September 2009
ISCA THE GRAND SCOPE-THE BIG PICTURE Dr. Anthony Wolf, D.C. Any organization must have a vision with the ultimate goal to be reached. Together, our ultimate goal as chiropractors is to strive to ensure the proper position of Chiropractic Healthcare in our global society. Our goal is to supply chiropractic care to 100% of the world’s population. Each of us is individually responsible for our role in this global vision. We spread the good news of chiropractic by educating and treating our patients. Our ethics and honesty also promote the integrity of chiropractic. As individuals, we also belong to larger groups such as the ISCA, ACA, and chiropractic institutions to promote chiropractic on a state and national level. This is where the power of numbers enhances our effectiveness. The ISCA is a body of doctors voluntarily serving our profession in varying degrees under the guidance of our Executive Director, Pat McGuffey. INVOLVEMENT: Individual involvement is the key to any association’s success. Get involved in your ISCA. District Meetings have been taking place over the last 6 months to unite Members more closely in their local area. The purpose of these meetings is to provide members with updated information on insurance, legislative and general practice issues. They are also an open format for discussion in regards to any questions you may have about your practice or the ISCA. The ISCA gathers information from our district meetings to help unite our efforts on issues affecting our membership statewide. It is all about organized communication. Be sure to attend your district meetings! The ISCA under Membership Committee Chair, Dr. Diane Vuotto, has launched a new communication effort “Brown Bag Lunch” conference calls. These calls are held bi-monthly. Don’t miss them! They are packed with current information directly affecting your practice. Information on the next “Brown Bag Lunch” conference call will be posted on our ISCA website, notices will also be e-mailed to our membership. You may also call Patrick Russell at the ISCA for more details. PAYING IT FORWARD: There are so many great things going on in the ISCA today as we plan to carry this great profession into the future. In the past 5 years, I have witnessed numerous members
“stepping up to serve”. When each of us looks into the mirror we need to say: “If it is to be, it is up to me”. Our chiropractic education and ability to practice chiropractic in our state is a direct result of the vision and dedication of our predecessors going above and beyond because of this great cause. I am confident they looked into that same mirror that we do today. Each individual doctor and the profession as a whole must succeed! We are it! We owe it to: • The millions of scoliosis patients that rely on chiropractic to halt or correct their deformity. • The parent whose child is on numerous drugs for ear infections and facing tube surgery only to be helped by chiropractic care. • The parent whose child wakes up with a headache every morning for the first 8 years of his life and on their 8th birthday did not wake up with a headache as a result of chiropractic care. • The millions of patients saved from surgery as a result of chiropractic care. • We owe it to our sons and daughters planning to make chiropractic their career choice. Each of us can add hundreds or thousands of other “miracles” of chiropractic care. We also owe it to society as chiropractic continues to be the most effective, least invasive and most cost effective form of healthcare. Do we want true Healthcare Reform? I say as chiropractors, the answer lies within our “HANDS”. It has been a great privilege to serve as president of the ISCA this past year and I look forward to our continued growth in the coming year! “The probability that we may fall in the struggle ought not to deter us from the support of a cause we believe to be just; it shall not deter me.” ---Abraham Lincoln We all have earned the great “gift” of chiropractic. We must—“Pay it forward”. Yours in chiropractic, Anthony C. Wolf, D.C., FICC
Inside This Issue President's Message.....................................................................................1 ISCA Board of Directors & Staff Info...................................................2 Executive Director's Message................................................................3 Update: from medicare NGS Medical Director..................................4 What Employers should be doing about the swine flu.....................4 Insurance reimbursement tip...................................................................5 Kansas State Board of healing arts endorses "Chiro physician"..5 Indian Medicaid Going Green.....................................................................5 Fibromyalgia: Debilitating but treatable w/ chiro care.................6 Allstate sues dcs in 4 states...............................................................6
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health care providers and associates sue blue cross......7 A dangerous courtesy................................................................................8 ISCA Legislative update.........................................................................9 Medicare: Quality: 2009 ACA Tool Kit......................................................10 "Cocsa adopts scoliosis awareness program".............................11 HHS Issues rule.......................................................................................12 F4cp Generates 55 million impressions..............................................13 ISCA Membership update and Q&A...................................................15 ISCA fall conference Oct. 9-11, 2009................................................16 ISCA Classifieds......................................................................................18-19
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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, D.C. 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, D.C. 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, D.C. 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, D.C. 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, D.C. 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, D.C. Crown Point, IN 219.661.8680 hayesfamilydc@hotmail.com District Two Bill Garl, D.C. 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 Association Manager prussell@LMVconsulting.com
Stacy Quasebarth Director of Communications squasebarth@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
Krista Rader Education krader@LMVconsulting.com 200 S. Meridian St., Suite 350 Indianapolis, IN 46225 info@indianastatechiros.org www.indianastatechiros.org 317.673.4245 phone 317.673.4210 fax
September 2009
Executive Director's Message Patricia McGuffey
The Indiana General Assembly has adjourned from the Special Session but our activity with legislators continues. Each week, I attend 5-8 legislative fundraisers that include golf outings, receptions, lunches and dinners. It is important that I attend and support legislators that assist with our legislative issues. Our ISCA BackPAC makes my attendance at the legislative events possible. I know you all have received letters requesting additional contributions to the BACPAC, I urge you to respond positively to the requests. ISCA had a successful year stopping onerous legislation and forwarding a portion of our legislation. In order to continue with that success, we need to contribute to supportive legislators and continue to strengthen our grassroots activities. In addition to giving to the BACKPAC, I hope you will continue contacting your local legislators and meet with them if possible before the next legislative session begins January, 2010. In addition to attending legislative events, on behalf of ISCA I will attend and also testify on behalf of ISCA at a number of interim legislative study committees that began meeting in August. Legislative interim committees’ recommendations must be completed by November 1st. These recommendations will be introduced by Legislators in the 2010 General Assembly Session. Some of the relevant study Commissions and Committees that have topics of interest to ISCA include: Health Finance Commission The commission is charged with studying the following topics of interest to ISCA: Health plan provider contract provisions that would require a contracted provider to accept more than a certain number of patients, and whether an insurer should be required to directly reimburse an out-of-network health care provider. (ISCA forwarded legislation regarding whether an insurer should be required to directly reimburse an out of network health care provider (AOB) and HEA 1300 required the Indiana Department of Insurance (IDOI) to study and present their findings to the Health Finance Commission. I am representing ISCA along with other health care providers’ lobbyists in meetings with IDOI. They have requested data on the number of patients chiropractors see out of network and the amount of uncompensated care. I have attended one meeting and at that time IDOI decided all healthcare providers’ data should be consistent so ISCA surveyed members to get data we can provide to the IDOI.) If you would still like to contribute data contact Patrick Russell at ISCA’s office. Also, I testified at the first Health Finance Commission on behalf of ISCA regarding the difficulties our out of network DCs have obtaining payments from patients when the Insurance companies send the payment directly to the patient. In addition, I talked about the problems we have in general with Insurance companies decreasing reimbursements, increasing administrative hassles at the same time the premiums continue to rise. ISCA will continue to bring our concerns with the insurance industry to the legislators and other policy makers.
