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ISCA Report

January/February 2008

President's Message Dr. Duane Binder, D.C.

Well, the New Year is upon us and I am sure that all of you had a joyous Holiday season with your family and friends. This past year has been tumultuous in many ways but we have a lot to be thankful for, so let’s count our blessings and proceed into the New Year. The ISCA has new changes beginning with our management team of LMV Consulting. Mrs. Pat McGuffey will be our new Executive Director with assistance from Mr. Lane Velayo. The executive committee has worked vigorously the past several months to assure that Pat and Lane have the resources to provide the services for you this upcoming year. They have already worked with the Membership, Speaker and Insurance committees to initiate some new programs that will provide information regarding Medicare issues, insurance coding and membership services. I am confident that the ISCA will have better communication with you to assist each of you when and if questions arise. Each of these committees will be providing their own reports as we become better organized in the next several months. Many of you have already been informed that our newsletters will be moving toward an e-version as it is more cost efficient and quick to send. More correspondence will be utilized with emails as well as more accurate updates will be posted on our website. So doctors, please inform the ISCA offices of

any changes to your email addresses and visit the web site frequently. Any legislative and insurance alerts or notices will be posted as we learn of them. This will provide convenient and quick communication to keep abreast of important issues. The immediate task at hand is this Legislative session which is considered a short one. There will most likely be a time when Pat McGuffey and the Legislative committee will need immediate assistance with grassroots efforts of making phone calls and emails to the Legislators. Pat will provide more information in her report. We held a Legislative Day on January 22, 2008. This very informative program showed everyone that attended the Legislative process, how bills are passed in Committee hearings, voted on in the House and Senate, then passed to the opposite Legislative body to repeat that process before any bill is passed or rejected. A Board of Directors meeting will be in the form of a retreat this summer that will also coordinate with some educational agenda. Dr. Tolle has worked hard to obtain speakers for Spring Convention and his committee is working to obtain speakers for next fall. If there are some good suggestions, I am sure that the committee would welcome input so they can provide a variety of topics that appeal to you. This is a new chapter in the history of the ISCA and the Board of Directors wish to provide each of you with services you desire and deserve. I am very confident that our new staff and Executive Director will be available and strive to serve each of you. Please take the time to visit the web site and review our staff. They also welcome you to call and visit.

Inside This Issue President's Message..................................................................................1 ISCA Board of Directors & Staff Info...................................................2 Medicare to issue new ABN in 2008.......................................................3 Executive Director's Message................................................................4 Going Cash...Is It Really the Answer?...................................................6 Special Report from CCGPP......................................................................7 Urgent Notice! HHS Office Seeks Chiro Records..............................8 Report of the Annual Meeting of COCSA..............................................9 NY Attorney General Concerned with Insurer' Dr Rating Sys.....10 Medicare Seminar at ISCA Spring Conf.................................................10

January/February 2008

Chiropractic Family....................................................................................11 Congress Halts Select Medicare Payment Cuts...............................11 Add Value to your life in 2008................................................................12 Watching YOur Health................................................................................13 The insurance process..............................................................................14 stop managed care and insurance abuse............................................15 Fraud or Lack of Medical necessity?....................................................16 Upcoming ISCA Events.................................................................................17 ISCA Classifieds............................................................................................18 ISCA Spring Conf & Registration Form..................................................20

ISCA Report


Indiana State chiropractic association Board of directors President Duane Binder, D.C. Clinton, IN 765.832.7777 First Vice-President Peter Furno, D.C. Zionsville, IN 317.338.6464

G. Matt Howard III, D.C. Muncie, IN 765.254.9481 Michael, Phelps, D.C. Martinsville, IN 765.342.2208

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

District Five Vacant District Six Stephen Frank, D.C. Anderson, IN 765.641.7700

District Directors

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

Second Vice-President Ray Nanko, D.C. Muncie, IN 765.288.3276

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

District Nine Nate Unterseher, D.C. Seymour, IN 812.522.2240

District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008

Secretary Marian Klaes-Lanham, D.C. Seymour, IN 812.522.2240

District Two Gerald Hofferth, D.C. South Bend, IN 219.484.1964

Alternate Directors at Large

District Nine Vacant

C.C. Paprocki, D.C. Whiteland, IN 317.535.7507

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 District Directors are selected by the District Directors themselves. The Alternate District Directors at Large are recommended by the Directors at Large and approved by the board.

Treasurer Chris Bryan, D.C. South Bend, IN 574.259.3355 Immediate Past President Anthony Wolf, D.C. Indianapolis, IN 317.898.1100 Past President Representative Michael Gallager, D.C. Indianapolis, In 317.571.1480 Directors at Large Ted Friedline, D.C. Salem, IN 812.883.1444

District Three James Cox II, D.C. Fort Wayne, IN 260.484.1964 District Four G. Lyman Shaw, D.C. Brownsburg, IN 317.852.3870 District Five Derek Dyer, D.C. Huntington, In 260.356.1616 District Six Robert Tennant, D.C. Shirley, IN 765.737.1117

Terry Tolle, D.C. Greensburg, IN 812.663.7640 Alternate District Directors District One Lewis Myers Valparaiso, IN 219.464.4444 District Two Vacant District Three Vacant District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885

District Seven Vacant

Indiana State chiropractic association staff & Info


Patricia McGuffey Executive Director

Stephanie Higgins Director of Events

Angie Gardner Receptionist

Lane Velayo Association Manager

Stacy Quasebarth Director of Communications

Gretchen Cox Administrative Assistant

Tom Johnson Chief Finanical Officer

Connie Vickery Governmental Affairs

Debra Scott Vice President of Operations

John Livengood Governmental Affairs

200 S. Meridian St., Suite 350 Indianapolis, IN 46225 317.673.4245 317.673.4210 fax

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January/February 2008


(Editor’s Note: Due to the vast amount of phone calls and questions regarding continuing education requirements, the ISCA will publish this every issue. Specific questions regarding licensure or CE’s should be directed to the Indiana Board of Chiropractic Examiners 317.234.2054.)

In order to renew your chiropractic license, you must certify that you have the following: • 24 completed hours of continuing education acquired after July 1, 2006. • 12 of these hours should have been acquired by attending approved seminars given between the dates of July 1, 2006 and July 1, 2007. • The remaining 12 hours should be acquired between the dates of July 1, 2007 and July 1, 2008. • Included in the 12 hour requirement each year are 4 hours of approved courses in public health and/or risk management. Continuing education is not required for the year in which the initial license was issued. If your original chiropractic license was issued between the dates of July 1, 2006 and July 1, 2007, you are only required to submit 12 hours of continuing education, including 4 hours of public health and/or risk management courses.

The State Board of Chiropractic Examiners will conduct a random audit of chiropractors to determine compliance with the continuing education requirements. If you are audited, you will receive notice under separate cover. Your are required by rule to retain a record of your continuing education for 4 years, including: • Verification of attendance received for the sponsor • Number of hours spent in the course • Subject matter presented • Name of the sponsoring organization • Date which the credit was earned

Become involved in ISCA!

Medicare to issue a new ABN in 2008

Many volunteer positions available!

Submission from Dr. James Cox II, , D.C.

ACA has informed us that Medicare will issue a new ABN (Advanced Beneficiary Notice) in early 2008. Please be looking for it. It will address issues of Chronic vs. Maintenance care more specifically than the current one. Watch your listserv articles. We will forward it to you as soon as we have it. Once released we will have approximately 60 days to implement. This is not much time but we will be responsible. Also I will be replaced as Medicare rep. As soon as the approvals are in place we will forward the new reps contact information. I will remain as a contact and aid the new representative. We have found people in the association who will serve well in the role due to their experiences. Please feel free to contact me, James Cox II, in the future at anytime with questions.

January/February 2008

A person who is issued an original license after July 1, 2007 is not required to submit continuing education for this renewal. If you have completed the continuing education requirements, you will be required to sign the statement on the back of the renewal application. By signing this statement, you are attesting under the penalties of perjury that you have complied with the continuing education requirements.

The Indiana State Chiropractic Association is now recruiting members for the following: Membership Committe Speaker/Conference Committee Other Volunteer Positions Those interested should contact either: Gretchen Cox, ISCA Administrative Assistant Email: Phone: 317.673.4245 or Dr. Duane Binder, ISCA President Email: Phone: 765.832.7777.

