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JUNE 2010

PRESIDENT'S MESSAGE Greetings Doctors,Summer is Here! Those of us that have children in school have survived another month of May! The ISCA Executive Board, Board of Directors and Members of our Committees have been meeting regularly to continue to maintain the strength of our association. The ISCA is the spine of chiropractic in Indiana continuing to support and protect the ability to practice Chiropractic in Indiana. Our Membership continues to Grow each year. This is a true testament to our resolve to come together to meet the challenges we face as a profession. Our Membership Committee, under the direction of Chair Dr. Diane Vuotto, is continuing to develop ways to keep us connected to each other. Two of these more recent developments are our online directory to enhance member to member referrals and Brown Bag Lunches to keep our Doctors informed on the latest issues that affect our practices. The ISCA has recently developed an Acupuncture Committee. This committee will be chaired by Dr. Larry Jaggers and will keep our ISCA members up to date on issues concerning the utilization of acupuncture in our practices. The Legislative Committee is gearing up for the upcoming session in January. Once again we will be focusing on introducing legislation in regards to our inclusion of spinal manipulation in the Healthy Indiana Program (HIP). We will also be introducing Assignment of Benefits Legislation which has gained much support over the past four years. We will be poised and ready to protect our scope of practice as we review all possible bills that will be introduced that have potential to harm or enhance the practice of chiropractic in Indiana.

Our entire membership needs to be ready to “answer the call” when we need to activate our grass roots efforts in contacting our legislators. We will also be requiring a very strong BackPac as we compete in an arena where we are outnumbered and out-funded. I am confident that we can show our strength and unity once again this coming year! Be sure to attend our ISCA Golf Outing, Friday, September 17th at Hickory Stick Golf Course in Greenwood, IN. The ISCA Golf Committee, under Chair Dr. Derek Dyer, is working hard to make this event bigger and better every year. It is a great way to support the ISCA and enjoy fellowship with our friends. Put together a foursome and make it a yearly tradition! Look for registration forms online and in the mail. Don’t miss the ISCA Fall Conference at the Hilton North in Indianapolis October 22-24! The ISCA Speaker/Convention committee has been working tirelessly, under Chair Dr. Sheila Wilson, to bring a variety of top notch speakers to our conventions. I would like to end with words from D. Stuart Briscoe: “When you check into work tomorrow morning, say to the Lord, “Here I am, Lord, uniquely gifted with skill, time and energy graciously provided by you. I recognize this and I believe that you have me where you want me, which means that this particular job that I thought last week was a real bummer is, in actual fact, a high calling, and I am going to live and work today as if that is exactly what it is.” It is truly a privilege to be a part of this profession working side by side with members of the Indiana State Chiropractic Association. Sincerely, Anthony C. Wolf DC FICC

INSIDE THIS ISSUE PRESIDENT'S MESSAGE.....................................................................................1 ISCA BOARD OF DIRECTORS & STAFF INFO...................................................2 EXECUTIVE DIRECTOR'S MESSAGE................................................................3 ACA INSURANCE LIAISON REPORT...................................................................3 NEW HEALTHCARE REFORM LEGISLATION...................................................4 DRS OF CHIRO & PATIENTS INCLUDED IN UNITEDHEALTH GROUP SET.......5 ACA UPDATE FROM DR. ROBERT TENNANT...............................................5 NEW FEDERAL FUNDS COMES WITH BIG GOALS................................6 ANTHEM BLUE CROSS GETS THE MESSAGE...........................................7 COMMISSIONERS HAMMER OUT DETAILS OF HEALTH-CARE REFORM.....8

JUNE 2010

CHANGES PROPOSED TO PHI DISCLOSURES UNDER HIPAA.........................9 ISCA PHOTOS FROM 2010.............................................................................10 ISCA ONLINE MEMBERSHIP DIRECTORY.........................................................11 MEDICARE AUDITS: WHAT THE CHIRO NEEDS TO KNOW......................13 HERNIATED DISC, RADICULOPATHY & A NEW APPROACH........................14 PROF. FOOTBALL CHIRO SOCIETY ANNOUNCES ROLE W/ NFL TEAMS...15 MEDICARE & MEDICAID PROGRAMS' ELECTRONIC HEALTH RECORD..16 ISCA LAST CHANCE SEMINAR JUNE 19TH............................................17 ISCA FALL CONFERENCE: OCTOBER 22-24, 2010...................................18 ISCA CLASSIFIEDS............................................................................................19




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

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


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

Second Vice-President James Cox II, D.C. Fort Wayne, IN 260.484.1964

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

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

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

Secretary Michael Phelps, D.C. Martinsville, IN 765.342.2208

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


District Six

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

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

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

District Four Peter Furno, D.C. Zionsville, IN 317.338.6464

Past President Representative Gary Billingsley, D.C. Indianapolis, IN 317.784.9311

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


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

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

David Davis, D.C. Winchester, In 765-584-3665

Lewis Myers, D.C. Valparaiso, IN 219.464.4444 Marian Klaes-Lanham, D.C. Seymour, IN 812.523.6476

Thomas Carrico, D.C. 120 Industrial Dr. Lawrenceburg, IN 47025 812-537-5616 C.C. Paprocki, D.C. Greenwood, IN 317.535.7507 John Volbers, D.C. Indianapolis, IN 317.299.3330 ALTERNATE DISTRICT DIRECTORS District One Chris Hayes, D.C. Crown Point, IN 219.661.8680 District Two Bill Garl, D.C. Bremen, IN 574.546.1111

E. Curtis Harris, D.C. Franklin, IN 317.736.7088

Awaiting Nomination & Board Approval District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 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.



Patricia McGuffey Executive Director

Stephanie Higgins Director of Events

Patrick Russell Association Manager

Stacy Quasebarth Director of Communications

200 S. Meridian St., Suite 350 Indianapolis, IN 46225 317.673.4245 phone 800.572.8002 toll-free 317.673.4210 fax

Tom Johnson, CPA Chief Finanical Officer

Connie Vickery Governmental Affairs

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Debra Scott, IOM Vice President of Operations

John Livengood Governmental Affairs


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JUNE 2010

EXECUTIVE DIRECTOR'S MESSAGE: PATRICIA MCGUFFEY, ESQ. CHIROPRACTORS LOSE!! Chiropractors that do not belong to ISCA do lose out as they do not get the membership benefits that ISCA provides. In addition, the entire profession loses because we lose the strength of numbers that provides a strong unified voice to the Indiana Legislature. I reviewed the Indiana Physical Therapists Association’s web site and they have more than 1400 members. Indiana has more than 900 licensed Chiropractors and less than half that number is members of the ISCA. Please encourage your colleagues to become members of the ISCA. We must band together if we hope to continue to protect the chiropractor’s license and your ability to practice. This year all 100 members of the Indiana House of Representatives are up for reelection as well as 25 of the 50 Indiana State Senators. This election will be the most important election in more than 10 years because the newly elected Legislature will redraw the districts in 2011. The Districts play a large part in whether the legislator will be elected since they can be drawn to favor a Republican or Democrat in that particular district. The ISCA and our BACKPAC want you to help us elect legislators that support Chiropractic. We want legislators that will prevent physical therapists from gaining “direct access”

to patients and performing spinal manipulation! We want legislators that will police the insurance industry to prevent them from reducing health care providers’ reimbursement at the same time they are raking in huge profits and increasing patients’ premiums. We want legislators who will stand up and say to the Governor and his Administrative that we want Chiropractors to be allowed to be full participants in the Healthy Indiana Program (HIP) and all State Health Programs. You can help the ISCA to elect legislators that support chiropractic by being a regular contributor to our BACKPAC. You can help us make sure legislators support Chiropractic by meeting with your State Representative and State Senator and discussing your practice, education, and the importance of Chiropractic for you patients. I am asking you to do these two things that can make all the difference and determine whether we will be successful OR NOT in the 2011 Session. The time to start is NOW not after the elections are over in November –that will be too late. Your help is desperately needed in other ways! If you are receiving this newsletter, you are an ISCA member but are you active in the Association? Do you pay your dues on time so that the ISCA does not have to utilize staff time and postage to keep your membership current? Do you attend our conferences, golf outings, seminars, regional video showings, and brown bag lunches (call in)? Do you serve on a Committee? Are you a regular contributor to our BACKPAC?