September 2009
MEDICAID OVERSIGHT COMMISSION The Commission is looking at expanding who can be served by the HIP Program among other issues. ISCA will work to see if the Commission will also consider expanding the HIP Program to include all chiropractic services. I attended the first meeting of this Commission and several legislators were angry with the Administration because there is such a long waiting list for this program. The state has 46,000 Hoosiers enrolled in the program, more than half of whom are childless adults. But a federal waiver caps that population at 34,000, and there is a waiting list of more than 20,000 childless adults. Medicaid managed care quality strategy committee The committee is charged with studying the following policy issues concerning medicaid: A. Emergency room utilization. B. Prior authorization. C. Standardization of procedures, forms, and service descriptions. D. Effectiveness and quality of care. E. The number of denials by a managed care organization, the reasons for the denials and the number of appeals and overturning of denials by a managed care organization. F. How reimbursement rates are determined by a managed care organization, including reimbursement rates for emergency room care and neonatal intensive care. (If ISCA members would like to have specific issues addressed with Medicaid Managed Care that fall under the topics listed above, please notify ISCA so we can testify on your behalf at the Committee meetings) Interim study committee on medicaid supplemental programs The committee is charged with studying the following topics: The merits and effect of expanding the Indiana check-up plan to cover additional childless adults through a federal Medicaid waiver or Medicaid state plan amendment. ISCA will work to get the issue of full chiropractic services in HIP addressed. The Legislative Council also recommended that the Budget Committee investigate the status of IBM's compliance with its contract with FSSA and review alternative service models available in the event of a breach of that contract. (As many of you know there have been numerous complaints regarding difficulty in getting Medicaid, food stamp, etc clients enrolled with the new IBM system) Additional issues that Legislative Council asked to be studied by the Council’s Legislative Evaluation and Oversight Policy Subcommittee and reported include: The Subcommittee is also required to do an evaluation of the Healthy Indiana Plan using specifically developed measurements and benchmarks. In addition, to attending numerous legislators’ events and monitoring the interim study committees highlighted above, I also continue to monitor the Indiana Register. I review proposed rule changes and notice of intent to adopt rules that might impact chiropractors and forward those to ISCA’s Legislative Committee so we can collectively determine potential impact. State Agency
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proposals that have an impact on chiropractors are also monitored on behalf of ISCA One other exciting development legislatively is that we will be meeting with leaders of the ICAI so they we can develop a joint legislative agenda. I will keep you apprised of all of these developments. I wanted share with you some of the activities that we do on behalf of ISCA on legislative activities when the Session is out and hope this has been helpful. In addition, our ISCA office is busy with planning for the Sept 24th golf outing as well as the OCT 9th, 10th, and 11th Fall Conference. I hope you all will attend both events. ISCA has numerous committees that meet and work on your behalf throughout the year. Go to our web site at Indianastatechiros.org to review committees and determine if there is a committee that you would like to serve on. We welcome your input .I hope all of you are enjoying your summer and please feel free to contact me if you have questions or would like additional information at pmcguffey@LMVconsulting.com or 317-673-4215.
From Medicare NGS Medical Director: The CPT code 97010 (Application of a modality to 1 or more areas; hot or cold packs) has a "B" = bundled status on the Medicare Physician Fee Schedule Database. Therefore, it is not to be billed or separately paid, even if it is a "noncovered" service. This basically tells us that this recent change, this year, means you cannot balance bill medicare patients for hot cold packs. I am not happy with this determination, but have no way to change it as of yet. Interestingly, Anthem is still paying the code. Since Wellpoint basically runs most of Medicare's policies, I look for this to change soon.
What Employers Should be Doing About the Swine Flu By David Elliott Jose, Esq. Various government agencies have been publicizing concerns about the potential problems that could arise this Fall and Winter relating to the H1N1 Flu. Since the federal government has identified health care offices and institutions as a primary setting for exposure, chiropractic offices and clinical settings need to be aware of the risks and the current developments in this area. An important consideration that should not be forgotten is the obligation that you have as a place of employment. Betsy Russell and Linda Cooley are partners in our employment law group, and they recently prepared the Alert below to advise employers on some of their legal responsibilities in this area. Exposure to health risks in the workplace has the potential for compliance complications relating to several employmentrelated state and federal laws, so significant responses should be coordinated with legal counsel familiar with latest developments in that field. The following is offered to assist you and your practice in general terms as you prepare for anticipated developments (keeping in mind that employment laws may contain special terms or exceptions to general rules). The World Health Organization, the Center for Disease Control, The Department of Health and Human Services and OSHA are raising increasing concerns due to the H1N1 Influenza A virus ("Swine Flu"). As an Employer, you need to reassure your employees that you are monitoring the situation and taking every precaution to keep your workplace safe. The Human Resources Department should maintain current information regarding the extent of any flu outbreaks by monitoring government websites. The best websites for monitoring the extent of the outbreak near you are:
www.pandemicflu.gov http://www.cdc.gov/swineflu/ http://www.cdc.gov/swineflu/recommendations.htm http://www.osha.gov/Publications/employers-protect-workersflu-factsheet.html http://www.osha.gov/Publications/exposure-risk-classificationfactsheet.html Employees need to be advised of the symptoms of the disease so they will know what to watch for. These websites provide practical information for employees and employers alike such as the symptoms of influenza, modes of transmission, personal and family response strategies to the disease, and community and workplace strategies. Advise your employees to take necessary precautions such as washing their hands regularly throughout the day and coughing into their sleeves. Provide hand sanitizers for use throughout the office, and make sure your cleaning staff is routinely cleaning doorknobs, door handles, telephone receivers, and any other surfaces that are likely to be germ transfer points. • If employees complain of flu-like symptoms, they should be sent home immediately. To protect the employee's privacy, the release of this information to co-workers should only be on a "need to know basis." • If you are a covered employer under the FMLA, advise FMLAeligible employees of their rights under the FMLA if they are out for more than three full consecutive days. You should also advise all employees to consult their physician if flu-like symptoms arise. However, do not advise any employee to visit any testing centers or facilities or require that they be tested for the disease without first seeking the assistance of legal counsel. Such requests could be a violation of the ADA or the new ADAAA. • Make sure your FMLA policy is up-to-date and includes the latest changes which recently took effect. If you have not made changes to your FMLA policy in the last six months, this
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is the time to review the policy. • Develop a plan for dealing with employees who refuse to come to work for fear of an outbreak of the disease. Uniformly and consistently apply all workplace policies and disciplinary measures to guard against later claims of discrimination. • Familiarize yourselves with the rules and regulations regarding payment of wages to exempt and non-exempt employees in case of a workplace shutdown as a result of the spread of the disease. • Consider implementing a 72-hour quarantine period for any employee who is returning from a country that has had a significant outbreak of the disease. Consider alternative workplace strategies that you can implement, such as telecommuting. Keep in mind that you may have to pay the employee who performs any work at home during the forced quarantine. Also, even if an exempt employee does not perform work from home, they will be entitled to be paid. • Discontinue nonessential travel internationally if there are travel advisories for particular countries. The travel advisories are published on the Center for Disease Control
INSURANCE REIMBURSEMENT TIP Numerous members have reported an attempt by Insurance Companies to further reduce reimbursement to providers by hiring claims clearing houses. In the typical scenario, the provider will be contacted by the clearing house representing the various insurance companies by fax or mail. The notification will include the insurance company’s name, patient name, date of service, total charge by provider and proposed discount (usually 10%). The provider is asked to accept the discounted amount and payment is promised to be processed quickly. Remember: the provider will not receive the proposed amount, the insurance company will only pay the percent of that amount as stated in their contract with the insured ie: 70%, 80% etc. Many of our members have had excellent success in either ignoring these notices or returning the notice rejecting the reduction. An example of terminology that could be used by the provider is as follows: I reject reduced reimbursement stated above on behalf of the patient(s) we will expect payment based on the full charges according to the % covered by the insurance company’s contract with the insured. If we do not receive such payment in a timely fashion according to Indiana Claims processing law, we will advise the patient of their right to complain to the Indiana Insurance Commissioner in regards to bad faith and unfair claims practices. Usually, the provider will receive payment with the full amount considered within days. If you have any questions or have any other issues similar or different, please do not hesitate to call the ISCA office. Anthony C. Wolf, DC, FICC
Website. • If you have an employee assistance program, remind your employees that these services are available to help them cope with additional stress that might result from an outbreak of the swine flu. If you have individual questions on this topic, you should contact your legal counsel, or you may contact Linda Cooley (317.238.6232) or Betsy Russell (317.238.6236). 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 KD_1701193_4.DOC
Kansas State Board of Healing Arts Endorses “Chiropractic Physician” Thanks to the hard work of members and staff of the Kansas Chiropractic Association, the Kansas State Board of Healing Arts will once again allow the use of the “chiropractic physician” title. The Board voted 8-3 to rescind its earlier policy disallowing the title. In addition, the Board also voted 8-3 to introduce legislation in 2010 to modify the definition of “physician” to include “chiropractic physician” under Kansas State statutes. ACA applauds the Kansas Chiropractic Association in its important and successful efforts to give DCs the right to use the “chiropractic physician” title in Kansas.
Indiana Medicaid Going GREEN Effective September 1, 2009 Indiana Medicaid will no longer mail paper EOB’s. All checks will come with an assigned RA Number that will be used to access the information online. ALL providers should have at this time their Medicaid ID # and password for online inquiries. Detailed information is listed in the August Newsletter for step by step instructions on accessing detailed breakdown of payments made. Archived information will be held for 30 days only online. Newsletters are available online at www.indianamedicaid.com on the Right side banner.