ISCA Report


Executive Director's Message Patricia McGuffey

I know many of you are quite familiar with our legislative agenda but I will review for those that are new to our issues or need a refresher course. Our three legislative priorities include “Assignment of Benefits” (AOB) legislation, “Spinal Manipulation Act”, and “Silent PPOs” legislation. Rep. Charlie Brown has introduced our AOB legislation, House Bill (HB) 1055. The legislation as introduced is the same as last year’s introduced version. HB 1055 would require insurance companies and HMO’s to pay health care providers that have not entered into an agreement with the insurer if the covered individual (patient) has assigned benefits (payment) to the provider.

I hope all of you had a wonderful Holiday and I wish each of you a prosperous New Year. This has been a year of many changes for the ISCA and I want to extend my sincere appreciation to all of ISCA’s members that have been supportive and committed to the growth and health of the Association. Thank you for the opportunity to serve you as your Executive Director and Lobbyist. Please know that I have an open door and I welcome all ISCA members to contact me with any of your questions, concerns, or suggestions. LMV Consulting has a staff of talented, enthusiastic individuals that stand ready to assist ISCA be successful in reaching all goals. We look forward to working with you to make ISCA an efficient, effective, and vibrant organization that provides excellent services and representation to all members. You can read about LMV on our web site www. Spring Conference Scheduled ISCA has numerous activities scheduled for 2008. I hope all of you will attend ISCA’s annual meeting March 7, 8 and 9. Dr.Terry Tolle, conference chairman, has worked tirelessly with Lane Velayo, ISCA Association manager to schedule important pertinent speakers that you will not want to miss. The spring conference will also bring back an old tradition and have a gala dinner on Saturday evening. Please bring your spouse and help to make this a time of renewing old friendships, developing new ones, and enjoying the camaraderie. Legislative Session Underway Also, the 2008 short legislative session began January 8th and will end by March 14th unless there is a Special Session. Property taxes will take center stage and it will be difficult to get legislators’ attention on other issues. ISCA needs all of your voices as we forward our priority legislation.


Currently some insurance companies will only pay a provider that has entered into an agreement with the insurer or HMO. The insurance company sends the claim denial or payment to the patient rather than to the health provider that has rendered the service. This creates difficulty for the patient who does not know how to file a timely appeal for a denied claim. In addition, it often prevents the healthcare provider from receiving payment for services rendered. Our legislative proposal would require the insurance company to pay the healthcare provider directly when the patient assigns the payment to the out-of-network healthcare provider. The “spinal manipulation act” legislative proposal, HB 1197 was filed by Rep Carolene Mays. It mirrors legislation passed by the Tennessee State Chiropractic Association. The proposal mandates that no person licensed under the health professional act may perform a spinal manipulation or spinal adjustment without first having the legal authority to differentially diagnose and have received a minimum of four hundred (400) hours of classroom instruction in spinal manipulation or spinal adjustment and a minimum of eight hundred (800) hours of supervised clinical training at a facility where spinal manipulation or adjustment are interchangeable terms that identify a method of skillful and beneficial treatment where a person uses direct thrust to move a joint of the patient's spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity. The legislation would also provide that any violation of the act would be an unlawful practice of chiropractic and grounds for the offending health care provider’s licensing board to suspend revoke or refuse to renew such provider’s license or take other disciplinary action allowed by law. It would also allow for the Board of Chiropractic Examiners to issue an injunction and the Attorney General or local prosecutor to file misdemeanor charges against the offending healthcare provider. Indiana licensed osteopaths and medical physicians would be exempt. Continued on next page...

ISCA Report

January/February 2008

Executive Director's Message Continued... This issue did not receive a hearing this year because of the fact it is controversial and is short session where legislators wish to concentrate on property taxes. Senator Bev Gard and Rep Phil Hoy have filed “silent PPOs” legislation (SB 159, HB 1097 respectively). The essence of the preferred provider network (“PPO”) is that providers agree to discounted reimbursement in order to participate in the PPO’s network, which ensures greater volume of patients. The use of “silent PPOs” is a practice that corrupts the integrity of the agreement. The “silent PPO” provides its network information, including its provider network and discounted fee schedule, to a third party entity. The third party entity accesses the network and the discount, even though it lacks any privity of contract with the providers in the network. In essence, it robs the providers of the ability to choose with whom they contract for a discount. The proposed legislation would prohibit these practices. Legislative Day Recap I would like to thank all of those ISCA members who joined us for ISCA Legislative Day, January 22nd. ISCA needs more members to take part in activities such as this because these face to face interactions with legislators make a difference when each of our legislative priorities comes before them. For those not able to attend Legislative Day, your grassroots activity is crucial to our efforts. We need for all of you to begin talking to your local legislators now about our proposals. ISCA will continue to send you action alerts as this session continues. Watch out for your Legislative Briefcases in the coming weeks. Members can keep updated on all ISCA activities at our web site I look forward to our work together in 2008 and seeing you at our spring conference. Please feel free to contact me at anytime. You may reach me directly by e-mail at, by phone (ISCA line) 317-673-4245, or my direct line 317-673-4215.

Notice To Members To all members that meet the requirements to serve on the Indiana Board of Chiropractic Examiners-please send your resume and political affiliation to ISCA to my attention - Pat McGuffey, 200 S. Meridian St, Suite 350, Indianapolis, IN 46225, An ISCA committee appointed by the President will interview potential board of examiner candidates at the spring conference to recommend to the Governor’s office. This will allow ISCA to be prepared when there are Board of Examiners openings. Following please find the information regarding requirements to serve on the Indiana Board of Chiropractic Examiners: Sec. 1.5. (a) There is created a board of chiropractic examiners. The board shall consist of seven (7) members appointed by the governor, not more than four (4) of whom may be affiliated with the same political party. • Six (6) of the board members must be licensed under this chapter and must have had at least five (5) years of experience as a chiropractor prior to their appointment. • One (1) member is to represent the general public and must be: (1) a resident of this state; and (2) in no way associated with the profession of chiropractic other than as a consumer. (b) All members shall be appointed for a term of three (3) years and serve until their successors are appointed and qualified. A vacancy occurring on the board shall be filled by the governor by appointment. Each appointed member shall serve for the unexpired term of the vacating member. (c) The members of the board are entitled to the minimum salary per diem provided by IC 4-10-11

Chiropractor of the Day AT THE STATE HOUSE As of the time this newsletter is going to print, there are still days when a chiropractor is needed for the Chiropractor of the Day program. Members of the House, Senate, and their staff greatly appreciate you being there to offer your services to them during the session. You can do a full day Tuesday or Thursday or a half day. Also, for those who do not work on Wednesdays or Fridays, feel free to volunteer to come in to the Statehouse for a Chiropractor of the Day ‘bonus day’. Contact Gretchen Cox 317-673-4245 ext. 156 or Lane Velayo 317-673-4245 ext. 130 at the ISCA office or you may also call Joan Howard at 765-254-9481 to get your name on the list.

January/February 2008

ISCA Report


Going Cash…Is it really the answer? By Bharon Hoag, CPC, CHC

Over the last five years I have been to many chiropractic events and have witnessed a profusion of consultants and other speakers telling physicians that the only chance of survival is to convert their practices to cash. I even heard a speaker say that if you accept insurance you are trying to serve two masters – presumably insurance carriers and patients -- referencing Biblical text in doing so.

Run the numbers and see that to collect $36,000 a month you need 300 patient visits a week if you collect an average of $30 per visit. One of two things will happen. You will charge more, which means you will have to provide more services, which means you will need to employ more people. Or you will need to work more hours to see more people. Either way you are out of balance.

Although there are a number of issues involved in this discussion, we must get the reasons why a practitioner would choose to “go cash.” I have absolutely no problem with cash practices and actually, there are situations where going cash is indeed the right solution. My problem lies in the reasons for converting.

Most people do not have the personality to pull off a cash practice. Do you really want to go through all of that just because you don’t understand the insurance world? Would it not be better for you to learn a few key things that will help you create GOOD systems in your practice to help you in the fight?

Human nature often tells us to run from what we don’t understand, and very few of us have the drive to master or understand all environments. Rather, we tend to conform to a situation or surrounding that makes us feel better about ourselves. Some give it the old college try, but with nothing left to give they get out, defeated and exhausted from the fight.

The problem in most practices is that their policies and/or systems are based on the threat of failure rather than on knowledge. For example, you create a call-back system for your patients because you don’t want them missing their appointments. But that simply ignores the problem. Ultimately that call will not help your patient stay committed. You need to educate yourself and your staff about patient conservation.