ACA INSURANCE LIAISON REPORT As the Insurance Liaison to the ACA, I have been able to share the concerns of ISCA doctors regarding insurance issues relevant in our state. Through this program, we are directly linked to other state liaisons which allows for recognition of trends and opportunities to work together in order to develop resolutions to problems with insurance companies. However, this program relies on the active participation of our members advising us on different issues they are experiencing with insurance denials, reimbursement, audits, etc. One current situation involves United Healthcare’s processing claims from chiropractic offices and applying the co-pay for spinal manipulation as well as the deductible for “physical therapy” services performed on the same visit. United Healthcare is “double-dipping” when this combination of services is performed in a chiropractic office. If this is happening to you, you should do the following: 1. Report this to the ISCA so we can accumulate this data. 2. Review the patient’s (policy holders) Summary Plan JUNE 2010

Description (SPD) to determine whether or not this is how their policy reads. 3. Call United Healthcare, ask for an “on-shore” representative and request that they reprocess claims internally, applying only the co-pay OR the deductible according to the SPD. Another developing issue involves Anthem Blue Cross/ Blue Shield’s action of notifying patients that BC/BS will be discontinuing inclusion of EOBs with the checks they send to patients for services rendered by their out-of-network provider. They are advising the patient go online to get their EOBs. Please advise the ISCA immediately if this is happening to your patients. Once again, you are strongly encouraged to bring insurance issues to the attention of the ISCA. Sincerely, Anthony C. Wolf DC FICC




By David Elliott Jose, Esq.

President Obama recently signed into law the Patient Protection and Affordable Care (the “Act”) along with the Health Care and Education Tax Credit Reconciliation Act of 2010, which makes changes to key provisions of the Act. Collectively, these form the Federal Healthcare Reform Legislation that will have a significant impact for the next several years. This combined legislation will have a significant impact on individuals, employers and healthcare providers. Some of those changes will take place immediately, and others will take place over the next few years. It would be impossible to cover all of the issues in a single column, even all of the issues having immediate effect. As a result, this column will focus on some of the changes having an impact on group health plans, and future columns will address issues relating to the expansion of Medicaid and Medicare coverage, the implications for private health insurance plans, and the effects of regulatory oversight by governmental authorities seeking to reduce services and recover payments. The provisions affecting group health plan will have an impact on fully-insured and self-funded plans. Many provisions have delayed effective dates beginning January 1, 2014 and later. Some of those delayed items relate to employer mandates to provide health coverage, individual responsibility to purchase health insurance, additional taxes on high-cost plans, and the creation of health insurance exchanges. However, some provisions directly affecting employer-sponsored health plans are effective as soon as the first plan year beginning 6 months after the date of enactment. Our law firm has several people who are analyzing and evaluating the many details associated with the impact of this legislation on group health plans. There are specific materials available through our law firm’s website and the

link to materials that we are preparing associated with Health Care Reform that you can review in order to see some of the detailed effects of this major legislation. Some of the areas for group health plans that are directly affected by this federal legislation include: • Lifetime limits on the dollar value of benefits for plan participants • Restricting rescission of coverage for a plan participant, except in limited circumstances • Providing coverage to dependent children until the child’s 26th birthday • Prohibitions on imposing pre-existing condition limitations or exclusions on dependent children under age 19 • Application of deductibles, co-insurance provisions and other cost-sharing provisions to preventive care services • New transparency and reporting requirements related to financial disclosures, claims payments and other data • Requirements associated with designating a primary care physician for plan participants This is a very limited snapshot of some of the specific provisions relating to group health plans. More detailed information is available through our website at www.kdlegal. com, with a link to materials from our employee benefits and executive compensation practice group. If you have questions or if you would like direction to an attorney who can assist you and your practice in evaluating these group health plan issues, you may contact David E. Jose at (317) 2386211 or Each situation is different, and the application of these many legal issues for a group health plan should be carefully considered. 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. © 2010, Krieg DeVault LLP

DOCTORS OF CHIROPRACTIC AND PATIENTS INCLUDED IN UNITEDHEALTH GROUP SETTLEMENT More Than $350 Million Available to Affected Parties A record-breaking settlement has been reached between the American Medical Association, et al. and UnitedHealth Group— the nation’s largest health insurer— for 15 years of artificially low payments for out-of-network services. More than $350 million has been allocated to compensate impacted providers and subscribers, including doctors of chiropractic and their patients, according to the American Chiropractic Association (ACA). Affected providers and subscribers should have received mailings from UnitedHealth Group that include an overview of the settlement, instructions for filing a claim for payment and proof of claim forms. Claims for payment must be filed by Oct. 5, 2010. Anyone filing objections to the settlement or opting out of the settlement must do so by July 27, 2010. Evidence of UnitedHealth Group’s improper business practices was confirmed after an investigation by New York



JUNE 2010

Attorney General Andrew Cuomo over allegations that a database operated by Ingenix, Inc., a wholly-owned subsidiary of UnitedHealth Group, intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures and the lack of audits. The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward. The creation of a new database, independently maintained by a nonprofit organization, is designed to remove this conflict of interest. The settlement will be finalized at the United States Courthouse, United States District for the Southern District of New York on Sept. 13, 2010. For more information about this settlement, the New York State Attorney General has made background information about the investigation and the settlement available online. In addition, Berdon Claims Administration LLC and the American Medical Association (AMA) have answers to frequently asked questions, detailed “next steps” and links to more information on their Web sites. Finally, AMA has developed a step-by-step guide for providers who are looking to maximize their recovery from the settlement.