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Fibromyalgia: Debilitating but Treatable with Chiropractic Care The Foundation for Chiropractic Progress (www.f4cp.com), a not-for-profit organization dedicated to increasing public awareness of the benefits of chiropractic, announced today that chiropractic care has been shown to reduce the agonizing pain, debilitating fatigue, and joint stiffness associated with fibromyalgia. While fibromyalgia, a medically unexplained syndrome affecting the muscles and connective tissues, responds to various treatments, chiropractic care in particular has grown sharply in popularity among the millions of sufferers for dramatically reducing chronic, widespread pain and restoring patients to healthier lives. Fibromyalgia involves turmoil of the central nervous system, yielding a situation known as central sensitization, which causes heightened nervous system responses, explains Gerry Clum, D.C., spokesperson for the Foundation and president of Life Chiropractic College West University. Overall health and wellness is affected by an individual™s nervous system, an area in which chiropractors are proficiently trained to address, making chiropractic care a viable option for fibromyalgia patients. While scientists continue to develop a better understanding of fibromyalgia, chiropractors aim to correct misalignments of the spine and pelvis through hands-on adjustments. As joint motion improves, fibromyalgia patients discover that the excruciating pain can be reduced or, in some cases, eliminated. Once this pain is under control, other symptoms associated with fibromyalgia “ such as fatigue, sleep deprivation, and depression “ also diminish. Chiropractic care has helped thousands of patients return to their normal lives. Retired Brig. Gen. Becky Halstead, the first woman General in the U.S. Army to command in Iraq, suffered from fibromyalgia during her service. The adjustments and nutritional advice I received from my chiropractor helped in treating the fibromyalgia and made me feel better on a day-today basis, raves the West Point graduate. For more information on Fibromyalgia and how chiropractic treatment can help treat this disease, please visit www. yes2chiropractic.com or contact your local chiropractor. About F4CP The Foundation for Chiropractic Progress is a 501c6 corporation that represents a cross section of the chiropractic and vendor communities with the goal of increasing the public™s awareness of the benefits of chiropractic. www. F4CP.org.
Allstate sues DCs in 4 states Chiropractors in four states — Texas, Ohio, Indiana, and Alabama — are being sued in a federal fraud lawsuit filed by Allstate Insurance Company. The lawsuit names 66 defendants and alleges that deception and coercion were used against people involved in automobile accidents at clinics in the named states. Allstate filed the suit in the U.S. District Court for the Northern District of Texas against Chiropractic Strategies Group Inc., (CSG) its owner Michael Kent Plambeck, related law office management companies, attorneys, telemarketers, and others involved in the alleged fraud scheme. It seeks in excess of $10 million for violations of the federal Racketeer Influenced and Corrupt Organizations Act (RICO). According to the insurer’s complaint, CSG allegedly solicits persons who have been involved in motor-vehicle accidents through telemarketing, which includes calls from a telemarketing entity the organization operates in Kenner, Louisiana. The telemarketers promise the prospective patients a free examination. The complaint also alleges that, once at the clinic, the solicited individuals are often coerced and deceived into treatment through a process the organization calls “conversion.” Potential patients are allegedly told they have sustained substantial injuries and require an immediate course of treatment. The complaint further alleges patients are then put through a standardized and unnecessary treatment plan. Once a solicited individual is “converted” into a patient, they are referred to a personal-injury law office associated with the organization. The complaint alleges persons working at these law offices often come directly to the clinics to “sign up” patients as clients. A number of individuals as well as business entities are named in the lawsuit. The businesses are Chiropractic Strategies Group Inc., Media Placement Services Inc., Professional Management Group LLC, Law Office Network LLC and associated clinics in Texas, Ohio, Indiana, and Alabama. Source: Allstate Corp., www.allstate.com
AUTO LIABILITY SERVICES PPO NETWORKS State Farm Auto Insurance has networked with Integrated Health Plan, Inc. Network providers are contracted to a 25% fee reduction. State Farm networks were effective mid July. Integrated Health Plan lists providers on a rolling basis even if you have not re-credentialed on a yearly basis. Integrated Health Plan, Inc offers an option out of Auto Liability Services if you contact Provider Relations. Contract changes take 90 days. Provider Relations Integrated Health Plan, Inc 4020 Park Street Suite 103 St Petersburg FL 33709 888-640-8707 ext 307 Additional Auto Carriers have aligned with other PPO health networks.
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health care providers and ASSOCIATIONS sue blue cross blue shield association and 22 related BCBS entities Pomerantz Haudek Grossman & Gross LLP today announced that it and co-counsel Buttaci & Leardi, LLC filed a class action lawsuit against the Blue Cross Blue Shield Association (“BCBSA”) and 22 leading BCBS insurers across the country on behalf of a putative nationwide class of health care providers, as well as the Pennsylvania Chiropractic Association (“PCA”), the New York Chiropractic Council (the “Council”), and the Association of New Jersey Chiropractors (“ANJC”). The suit challenges the Defendants’ abusive practices in using post-payment audits and reviews, and improper repayment demands, to pressure providers to repay substantial sums that have previously properly been paid as health insurance benefits for services provided to BCBS subscribers. The action alleges that the post-payment audit and review process as applied by the various named BCBS Entities violates the Employee Retirement Income Security Act of 1974 (“ERISA”), in that its repayment demands are retroactive determinations that particular services are not covered under the terms of the BCBS health care plans, but without proper appeal or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers. The complaint further alleges that the post-payment audit and review process, as well as the forced withholds of unrelated benefit payments to offset alleged prior overpayments, violate the Racketeer Influenced and Corrupt Organizations Act (“RICO”). The PCA, the Council and the ANJC are participating in the action in an associational capacity on behalf of their members, while fourteen individual chiropractors and one occupational therapist, located around the country, have sued as the class representatives of the putative class. According to Gene Veno, Executive Vice President of the PCA, “we met on numerous occasions with Blues Senior Management in an effort to establish a fair and balance approach to conducting post-payment reviews, but to no avail.” As a result, he added, “the PCA elected to join this action to ensure that the rights of our members are protected.” Four of the 15 named individual plaintiffs are Pennsylvania chiropractors. Dr. John LaMonica, Chair of the Insurance Committee for the Council, states that “this action is an important step by the chiropractic profession to fight back against the egregious actions being taken by Blue Cross Blue Shield companies against our members and other providers nationwide.” The Council and the ANJC had previously joined in a class action recently filed against Aetna, Inc. for similar post-payment audit practices. In the complaint, Plaintiffs allege that, as a means to maximize its profits, the BCBS Entities use their post-payment audit and review process to make retroactive adverse benefit determinations whereby they demand that providers repay funds they had previously received for providing services to BCBS subscribers. Moreover, the BCBS Entities frequently withhold new benefit payments for unrelated services to apply toward the alleged overpayments, even where there has been no valid appeal process or validation that any sums are in fact owed by the providers. “In essence,” says Plaintiffs’ counsel Dr. Brian Hufford of Pomerantz Haudek, “the BCBS Entities simply state there are overpayments and then just take the money from providers, without valid due
September 2009
process protections. We believe this is a blatant violation of law.” The Complaint further alleges that the BCBSA is coordinating the recoupment efforts with its state BCBS licensees on a nationwide basis. Plaintiffs seek to enjoin the BCBS Entities from continuing to engage in impermissible audit and recovery practices and to compel them to return the funds they have improperly withheld. The amount of funds that are at issue in the lawsuit are substantial. On June 30, 2009, the BCBSA announced that its National Anti-Fraud Department had “recovered nearly $350 million as a result of the anti-fraud investigations in 2008.” Plaintiffs’ co-counsel Vincent N. Buttaci of Buttaci & Leardi states that “we believe a substantial portion of this ‘recovery’ falls within the improper practices we are challenging in this action.” Pomerantz Haudek, which has offices in New York, Chicago, Washington, D.C., Columbus, Ohio and the San Francisco Bay area, is acknowledged as one of the premier plaintiff class action firms, and, in particular, has been a leader in the industry in health care class actions on behalf of providers and patients. Recently, the Pomerantz firm was designated to be Chair of the Plaintiffs’ Executive Committee in a multidistrict litigation pending against Aetna in the District of New Jersey on behalf of both providers and subscribers, challenging how Aetna determines usual, customary and reasonable (“UCR”) rates for out-of-network health care services. In making the appointment, the Court stressed the significant role Pomerantz had played in a $249 million settlement of its UCR class action against Health Net, stating that the Court had “similarly appointed Pomerantz to be Plaintiffs’ spokesman to the Court in the Health Net litigation because the Court found D. Brian Hufford, Esq. to be the attorney most capable of presenting Plaintiffs’ position in a clear and concise manner.” In re Aetna UCR Litig., 2009 Dist. LEXIS 66853, *8 n.4 (D.N.J. July 31, 2009). Founded by the late Abraham L. Pomerantz, known as the dean of the class action bar, Pomerantz Haudek pioneered the field of securities class actions. Today, more than 70 years later, Pomerantz Haudek continues in the tradition he established, fighting for the rights of the victims of fraud, breaches of fiduciary duty, and corporate misconduct. The Firm has recovered numerous multimillion-dollar damages awards on behalf of class members. Buttaci & Leardi, based in Princeton, New Jersey, has a dynamic national health care practice, representing licensed health care providers, group practices and other provider-related entities throughout the country. It has extensive experience representing providers in challenging post-payment audits and retroactive recoupments, including those pursued by numerous Blue Cross Blue Shield licensees, and has obtained tremendous success on behalf of its clients. Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. If you have any questions, please contact D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (614-410-6501) or email (dbhufford@ pomlaw.com), or Vincent N. Buttaci, Esq., of Buttaci & Leardi, LLC, by phone (609-919-6312) .