I am not going to tell you that either course is easy or the right one but I am going to challenge you to make sure you make an educated decision. Most consultants will tell you that dealing with insurance carriers will only take you off-purpose; that it will make you treat patients based on their coverage rather than on their need. I agree with them. Most of you do this, and it is not appropriate. The problem lies in whether or not you and/or your staff have been properly trained in business affairs. When you graduate from Chiropractic College you are a well trained physician. You are expected to go into practice and know everything that it takes to run a business. That in and of itself is a big hurdle, but then you realize that you are supposed to know exactly what insurance companies want: what insurances you should be a part of; how to know how to verify your patients’ insurance; how to communicate that coverage to your patient. But you really don’t know how to do any of that. All you want to do is treat your patients and get them well, as you know you can.

There are resources that can help you in this drive for knowledge. I lecture at a variety of different Chiropractic conventions and teach the basics of coding and documentation which help you to create more effective systems in your office. Over the last 10 years, I have helped thousands of chiropractors to educate themselves to a level where they feel that they can control their own reality. Now is the time to start learning the keys to keeping your practice in its most efficient and effective state. The key to any successful business is knowledge of the environment. Are you knowledgeable about yours? Unfortunately your ability to treat a patient is only 20% of the knowledge needed to do your job. Where did you get the other 80%? Most of you never did; you have gotten where you are by trial and error. You survive, but it is still a fight every month to meet overhead. Many of you feel that if you just miss one step you will crumble.

The logical thing to do is engage an insurance person, isn’t it? So you look for some one that has a lot of experience, figuring they can train you and you will no longer have to worry about that part of the practice, right? But there is another problem: you have no idea if your insurance person is capable or even if he/she is doing a good job. You put your trust and livelihood in his/her hands and hope for the best.

Don’t live that way. There are options and you need to search them out. I am always happy to help. Call me and we'll talk and see what your first steps should be!

I have gone to a number of offices and done a practice analysis only to discover that the insurance person on staff was siphoning off money from the practice. The doctor had no idea because he/she did not understand what the staff person was doing. Or better yet, you get an outside billing company only to find that it is little more than a glorified post office and that you are still responsible for communicating the insurance details to the patient and ultimately fighting for the claims with no idea about what you are doing. Most of you reading this understand exactly what I am talking about.

Bharon Hoag is the Senior Consultant in the ACOM Healthcare Business Consulting Group and has attained certification both as a Healthcare Compliance Consultant and as a Professional Coder. Both certification programs involve a course of education followed by a rather rigorous examination. Additionally, 18 hours of annual continuing education is required to maintain each certification. He was founder and president of Hybrid Management, Inc. He has spent the last 8 years traveling across the United States teaching chiropractors proper coding and case management strategies. Visiting thousands of chiropractic offices gives him a strong grasp of the challenges facing the modern day chiropractic clinic.

What is the answer? Go cash so you don’t have to deal with it? And what does that entail? Some practitioners have amazing practices that are all cash. They make a good living, they have quality time with their families, and their lives are in balance. But most, and I mean most, are completely out of balance.


Is “going cash” the answer? It may be, but you had better make sure before you go!

For more information, call 866-286-5315 ext. 601; email at or visit

ISCA Report

January/February 2008

A Special Report from the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Respectfully submitted by: Dr. Mark Dehen, CCGPP Chairman

The Problem The state of California is under siege caused by the misuse of ACOEM (Academy of Occupational and Environmental Medicine) and ODG (Official Disability Guideline) guidelines. It has driven many DCs out of business and has adversely affected the care of thousands of patients. While many believe both documents are overly restrictive, others (normally payors and MDs) believe the documents allow adequate treatment, but are often misinterpreted by consultants and claims administrators who do not understand the proper application of a guideline. Many payors in California (and many across the nation) use guidelines like rigid cookbooks/prescriptions for care instead of serving only as a guide. As a result of the adverse affect on patient care, and at the request of the leadership of the California Chiropractic Association, CCGPP has decided to weigh in and assist California. Generally, what happens in CA inevitably ripples across the United States within a few years. For example, in Ohio, denials are now being seen using ACOEM as the axe, despite the fact that very few if any DCs have gained access to the contents of ACOEM, nor ODG. We need to act now...and we need your help. In our opinion both ACOEM and ODG were developed with inadequate chiropractic input. Both documents are restrictive, especially in relation to chiropractic treatment of the chronic pain patient. After in-depth and detailed review of the literature, the CCGPP/Commission released the Low Back literature synthesis. The Low Back chapter fully supports chiropractic management, inclusive of spinal manipulation, for the chronic pain patient. Therefore, CCGPP will begin work on an ambitious project to help California and provide the rest of the nation the tools to fight inappropriate denials based upon misuse of ACOEM and ODG. At the same time, it remains our desire to work directly with the publishers of ACOEM and ODG in an effort to update the recommendations based upon current literature. The Solution CCGPP intends to assist California in their current fight relating to workers' compensation by initiating a Delphi consensus panel, which will review the literature, review ACOEM and ODG guidelines, and develop treatment recommendations more aligned with current literature and appropriate chiropractic practice. The Delphi panel will consist of a diverse group of national content experts representing a broad cross-section of chiropractic practice, to maintain integrity of the process and recommendations. Delphi Consensus Process Description The Delphi process will consist of the following steps/process: 1. Collect seed documents (ACOEM, ODG guidelines, CCGPP literature synthesis, CA WC Chronic Pain draft guideline, etc.). 2. Develop seed statements concerning number of visits for

January/February 2008

acute and chronic LBP, (outcomes and progress measures, etc.). 3. Appoint Delphi Group members (CCGPP Council will seek nominations for members from the field. Representation of all stakeholders is essential, and diversity of opinion, location, and background is important. The group will include experienced DCs from across the nation, including content experts and those recognized academic/research experts in LBP. A multidisciplinary representation is helpful.) 4. Coordinator will conduct Delphi rounds by email until all comments are received and agreement is reached (must keep to a specified time limit). 5. Final document containing results is completed by coordinator. All participants are recognized by name and affiliation in publication. California law requires that nationally recognized guidelines be used, and the California Division of Workers' Compensation (DWC) is reviewing alternative guidelines, particularly for chronic pain patients. ACOEM is, by statute, considered "reasonable," although the State recognizes the ACOEM guidelines fall short in chronic cases. We have been given a golden opportunity to complete this consensus process and influence the guidelines California (and the rest of the nation) DC's will live with for years to come. Initially, the leadership in California led by Dr. Gary Globe, appointed by the DWC to represent the chiropractic profession, hoped to provide nationally published chiropractic guidelines to use in lieu of ACOEM, as required by California state law by December 5, 2007. However, due to technical circumstances, that deadline has been extended until June 1, 2008. Therefore, if the CCGPP can complete this work in the interim there is an excellent opportunity to immediately improve the Workers' Compensation environment in California and, eventually, across the nation. It is important to have, at minimum, a completed draft of this work completed by the next WC committee meeting on March 19, 2008. We request that you consider sponsoring this process with additional funding, if possible. While a Delphi process is relatively inexpensive, there will be administrative costs that will be beyond the current budget of the CCGPP. However, we are unwilling to forego this opportunity and are therefore stepping forward with the project, despite the need for additional funding. If you have any further questions, please feel free to contact us. Dr. Mark D. Dehen, CCGPP Chair may be reached at: [email] 507.388.7744 [phone]

ISCA Report


Thousands of uninsured Hoosiers can now have access to affordable health care through the new Healthy Indiana Plan Thousands of uninsured Hoosiers can now have access to affordable health care through the new Healthy Indiana Plan. Applications for the program will be accepted starting Monday. Dec. 17. The application program began Monday, Dec. 17, and coverage began in January. To be eligible for the program, applicants must be between 18 and 64 years old, have a household income between 22 percent and 200 percent of the federal poverty level and must have been uninsured for at least six months. The program differs from traditional entitlement program because enrollment is dependent upon available funding, and eligibility will be on a first-come, first-served basis. Participants will make a modest financial contribution to the plan, providing incentives for individuals to price shop and look for the best values in medical services and prescriptions. Those whose income is too great to qualify for the program, but who are still uninsured, may buy into the HIP program and will not receive state subsidy. For more information on HIP and to download an application, visit, or call 1-877-GET-HIP-9.