The Postcard is in the Mail – Does Your Practice Qualify for the New Small Business Tax Credit? The Internal Revenue Service has begun mailing postcards to more than four million small businesses and tax-exempt organizations to make them aware of the benefits of the recentlyenacted small business health care tax credit. Included in the newly enacted Patient Protection and Affordable Care Act, the credit, which takes effect this year, is designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have. In general, the credit is available to small employers that pay at least half the cost of single coverage for their employees in 2010. The credit is specifically targeted to help small businesses and tax exempt organizations that primarily employ low- and moderate-income workers. For tax years 2010 to 2013, the maximum credit is 35 percent of premiums paid by eligible small business employers and 25 percent of premiums paid by eligible employers that are tax-exempt organizations. The maximum credit goes to smaller employers — those with 10 or fewer full-time equivalent (FTE) employees — paying annual average wages of $25,000 or less. Because the eligibility rules are based in part on the number of FTEs, not the number of employees, businesses that use part-time help may qualify even if they employ more than 25 individuals. The credit is completely phased out for employers that have 25 FTEs or more or that pay average wages of $50,000 per year or more. Eligible small businesses can claim the credit as part of the general business credit starting with the 2010 income tax return they file in 2011. The IRS said the value of the credit would not be reduced by state health-care tax credits, which exist in as many as 20 states, according to a list compiled by the National Conference of State Legislatures. Businesses will also be permitted to apply the credit to vision, dental and other such coverage, so long as they pay at least 50 percent of their workers' premiums. The new rules also allow businesses to use one of three methods to determine number of full-time workers, counting bodies, weeks worked, or hours worked, whichever is easier and more beneficial. And the IRS said it would permit businesses to claim the credit this year even if they do not currently meet a requirement under the law to provide the same level of coverage to every worker. For more information regarding the tax credit visit the IRS FAQ website:,,id=220839,00.html

JUNE 2010



WELCOME NEW ISCA MEMBERS! Kenneth Hideman, D.C. Joseph Hofferth, D.C. John Kostidis, D.C. Samantha Hofferth-Francis, D.C. Cory Harkins, D.C. William Lynden, D.C. Laura Cooper, D.C. Ross Hartings, D.C. Trevor Gilbert, D.C.

Troy Byall, D.C. Michael Richards, D.C. Amanda Smith, D.C. PJ Erickson, N.D. Phillip Shanks, D.C. Robyn Makie (student) Adam Daniels, D.C. David Chavarria, D.C. Amber Morton, D.C.

NEW FEDERAL FUNDS COME WITH BIG GOALS J.K. Wall - Indianapolis Business Journal Indiana has now received nearly $50 million in federal bucks to digitize health care around the state. But the latest grant—$16 million to the Indiana Health Information Exchange—comes with specific, ambitious goals for health care providers. The Indiana Health Information Exchange will use the latest round of money, called a Beacon Communities grant, to expand its Quality Health First program. That program tracks lab test results for each participating physician and shows them how well they are doing at testing their patients for chronic disease and preventing the disease from worsening. The expansion will now try to include information from physician exams of patients. IHIE has committed to get at least 60 percent of physicians in its geographic area connected to the program over a 36-month period. The geographic area runs Kokomo to Anderson to Richmond to Bloomington to Indianapolis and its suburbs. In that area, IHIE told the feds it could reduce preventable hospital visits and walk-in emergency room visits by 3 percent; reduce duplicative imaging tests by 10 percent and reduce readmissions to hospitals of walk-in patients by 10 percent. It also hopes to increase screening for colorectal and cervical cancers by 5 percent, increase by 10 percent the proportion of patients whose diabetes is under control, and increase by 10 percent the proportion of diabetics whose cholesterol is under control.


“Our Beacon Community Program will be a guiding light to others showing Indiana’s sustainable, secure and robust infrastructure can promote an effective, efficient, secure and reliable health care system across the nation,” Dr. Marc Overhage, CEO of the Indiana Health Information Exchange, said in a statement. The money to juice adoption of health information technology comes from the 2009 stimulus act. The latest round of funding was announced Tuesday by the U.S. Department of Health and Human Services. Last month, HHS gave $10.3 million to form Indiana Health Information Technology Inc., which will coordinate work between Indiana’s five health information exchanges, including IHIE in Indianapolis. In February, Ivy Tech Community College and the Indianapolis Private Industry Council received $9.8 million to train workers for the health information technology fields. Also, Purdue University received a $12 million award to develop a regional extension center program to help rural doctors implement electronic medical records. BioCrossroads, the Indianapolis-based life sciences development group, sees health information technology as an industry for potentially high growth in Indiana. In 2009 BioCrossroads launched Exibhit Indiana, an initiative focused on speeding development and use of health information technology in Indiana and the nation.


JUNE 2010

COMPANIES DONATE VITAMINS TO NUHS CLINICS THAT SERVE THE HOMELESS National University of Health Sciences (NUHS) received pallets of vitamins and supplements from Standard Process and Anabolic Labs to dispense in three of its clinic programs that treat the homeless and medically under-served. NUHS operates two clinics housed in Salvation Army mission facilities in Chicago. Its suburban Aurora clinic also routinely serves clients at area soup kitchens, as well as homeless patients referred from local social service agencies.

That’s why two companies donated several thousand dollars worth of prescription-quality vitamin, herb, and mineral supplements to the NUHS clinics. The donations will allow doctors to not only recommend specific vitamins to help these patients, but to give them a supply to take with them.

While NUHS clinicians and interns can offer free physical exams, diagnoses, and a wide range of chiropractic treatment to these patients, getting them the proper nutritional supplements they need is difficult and costly, and often impossible.

“We are extremely grateful to both Standard Process and Anabolic Labs for these donations, as it gives our clinics, our doctors, and interns the tools they need to help their patients,” says Dr. Parish. “Many of these patients have had a long history of poor nutrition that has contributed to a deterioration in their health condition. Effective supplementation of vitamins and minerals can greatly affect their treatment outcome, and help them on the physical road to recovery as they rebuild their lives.”

“Most of these patients cannot afford enough food to eat, much less vitamin and mineral supplements — even if they know it would improve their health,” says Dr. David Parish, dean of clinics for NUHS.

For information about supporting NUHS clinic services for the medically underserved, call 630-889-6529. Source: National University of Health Sciences, www.nuhs. edu

ANTHEM BLUE CROSS GETS THE MESSAGE Mercury News Editorial What a coincidence. One day after Anthem Blue Cross' parent, WellPoint, Inc. of Indianapolis, announced its obscene first-quarter earnings increase of 51 percent, the insurance giant informed Californians that it had made "inadvertent miscalculations" and would withdraw its equally obscene 39 percent proposed rate increase. Anyone out there still think it's OK to leave insurance companies to their own devices? It's hard to determine exactly who deserves the most credit for forcing Anthem's change of heart. President Barack Obama's assault on the state's largest insurer during the health care debate got the ball rolling. Sen. Dianne Feinstein's proposed legislation calling for more stringent reviews of insurance company rate hikes deserves mention. And California Insurance Commissioner Steve Poizner, a candidate for governor, played a significant role with his investigation into Anthem's so-called calculations to justify the rate increase. Anthem's announcement doesn't mean its 700,000 California policyholders can relax. The company said it would refile a rate increase request "as soon as possible, likely sometime in May." Who knows what new math tricks corporate executives will have learned by then?

JUNE 2010

The insurance company admits it "overstated" medical trends. No kidding. Anthem and its competitors need to get the message that skyrocketing medical costs are one of the biggest threats to the nation's ability to compete in the global marketplace — and part, though not all, of the reason is the profit margin that goes to insurance companies. Any future rate hikes, even the less outrageous, deserve close scrutiny to protect Californians' best interests. Source: San Jose Mercury News: /opinion

COMPANY NEWS Indiana Gov. Mitch Daniels was 1 of 15 governors who told the federal government they don't want to help create a temporary high-risk insurance pool. The pools, which would end when the new federal health law creates insurance exchanges in 2014, would be funded with $5 billion. But Daniels, in a letter to the U.S. Department of Health and Human Services, said he fears that money will run out before 2014 and Indiana will have to pick up the bill. Daniels noted that Indiana already operates its own high-risk insurance pool, in which about 7,000 Hoosiers participate. "In the end this was not a close call for Indiana," Daniels wrote to the feds. "The risks Indiana is being asked to take are well beyond any range of acceptability." A report by noted that most Republican governors, like Daniels, have told the feds to create the exchange on their own while most Democratic governors have said they would help.