ISCA Report
A Dangerous Courtesy
By Louis Campbell, JD, C. Jacob Ladenheim, Rob Sherman, Esq. and Louis Sportelli, DC Anyone who has been to seminars sponsored or attended by chiropractors is familiar with the practice of "courtesy" adjustments. This tradition is time-honored and pervasive throughout the profession. From a lawyer's standpoint, the malpractice implications of rendering treatment without benefit of adequate history, exam, x-rays, and proper facilities is appalling. Advising chiropractors to refrain from rendering such adjustments is, however, as fruitful as telling lawyers to draft documents in plain English. Worst Case Scenario Potential malpractice risks from such treatments can be exacerbated by the statutory provisions of the state in which such services are delivered. For example, Idaho law provides that: When a person has been a recipient of services constituting the unlawful practice of chiropractic, whether or not he knew the rendition of the services was unlawful, proof of the rendition of unlawful services ... in an action against the provider ... for damages allegedly caused by the services, constitutes prima-facie evidence of negligence, shifting the burden of proof to such provider ... (emphasis supplied). What that means is that instead of the injured patient having to prove negligence, the defendant doctor must prove that he did not deviate from the appropriate standard of care. While many doctors will scoff at warnings about such problems as typical lawyer paranoia, the colleague being adjusted may not be the one to file the suit. If, for example, a stroke should occur, it may well be a widow or guardian of infant children bringing suit. Those potential plaintiffs may feel absolutely no sympathy, camaraderie or brotherhood militating against filing suit. Overcoming a prima-facie case while admitting that one performed no comprehensive history, exam or other
diagnostics is certainly an uphill battle. Moreover, the Idaho code provides that in such cases plaintiffs may also recover reasonable attorney's fees and court costs. What It Means to You It is hazardous to adjust friends, colleagues or even relatives while attending seminars. That hazard can increase greatly when the doctor performs such services outside his state of licensure. The hazard can be compounded more by the statutory provisions of the state in which the manipulation is given. As if these problems aren't sufficient, standard malpractice insurance policies have exclusions for any injury resulting from "an act in violation of any United States or state statute governing the commission of a crime." (NCMIC sample policy language). In Idaho, as in all states, practicing without a license is a criminal offense. Not only may the doctor doing a favor for a colleague find himself faced with prima-facie evidence showing negligence, but his act may void his insurance coverage leaving him personally exposed for any judgment or the expense of retaining counsel. Finally, any doctor unfortunate enough to be charged and convicted of the offense of practicing without a license faces license suspension in his home state for the criminal conviction. Doctors are urged to never provide services in states in which they are not licensed and to be extremely circumspect in ever providing services outside of their offices. Louis Campbell, J.D. C. Jacob Ladenheim, J.D. Robert P. Sherman, J.D. Louis Sportelli, D.C. SOURCE : http://www.chiroweb.com/mpacms/dc/article. php?id=42031
Illinois Amends Regulation Allowing DCs to Perform Services in Assisted-Living Facilities The Illinois Legislature recently amended its regulation governing the provider types eligible to provide services to assisted-living facility residents. Previously, the regulation only allowed physicians licensed to practice medicine to provide care. The new language now allows for doctors of chiropractic to provide care to residents and states, “Nothing in this Act shall preclude a physician licensed under the Medical Practice Act of 1987 from providing services within the scope of his or her license to any resident.� ACA applauds the efforts of doctors in Illinois who worked to have this language amended and to allow DCs to care for individuals residing in assisted living facilities.
ISCA Report
September 2009
ISCA Legislative update By Dr. Anthony Wolf Greetings Doctors, The ISCA Legislative Committee has been very active on behalf of ISCA members. The committee meets every week during session 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 4 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. The ISCA will be aggressively pursuing AOB Legislation in the House and Senate in the upcoming session.
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. The ISCA will once again work to include language to include CMT in the HIP program. Each year there are numerous other bills that would have a severe negative impact on the practice of chiropractic in Indiana. This upcoming year will be 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 will be 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.)
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Actively support your Senator and Representative in your area. Create an open dialogue with your elected officials
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If you have any questions concerning our legislative issues, please do not hesitate to call the ISCA office or call me directly at (317) 690-0769. It is a privilege and a blessing to serve this Great Profession. Dr. Anthony Wolf Chair: Legislative Committee
Currently, the HIP program does not include Chiropractic Manipulative Therapy.
September 2009
ISCA Report
Medicare: Quality: 2009 ACA Tool Kit for Quality Reporting ACA Tool Kit on the Medicare Physician Quality Reporting Initiative: Helping Doctors of Chiropractic Improve Quality Patient Care The Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting Initiative (PQRI) will continue in 2009. Beginning January 1, 2009, physicians and other providers who report certain quality measures may be eligible for a 2.0% payment increase, to be paid in the third quarter of 2009. To assist doctors of chiropractic who may elect to participate in this program, ACA has compiled useful information developed by the ACA, the American Medical Association (AMA), as well as CMS, to help familiarize the chiropractic profession with the measures relevant to their practice and facilitate the data collection required to successfully report clinical performance data. Chiropractic office participation in the PQRI is critical, as it demonstrates to CMS and the rest of medicine that the chiropractic community is serious about quality care improvement. It is through the enhancement of quality patient care that the chiropractic profession will enhance its involvement in our nation’s health care delivery system. For 2009, ACA has identified three PQRI measures and one measures group applicable to chiropractic practices. The measures include: pain assessment prior to initiation of treatment, functional outcome assessment in chiropractic care, and health information technology adoption/use (electronic health records). The one measures group on which chiropractors will be eligible to report is the back pain measures group. A complete list of all 153 quality measures and 7 measures groups can be found at www.cms.hhs.gov/pqri. WHAT DOCTORS OF CHIROPRACTIC NEED TO KNOW Chiropractic Specific FAQ on 2009 PQRI – A list of specific questions and answers related to chiropractic participation in the 2009 CMS PQRI. The answers are based upon available information from CMS. Basic Preparation and Participation Strategies for Chiropractic Practices – Practical tips for how to successfully play a part in the 2009 PQRI. 2009 QUALITY MEASURES APPLICABLE TO DOCTORS OF CHIROPRACTIC Below outlines the measures specification and data collection tools for the three measures applicable to Doctors of Chiropractic. Please click on the three links listed below each measure title to view the following: 1. Measure Description This document contains additional descriptive information regarding the measure and should help users determine if it is a measure on which they would like to report. In particular, the document describes what type of information is required to report on the measure and how frequently reporting is required. 2. Data Collection Sheet A step-by-step tool for clinical use and office/billing staff use.
