAVE Intseg. Traction Table: $700.00 (Two free therapy tables with ERGOWAVE purchase / Shipped from or picked up in Fort Wayne; email: lyonschiro@ verizon.net. Posted 12/02/08 (M) X-RAY SUITE: Chirotech 300/125 Anatomical Generator, indestructible Kodak 100 processor, Custom grey oak 36 X 48 view box, earth screens, Bolan type filtration system, total floor footprint 4 X 6 feet, removable wall leading, 3 doors with sliding lead shielding, ~600 shots on new Varian tube, $11,500.00 complete or best offer. Call Dr. Gary Shaw at (317)852-3870. Posted 10/30/08 Hands Free Ultra Sound Machine, Computerized Range of Motion and Muscle Test Machine, and a Rehab Exercise Machine for Back/Hip. All in great condition. Call SpinalAid at 317-272-4100. Posted 10/27/08 ABS Decompression Table: Great table in excellent condition. Very good results with table. Merged with another doctor who also has a decompression table. Option to purchase or assume lease which is already one-half paid. Call (616)566-1151. Posted 10/07/08 LIKE NEW Chirotech Elevation Table with pelvic drop piece, new Light brown leather covering in 2007, $2400.00. Like New Zenith Model 210 CI Cast Iron Hi-Lo Table with new brown leather, pelvic drop, $2500.00 Both Tables professionally refurbished by Haffner X-Ray in 2007. Contact Dr. Shawn Pala 317-770-1970 or email: palachiro@sbcglobal.net. Complete Bennett X-Ray Room Equipment & Accessories (processor needs motor)- 14x17 high frequency autotech, asking $7000.00; 4-Tier X-Ray File Shelves, $200.00; Petecto Scales, $100.00; X-Ray Copier, $200.00; 2 3-Panel
ISCA Report
Screens, $150.00, 2 Standard Therapy Tables (Walnut Finish), $300.00. Call Dr. Jim Ebler at 812-397-2981. Posted 9/18/08 Transworld 300ma 125 kvp chiropractic Xray system complete with floor to wall tubestand with electric locks, 14x17 wallstand with grid, certified collimator and 1.0 - 2.0 140,000 HU tube. Comes complete with operator barrier, cassettes; darkroom accessories and Fischer automatic 90 second cold water film processor. $4,000 obo. Call for details (812) 345-2375. Posted 8/6/08 2 Zenith Hi-Lo tables, older models with longer cast iron bases. Good condition without drops. $1500 for both. Contact 317-474-5574. Posted 8/1/08 Zenith Hylo, Stationary Benches, E-Stim machines, Hydroculators and covers,View Boxes, Phones, Fold-out Wall Desk, Metal Shelves, etc... Call Dr. Boruff for details. 765-437-4083 or email pboruff@sbcglobal.net. Posted 7/28/08 Zenith Hi-Lo adj maybe 80’s model $500. Gonstead pelvic bench plaid (80’s) $200. Mettler Ultrasound Sonicator $75. Sentry Systems Muscle Stim Hi Volt $350. Nemectron Endosan Muscle Stim $400 Equipment needs calibrated. Spine model $125, metal/wood spine $175 xray: dark room light $75, gloves $125, wood film holder $75, lead apron $125, shields $10, x-ray cassettes: 4 14x17 $125 ea, 5 8x10 $75 ea., 1 10x12 $85, Full Spine $125, Supports: 4 Lumbar $12ea, 8 Cervical Supports $10ea, C sp collars $10ea, Patient Gowns $4 each. Call Kathleen Sanderford, D.C. 765-683-0845 or email katsan7@yahoo.com in Anderson, Indiana. Posted 7/17/08 Large exterior chiropractic sign, fully illuminated. Currently says chiropractic neurology center but can be adapted to suite. Please call (317) 848-6000 or email drralston@ chironeuroindy.com interested. Posted 7/09/08 Save 50% on a 3 month old “ErgoWave” intersegmental traction table. Barely used (Really). 1st one to call with $900 cash takes it home. Call Dr. Lyons at 260-409-5871 (Ft. Wayne) Posted 7/2/08
Post a Classified Ad 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 issue.
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ISCA Report
200 S. Meridian St. Suite 350 Indianapolis, IN 46225 317.673.4245 www.IndianaStateChiros.org
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