Quick quiz: If you were a regulator interpreting the new requirement that health insurers use at least 80 or 85 percent of their premium dollars to pay medical bills or otherwise improve consumers' health, which of the following expenses would you count toward the quota: 1. Combating fraud and other overbilling by doctors and hospitals. 2. Running "utilization review" or "pre-certification" departments to determine whether the insurer should cover treatment that doctors have proposed. 3. Conducting internal or external reviews when patients appeal an insurance company's decision to deny coverage. Insurers have urged regulators to give them credit for all of the above. In comments submitted to the National Association of Insurance Commissioners (NAIC), which is helping the government translate the new requirement into detailed rules, members of the industry have asked for permission to count a wide range of expenses. The BlueCross BlueShield Association, for example, has told rulemakers that its efforts to improve health quality include "reducing inappropriate and sometimes potentially harmful care." Consumer advisers to the NAIC have countered that some expenses the association proposed including "are core administrative functions of insurance companies." "Indeed, a major function of [those] activities is to deny services to enrollees and to contest their claims to services," six NAIC consumer representatives wrote. As the debate playing out at the NAIC shows, the long, hardfought battle over-health care legislation is quickly turning into a battle over health-care regulations. The ultimate impact of the law President Obama signed depends on fine print that has yet to be written. One of the first rules the government must issue will explain how to calculate so-called "medical loss ratios," which traditionally measured the percentage of insurance premiums that insurers devoted to medical claims. Starting next year, insurers covering individuals and small groups must have medical loss ratios of at least 80 percent, and insurers in the large group market must have ratios of at least 85 percent.


The idea was to make sure that consumers get value for their premium dollar, partly by discouraging excessive spending on items such as advertising, administrative overhead, shareholder dividends and executive pay. Insurers that fall short of the required medical loss ratios must pay annual rebates to their enrollees. Insurers already won a round in the drafting of the new law. It allows them to count not just medical bills but also "activities that improve health-care quality." That language leaves considerable room for interpretation. Insurers have argued that it should encompass nurse hotlines and care management programs -- for example, efforts to protect patients from harmful drug interactions and make sure they stay on prescribed treatment regimens. "It is critical that the medical loss ratio not be used as a vehicle to remove quality programs and their benefits from policyholders," America's Health Insurance Plans, an industry group, wrote. Some of AHIP's recommendations took a broader view. The group urged rulemakers to consider the expense of complying with "costly new administrative simplification standards." In addition, AHIP said, "We strongly urge the inclusion of all fraud programs in the quality category to recognize that in order to maximize the provision of quality care, carriers must maximize the funding to pay for it." Aetna wrote that the ratio should include utilization review, health information technology and external appeals. Appeals contribute to quality by ensuring that patients "access appropriate care in a timely fashion," Aetna said. Aetna also argued for costs associated with "arranging favorable provider reimbursement rates." Assurant Health wrote that quality improvement efforts include evaluating medical bills for proper coding, creating personal health records for patients, and making information available about the cost and quality of individual healthcare providers. Such information "will result in lower quality providers being driven out of business, thereby increasing the overall quality of care," Assurant said. The BlueCross BlueShield Association said that the ratio should include the cost of checking health-care providers' medical credentials before admitting them to an insurer's network. The association noted that its proposed definition of quality-related functions "has significant overlap with 'cost


JUNE 2010

containment' activities." Some of the big questions rulemakers must answer are whether medical loss ratios for each insurer should be computed at a state-by-state or countrywide level, and whether they should be reported for segments of an insurance company's business or for the company as a whole. Taking a broader approach could entail less administrative expense but could mask historically sharp variations. CHANGES PROPOSED TO PHI DISCLOSURES UNDER HIPAA; HHS SEEKS COMMENTS The HIPAA privacy rule currently requires providers to notify patients when their protected health information (PHI) is disclosed to others, except in cases when the disclosure is for the purpose of treatment, payment and health care operations. However, this rule will be expanded soon because of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was passed as part of the American Recovery and Reinvestment Act of 2009. The HITECH Act calls for the Department of Health and Human Services Office for Civil Rights (OCR) to require HIPAAcovered entities to notify individuals about disclosures of their PHI made via electronic health records—including those for the purposes of treatment, payment, and health care operations. It is important to note that this rule only addresses disclosures via electronic health records, but the new regulation has the potential to cover requests for records for claims review, FMLA forms, disability claims, attending physician statements, CMS audits/reviews, referrals, hospital records, and outside tests, labs and surgeries.

Other potentially high-stakes decisions involve more arcane issues. A group of consumer representatives to the NAIC have argued that the medical loss ratio should reflect only those claims the insurer has already paid. That would prevent insurers from gaming the system by manipulating reserves for pending claims, the consumer representatives wrote.


In this week’s installment of Good Morning America’s new series “Help Me Fix It,” medical correspondent Richard Bresser, MD, talks about the prevalence of back pain and suggests ways to get relief without going under the knife— including consulting a chiropractor. He also emphasizes the importance of getting a second opinion when surgery is recommended by one practitioner. Watch the full segment at OnCall/video/fix-back-pain-10612752


According to the rule, disclosures must include: • the date of disclosure • the name and address of the entity or person receiving the disclosure • a description of the information disclosed, and • a copy of the request for disclosure or a brief description of the reason for disclosure. However, the HITECH Act does require the HHS Secretary to balance the individual’s right to notification with the administrative burden placed upon covered entities to fulfill this requirement. OCR is requesting information from affected entities and is accepting comments on or before Tuesday, May 18, 2010. Providers and practices are encouraged to go to pdf/2010-10054.pdfto read about the rulemaking process, background information on the regulations involved, specific questions on which OCR is seeking comment, and instructions on how to submit comments to OCR for consideration. After comments are considered, a proposed rule will be drafted and publicized, at which time there will be additional opportunity to comment. JUNE 2010


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CAREER COACH: DOCTORS NEED TO WORK ON THEIR BUSINESS SKILLS By Joyce E.A. Russell -Washington Post With the health-care bill now law and set to take effect this fall, providers are scrambling to figure out what this means for them. For many, it means they better have the business end of their practice in shape if they are going to succeed. Many doctors likely weren't thinking about business skills when they got into the field of medicine, nor did they have time to take business courses. I recently asked Michael R. Yochelson, associate medical director of the neurological program at National Rehabilitation Hospital, his thoughts as his industry faces major changes in the health-care system. "It doesn't matter whether or not one has an inherent interest in business -- in order to survive, this knowledge will be critical. It will be imperative for physicians to acquire stronger business skills," he said.

will create advantages and differentiation as the industry becomes more competitive. It just may mean survival for some practices," he said.

For physicians, negotiations with insurers are a complex, time-consuming part of the job. Doctors play David in negotiations when going up against top insurance companies and the behemoth Medicare and Medicaid systems (which provide 80 percent of the country's health insurance). As Yochelson notes, "what is often frustrating to physicians is when the insurance companies say 'no' to the tests, medications and procedures that doctors deem necessary for treatment. If the physician still advocates the treatment plan, then the patient may have to pay higher bills or the hospital or clinic has to cover the costs, neither of which is a desirable outcome."