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It allows the physician or other eligible professional to record the clinical information required for the measure by checking the appropriate box, and the coder to subsequently select the corresponding billing code. 3. Coding Specifications Includes a complete list of ICD-9 and CPT codes to identify patients eligible for the measure. A list of the quality codes for each measure is also included. The coding specifications document is to be used in conjunction with the data collection sheet to determine the appropriate code or combination of codes to be reported. #124. Adoption/use of health information technology Measure Description Data Collection Sheet Coding Specifications #131. Pain assessment prior to initiation of patient treatment Measure Description Data Collection Sheet Coding Specifications #182. Functional Outcome Assessment in Chiropractic Care Measure Description Data Collection Sheet Coding Specifications Back Pain Measures Group (Measures #148-151) Measures Group Description Data Collection Sheet HIGHLIGHTED RESOURCES FROM CMS • Handbook for PQRI Participation – A handbook that delineates coding and reporting principles, as well as provides implementation guidelines for how to successfully report measures using clinical scenarios. (Coming soon!) • PQRI Specifications List – Complete specifications for the 153 measures and 7 measures groups that make up the 2009 PQRI. To access all available PQRI educational resources, visit www.cms.hhs.gov/PQRI on the CMS Web site and click on the Educational Resources tab.
Harkin takes over reigns of key senate committee Iowa Democratic Senator Tom Harkin earlier this week officially took over as chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP), replacing the late Ted Kennedy. Taking the gavel of this key committee further amplifies the significance of Sen. Harkin, as the health care reform debate continues to dominate the nation’s domestic policy agenda. A long-time chiropractic champion, ACA congratulates Senator Harkin on this important assignment and looks forward to working with him and his excellent staff in the weeks and months ahead.
ISCA Report
September 2009
ACA UPdate: ACA Continues to Stress the Importance of a Vigorous Grassroots Response by the Chiropractic Profession and Patients By: Dr. Robert Tennant, D.C. - ISCA Second Vice President
The House and Senate have returned from their August recess. The ACA has worked with congressional offices to build support for chiropractic-related issues and to address concerns the ACA has with the current status of health reform bills in both bodies. A major area of activity continues to focus on provider non-discrimination issues and details of proposed benefits packages that might be adopted as part of a new “public plan” under consideration for adoption. With controversy over health care reform growing, and with citizens becoming increasing vocal in expressing their concerns, it remains vital that issues of specific interest to the chiropractic profession receive appropriate amplification, especially now that the congressional recess period has ended. ACA warns its membership and the entire profession, that the profession’s voice is in danger of being “drowned out” by a host of other, competing voices during the next several weeks as the reform issue grows more heated and controversial. To make its voice heard above this chatter, it is important that all DCs engage in a new round of grassroots activity and seek to involve their patients in a supporting role. All DCs are encouraged to immediately go online to ACA’s Legislative Action Center and send an E-MAIL MESSAGE to your members of Congress in both the House and Senate. This process is simple, largely automated, and easy to do. Whenever possible, all DCs and patients should continue to lobby their members of Congress, and where possible make local visits to congressional offices and take part in “town hall” type meetings over the recess period. ACA has prepared a Tool Kit that all DCs should become familiar with and use when meeting with their federal legislators. The Tool Kit will be updated regularly; in addition, we will promote ACA updates on health care reform at www.acatoday.org/hcr.
“COCSA Adopts Scoliosis Awareness Program” The Congress of Chiropractic State Associations (COCSA) announced that it has adopted the Scoliosis Awareness Program produced and provided by the non-profit, Scoliosis Care Foundation. COCSA’s board of directors voted to join forces with the Scoliosis Care Foundation in offering all chiropractic state associations access to educational materials from Scoliosis Care Foundation that have the potential to make a positive impact on the way scoliosis is treated in the United States. The mission of the non-profit, Scoliosis Care Foundation, is to increase awareness of the need for better detection programs and non-surgical interventions in caring for children and adults who have Idiopathic Scoliosis. Dr. Gary Deutchman, the Foundation’s Director and Founder, believes that scoliosis is often being mismanaged by the current healthcare system. According to the Scoliosis Care Foundation, Idiopathic Scoliosis curvatures that might be detected early on in the condition are being missed by school systems that rely solely on the Adams test, which often is only performed once in a child’s life. In the event a curvature is detected, orthopedic surgeons offer few options. Marc Lamantia DC, DACNB, Science Advisor at the Scoliosis Care Foundation, reported to COCSA’s Board of Directors that, “Most children diagnosed with scoliosis do not have any pain and will only exhibit minor postural changes in the early stages of the progression. This makes better screening procedures essential to early detection.” Further, he added, only 26 states currently mandate scoliosis screening in the public schools. This leaves literally millions of children without adequate screening. Dr. Jeffrey Fedorko, COCSA President, sees a controversy around the currently accepted screening practices, because the Adams test, which is considered the gold standard of school screening, creates many false negatives and false positives. In many cases, this has led states to abandon school screening programs for scoliosis, effectively abandoning any
September 2009
chance of early intervention for those children who might otherwise have been identified in early stages of the disease. “Even in states that implement a school screening program, if it is done infrequently, the curvature may present itself either before or after a scheduled screening, thereby leaving the curvature undetected as it continues to worsen,” Dr. Fedorko observed. “COSCA sees this is as a great opportunity for the Chiropractic profession to partner with a non-profit organization that is dedicated to the well being of our children and together, to educate parents on the sometimes minor postural changes that could indicate a possible development of scoliosis.” The Scoliosis Awareness Program The Scoliosis Care Foundation is dedicated to improving education, treatment and diagnosis of scoliosis. The Foundation is calling upon the chiropractic profession to become more involved with public education programs and is offering materials such as Slide Presentations, screening forms and continuing education opportunities for the treatment of scoliosis. New for 2009, the Foundation has created The Scoliosis Awareness Program. This 60 minute, parent-oriented slide show is available from the Foundation’s website, at http://www.scoliosiscare.org/screen.html. Just scroll down until you reach the pdfs entitled “SCF Scoliosis Awareness Program” and “SCF Slide Script.” The Foundation’s Science Advisor, Marc J. Lamantia, DC, DACNB, is also currently seeking chiropractors who are interested in becoming regional representatives for the Foundation, as well as assist in a multi-clinic study to document the chiropractic profession’s ability to co-manage cases without the need for orthotist/ orthopedist intervention. For more information, visit the Scoliosis Care Foundation website at www.scoliosiscare.org or call the Foundation at 800-391- 8837.
ISCA Report
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HHS Issues Rule Requiring Individuals Be Notified of Breaches of Their Health Information As required by the Health Information Technology for Economic and Clinical Health (HITECH) Act passed as part of American Recovery and Reinvestment Act of 2009 (ARRA), the U.S. Department of Health and Human Services (HHS) issued “breach notification” regulations today requiring health care providers and other HIPAA covered entities to notify affected individuals following a breach of unsecured protected health information. The regulations require covered entities to promptly notify affected individuals, the Secretary of HHS, and in some cases, the media, of a breach. Smaller breaches may be reported to the Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate. The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA. To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulation an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals. Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information. This guidance will be updated annually. The HHS interim final regulations are effective 30 days after publication in the Federal Register and include a 60-day public comment period. For more information, visit the OCR web site at http://www.hhs.gov/ocr/privacy/.