URGENT NOTICE! HHS Office of Inspector General Seeks Chiropractic Records ACA to offer informational assistance to doctors who receive record request. From an ACA Special Notice of 12/19/07 The Department of Health and Human Services Office of the Inspector General (OIG), the entity responsible for identifying and reporting inefficiency in Medicare, Medicaid and other related HHS agencies, announced in their 2008 Work Plan that they would again seek records from doctors of chiropractic, as a follow-up to their 2005 report on chiropractic documentation. We are asking that all doctors of chiropractic who receive an OIG record request to please contact the ACA Office of Government Affairs via e-mail at or for assistance to fully comply with the request.* It is critical that doctors of chiropractic include all necessary information upon receipt of an OIG record request. It is also imperative that this be done in a timely fashion by the date specified by the OIG. Therefore, we strongly recommend that doctors of chiropractic who receive an OIG record request immediately contact ACA so that we can provide the essential information to help you navigate through the OIG request process. * This is informational assistance only. ACA cannot be responsible for individual documentation requests or content, nor can ACA be responsible for any resulting liability and/or action taken by any regulatory authority. ACA’s assistance is designed to provide authoritative information to help doctors of chiropractic fully and accurately comply with the OIG request. This assistance is provided with the understanding that the ACA is not engaged in rendering legal or other professional services. If legal advice or other expert professional assistance is required, the services of a competent professional person should be sought.


ISCA Report

January/February 2008

Report of the Annual Meeting of the Congress of Chiropractic State Associations State chiropractic leaders gathered in Nashville over November 8-10, 2007 for the annual meeting of the Congress of Chiropractic State Associations. Set to the theme "A Sound Investment," over 125 delegates from 44 state chiropractic associations participated in round table discussions and workshops aimed at improving their operations and overall effectiveness in serving their members and advancing the chiropractic profession. In addition to providing association management training for state elected leaders and staff, the meeting covered chiropractic's hottest issues, the introduction of new COCSA programs and policies, and the election of COCSA leaders for 2008. Sponsors of the 2007 meeting were Tennessee Chiropractic Association, NCMIC, Foot Levelers, Parker Chiropractic College, AMI (Alternative Medicine Integration), Core Products, Life University, Standard Process, Payment Processing Consultants, and Queue Marketing on Demand. Following is a brief summary of the primary activities and issues of the 2007 Congress. Launch of A New Outcome "A NEW OUTCOME" presentation by Alternative Medicine Integration, Group, L.P. (AMI) outlined the reason for endorsement by the Congress. Richard Sarnat, M.D., President and co-founder of AMI, spoke on the vision for a wellness and prevention health care system, which utilizes the education and vision of the Doctor of Chiropractic. This innovative approach to health care has been developed and outcome data collected by AMI for the past decade. This data supports the cost effectiveness of chiropractic and provider performance for the payer community. COCSA looks forward to the success of our joint venture with AMI for the future of the chiropractic profession and our member associations. Unity of Action Last March the board of directors of COCSA met at Parker College for our annual planning meeting session, where discussion focused upon the needs of our state associations. It was clear to us that the major difficulties all had one factor in common: Medicare. For the better part of our time together, we entertained the idea of developing our own Medicare initiative. But we came to realize that our roll was not to launch our own plan but rather to orchestrate a drive towards a unified national effort to address this critical matter. That decision led to the drafting of the Unity Resolution calling for the merger of the ACA and ICA. Since March, Unity has been the subject of many discussions in many circles and among many chiropractic leaders. And what we have come to realize is that unity does not have to be about "Bricks and Mortar". What we are about is Unity of purpose. Dr. Jerry DeGrado COCSA President stated, "I am so pleased to tell you that I sat in a room with the leaders of the ACA, ICA and the states involved in the demonstration project where with respect to Medicare reform... we said NO to duplicity of effort, NO to different game plans, NO to proprietary mindsets and "YES" to ONE GOAL; ONE game plan & ONE national voice! As COCSA president, I speak for our Board when I say that it is our expectation that this UNITY OF PURPOSE will stay the course and it is my pledge to you that COCSA will be there every step of the way to ensure its success." Focus on COCSA Programs COCSA leaders reviewed the successes of the past year and announced several new programs for 2008. Among those introduced were "A New Outcome" from AMI, Payment Processing Consultants credit card processing, and the expansion of the Straighten Up program around the globe. During the Saturday luncheon, Kent Greenawalt and Yolanda Davis of Foot Levelers presented a $20,250 check to COCSA President Dr. Jerry DeGrado, representing state association use of Foot Levelers Speakers Grant Program. Checks were also presented to COCSA from NCMIC and AMI. The next meeting of the Congress will be held on: November 6-8, 2008 in San Antonio, Texas For additional information: R. Jerry DeGrado, DC - President Congress of Chiropractic State Associations 1530 S. Oliver #171 Wichita, KS 67218 Phone: 316.681.0777 or 877.454.0777 Fax: 775.703.0118 Email: Website:

January/February 2008

ISCA Report


New York Attorney General Concerned with Insurers’ Doctor Rating Systems: ACA Closely Monitoring Development of Quality Measures in Washington Submitted by Dr. Robert Tennent, D.C.

Over the past year, a number of private insurers have begun rating providers on a variety of quality indicators. Providers who rate well based on insurers’ criteria will often receive incentives such as monetary rewards or exclusion from certain pre-treatment authorization requirements. While most in the health care community agree that quality providers should be rewarded, many are also concerned with the criteria on which insurers base their ratings. According to a story in the Oct. 19, 2007 issue of the Buffalo Business First newspaper, New York Attorney General Andrew Cuomo recently expressed his concern that physician quality ranking systems, as currently designed, may not be in the best interest of consumers and may actually steer patients toward cheaper, but not necessarily better, quality care. The article reported that Cuomo, as part of an expanding investigation, wrote to New York health plans Empire Blue Cross Blue Shield, Preferred Care and HIP Health Plan of New York/GHI requesting information on their doctor ranking programs. Medicare ACA shares Cuomo’s concerns and is closely monitoring the development of quality measures in Washington, D.C. In fact, the House of Delegates approved a plan in March that would bring chiropractic’s voice to the table in the ongoing debate surrounding the development of quality measures in Medicare. Reimbursement was linked to the reporting of quality measures for the first time in CMS’ Physician Quality Reporting Initiative (PQRI), a Medicare pilot program included in the Tax Relief and Healthcare Act of 2006. Any permanent changes to the Medicare system related to quality measures that result from the PQRI program are significant because many private health plans use Medicare as a model.

Medicare Seminar at ISCA Spring Conference Submitted by Dr. Marian Klaes-Lanham, D.C.

Many doctors are aware that Medicare is conducting audits throughout the state of Indiana and elsewhere in the country. The purpose of the audits is to determine if DC’s are properly documenting their care. For most of those who were audited it appears that Chiropractors are not in compliance with the mandates of their LCD, or Local Carrier Determination. If you are not already familiar with this document, it is the guidelines for Medicare documentation. It carefully outlines what is required when treating a Medicare patient. You should have a treatment plan, a short term goal, long term goals, and the medical necessity for treating the patient. According to the guidelines, pain is not an adequate reason for treatment. As we know, Medicare does not pay for maintenance care, however how many know the definition of maintenance care? According to the LCD, Maintenance Therapy “includes services that seek to prevent disease, promote health, and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition.” Does this not sound like what we do on a regular basis? Does every chiropractor know how to correctly utilize the GY, GA, GZ, GP, and AT modifier? Do you know how to correctly use the ABN and the NEMB? Do you know the difference between going Par and Non-Par? All the above are serious issues facing Chiropractors who work with Medicare patients. For those who are not familiar, and for those who want to be sure you are doing things correctly, Susan McClelland, BS, CCA, FICC, will be speaking at the ISCA Spring Convention on Saturday from 8:00 am until 6:30 pm to address these issues. Mrs. McClelland is married to Dr. George McClelland, and has her own consulting business which specializes in Medicare compliance. She personally reads and familiarizes herself with each LCD prior to speaking at various groups throughout the country. She knows and understands the Medicare system and can answer questions regarding Medicare issues for each section of the country. It is highly recommended you attend this seminar to familiarize yourself with documentation requirements for those who take care of Medicare patients. The seminar will be held March 8, 2008 in Indianapolis, IN.

Visit (look for the “Quality Movement” link) for regular updates on ACA’s activities related to the development of quality measures in Medicare. You can also learn more by reading “Golden Opportunity: Chiropractic and the Quality Movement” from the June 2007 issue of ACA News; go to and click “ACA News Archive.”