Above all, don't underestimate the importance of polished communication skills. Your communications with your staff, insurers, other doctors and patients can be the deciding factor in the success of your business. Treat all of these clients with the respect you'd expect from any business service provider -- be attentive, responsive and professional.

What do you do when you find yourself negotiating with a much stronger entity? You may need to be flexible and think about several different treatment plans. Then you'll need to make a very strong medical case for why your proposed optimal treatment plan is essential. You'll need to demonstrate how the situation offers win-win-win outcomes: why ordering only the most critical tests or treatments is best for the insurer, the healthcare provider and, most importantly, the patient. Physicians also have to worry about marketing more than ever before -- both to potential patients and to other physicians, particularly primary-care physicians, who provide crucial referral business. Specialists need to spend more time nurturing relationships with primary-care physicians to make sure they are referring patients for care. In a discussion with another physician, Kevin Streete, we talked about how speaking the language of business will help physicians. He suggests that doctors will need to "understand the importance of knowing the marketplace, especially developing innovative marketing and branding strategies that


Identify your practice's strongest competition and come up with a strategy to showcase your strengths. Do you have a small practice that can offer focused, personal attention? Does your large practice with more on-site services make you more attractive? Like any business, have the data to back up your assertions. Highlight your success rates or your sustained patient growth to demonstrate why other physicians should refer patients to you. Present this information in a way that's easy for other busy doctors and patients to understand.

What else can doctors do to enhance their business skills? More medical professionals like Streete and Yochelson have turned to formal business education to enhance their knowledge. Many organizations, such as the Medical Society of the District of Columbia, the Medical Society of Virginia and MedChi, the Maryland State Medical Society, provide information, consulting assistance and classes to help physicians run successful, profitable businesses. (Disclosure: MedChi partners with the Robert H. Smith School of Business to offer a program that covers negotiations, leadership, finance, marketing and more.) Yochelson understands his industry's critical need: "The reality is if you don't understand business practices, you can't survive in today's market -- and if you don't survive, you won't do anyone any good. You will no longer be practicing medicine and providing the much-needed care to the patient that you went to medical school to treat." Joyce E.A. Russell is a Ralph H. Tyser distinguished teaching fellow at University of Maryland's Robert H. Smith School of Business. She is a licensed industrial and organizational psychologist and has more than 25 years of experience coaching executives and consulting on leadership and career management. She can be reached at jrussell@rhsmith.umd. edu.


JUNE 2010

ISCA ONLINE MEMBERSHIP DIRECTORY The ISCA will soon be uploading its first ever online membership directory. This directory will have a complete listing of all ISCA members, searchable by zipcode, first and last name among other options to make it easy for consumers to find your practice. We will be providing a free basic listing for all ISCA members that will include your first and last name, clinic name and address, business phone number and fax and the year you became an ISCA member. For the low additional cost of $100 a year, ISCA members can upgrade to a Premium Profile that will expand your listing in our online directory. The Premium Profile includes a description (40 words or less) of your practice, hours of operation, payment types accepted, techniques, specialties, alternative services, social media links, a profile picture and more! Please make sure to provide us with any changes and updates using the form provided on the back of this page that you would want reflected in this new online directory and fax or mail back this form back to our Association headquarters at 200 S. Meridian St. Suite 350 Indianapolis, IN 46225 or fax to 317-673-4210. If you have any questions about the new online directory, please call Patrick Russell at 317-673-4245 or toll-free at 800572-8002 or email Thank you!

ISCA Website Membership Directory Basic Free Listing First Name:__________________________________________________Last Name:_________________________________________________ Clinic Name: _________________________________________________________________________________________________________ Clinic Address: ________________________________________________________________________________________________________ City: _______________________________________________________________ State: ________________

Zip: _____________________

Business Phone (______)______________________ Business Fax: (______)______________________ ISCA Member Since: ______________

I want to upgrade to the Premium Listing at Yearly $100 rate (USE FORM ON THE PAGE OF THIS PAGE) ONLINE DIRECTORY PREMIUM LISTING PAYMENT OPTIONS (You may also pay by ACH deduction from your checking account -- contact the isca office for information) AMEX




CARDHOLDER:_______________________________________________________________ CARD #:____________________________________________________________________ EXP.__________________________ 3 DIGIT SECURITY #:___________________________ SIGNATURE:_________________________________________________________________ MAIL: ISCA 200 S. Meridian St, Suite 350 Indianapolis, IN 46225 FAX: 317.673.4210 JUNE 2010



PREMIUM LISTING - $100 A YEAR Premium Listing - $100 Yearly Rate Website: ___________________________________________________ Office Email:_____________________________________________ Secondary Office Location(s):___________________________________________________________________Praciting Since: _________ Education: ____________________________________________


Profile Picture (Email JPG file to

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Twitter: ______________________


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Insurance Accepted: q Medicare

q Medicaid

q Healthy Indiana Plan

q Anthem Blue Cross Blue Shield

q Aetna

q United

q Humana

q Sagamore

q Other:______________________

About Our Practice (40 words or less): __________________________________________________________________________________ ____________________________________________________________________________________________________________________ Hours Of Operation: __________________________________________________________________________________________________ Payment Types Accepted:

q Visa/Mastercard

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Techniques: q



Logan Basic


Torgue Release




Nimmo Trigger Point Therapy




Applied Kinesiology


Motion Palpation




Bio-Energetic Synchronization(BEST)




Myofascial Release


Cox Flexion Distraction


Neural Emotional Technique


Spinal Decompression


Thompson Terminal Point


Atlas Orthogonal/Upper Cervical




Palmer Toggle Recoil




Sacro-Occipital Technique (SOT)



Modalities: q Ultra-violet




Electrical Muscle Stimulation




Short Wave


Low Intensity Laser Therapy







Diplomate of the American Chiropractic Neurology Board


Diplomate American Board of Chiropractic Orthopedists


Certified Chiropractic Extremity Practitioner


Certified Chiropractic Sports Practitioner


Diplomate—American Board of Chiropractic Internists


Chiropractic Certification on Spinal Trauma


Diplomate, American Chiropractic Board of Radiology


Fellow, Academy of Chiropractic Orthopedists


Diplomate American Chiropractic Board of Sports Physicians


Certified Clinical Nutritionist


Board Certified, Rehabilitation, Musculoskeletal System


Diplomate of American Chiropractic Board of Nutrition

Alternative Services:






Therapeutic Massage


Sports Chiropractic


Chiropractic Orthopedics


Physical Therapy









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Indiana State Chiropractic Association 200 South Meridian St., Suite 350 Indianapolis, Indiana 46225 800-572-8002 toll-free• 317-673-4245 • 317 673-4210 fax • •


Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs.

First convened in September 2007, the Chiropractic Summit represents leadership from some 40 organizations within the profession. The Summit meets regularly to collaborate, seek solutions, and support collective action to address challenges with the common goal of advancing chiropractic.

From Medicare’s inception, the federal government has used private insurance companies to process claims and perform related administrative services for the program’s beneficiaries and health care providers. Today, CMS relies on a network of contractors to process nearly one billion Medicare claims each year from more than one million health care providers. In addition to processing claims, the contractors, in conjunction with other entities, enroll health care providers in the Medicare program and educate them on Medicare billing requirements, process claims appeals, answer beneficiary and provider inquiries, and detect and prevent fraud and abuse.