Connect with us! ISCa Joins social media platforms - FAcebook & Twitter
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Find the link on the bottom left hand side of the ISCA homepage at http://www.indianastatechiros.org/
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ISCA Report
September 2009
F4CP generates 55 million impressions in July August 11, 2009 — The Foundation for Chiropractic Progress is pleased to report that the current news releases being circulated have generated more than 55 million impressions throughout the month of July. The most up to date numbers for each story are featured below and full reports will be available to be viewed on the Web site come August. To view these media reports, please visit www.foundation4cp.com/news. Cell Phone Elbow: This release focused on cubital tunnel syndrome, also known as “cell phone elbow.” The foundation suggests people use headsets to protect themselves from possible injury. As of July 28, this release generated 76 news articles in eight different states with a readership of 3,470,896. The sites it was on were viewed by 6,300,000 unique visitors per month. Handbag: Health experts say that many women are carrying 10-15 pounds in their handbags, compared to the doctor recommended one to two pounds. To prevent injury, the foundation suggests using a bag with two shoulder straps or pulling a carrying case with wheels. As of July 28, this release generated 256 news articles in 16 different states with a readership of 6,657,904. The sites it was on were viewed by 6,341,234 unique visitors per month. Retired General Becky Halstead: The latest foundation sponsor, Becky Halstead, credits “adjustments” and nutritional advice she received from a chiropractor for helping treat her fibromyalgia. As of July 28 this release generated 64 news articles in 11 different states with a readership of 1,128,080. The sites it was on were viewed by 6,303,100 unique visitors per month. Jerry Rice (Radio): This PSA announcement features direct quotes from foundation spokesperson, Jerry Rice. Jerry Rice talks about his first experiences with chiropractic car during his football days and his continued use of chiropractic care during his “Dancing with the Stars” stint. As of July 29 this release had been broadcast 222 times in 38 different states with an audience of 17,560,932. Jerry Rice (TV): This commercial features the importance of chiropractic care for all type of athletes. As of July 30 this release had been broadcast 190 times in 31 different stats with an audience of 121,533,534. Jerry Rice (Matte): As of July 28 this release generated 264 news articles in 18 different states with a readership of 9,481,360. The sites it was on were viewed by 6,344,893 unique visitors per month. Neck Pain: This release reported that interventions by a chiropractor can sometimes be the best option for neck pain. As of July 21 this release generated 184 news articles in 16 different states with a readership of 6,193,776. The sites it was on were viewed by 6,300,000 unique visitors per month. High Heels: Wearing high heels can affect the entire body, particularly the knee, hip and spine. This release notes that the abnormal weight bearing and stressful posture induced by high heels can strain both the lower back and the neck. As of June 23 this release generated 280 news articles in 30 different states with a readership of 53,829,632. The sites it was on were viewed by 6,344,987 unique visitors per month. Source: Foundation for Chiropractic Progress, www.f4cp.org
Save the DAte! ISCA Golf Outing September 24, 2009 Trophy Club Golf Course 3875 N. St. Rd. 52 Lebanon, IN 46052 September 2009
ISCA Report
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Buy a chiropractic table in 2009 and see big tax savings Chris Towery
With the economy still in recession and many businesses are experiencing a drop in revenue from previous years, 2009 might not seem like a good time to invest in new equipment, such chiropractic tables. However, new tax laws designed to stimulate growth and investment among small and medium-sized businesses has not only made it a good time to buy a table for your practice, it's made it the best time in years for those who qualify. And since the new legislation only lasts through 2009, it's important DCs take advantage of this opportunity as soon as possible. The Stimulus Acts The Economic Stimulus Act of 2008, enacted by President Bush, substantially increased the amount business owners can deduct from their taxes for purchasing business equipment in 2008. And following President Obama's election this year, his American Recovery and Reinvestment Act (ARRA) extended these deductions to purchases made during 2009. The specifics on these deductions can be found in Section 179 of the IRS Tax Code. Section 179 increases the limits of deductions for business equipment from $125,000 to $250,000. This allows business owners to deduct the full price of qualifying equipment—up to $250,000—during the same year it was purchased, rather than using the traditional method of depreciating the cost of the equipment by a certain percentage over a period of years. The 179 deduction also substantially raised the total allowable amount of equipment purchased for the year from $500,000 to $800,000. Because of this, a business is eligible for the deduction of up to $250,000, provided the total amount of equipment purchased that year does not exceed $800,000. This was done to make the legislation most beneficial for smallbusiness owners, rather than larger companies. Additionally, for those whose equipment purchases run over the $250,000 limit, 179 provides a 50-percent "bonus depreciation" on the purchase amount that exceeds $250,000 up to the $800,000 total purchase limit. For those who go over the $800,000 maximum, the excess amount of the purchase will be reduced dollar-for-dollar, which eliminates the benefits of the deductions.
during 2009. However, if one's equipment purchases exceed $250,000, but are under $800,000, they're still eligible for a bonus depreciation of 50-percent on the amount of the purchase that exceeds $250,000. Then, the normal first-year depreciation can be taken on the remaining 50 percent. Buying vs. leasing Because Section 179 applies to equipment purchased or leased during 2009, the money you save through these deductions can actually exceed your lease payments for the year. For example, using a non-tax capital lease, you can purchase a new table and write off up to $250,000 for 2009, without actually spending $250,000 on your total lease payments for 2009. Also, you are still eligible for the 179 Deduction if you buy a table using a finance agreement. This all might seem too good to be true, but since we're in such a major recession, the government is going to great lengths to provide incentives for businesses to invest in themselves and lower operating costs. However, like many TV infomercials tout, the savings through Section 179 is a "limited-time offer." Because President Obama only extended the 179 Deduction through 2009, there's no guarantee the legislation will be renewed in 2010 and beyond. So if you're considering purchasing a vibration exercise therapy platform to provide enhanced active care for your patients, this year might just be the best time to do it. For more information, go to www.section179.org. Sources: www.section179.org, www.irs.gov This information is only a brief summary of the tax code and is not exhaustive. Make sure you consult a tax professional to see if your practice qualifies before taking any action. Chris Towery is the former associate editor of MASSAGE Magazine and is currently a full-time freelance journalist. He has written hundreds of articles for more than 20 different magazines, newspapers, and custom publishers. Much of his recent writing has been for the complementary and alternative healthcare industry. To contact Chris, email cmreuben@yahoo. com.
What equipment is eligible? There are limitations to the 179 Deduction, but they are typically very generous. Only certain types of equipment qualify for the deduction, but chiropractic tables are considered eligible for the deduction, provided you purchase and install the platform between January 1st and December 31st, 2009. To sum up, business owners can deduct the full price of qualified business equipment up to $250,000, as long as their total equipment purchases for the year don't exceed $800,000, and the equipment was purchased and put into use
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ISCA Report
September 2009
ISCA Membership update Platinum Members: Duane Binder Anthony Wolf Robert J. Krause Robert W. Foster Robert W. Tennant Calvin E. Finch David S. Dyer Kenneth Ackles Christopher Nunier Charles Solano James M. Cox, II Gold Members: Michael Gallagher Steven C. Mangas Gary R. Billingsley Robert C. Prather Michael Toney Robert P. Maddox John S. Wagner Benoit O. Choiniere
Marian F. Klaes-Lanham Chris J. Klaes Diane Vuotto Silver Members: Stephen Price Michael Mungovan Mark A. Schneider Charles Cochran Thomas Stevens Peggy Solano John W. Moore Daniel J. Benko John R. Krawchison Gerald A. Langley Eric L. Mitz
Newest ISCA Members: Jeremy A. Legge Mitchell Monday Wei Chen Yang Nicholas Goins Christopher Galloway Robert Hatfield Jason Welsh Troy D. Smith Joseph J. Paun Kristen A. Hartwell Jason R. Golec Eric L. Mitz David J. Evans James W. Biser Ryan L. Dailey Michael O'Donnell Newest Allied Member: American Chiropractic Supplies
Indiana state chiropractic association Q&A Letter excerpt from an Anthem Network Development Manager to an ISCA Member – Why have my Athem reimbursements changed? “Regarding Anthem’s 11/01/2009 fee schedule change, each year we review our entire fee schedule for our annual fee schedule update. We have reviewed blinded data we have available, which indicates the Anthem Fee schedule is very competitive within the state. However, it is also important to note that we have data to show the cost of health care in Indiana is much higher than our surrounding states. One of those drivers is the unit cost of the medical care. The Professional fee schedule is a significant driver of the unit cost in Indiana. When comparing our Indiana professional fee schedule to other Anthem states, Indiana's fee schedule and specifically the Chiropractic fees are very generous. Each year we complete an analysis of our professional fee schedule and make changes. Some codes are increased, some are decreased and some stay the same. We would be happy to review data from the individual chiropractors as to why they can not deliver care for these Anthem rates. To date we have not received this information from the individual Chiropractors in Indiana. When this data is received we will be happy to review it for our annual fee schedule change. Indiana DCs need to send information to Athem if you want your fees increased. Patrick Russell Indiana State Chiropractic Association 200 S. Meridian St., Suite 350 Indianapolis, IN 46225 prussell@LMVconsulting.com 317-673-4245
September 2009
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2009 fall Conference
October 9-11, 2009 Hilton North Indianapolis 8181 N. Shadeland Ave. Indpls, IN 46250
Schedule at a Glance
Friday, Oct. 9 4:00 PM Registration 5:30 PM - 9:30 PM Laws Affecting Chiropractic Saturday, Oct. 10 7:30 AM 8:00 AM - 12 NOON 8:00 AM - 12 NOON 12 NOON - 1:30 PM 2:00 PM - 6:00 PM 2:00 PM - 6:00 PM 6:00 PM 7:30 PM
Registration 21st Century Chiropractic Billing and Filling out the 1500 Form Annual Meeting/Saturday Luncheon 21st Century Chiropractic RACS, CERT and Medical Review, Coverage & Doc. After Hours Reception Platinum/Gold Members Dinner
Sunday, Oct. 11 8:00 AM - 12 NOON Documentation, Coding and Medical Compliance 8:00 AM - 12 NOON CPR Certification Friday October, 9th (5:30PM – 9:30PM) 4 hrs Laws Affecting Chiropractic SPEAKERS: Mark K. Sullivan & Andrea L. Cohen , Sullivan & Associates 1. Hippa Issues : Maintaining Confidentiality 2. Collection Issues : Fdcpa & How It Affects You 3. Protecting Your Fees In Pi Cases : Life After Midtown Case 4. Adding New Professionals : How To Insure Smooth Integration And Avoid Nasty “Divorces” 5. Stark Act: Pitfalls 6. Attorneys: Marketing and Referrals 7. How To Avoid Unpleasant and Costly Attorneys Fees 8. Open Q & A
Risk management Saturday October 10th (8:00AM–12:00 Noon) Part 1 - 4HRS (2:00PM- 6:00PM) Part 2 - 4HRS 21st Century Chiropractic: Clinical Lessons from the Trenches SPEAKER: Steve Troyanovich, DC Through the use of clinical parables, one of the profession’s best storytellers and teachers illustrates important lessons about proper examination and treatment, risk management, and interprofessional relations. This fun and entertaining seminar will equip you with practical information to help you provide better care to your patients and prepare you to be able to interact on an equal basis with your local medical counterparts. Saturday October 10th (8:00AM - 12:00 noon) 4 hrs Billing And Filling Out The 1500 Form SPEAKER: Lindy Lady, CPC - National Government Services No bones about it! This 4 hour seminar is intended just for chiropractors and their staff. This course outlines: The most up to date Medicare billing information, and includes a complete overview of the CMS-15000 claim form. We will discuss the benefits of moving to electronic claim submission, Physician Quality Reporting Initiative (PQRI), E health records and how to complete the new ABN form and how to properly file Medicare appeals.