ISCA Report

January/February 2008

Chiropractic Family

Dr. G. Matt Howard III, D.C. - ISCA Legislative Chairman We are all part of the Chiropractic Family. Doctors, wives, husbands, children, patients, chiropractic patients, professional ISCA administrators, etc. are members of our family. My father, a chiropractor, always said that we are a chiropractic family and family members take care of each other. In my 40 years in practice, our chiropractic family has always been under attack. As always we must defend ourselves against our attackers. In the past our adversaries have been well funded legions and the present enemy is no less well funded and no less well prepared. We must likewise be prepared to meet the challenge. We do this by developing a strategy which includes a plan to introduce the appropriate legislative bills, a plan to defeat the bills that will be detrimental to us, fully fund the Back PAC, and do the grassroots contacts with each of our (your) legislative representatives and senators. One way to interact with your Representative and senator is to volunteer and serve at a Chiropractor of the Day for the legislature. Another way to interact with your representatives and Senators is to respond to the periodic call to action letters from the legislative committee and contact these people who represent you and your patients when important bills need to be acted upon.

right to do spinal manipulation in direct competition with you. I’m not aware yet of the occasional bills to restrict your ability to practice and to be paid for your services. We will be introducing a piece of legislation to force the insurance companies to pay, directly to the doctor, the out of PPO network services to their patients. We will also introduce a legislative bill that will reverse the common insurance practice of “most favored nation”, which means that if you’re being paid $25.00 for a service by company A and if company B who is paying your $35.00 for the same service, finds out about it, then company B can reduce your reimbursement to the $25.00 for that service and you have to accept the change. There may be other bills that may need to be introduced as the need arises and we will keep you informed, so read your letters and e-mails. • Please respond when we ask you to • Contact your representatives and senators • Contribute to Back PAC • Volunteer to be the Chiropractor of the Day for the legislature • Support your ISCA’s efforts to protect your patients rights for your services and your right to practice your profession

At this date we don’t know the numbers of the bills to be introduced, but we know that we will be facing bills from the physical therapists for direct access to treat patients and the

Congress Halts Select Medicare Payment Cuts; DC’s Will Experience Small Reduction Congress, on one of its final acts of the session, passed legislation that temporarily halts a 10% across-the-board cut to the Medicare Physician Fee Schedule (MPFS). Instead, the bill will provide for a slight overall increase of 0.5%. Doctors of Chiropractic had been facing a 12% overall cut to the MPFS, caused by revised practice expense relative value units. However, because of the action taken by Congress, the final result will be a 1.5% reduction to chiropractic services reimbursed by Medicare. Changes to the fee schedule take effect on Jan. 1, 2008. However, the legislation passed by Congress is just a six-month reprieve from the reimbursement cut, which leaves the outlook beyond the next six months highly uncertain. “The ACA is pleased that Congress has at least temporarily halted this portion of the upcoming cuts in physician Medicare payments.” said ACA President Dr. Glenn Manceaux. “We will, however, continue to lobby on behalf of our members for fair reimbursement for doctors of chiropractic under Medicare. Congress and the Department of Health and Human Services must find a permanent solution to the problems with the physician fee schedule, because ultimately, those most affected by this annual dilemma are our patients.” For the most up-to-date information on Medicare reimbursement, please call or visit your local Medicare carrier’s Web site. To find fee schedule information specific to your carrier and geographic location, please visit the fee schedules portion of the ACA web site.

January/February 2008

ISCA Report


Add Value to Your Practice and Life in 2008 Submitted by: Sam Martin, M.B.A. – Chiro Complete

In his book The Purpose-Driven Life, author Rick Warren writes, “Our value is not determined by our valuables. The most valuable things in life are not likely to be our things.” If you have a chiropractic license, you hold one of the most valuable things in life. How can you put a price on the ability to remove interference in the body, allowing the body to heal itself?

So we have established our January goals as follows:

If you have struggled over the past few years being a chiropractor, I am sure it is not chiropractic that has you down but the business of chiropractic. If you do not have systematic business procedures set in your office, it is hard to focus on the life changing power of chiropractic.

Next, you need to establish set office procedures to make sure you reach all these goals. Your first and second day procedures should be consistent and thorough each time. You should give every new patient your recommendation of care, and schedule those appointments in advance. You should have consistent procedures for missed appointments and to reactivate patients that have dropped from care. You should have a consistent procedure for communicating with the local medical doctors of your patients to educate them about you and the benefits of chiropractic. You should have a consistent patient education system to move your patients from active care to maintenance or wellness care.

Here are a few helpful hints to make 2008 a successful year for your business of chiropractic. Set specific goals each month for new patients, patient visits, services, and collections. You cannot simply throw a figure out and leave it to chance. You have to set a plan in action to reach those goals. Maybe your new patient goal is 30 new patients for the month of January. The only way you will reach this goal is by having enough new patient activity to reach that mark. Thus everything you plan should have a specific goal. Here is a sample of a January New Patient Plan. New Patient Activity Goal “A New Years Resolution” newspaper ad 5 50 Business Referral Cards to be handed out to patients 5 1 Health Lecture at local Curves Fitness Center 4 1 Patient Appreciation Dinner Workshop 8 20 Medical Doctor contacts 1 1 Business Networking Meeting 1 Holiday Gift Letter Certificate 6 Total 30

New Patients Patient Visits Services Collections

30 750 $52,500 $37,500

Once you have set procedures, and you do them consistently, it becomes very easy to reach your goals or make adjustments when necessary. If you need help with office procedures or implementing new patient planning, contact Sam Martin with Chiro Complete at (812) 275-2787 or to schedule a free 30 minute consultation during the month of January.

That is a plan for 30 new patients. If at the end of the month, we fall short, we know why and can make adjustments to February’s new patient goals. We can now set appropriate goals for the other statistics. If you know your patient visit average (patient visits divided by new patients) then it is easy to set your patient visit goals. If your patient visit average is 25 then your patient visit goal would be 750 for January. If you know you average $70 per patient visit in services, then you can multiply $70 X 750 patient visits which gives you a goal of $52,500 in services for January. If you know your average collections per patient visit is $50 then you can multiply that by 750 for a total collections goal of $37,500.


ISCA Report

January/February 2008

Watching your health: Practitioners hope to reach more patients via YouTube By Tom Kisken - Scripps Howard News Service

It’s not brain surgery. An argument pushing more surgeons, dentists and chiropractors into using online videos to reach patients is pretty basic. People don’t read, at least not when they can watch. “People prefer videos over reading because they’re human beings,” said Dr. Ed Fotsch, CEO of Medem Inc., a San Francisco company helping doctors use Web videos to bring in new patients and educate people on conditions ranging from allergies to posttraumatic stress disorder. “There’s a heck of a lot more people who saw ‘The Lord of the Rings’ than read the book.” And you don’t need to read much more than to wade into a video universe cluttered with the “Star Wars”-inspired satire “Chad Vader – Day Shift Manager,” reports on road closures and everything in between, including health care. Baseball legend Johnny Bench hosts infomercials that show a Ventura chiropractor explaining spinal decompressions. Baby Sofia’s tiny left foot kicks off a six-minute video about her birth Sept. 28 at Santa Paula Hospital in Santa Paula, Calif. “This is kind of a brave new world for me,” said Dr. Steven Greenman, a Westlake Village, Calif., cosmetic dentist who has been using video for less than a month to tell people about dental implants and porcelain veneers. Already, he’s adopted a rule: no shots of open-mouth drilling. No blood. “I think video can go too far in explaining a new procedure and it can scare a layman,” he said. Greenman expects a menu of about 20 short videos will increase visits to his Web site threefold. Even more importantly, the video is designed to increase his search-engine visibility, meaning that when people search online for “cosmetic dentists” and “Westlake Village,” they’ll get his name. That’s huge, because the Internet gives him a chance to reach people who otherwise wouldn’t hear of him. He paid $20,000 to a company that produced and edited his high-definition videos and worked on search-engine visibility. They set up a Web site that allows people to watch a video and with a few mouse clicks contact the doctor and tell him what procedures they want and when. Others make their own videos at little cost and post them on YouTube or pay companies like Medem to embed them on Web sites. Dr. Steven Alff, a Ventura, Calif., chiropractor, pays a consulting firm for services that include an infomercial hosted by Bench, the Hall of Fame baseball catcher. The segment was aired on public access television, and then Alff’s 24-year-old son suggested slicing it down into smaller segments and posting it on YouTube. Now Alff is talking about grabbing a camera and doing more videos himself. “It’s a way of getting more visibility, and it’s very inexpensive,” he said. “Most of the marketing I do is very expensive. This you can put it on there and you’ve got access to thousands, millions of people.”

January/February 2008

ISCA Report


The insurance process By Dr. Peter G. Furno, D.C.