A major focus of the Summit is to improve practitioner participation, documentation, and compliance within the Medicare system. The article that follows below is the fourth in a series developed by the Chiropractic Summit Documentation Committee, and it focuses on Medicare audits. This article, as well the one which will follow, will cover audits, subsequent denials, and appeals, as well as misinformation and misconceptions about the Medicare appeal process. With the significant increase in chiropractic providers across the country being audited by Medicare, there appears to be much confusion and uncertainty in how best to respond. We hope this article will help. First, the Summit encourages all DCs to appeal improperly denied claims. Remember that appealing is not only a service to your patient, who has the right to be reimbursed, but is also a service to our profession. Second, the Summit recognizes many DCs are unaware (or even unconcerned) about the Medicare Medical Review process until they receive notice of audit. This article is to help inform the profession about this process BEFORE notice of an audit is received and to give guidance for follow-up. It is strongly encouraged that you retain these articles on file for discussion with your staff and patients. There are several types of audits/reviews within the Medicare system. Most practitioners have heard of Comprehensive Error Rate Testing (CERT) reviews and Office of Inspector General (OIG) reviews. However, these articles are purposely focused on different types of review—the reviews that may result in denials requiring repayment to the Medicare fund and the appeals of those denials. Most of these reviews are referred to as “Probe” reviews; however, they are not the only reviews that may result in refunds by doctors to Medicare. To understand the Medicare Medical Review process, certain Medicare basics are needed. It is important to know that the Centers for Medicare & Medicaid Services (CMS) is a division/agency of the Department of Health and Human Services (HHS), a department of the executive branch of the federal government. CMS, formerly known as Health Care Financing Administration (HCFA), is the federal agency responsible for administering Medicare, as well as Medicaid, CHIP (Children's Health Insurance Program), HIPAA (Health JUNE 2010

Most, if not all, DCs’ interaction with Medicare is with Medicare “contractors.” Chiropractic and other types of private provider offices interact almost exclusively with contractors known as PART B “carriers” or “A/B MACs” (Medicare Administrative Contractors). All contractors are required to perform certain functions which include defending the integrity of the Medicare Trust Fund. CMS is required by the Social Security Act to ensure payment is made only for reasonable and necessary healthcare services. To meet this requirement, CMS contracts with carriers/MACs and Program Safeguard Contractors (PSCs) to perform claim data analysis which will identify atypical billing. After data analysis, the contractors must verify any billing problems through probe reviews. The contractor then determines the severity of the problem and the appropriate actions to be taken, such as further Medical Review. This article and the article(s) to follow are intended to provide a general overview of the Medical Review (MR) program to assist chiropractic Medicare providers in gaining a better understanding of the MR process. Medical Review is an important part of the Medicare Integrity Program which requires contractors to identify inappropriate billing and develop interventions to correct the problem. MR is defined as a review of claims to determine whether services provided are reasonable and necessary, as well as to follow up on the effectiveness of previous corrective actions. Atypical billing patterns and/or specific errors can prompt MR, as well as just arbitrary/random selection. Contractors can perform MR functions on any claim appropriately submitted to a carrier or MAC in meeting their contractual obligation to CMS. Whether you are a participating provider or a nonparticipating provider (non-par), accepting or electing not to accept assignment, your claims are subject to the review process. The assumption that non-par providers or providers that choose not to accept assignment are exempt from this process is a common misunderstanding



within the chiropractic profession. Through data analysis and information evaluation (e.g., complaints), suspected billing problems are identified by contractors. These contractors then use Progressive Corrective Action (PCA) to ensure that MR activities are targeted to problem areas and that the imposed corrective actions are appropriate in the context of the severity of the problem. Before assigning significant resources to potential claim problems, contractors must validate claim errors through the use of probe reviews. The next article will continue discussion on the contractorprovider relationships, including the rationale for audit, the MR process, and the appeal process available for denied claims.

The members of the Summit Subcommittee on Documentation are Dr. Carl Cleveland III, Dr. John Maltby, Ms. Susan McClelland, Dr. Peter Martin, Dr. Ritch Miller, Mr. David O’Bryon, and Dr. Frank Nicchi. Dr. Ritch Miller served as principal author of this article with contributions from members of the subcommittee. For further information on these subjects and others please refer to the sources for this article which include: CMS articles, publications and the CMS manual system, the ACA website (, and the ICA website (

HERNIATED DISC, RADICULOPATHY AND A NEW APPROACH In a new study Murphy et al. from the Rhode Island Spine Center report clinical success with challenging patients with persistent back pain and lumbar radiculopathy secondary to confirmed herniated disc. They adopt what they call a diagnosis-based clinical decision rule (DBCDR) summarized as follows: a. The 3 essential question of diagnosis are first, are the symptoms with which the patient is presenting reflective of a visceral disorder or serious disease (red flags for referral); second, from where is the patient’s pain arising; and third, what has gone wrong with this person as a whole that would cause the pain experienced to develop and persist? b. On the second question, acknowledging that the precise origins of pain cannot be determined for most patients, the four signs of greatest importance are: i. Centralization signs – detected by endrange loading examinations first developed by McKenzie Methods ii. Segmental pain provocation signs, -detected through palpitation and pain provocation tests iii. Neurodynamic signs – neurodynamic test iv. Muscle palpation signs – palpation


Murphy et al. report on 49 consecutive patients with disk herniation confirmed on imaging, pain and disability for an average of 60.5 weeks, then chiropractic management based on the above DPCDR and it is noted: a. Treatment was individualized but patients were generally seen 2 to 3 times per week for 3 weeks initially. Treatment was one of more of distraction manipulation, neurodynamic techniques, end-range loading maneuvers, joint manipulation, myofascial techniques and exercise begun “well before pain resolution” and “from the beginning in most cases” to make the “important education point that movement and activity should be pursued even in the presence of pain”. b. At baseline, end of treatment, and an average of 14.5 months after treatment there were assessments of disability (Bournemouth Disability Questionnaire), pain (Numerical Rating Scale), fear beliefs (Fear Avoidance Beliefs Questionnaire) and self rated improvement. c. “Clinically meaningful improvements in pain and disability were seen in 79% and 70% of patients respectively at the end of treatment, and 79% and 73% respectively at the end of long term follow-up at 14.5 months. (Murphy DR, Hurwitz EL, McGovern EE A Nonsur gical Approach to the Management of Patients with Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study with Follow-Up. (2009) J Manipulative Physiol Ther 32 (9):723-733).