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Saturday October 10th (2:00PM - 6:00pm) 4 hrs RACS, CERT And Medical Review, Coverage And Documentation SPEAKER: Corrinne R. Ball RN CPC - National Government Services This session is designed to give the participant the most up to date information on Medicare audits. We will look at the Recovery Audit Contractors (RACs), Comprehensive Error Rate Testing (CERT) program and Contractor Medical Review audits, and findings. This session will also explore Medicare coverage and documentation.
risk management Sunday Oct. 11, 2009 (8:00am – 12:00pm) 4 hrs Documentation, Coding and Medical Compliance for the Chiropractic Practice SPEAKER: Deana S. Rehmel D.C., MCS-P Dr. Rehmel would like to invite you to an overview of medical compliance and a review of documentation guidelines. Attendees will obtain an understanding of regulatory compliance issues associated with a physician’s practice environment and arm themselves against audits, fines and litigation with a basic knowledge of the laws, rules and regulations, which effect the daily operations of a practice. The information in this seminar is one you can take home and start implementing in your practice on Monday morning. Subjects covered include Documentation, Coding and modifiers, HIPPA, ERISA, NCQA guidelines, and New OIG material.
risk management Sunday, October 11th (8:00am – 12:00pm) 4HRS CPR Certification: Offered through the American Heart Association, this CPR class is designed to give the attendee the finest cardiopulmonary resuscitation instruction available. This interactive course will prepare you to provide assistance in the event that an adult, child, or infant is choking, has stopped breathing, or has no heartbeat. The class includes certified instruction, video, hands-onpractice and a final certification test. Be sure to wear comfortable clothing for CPR skills practice. Space is limited so attendees MUST pre-register, only the first 50 registrants will be able to take the class. Cost is $60. If taken in conjunction with a 12 HR CE Package the cost is $30. Discount not applicable to CA conference packages. Platinum members free of charge.
ISCA Report
September 2009
ISCA fall Conference Registration Form
Return to: ISCA 200 S. Meridian St, Suite 350 Indianapolis, IN 46225 or by Fax: 317.673.4210 Please check the courses you plan on attending
BILLING & FILLING OUT THE 1500 FORM* Sat. 4 hr Session (8 AM - 12:00 PM)
Doc., Coding & med. compliance* Sun. 4 hr Session (8 AM - 12:00 PM)
Laws Affecting your practice* Fri. 4 hr session (5:30 PM - 9:30 PM)
21st Century Chiropractic Sat. 4 hr Session (2 PM- 6 PM)
CPR CERTIFICATION Sun. 4 hr Session (8 AM - 12:00 PM)
21st Century Chiropractic Sat. 4 hr Session (8 AM - 12:00 PM)
RACS, CERT & Medical Review...* Sat. 4 hr Session (2 PM- 6 PM)
* = Risk Management
Please indicate if you will attend the luncheon and After Hours, to assure we provide sufficient meals for all attendees. Additional lunches and After Hours tickets 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____ (1 included with purchase of 8 or 12 hour package) I will attend ISCA After Hours YES____ NO____ (1 included with purchase of 8 or 12 hour package)
12 Hour Package
Registration Type
8 Hour Package
CA rate: CA $109 (up to 8hrs) CPR: $60 / $30 if taken in conjunction w/ 12 HR CE registration After Adv. Sept. 18 guest rate: Guest*/Student $75 ------------lunch rate: Lunch Ticket $30 (1 included with 8 or 12 hr packages) $145 $195 After hours: Additional After $165 $215 Hours Ticket $30 $210 $260 (1 included with 8 or 12 hr packages) *non DC Guest $230 $280 4 Hour Package
After Adv. Sept. 18 1. Platinum.......... complimentary -------------2. Gold & Silver.............................. $350 $400
After Adv. Sept. 18 ------------$230
$280
3. Member (in good standing).... $400 4. Member (in arrears)................. $515
$450
$270
$320
$565
$310
$360
5. Non-Member............................. $535
$585
$330
$380
*Members shall only be eligible for all membership benefits, including Fall Conference registration prices, if they are in “good standing.” The ISCA’s By Laws state the following, “a member shall not be in ‘good standing’ when his or her dues are more than two (2) quarters in arrears. ‘Good standing’ will be determined at the time registration is received in the ISCA office.
Platinum members of the ISCA may attend the Fall Conference free of charge but registration is still required.
Contact Name Address
Clinic Name City
Phone (
)
State Fax (
Zip )
packages
registration type 12 HR, (Example: Platinum, Member) (Example: CA, etc)
Registrant Name
Amount
$ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ Payment Information
Amex
Visa
Mastercard
Check (Make Payable to ISCA)
Total $__________
Cardholder:______________________________________________ Card #:__________________________________________________ Exp.______________
3 digit security #:_________________ Signature:__________________________________________________
Questions? Call 1.317.673.4245, or e-mail info@indianastatechiros.org / Refunds at 90% until Sept. 18. No refunds after Sept. 18.
Register online at www.indianastatechiros.org!