Now under wholly new management, the Indiana State Chiropractic Association is focusing on service to its membership, with one of those services focusing on education of the insurance process. Undoubtedly, the life-blood of any practice is cash flow. If the practice, in greater part, relies on insurance reimbursement, it is imperative for the doctor and staff to understand how the “insurance game” is played and to play according to the rules - if the practice is to remain viable. The insurance game is not rocket science. It is simply a system demanding specific requirements to be met before contractual reimbursement is authorized. To violate these demands is to figuratively shoot yourself in the foot! It matters not what you perceive to be right or wrong, it matters only what the insurer perceives to be right. That means you have to play the game. Although most practitioners already know the rules of the game, they refuse to play to those rules and, must thus suffer the consequences. However, this basic reminder is in order for all of us dealing with insurance companies. What we do with the information is entirely up to us. The Key To Reimbursement For Chiropractic Claims Do insurers ask you repeatedly for patient records or for information that you have already provided to them? Is the administrative hassle frustrating you and costing you time and money? By following a simple set of clinical documentation requirements, you can simplify the reimbursement process and help ensure that your claims are handled fairly and efficiently. Last year, representatives from 13 of the largest insurance companies in the United States met with ACA representatives during the second meeting of the ACA-sponsored Claim Solutions Work Group. According to insurers at the meeting, they too are frustrated by the documentation process and complained that chiropractic clinical documentation was often unreadable, non-specific and did not effectively convey the improvement being made by the patient. Based on the suggestions made during this meeting and on recent trends, ACA recommended a set of 11 documentation requirements to be considered as appropriate in patient record keeping. Some of the insurers present at the meeting agreed that using these practices could reduce clinical record requests by 50 percent. How will ACA's agreement with national insurers on clinical documentation affect you in daily practice? You can avoid medical record requests from insurers if you know and use these simple steps for patient documentation. You can tell insurers who ask for unnecessary medical records that you have complied with nationally accepted standards


endorsed by the ACA. In addition, you can point out that further requests for records with disregard to these recommendations represent unfair claim practices. • The ACA recommends that these basic requirements be considered as appropriate clinical (medical) documentation in patient record keeping. A concerted effort by the chiropractic profession to standardize clinical (medical) documentation will improve the frustration level and reimbursement experience exponentially. • The nationally accepted HCFA billing 1500 form must be completed in detail. This means all required fields must be completed. • Subjective, objective, and treatment (if rendered) components should be incorporated into patient records on each visit. A customized format is not needed but these elements must exist consistently. Any significant changes in the clinical picture (e.g. significant patient improvement or regression) should be noted. • All ICD-9-CM diagnosis codes and CPT treatment and procedure codes must be validated in the patient chart and coordinated as to the diagnoses and treatment code descriptors. • Uniform chiropractic language should be used within the profession for describing care and treatment. Non-standard abbreviations and indexes should be defined. • Documentation for the initial (new patient) visit, new injury or exacerbation should consist of the history and physical and the anticipated patient treatment plan. The initial treatment plan, except, in chronic cases, should not extend beyond a 30-45 day interval. Subsequent patient visits should include significant patient improvement or regression if demonstrated by the patient on each visit. As the patient progresses, the treatment plan needs to be reevaluated and appropriately modified by the treating doctor of chiropractic (chiropractic physician) until the patient can be released from care, if appropriate. • If the patient is disabled, a statement(s) on the extent of disability and activity restriction is needed at initial and subsequent visits as appropriate over the course of care. • Records can be attached to each billing to pre-empt requests; however, it is not mandatory. Local insurers should be contacted for preferences (i.e., No fault PIP insurers may require records every visit while health insurers may not). • All records must be legible and understandable, released within the authority given by the patients, in a secure, confidential manner and in compliance with existing state (or federal) statutes. • The patient name and initials of the person making the chart notation (especially in multi-practitioner offices) should appear on each page of the medical record. If the above recommendations have been met, then the answers as to why the necessity for continuing treatment are answered.

ISCA Report

January/February 2008

STOP MANAGED CARE AND INSURANCE ABUSE URGENT STATE ASSOCIATION ACTION NEEDED NOW! The Chiropractic Profession's Call to Action. ACA and COSCA need Indiana's Help. As you are aware our profession has been under severe financial duress due to the actions and policies of certain chiropractic managed care networks and related companies. Managed care and insurance abuse continues to plague our profession and harm our patients.  ISCA is asking all DCs to assist in the procurement of data to document this abuse.

Data collection of un-sanitized records has been underway since May. This effort has further opened the door to clarifying that the inappropriate policies used to "manage" chiropractic are, without a doubt, restricting necessary care.  We need, and respectfully request, your help with these two very critical initiatives to continue the progress made.

Significant progress has already been made in some states and a series of state investigations have been initiated including Indiana's Department of Insurance. The collaboration among many states' regulatory agencies has elevated this cause to a national issue.  With your assistance in gathering data, we can support this critical effort by state and federal regulatory officials and show how the chiropractic profession and our patients have been unfairly treated.

Initiative #1: Managed Care Data Collection to Document Abuse We need you to assist in procuring at least 100 cases (unsanitized patient files) of inappropriate denial of care from Indiana. We will address this initiative first, with the second initiative to follow shortly. Visit the COCSA website at www. for links to both initiatives on ACA website. The website will provide information on how to forward patient files.

CURRENT WINDOW OF OPPORTUNITY ACA reports in over 20 states the attorneys general offices and departments of insurance have been either visited or contacted.    Many of these contacts have been made with and as a result of the excellent cooperation received from state associations. (ISCA had had two meetings with IDOI, the last meeting was Jan. 17 and we will report on this in next newsletter) The raising of the consciousness of these regulatory officials on the problem of managed care and insurance abuse has been successful.  The message back from these officials has been very clear - if DCs provide ACA and COCSA with the hard evidence of these abuses, regulatory officials will act and act decisively. 

Initiative #2: IDOI Appeals We need to find ways to mobilize every chiropractor in Indiana to take the time to exhaust internal appeals for every denial or restriction from insurers/networks and, if not successful, to file IDOI complaints so that a massive investigative process can be started that will cross state lines.

As agreed at the recent COCSA Convention in Nashville and the ISCA leadership, we are requesting the active cooperation of all Indiana DCs in procuring this information about chiropractic insurance abuses. It is essential for all of us to realize that the solutions to many of our problems are already at hand; we just need the commitment and will to follow through. Both federal (i.e. ERISA) and state statutes are already in place to facilitate aggressive enforcement activities.  Now that we have regulators attention, they seek more complaints to show how pervasive the problems are in each state and they would like this documentation to follow the channel of direct complaints from patients and providers.  Because of previous efforts, regulators now increasingly understand the insidious nature of certain managed care policies and procedures and they are ready to act based on well-documented complaints outlining these abuses. A recent effort of the DOIs of 36 states (including Indiana)against United Healthcare shows the success of such collaboration among regulators resulted in a penalty of $20 million, with an agreement to implement a three-year "process of improvement" plan. And, in the case of Maryland's DOI, one complaint initiated the investigation process.

The ISCA leadership is very serious about this effort to level the playing field for Indiana DCs and their patients. We all have a lot on our plate but we must complete this task and succeed. Help us to help you.  Let's show the profession what we can do when we work together.  Please work with us, and take focused action NOW to show that we can unite for a common purpose to help each other, the entire profession and the patients we serve.  File your insurance complaint on the provider complaint form and have your patients to file complaints on the patient complaint form at

January/February 2008

For years, our docs have been complaining about the abusive and unfair practices and policies of managed care and insurance organizations. For years, DCs have asked how to stop this abuse.  Well, we now have a plan. Please do everything you can to focus our profession and patients on achieving success in this very critical effort.

ISCA Report


Fraud or Lack of Medical Necessity? By Bharon Hoag, CPC, CHC

How do you convey that need? You do it through your documentation, Narrative reports and SOAP notes. There is an old adage that says “If it is not written it is not so.” This is a golden rule in healthcare. Ask any expert in the field of coding and compliance and they will tell you that if it was not written down, it did not happen. Next, there is the question of what needs to be documented? That all depends on what procedures you do with the patient. CPT coding has very little to do with finances; rather, it is all about telling a story. If you bill a 99203 (new patient office visit), commonly known as a new patient exam in chiropractic, you are telling the insurance company that you saw a patient that neither you nor anyone else in your group practice has seen in the last three years. You are also saying that at the minimum, you took a detailed history, performed a detailed exam and made medical decisions of low complexity.