JUNE 2010

PROFESSIONAL FOOTBALL CHIROPRACTIC SOCIETY ANNOUNCES ITS ROLE WITH EVERY NFL TEAM The Professional Football Chiropractic Society (PFCS) takes pride in announcing that all 32 teams in the National Football League offer their players and personnel chiropractic physician services as part of the triage in managing and preventing injuries. According to the Foundation for Chiropractic Progress, this distinction is a benchmark for the profession and documents the important role that chiropractic care plays in optimizing athletic performance. “The robust need for chiropractic care in the NFL has been deeply driven by the players’ desire for peak physical conditioning and not simply for injuries,” states Spencer H. Baron, DC, DACBSP, immediate past president of the PFCS and Miami Dolphins team chiropractor for the past 14 years. “From the earliest years of full contact football, their bodies are subject to structural stress that doctors of chiropractic are specially trained to care for. Many DCs who provide their services to professional athletes travel with their respective teams throughout the season, treating players up until game time, during the game and sometimes immediately following.” Rob Lizana, DC, who treats many of the players of the Super Bowl Champion New Orleans Saints, even moved with the team when they relocated to San Antonio, Texas, following Hurricane Katrina. He treated players in Miami leading up to the Super Bowl game, an advantage that many players were especially thankful for. According to Saints wide receiver Marques Colston, who had seven catches for 83 yards in Super Bowl XLIV, “I always see Dr. Rob for chiropractic care on game day to get my body balanced, flexible and ready for action. I see him several times a week for rehab and to recover faster from the last game.” Saints running back Reggie Bush has been receiving regular care since playing football in high school and during his collegiate years. “I look at chiropractic care as important to keeping me healthy and at the top of my game,” said the former Heisman Trophy winner and two-time National Champion while playing for the University of Southern California (USC). Saints wide receiver Lance Moore, who converted a crucial 2-point conversion during Super Bowl XLIV, also relies on chiropractic treatment to be game-time ready. “Not only did my chiropractor get me back on the field, but he helped me to stay on the field. My body just feels much better overall because of the care I’ve gotten,” said Moore. Many professional athletes are outspoken about their experiences with chiropractic care. Most notably, 2010 NFL Hall of Fame inductee Jerry Rice, who is a spokesperson for the Foundation of Chiropractic Progress, a notfor-profit organization dedicated to educating the public of the many benefits associated with chiropractic care. “I did a lot of things to stay in the game, but regular visits to my chiropractor made all the difference,” Rice asserts. About the PFCS PFCS is an organization of chiropractors who provide the highest quality chiropractic health care to the elite athletes of Professional Football. Their mission is to communicate, educate, initiate and continue a better understating of chiropractic for athletes, coaches, administrative, and healthcare staff of NFL teams. Their goal is to enhance the health and performance of each and every individual athlete, so they may express their optimal health potential.

JUNE 2010




MEDICARE AND MEDICAID PROGRAMS; ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM (42 CFR PARTS 412, 413, 422, AND 495) The American Chiropractic Association (ACA) is a professional society composed of doctors of chiropractic (DC) whose goal is to promote the highest standards of ethics and patient care, contributing to the health and well-being of millions of patients. The ACA currently has over 15,000 members, making it the primary representative of the chiropractic community. Below are ACA’s comments regarding CMS Proposed Rule 0033-P. First, the ACA would like to applaud the work that has been done thus far by CMS, the HIT Standards Committee and the HIT Policy Committee in developing the proposed regulations for achieving meaningful use in HIT. This is an ambitious undertaking with an equally ambitious timeline for implementation. It is clear that more time and attention will be needed to revise and adjust the regulations and ACA appreciates CMS’ acknowledgement of the areas in the proposed rule that need additional refinement to accommodate all relevant healthcare provider groups. At this time the ACA has strong concerns regarding three of CMS’ twenty five objectives for achieving meaningful use. Currently CMS proposes to require eligible professionals (EP) to generate and transmit permissible prescriptions electronically. According to the proposed requirements EPs would be required to submit at least 75 percent of all permissible prescriptions using certified EHR technology. CMS goes on to state that “an EP must utilize this capability as part of the daily work process.” This objective would prohibit eligible providers who do not prescribe medications as part of their scope of practice, from meeting meaningful use criteria. The ACA understands the benefit of having providers who prescribe medication to transmit prescriptions electronically. However, providers who do not write prescriptions should not be precluded from achieving other meaningful use benchmarks. The ACA supports the requirement that any EHR system have the ability to transmit prescriptions electronically, however, the ACA suggests that CMS revise the EP measure for achieving this objective. The measure for this objective currently states, “At least 75% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.” CMS goes on to indicate, “The numerator for this objective is the number of prescriptions for other than controlled substances generated and transmitted electronically during the EHR reporting period. The denominator for this objective is the number of prescriptions written for other than controlled substances during the EHR reporting period.” ACA suggests CMS revise the measure for this objective to read, “At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.


Those providers reporting zero in the numerator and zero in the denominator for this objective will be required to demonstrate the functionality of the electronic health record to achieve this objective but will not be required to meet the 75% measure threshold.” The second issue that will preclude some DCs from achieving meaningful use is the requirementto “Perform medication reconciliation at relevant encounters and each transition of care.” CMS’ measure for this objective states, “Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.” As there are a number of eligible providers who do not prescribe medication, performing medication reconciliation is not a typical function within their practice. As such, the ACA requests that those eligible providers who do not prescribe medication be exempt from this objective. Our final issue of concern pertains to the reporting of core measures and specialty measures. CMS has proposed to require that all EPs treating Medicare and Medicaid patients in the ambulatory setting report on all of the core measures as applicable for their patients. The measures in the core measures group include inquiry regarding tobacco use, blood pressure measurement and recognition of drugs to be avoided in the elderly. The ACA supports CMS’ belief that these measures are of great importance to the general population and they fall within the scope of practice for doctors of chiropractic. However, the limited coverage for chiropractic services under Medicare adversely impacts the ability of DCs to report on these measures. While only one of the proposed core measures is currently a PQRI measure, it is presumed that CMS will follow the PQRI model for developing further measures specifications. If so, the work described in these measures will essentially fall under evaluation and management (E/M) services, with E/M codes listed as the primary denominators codes. In this case, DCs will be unable to satisfy this measure and achieve meaningful use of an EHR as we are currently restricted from billing CMS for these codes. CMS has indicated that for PQRI, providers may only report on measures for covered Medicare services for their provider type. Under Medicare, only the Chiropractic Manipulation Treatment (CMT) codes are covered services for DCs. E/M services are not covered by Medicare when performed by a DC. It would not be appropriate to address this issue by simply adding the CMT codes to the denominators for these core measures as this would force DCs to use CMT codes to report on E/M level services, compromising the integrity of the reporting and the


JUNE 2010

MEDICARE AND MEDICAID PROGRAMS CONTINUED... codes. It is the request of the ACA that CMS examine how it reimburses DCs for the provision of services and expand coverage to include the full scope of services DCs currently provide to their Medicare patients. This coverage issue has long created a burden on patients and now creates a significant barrier for fully participating in federal programs which are intended to support the provision of quality care. The ACA appreciates the fact that CMS’ already recognizes that the current outline of specialty measures is not all inclusive and that adjustments and an option for specialties to opt out is necessary. The ACA would like to request that DCs be exempt from reporting on a specific specialty measures group, due to the restrictions in reimbursement under Medicare outlined above . As an alternative, we recommend that DCs be required to report on those PQRI measures for which we are currently eligible to report. These measures include #124. Adoption/use of health information

technology, #131. Pain assessment prior to initiation of patient treatment and #182. Functional Outcome Assessment in Chiropractic Care. The ACA is committed to participation in quality care initiatives to the fullest extent that CMS will allow and stands ready to assist CMS is addressing the issues delineated above regarding coverage issues and the barriers that those issues create for patients and providers alike. Thank you for this opportunity to provide comments on the proposed rule. Rick McMichael, DC American Chiropractic Association President CMS Posts Comments on Proposed Meaningful Use Rule ONLINE: ts?Ne=11+8+8053+8098+8074+8066+8084+1&Ntt=CMS-20090117&Ntk=All&Ntx=mode+matchall&N=8060