Indiana State chiropractic association classifieds PRACTICES FOR SALE
Associates Available
Nice office on NW side of Indianapolis for sale. Good mix of PI and Insurance. Office has new equipment including, Kodak Digital CR x-ray processor with 37" LCD TV for viewing x-rays, X-ray machine, Back Project's ATM-2, 1 Hydro-massage table, 4 Intersegmental traction tables. Drop adjusting table. Necksys and Synergy low tech rehab, 2 exam rooms, open adjusting/ rehab area. Office has been established 16 months and sees around 400 patient visits per month on a 3 1/2 day week. Office markets well and is in a very visible location. This office is NICE!! Call 317-4647530 or email drspine26@yahoo.com Posted 05/27/09 (M)
Seeking Part-time Associate Position. I am available on Tuesdays and Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. References available. Email me at ckwhitemandc@sbcglobal.net or contact me at my office. Dr. Chris Whiteman (765) 864-1877. Posted 5/18/09 (M)
Excellent Opportunity for a Chiropractor in a newer 2,000 sq ft , state of the art clinic located in beautiful Fishers, Indiana. This turn key office is ready to go for a nominal amount. The current DC/Owner is looking to downsize. If you have excellent credit the current owner is willing to transfer office and equipment lease over to you. Equipment includes Cervical/Lumbar Decompression, Digital X-ray, Cold Laser Therapy, Hill Flexion Distraction Tables, Open Bay Physiotherapy. and more! Call (317) 607-0464 or email: ChiropracticWellness2009@gmail.com if interested in learning more. Visit www. fishersfind.com to learn more about the fantastic demographics and location. Posted 05/27/09 (NM) Beautiful Southern Indiana University Town: Priced over $200k below appraised value! Northwest: Doctor collected $960K+ this year! West Central: Practice is 60% from referrals. Collections $317K+. Call Professional Practice Advisors, Inc. 800.863.9373 www.practiceadvisors.com Posted 04/15/09 (NM) Perfect for a new practitioner or an established chiropractor looking for a satellite location. Located in an upscale area. Established practice with an excellent reputation. Several fully equipped therapy rooms. Owner runs office as part time but has almost 300 active clients. Unlimited growth potential. Contact 317-2552620 or norm@allanmichaelgroup.com Posted 04/03/09 (NM)
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Recent graduate of National is looking for position in Indianapolis. Trained in Diversified, ART, Graston, KT, Thompson and Activator. Extensive background in rehab, PT and nutrition/internal medicine. Energetic, highly-motivated and reliable chiropractor looking for opportunity to learn from an experienced chiropractor. Call Dr. Shelley Coughlin at 815-483-3336 or email coughlindc@gmail.com. Posted 4/22/09 (M) Associates Wanted Associates needed to run busy Satellite clinics across the U.S. Self-motivated Clinic Directors needed for busy practices. No previous experience needed, but must be driven and eager to learn all aspects of running your own Chiropractic clinic. Income starts at $60,000/year, but bonuses create unlimited income potential. Paid training, vacation time and health insurance are just a few of the added incentives. If interested, please email your resume/CV to Rebecca at Recruiter@careersinchiro.com Posted 8/25/09 (NM) Indiana Associate/Partner wanted for either of 2 new practices planned to open late summer in Indy area. Must be a leader, goal oriented, confident, task oriented, self starter, good communicator, willing to put in the time and effort to market and build a successful practice. Visit www. spinallogicchiropractic.com and call Dr. Mike 317-340-4368 Posted 07/01/09 (NM)
ISCA Report
Indiana licensed Associate/Partner wanted, must be a leader, goal oriented, confident, task oriented, self starter, good communicator, willing to put in the time and effort to market and build a successful practice, who is willing to work as a associate then earn your way to partner with a large upscale chiropractic clinic in suburb of Indy. See - www.spinallogicchiropractic. com and then call Mike 317-340-4368. Posted 07/01/09 (NM) Southern Indiana - Excellent opportunity at an established chiropractic office of 20 years in a small town in southern Indiana. Work independently but benefit from successful 3 affiliated clinic's shared expertise. Email resume to tenaxinc@fuse. net. Posted 6/26/09 (M) Associates Wanted! We are looking for 2 associate positions. Candidates must be self starters, energetic, and willing to learn. Positions are in northwest Indiana and Indianapolis. Please email resumes- No calls please dervin@healthsourcechiro.com Posted 4/3/09 (M) Vacation Doctors Office Coverage: Traveling Chiropractors, America's first Chiropractic employment agency, has been Providing quality, caring Temporary and Associate Doctors nationally for over 25 years. Call 1-800-624-8876; or visit our web site @travelingchiropractors. com Posted 8/12/09 (NM) Vacation - Fill-in, Etc. I have sold my practice in Iowa and am moving to Indiana. Logan grad and 40+ years experience with multiple techniques specializing in extremities. Call Dr. Larry Phipps at 641751-7755. Posted 8/7/09 (M) Vacation, Maternity Leave, Seminar Fillin, Etc. Palmer graduate, 20+ years of experience, licensed in Indiana, NCMIC insured. Proficient in multiple techniques; diversified, activator, soft tissue, drop, flexion/distraction, basic. Able to travel statewide. Excellent adjusting & people skills. Call Dr. Guest - 317-462-0022 or email drvgpnow@yahoo.com. Posted 6/8/09 (M)
September 2009
Indiana State chiropractic association classifieds Fill-in/Vacation relief Doctor! Licensed in Indiana & Kentucky, Multiple techniques, $400.00 a day. Contact Bill Overstreet, D.C. (765) 480-6283 or bojostreet@hotmail. com Posted 5/27/09 (NM) Do you want a day off? Available Tuesdays and/or Thursdays. I work in my own office on the other days. Excellent adjusting and people skills. Comfortable with high volume. Diversified technique. $400 a day base fee. References available. Email me at ckwhitemandc@sbcglobal.net or contact me at my office. Dr. Chris Whiteman (765)8641877. Posted 4/28/09 (M) Equipment For Sale Office Equipment for sale, everything must go. Zenith Hi-Lo Table $2500, 2 SOT flat adjusting tables-$75 each, Exam Table $50, Amrex Low Volt Therapy Unit-$300, 3 Chiropractic Pictures-$15 each, Reception Area Chairs-$15 each, Bilateral Scales-$50 If interested call (219) 798-6410 and ask for Matt. Posted 7/27/09 (NM) -X-RAY SUITE for sale: Chirotech 300/125 Anatomical Generator, rare earth screens, Bolan type filtration system, total floor footprint 4 X 6 feet, ~600 shots on new Varian tube, add digital tomorrow. Automatic computer/digital calculations on LCD Illuminated control board. ***Qualifies for huge section 44 tax reduction*** Electrical components for connection equipment included. All darkroom accessories also included EXCEPT processor which is also available. Pictures on request. NEED ROOM FOR REHAB !! MUST SELL!! $9,500.00 or best offer! Call Dr. Gary Shaw at (317) 507-1376. ALSO AVAILABLE Custom grey oak 36 X 48 viewbox Indestructible Kodak 100 processor w/ extra heat element and motherboard Removable wall leading & 3 sliding lead door/window shields. Associate foot scanner (unopened) from Foot Levelers. Posted 7/20/09 (M)
September 2009
Chattanooga Intellect Legend Combo EStim Pre-mod, Russian Stim, IFC, high Volt, Ultrasound Machine is like new. 3 years old, but hardly used. Selling b/c I do not use it at all anymore. $3000 Brand new. I will sell for $1500 to get rid of it. Contact Mark Jones at 317-867-4323 or drjones@joneshealth. com Posted 7/8/09 (M) -X-Ray Unit and Processor - Fisher 300/125 xray unit with 14 x 17 cassette holder and Alphatek Cold Water Processor . 7x17, 14x17 and 8x10 cassettes included $6000 OBO. Contact Dr. Bob Graham 616-5307474 or spinalcare08@sbcglobal.net Posted 05/04/09 (NM) Mobile Lead Barrier 30" X 72" with 8" X 10" window $650.00. Contact w.garl@mchsi. com or 574-546-3435. Posted 05/01/09 (M) Complete Bennett X-Ray Room Equipment & Accessories (processor needs motor)14x17 high frequency autotech, asking $6700.00; 4-Tier X-Ray File Shelves, $175.00; Petecto Scales, $75.00; X-Ray Copier, $175.00; 2 3-Panel Screens, $125.00, 2 Standard Therapy Tables (Walnut Finish), $275.00. Call Dr. Jim Ebler at 812-397-2981. Pictures can be emailed to interested parties. Posted 4/22/09 (NM)
Post a Classified Ad ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. ISCA Report: Quarterly Member Printed Newsletter Deadlines are for ads to be included in the printed version of the ISCA Report Classified ads will also be posted online until the next issue’s deadline. March Issue Ad Submission Deadline Feb 25 June Issue Ad Submission Deadline May 25 September Issue Ad Submission Deadline August 25 December Issue Ad Submission Deadline November 25 To place a classified ad visit us online at www.indianastatechiros.org or call 317.673.4245.
Hands Free Ultra Sound Machine, and a Rehab Exercise Machine for Back/Hip. All in great condition. Call SpinalAid at 317272-4100. Posted 4/15/09 (M)
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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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