With post payment audits increasing by 29% in 2006 according to the Office of the Inspector General, the question of “cause” has become one that should be on your mind. There are healthcare providers that are now paying back hundreds of thousands of dollars and they are not really sure why. They were audited and found to have billed services that were not medically necessary. But were these treatments truly not medically necessary? At this point it does not matter because they have already been found guilty, and have been ordered to repay the specified amount. If you get one of these letters, make sure you contact a coding and compliance expert before you admit to anything or agree to repay anything. There are a few of us that can: 1. Help you make sure you are protected 2. Help you win the opportunity to justify the claims in question and very possibly to overturn the ruling. Don’t be scared, be prepared! What if they use the word “fraud,” and what does that mean? In order for anyone to convict you of insurance fraud they must prove that your intent in the billings were to defraud the carrier. Most of you can easily prove you did not intend to defraud anyone. But does that mean you are innocent? It does not. You may not have committed fraud but you still may have billed for services you were not to be paid for. When you verify a patient’s insurance benefits, you are simply determining policy coverage. It does not entitle you to any of it. Rather, everything depends on the patients and their actual need for care.


Chiropractors get in trouble because they do not understand what they are saying when they bill a procedure. Most of you are merely looking at the financial compensation rather than the documentation requirements. How many of you know what is required of a detail history? Most of you think you know but I submit that if I asked, you would not give me the right answer. I am not trying to say you are all dumb, rather that you are ill-informed. Please understand I do not blame you for this situation, rather that it is endemic to our profession as a whole. You need to understand the codes that you are billing and the story they are telling. If a post-payment audit happens in your office, examiners are most likely to find issues of medical necessity in the later visits of the case. Our profession inherently is very repetitive. Your notes become extremely repetitive. It is interesting to me but there are new technology solutions that are marketing the ability for you to hit a single button to reproduce your notes for that day. Is the patient the same on Thursday as he/she was on Monday? Probably not. Nevertheless, we have fallen into a medical way of thinking when we document. You need to start writing how you think. You need to show on a visit-to-visit basis the functional change in your patient. It is critical that you understand how carriers define medical necessity. Medicare defines it as: • Acute subluxation: A patient’s condition is considered acute when the patient is being treated for a new injury, identified by x-ray or physical exam as specified above. The result of chiropractic manipulation is expected to be an improvement in, arrest or retardation of the patient’s condition. • Chronic subluxation: A patient’s condition is considered chronic when it is not expected to completely resolve (as is the case with an acute condition), but where the continued therapy can be expected to result in some functional Continued on next page...

ISCA Report

January/February 2008

Fraud or Lack of Medical Necessity? Continued...

improvement. Once the functional status has remained stable for a given condition, further manipulative treatment is considered maintenance therapy and is not covered. • Maintenance Therapy: A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition is not a Medicare benefit. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered to be medically necessary under the Medicare program. Based on these definitions, you can see that you need to document that there is some sort of functional improvement. How can you do that when you are only saying that the patient is two out of ten, which it may say on five of your last six notes. Again, document how you think. Ask the right questions! As wise person once told me, “…the reason I always get the wrong answers from people is because I never ask them the right questions.” I took that to heart and have learned over my short years that if I truly need information I need to ask the right questions. So you must do with your patients. Don’t ask them how they're doing; you will get a canned answer. Ask them how their functioning; how it is to get in and out of bed; in and out of the car, and so on. Ask them functional questions and you will get functional answers. This will keep your subjective more alive and vital. It is not hard to have good documentation, it is actually pretty easy. You just need to know the rules and the definitions of the terms. If you are afraid of an audit, you are probably just not prepared. So get prepared! Give me a call and let me help you or find another way to educate yourself. The future is in your own hands! Bharon Hoag is the Senior Consultant in the ACOM Healthcare Business Consulting Group and has attained certification both as a Healthcare Compliance Consultant and as a Professional Coder. Both certification programs involve a course of education followed by a rather rigorous examination. Additionally, 18 hours of annual continuing education is required to maintain each certification. He was founder and president of Hybrid Management, Inc. He has spent the last 8 years traveling across the US teaching chiropractors proper coding and case management strategies. Visiting thousands of chiropractic offices gives him a

Join ISCA The mission of the Indiana State Chiropractic Association is to represent the chiropractic profession and to promote its public image and contributions to quality health care on state and national levels. Member Benefits • Regular and Timely Communications • Statehouse support that protects your profession • Membership Directory published annually • Discounts on continuing education • Website with ‘members only’ section, answering your frequently asked questions • ISCA staff support to answer your practice questions • Becoming a part of a network of Chiropractic professionals locally and statewide For more information about membership contact: Lane Velayo, ISCA Association Manager Email: Phone: 317.673.4245

Upcoming ISCA Events Mark your calendars, ISCA has many great events coming up this year - you won't want to miss out! Check out for updates! ISCA Spring Conference March 7-9, 2008 Hilton Downtown Indianapolis 120 W. Market St. Indianapolis, Indiana 46204

ISCA GOLF OUTING September 23, 2008 Purgatory Golf Course 12160 E. 216th S. Noblesville, Indiana 46060

ISCA FALL CONFERENCE October 31 - November 2, 2008 Sheraton North, Indianapolis 8787 Keystone Crossing ndianapolis, Indiana 46240

January/February 2008

ISCA Report


Indiana State chiropractic association classifieds PRACTICES FOR SALE For Sale -- Building Only -- Ft. Wayne: Free Standing - High Traffic St. Ample parking, signage, close to downtown area. X-ray machine/Processor included. New roof and re-entry remodeled. Business about 1,100 SF plus 2 bedroom apartment attached with appliances. Great place to start or relocate. Priced to sell: $139,500 OBO Call 260-433-0514. Posted 1/21/08 5-year-old established satellite practice in Georgetown, In. 10 mins from Louisville, Ky. Netted $59k in 2007. Lease expires in April and I am not interested in hiring a new associate. 1300 files, fully equiped and staff will stay for transition if needed. Make me an offer. 502-548-8877. Posted 1/18/08 Small town, west-central Indiana cash practice, collecting easy 150K/year on 3 days /week. LOW overhead, no competition. Doctor will stay for smooth transition. This is an awesome opportunity for a principled chiro looking to settle in a quiet mid-west community and have a stable, cashpractice with low overhead. 1500Sq. Ft. Newly remodeled. Price $150K, financing available. For more information please call 765-762-6210. Practice for sale in Portland, OR in health conscious community that shares building with Whole Foods, Starbucks, Acupuncture Clinic, Hollywood Video etc. Practice collected $166,704 in second year and Dr. take home was $105k before taxes. Highly visible website and referral relationship established. Zip code boasts the highest median income and % of college grads in the area. Transition period along with turnkey systems are in place to guarantee a smooth changeover. Practice selling for $107,000 which includes $25,000 in A/R. Visit following website for more info practice_/welcome.html Progressive college community close to Fort Wayne, Indiana. Busy highway. Long-established beautiful chiropractic office with space to expand, sublet, and/or live in. Creative financing for doctor ready to own practice. Phone 260-402-7657 or email 3 year old practice for sale. 20 minutes south of Indianapolis. Practice averages 120 visits per week. Doctor needs to relocate out of state for family reasons. Practice collections will be approx $220,000 to $230,000 for 2006. Please contact Chris (317)777-4957. Great location, successful & profitable practice for sale. Clinic property is directly in front of Wal-Mart Supercenter. Established in the same location for 45 years. Since 1984 has operated as a multiple doctor clinic, currently with two full time doctors. There is space and the need for an


additional doctor. Clinic is profitable produces full time income for future owner/manager. Doctors and staff are available and willing to stay which could allow the new doctor/owner to practice with virtually no overhead on his/her personal work. Willing to sell practice and real estate or practice with lease on the property. Conventional terms on the sale or owner financing is available with substantial down payment. Call Jim (260) 668-7250. 45 years of success, profitable multi-doctor clinic located in NE Indiana. Diversified practice complete chiropractic, holistic care utilizing nutritional and homeopathic treatments. Space for another full time doctor, turn key operation with trained staff and two doctors. Priced below one year's actual collections, includes equipment and inventory. Serious inquiries only. JOG/ChiroSales, PO Box 98 Fremont, IN 46737 (260) 668-7250

Practices Wanted Retiring, relocating or just want help managing your practice We can help. We want to buy your practice. Premier Sports Chiropractic of Indiana 317-844-7000, ask for Dr Stacey Conrad or email Medical strip center for lease in Indianapolis at 10th & Mitthoeffer. Other tenants include: Dr. Tavel’s Family Eye Care, Immediate Care Center, 21st Century Dental. 1250 sf unit available and the space is built out with private offices. Ideal for a chiropractor! Over 40,000 cars per day travel by this center and the current tenants bring in over 90 patients each day. Contact Ken Ormsby for additional information at 317-450-8851, or by email