ISCA LAST CHANCE SEMINAR: JUNE 19TH 8AM - 6PM HIlton Garden Inn NW - 6930 Intech Blvd. Indianapolis, IN 46278 - 317.288.6060

Don't miss out on your opportunity to get in the required Continuing Education credits prior to June 30th. Indiana Statute dictates that every Licensed Chiropractic in Indiana gets 4 hours of risk management each year. Join us for one of these 4 hour Risk Management sessions: 8AM-12PM Dr. Stephen Savine: Ethics and Risk Management (provided by NCMIC) 1:30PM-5:30PM Dr. Stephen Savine: Documentation and Risk Management (provided by NCMIC)



Member (in good standing): $270

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Non-Member: $330

Non-Member: $250

REGISTRATION: Please register by 6/11/2010

If only choosing one 4 hour session please select which session ( Ethics or Documentation )

Name_______________________________________________________ Clinic________________________________________________________ Address _____________________________________________________ City _______________________________State_________Zip _________ Phone (______)_______________________________________________ Email_______________________________________________________

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Mail Registrations to: ISCA 200 S. Meridian St. Suite 350 Indianapolis, IN 46225 Questions? Please contact Patrick Russell at or call 317-673-4245.


CDI – DR. KENT REMLEY Adv. Imaging 101, Interventional Pain Mngt. 101, Adv. Pain Mngt. Tech., Osteoporosis & Vertebral Aug, Min. Invasive Spine Surgery* Fri. 5:30-9:30

DR. LISA BLOOM DC, DACS, DIBCN Neur. & Vert. Subluxation Cplx. Sat. 2-6 . DR. LARRY JAGGERS DC, LAC & DR. TOMMY THOMPSON DC, LAC – Chiro., Acupuncture, & Nutrition Sat. 8-12

DR. LISA BLOOM DC, DACS, DIBCN: Neurology & The Vertebral Subluxation Complex Sat. 8-12

DR. LARRY JAGGERS DC, LAC & DR. TOMMY THOMPSON DC, LAC – Chiro., Acupuncture, & Nutrition Sat. 2-6

DR. LARRY JAGGERS DC, LAC & DR. TOMMY THOMPSON DC, LAC – Chiro., Acupuncture & Nutrition Sun. 8-12 DAVID JOSE, ESQ – Legal Compliance for Your Professional Practice and Association* Sun. 8 -12 * = 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)

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


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

Adv. 1. Platinum.......... complimentary -------2. Gold & Silver.............................. $350

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CA RATE: CA $109 (up to 8hrs) CPR: $60 / $30 if taken in conjunction w/ 12 HR CE registration GUEST RATE: Guest*/Student $75 LUNCH RATE: Lunch Ticket $30

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*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.

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INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS PRACTICES FOR SALE Southside Indianapolis. Established 14 years. Located in professional building with Dentist, MDs and MRI facility. High growth community near St Francis Hospital. Gorgeous, open floor plan with rehab area, part time PT and fulltime LMT. 1000 visits monthly. 17 hr work week. Contact Posted 10/22/09 (M) Perfect opportunity for a new practitioner or someone looking for a satellite office. Established practice located in Peru Indiana (215 W. Main). 1 Exam room, 2 tables, and waiting room furniture included. Willing to negotiate. Contact Dr. Smelser at 765-4727610. Posted 10/17/09 (M) Practice which pays for itself and a doctor's paycheck! Collections about ÂźM per year. Small town practice. Doctors semi-retired. With down payment and contract, owner carries paper for associate doctor ready to own and grow. Contact tabascoi812@ Posted 09/17/09 (M) ASSOCIATES AVAILABLE Independent Contractor Available: New Independent Contractor looking to rent space in greater Indianapolis area from established doctor who has extra room. Why not make money on the extra space you are not using and help a new doctor get established? Contact Shelley Coughlin at 317-453-7005 or Posted 2/9/10 (M) Seeking full time associate position in successful Indiana practice. I am currently a student at Logan College of Chiropractic and plan to graduate in April, 2010. I am conscientious, reliable, and self motivated ATC (certified athletic trainer) seeking an associate position that provides growth and learning opportunities. Main Techniques are Cox and Diversified, and also trained in Thompson & Graston. Please feel free to contact me with any questions or to request a copy of my resume. lizaschuck@hotmail. com Posted 1/29/10 (M) Seeking full time associate position. Current student at Palmer in Florida, will graduate in March. Looking to join practice in Louisville/

JUNE 2010

Southern IN area. Hard worker, dedicated, and passionate about chiropractic. Techniques used: Diversified, Gonstead, Thompson, Motion Palpation, Activator, Flexion Distraction, Graston. Contact Kyle Bowling (502) 594-8326, kylebowling@ Posted 1/21/10 (M) Seeking part-time or full-time associate position. Very good rapport with patients and comfortable with fast-paced office. Mainly diversified technique, but comfortable with others. Adam Davis, DC (812) 767-0394 or dradamdavis@yahoo. com Posted 9/29/09 (M) ASSOCIATES WANTED Associate wanted to take over practice of Doctor ready to retire. Call 877-897-9968. Posted 3/1/10 (M) Rapidly expanding Lake County practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic doctor is a must. Must be proficient in Cox Distraction, Palmer Diversified, and Thompson techniques. Salary and profit share of clinic are offered. E-mail resume to: chirodan@ Posted 2/24/10 (M) Energetic and busy Fishers practice looking for a DC who is passionate about subluxation based chiropractic care. Family wellness is our specialty. Join our team of professionals who feel called to do what we do. Contact us at Posted 1/14/10 (M) Associate position available at vibrant, busy 30-year practice. Located in beautiful, recession-proof Bloomington, home of Indiana University. Newly remodeled clinic with exceptional visibility. A chiropractor will see more patients, earn more income, and work less hours in this position compared to starting a solo practice. Send CV resume to or 2501 E. Third St. Bloomington, IN 47401. Posted 12/10/09 (M)

team of four chiropractors, two massage therapists and a great staff. Please respond to Posted 12/03/09 (M) Licensed or soon to be licensed Associate Doctor needed for busy Northwest Indiana chiropractic office. Great location, in a growing practice, located less than an hour from Chicago. Please send resume to or call 219-7763781. Posted 10/28/09 (M) Excellent position open for the right doctor in our expanding wellness center. Must be wellness focused with integrity and strong personal ethics non negotiable. Nine year established practice. Email resume and vision statement to jcjchuffman@ - East central Indiana. Posted 10/1/09 (M) EQUIPMENT FOR SALE Titan Table Automatic flexion-Distraction table with cervical, thoracic and pelvic drops. Very good condition. Black with automatic shut off timer and smooth running motor. Asking $2000.00. Contact me at 765-342-2000 or allaboutchirocare@ Posted 2/3/10 (M) Bennett HFQ300 w/anatomical programming, dark room accessories, and AFP mini med red 90 automatic film processor w/stand and tanks. If interested, please call office for details Case Chiropractic, Greencastle, 765-630-8191. Posted 1/14/10 (M) POST A CLASSIFIED AD ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. To place a classified ad visit us online at or call 317.673.4245.

Chiropractor wanted for a beautiful clinic in Fishers. Must be highly energetic, confident, a good communicator and willing to put in the time and effort to market and build a successful practice. Pay will be based on production. Come be part of a great



ISCA Report

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


ISCA Summer Newsletter 2010  

news in chiropractic.