Associates Available Associate Available - position wanted primarily in the North Indianapolis Metro area. Will consider other areas. Current Indiana license, diversified, Graston Technique Certified. Hard worker, caring, dedicated to providing quality care to patients. Contact Dr. Rebecca J Amstutz 612-730-6547 or email Posted: 1/23/08 I am a Indiana licensed D.C. looking to associate in the NW Indiana area. I can be reached at (219)759-5586 or email me at DrDiff952@msn. com (M)

Associates Wanted Established Indianapolis chiropractor looking for associate interested in joining a multi-disciplinary practice. AO experience a plus. Check us out on the web at Send

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resume and cover letter to info@pratherwellness. com. Fort Wayne practice with decompression, Medx Core strengthening, and musculoskeletal emphasis needs a new doctor to join one with 20 years experience. Email with your application. Do you want to be a Dr. or a back cracker? Learn from a Dr. trained in orthopedics, AK, and functional medicine. Treat more than just sore backs. Call Peter H. Dyer D.C. 574-583-7012 Associate needed for busy Louisville, KY clinic. No experience needed, but must be driven and eager to learn to run your own practice. $100,000/ year minimum guaranteed plus unlimited bonus to care for patients that we provide for you! In addition, keep 60% of any patients you generate. Paid training, vacation time and health insurance are just a few of the added incentives. Fax CV to 504-467-0093 or email Busy, established office in Middlebury, Indiana seeks full or part-time associate now. Great location, staff, hours and income. Contact us at 574-825-9124 for interview, fax 574-825-1127. Fill-in doctor or associate needed for practice in Southern Indiana. Need a 9 month commitment with opportunity to stay on as independent contractor or associate after the 9 month period. IF interested contact Sam Martin at (812) 2752787 or email Indiana Licensed Associate Wanted: If you want your own practice and be successful in as little as 6 months then call me. Will train to be successful and you must be willing to work hard, willingness to listen and learn, strong philosophy. Techniques-Diversifeid, Thompson/Drop table, and Activator. Competitive salary + bonus. Call Dr. Michael A. or or High energy, fast paced Indianapolis clinic needs a coachable, highly motivated associate. Experience in corrective adjustive techniques, rehab and wellness,. Positive, upbeat personality a must. Please contact. Dr. Jonathan Hull at 317331-8176 or e-mail Associate needed for busy Indianapolis satellite clinic. No experience needed, but must be driven and eager to learn to run your own practice. $70,000/year minimum plus unlimited bonus to care for patients that we provide for you! In addition, keep 60% of any patients you generate. Paid training, vacation time and health insurance are just a few of the added incentives. Fax CV to 504-467-0093 or email Golden





January/February 2008

Indiana State chiropractic association classifieds Perfect for doctor who wants to own their own practice or just learn how to run a successful business. Excellent salary with bonus and buy-in opportunities. E-mail inquiries to principleddc@ Chiropractor Wanted for Southern Indiana Town. I am looking for a motivated self starter who wants to learn how to run their own practice. Skills learned will not only include patient education, adjusting, and patient care, but also develop patient flow, office procedures, insurance, marketing, etc.. Position includes a base salary plus bonuses. If interested call (812) 265-6141 Busy chiropractic office looking for tandem chiropractor. Fun, team atmosphere. Must use: Thompson, Activator, Cox Flexion/Distraction. Pay starts at $1000/wk. Bonus pay with practice growth. Trimboli Chiropractic is in Indiana 35 minutes from Downtown Chicago. Contact us through our website:, by phone (219) 836-8890 or by fax (219) 836-2344 Independent Contractor/Associate - Palmer graduate seeking independent contractor/ associate for 2 Indianapolis clinics – Speedway & new state of the art clinic opening in Fishers/ Noblesville approximately in December 2006 with the opportunity to operate one of the clinics on your own. Techniques used are Palmer Package, Diversified, Thompson, Flexion Distraction & Activator but willing to accept other techniques. Looking for someone that is eager to grow with the practice. New office will include cold laser therapy, lumbar decompression, massage & acupuncture. Both clinics accept most insurance. Large percentage of patient base is personal injury. Salary would be negotiable depending on the situation. Fax resume to 317-299-0017 or email

Vacation Doctors 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 Vacation Doctor Needed - 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 219-661-8680 (ask for one of the doctors) or e-mail Palmer graduate, 25 years experience, excellent adjusting and people skills. References available.

January/February 2008

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 Indiana and Kentucky licenses, OUM insured, multiple techniques, $400 per day. Call Bill Overstreet (765) 480-6283 or email bojostreet@

Equipment For Sale Equipment Wanted - D.C. looking for used Arthrostim adjusting instrument. Please contact Wes Kemp, D.C. Phone: 812-897-1700 Email: Posted: 1/23/08 Equipment For Sale - Thomas Heritage 7 Drop Table with black upholstery and manual lumbar and thoracic drops; Amrex U/50 ultrasound; SAM unit with bilateral scales, carrying case, and screening sign; Activator Adjusting Instrument: All equipment is in excellent shape and has hardly been used. Will email pics if interested. Can also be purchased as a package. For more information please contact Wes Kemp, D.C. Phone: 812-8971700 Email: Posted: 1/23/08 FULL X-Ray Room setup; Chirotech D-325 Anatomical Generator; 300x125 computerized auto anatomy console; 180 degree rotating tube-bucky; 5 year old Varian Tube (replaced during move); Bolan style filtration system; Rare earth cassettes/screens; 3 lead door shields on tracks to cover doors and windows when in use; Processor/darkroom Indestructible Kodak 100 plus auto processor card flasher; red light; lead x-ray storage bin/with film; qualifies for huge tax write-off taxes owed $12,500 or best offer.Contact Dr. Shaw 317-852-3870. Equipment Wanted - Relaxo Hylo with hydraulic extension. Email Insight Millennium Second Generation Subluxation Station. Surface EMG, Range of motion scan, and rolling thermography. Great for documenting progress of the patient. Perfect for evaluating children. $5500 OBO e-mail drjames02-misc@ or call 812-480-4483 Starting practice on low budget? I have some inexpensive equipment to help out. 1.Fischer Processor Stand; 2.Parts for Fischer Model K plus Processor; 3. SOT blocks, and Board; 4. Privacy Curtin Approx.. 8'x4' track "L" shaped; 5. 1 Bench style exam/adjusting table gray in color.; 6. 2Gray therapy tables; 7.Amrex Synchro-pulse High Volt Stimulator; 8. Amrex Syncrosonic Ultrasound; 9.Mettler Sys e-Stim 206 10. Wolf xray film

ISCA Report

flasher 11. Kodak X-omatic Id Camera. Flasher Call to make offer. 219 872 5151 or email me at Like new treadmill, Anatomotor table, Abdominal/ Back/Side Combo machine for Rehabilitation Therapy, Unatended ultrasound machine, Bowflex machine. Call for details on any item. SpinalAid at 317-272-4100 Fully refurbished Zenith Cox model 100 table complete with elevation, power tension, assist handle, cervical flexion and cranberry upholstery. Price to sell at $5995. Includes Indiana delivery! Contact Nate Domingez of Haffner X-Ray at 317773-5171 X-Ray Unit: 2004 Spectra 325e, 300mA, 125kVp. Includes console with digital mAs display (with line compensation and tube protection), tube stand, and bucky. Still under warranty. Barely used and in brand new condition. $7500 or take over lease. 502-548-8877 Equipment for Sale - Hill AirFlex Deluxe flexion distraction table complete with all 4 pneumatic drops, elevation, tilt head, abdominal breakaway, power tension and distraction, pick your color! Price: $4995 includes Indiana delivery. Call Nate Domingez at 317 773 5171 Equipment for Sale - Zenith II Hylo Table. Drop Pelvic, breakaway abdominal, burgundy cushions only 1 year old, extra wide pelvic section, works great. $4000. Call 765-935-1000. Jon Equipment for Sale - Zenith 210 Hylo with pelvic drop and new burgandy cushions and pancake footswitch ($3300). Galaxy stationary adjusting table ($150). Two 14 x 36 x-ray viewboxes ($100 each). Can send pics via email. Call Dr. Jon (765) 935-1000

Post a Classified Ad ISCA members may place classified ads for free. ISCA member ads will run for two consecutive issues unless otherwise requested. Non-members may place ads for $25 an issue. To place a classified ad, please email the following information to or visit us online at Name: Address: City: State: Zip: Phone: Email: Are you an ISCA member? Yes or No Category: Text:


ISCA Report

200 S. Meridian St. Suite 350 Indianapolis, IN 46225 317.673.4245

ISCA 2008 Jan/Feb Newsletter  

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