Page 1

ISCA Report

March/April 2008

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

The New Year is off to a good start with our newsletter, meetings with Anthem and the Department of Insurance. The Legislative session has brought us some optimism regarding the Assignment of Benefits issue that Mrs. McGuffey will report on with more details. The Legislative Committee has worked hard at the grass roots level in communicating with the members to contact the Senators and Representatives. I thank them and all of you that made calls or emails to the Legislators. We should not forget that the PT issue of direct access has been thwarted again thanks to the staunch support of Senator Ron Alting from Lafayette. We all need to send him a letter or card thanking him for his support of Chiropractic and our issues. LMV Consulting hosted a Legislative Day on January 22, with a luncheon and program designed to educate the Doctors on the various steps involved in the Legislative process. The procedures to get bills heard in committees, then on the respective Chamber floor, votes to pass a bill and on to the other Chamber to start the process again. It was very informative as we were then taken to the State House to meet with Legislators about our issues and concerns. Those of you that did not attend should make an effort to attend next year. Our membership committee has been busy in promoting better membership incentives and communications. They are in the process of developing a mentor program for newer members or those that would like assistance. They will be attempting to gather information and update our membership database so if you have changes in addresses, phone, or fax numbers and email addresses please inform the ISCA offices so we may keep current. We are striving to make our newsletter an electronic

version to reduce costs as well as make it more efficient so updated email addresses are important. During the transition from our previous management firm, some of last year’s new members have not received their certificates or new member packages. If you or some one you know has not received those items, please contact the ISCA offices so we may rectify that situation. I apologize for this oversight and inconvenience. It has been over a year ago that the ISCA went through some tumultuous ordeals and I would like to dispel the notion that Chiropractors are their own worst enemy. Your Board of Directors has been very diligent and sensitive in working with me through this past year. They have taken considerable amount of their time and resources in an attempt to provide you with a more productive and active ISCA. They have provided input and discussions about the future of the ISCA and how they feel we should function as a profession. We want your input and assistance in providing services and information that you want and deserve. I was quite pleased with the attendance at the convention. I would like to thank all that attended the lecturers and especially those that attended the Gala event. I would also like to thank the ISCA staff and LMV consulting for a job well done especially on the late notice in preparation for the Spring conference. Cooperation through the entire profession is a must and at times we all feel downtrodden with audits, reduced fees, network problems and bureaucracy. However, we have to lean on each other for support and be grateful for our many attributes and blessings. Mutual cooperation with the ICAI has been ongoing with communication on Legislative and insurance issues. I feel that we are more “united” than everyone thinks. We just have to acknowledge and trust in what is inevitable if we are to grow as a profession that provides Chiropractic services to our patients.

Inside This Issue President's Message..................................................................................1 ISCA Board of Directors & Staff Info...................................................2 What Do I need for CE?..............................................................................3 2008 Chiropractors of the day & Special Thanks.................................3 Executive Director's Message................................................................4 ISCA Legal Counsel....................................................................................6 Become Involved In IsCA............................................................................7 Medicare Update.............................................................................................8 Prepayment Review of Chiropractic Services................................9 U.S. House Introduces Chiro/Armed Forces Resolution.................9

March/April 2008

Tips to Facilitate the medicare enrollment process.......................10 ACA News Update From Dr. Tentant.......................................................11 HHGreg Bill Dies in Senate (Inside indiana Business Article)..11 CUOMO Announces Inudstry-Wide Investigation.......................12 Letter to U.S. News & World Report................................................13 The Price of Pain.......................................................................................15 Support Expansion of VA's Chiro Care Program.................................15 ISCA Anthem Letter.....................................................................................16 President Bush Proposal for Cuts to Medicare.............................17 ISCA Classifieds...................................................................................18-19

ISCA Report

1


Indiana State chiropractic association Board of directors President Duane Binder, D.C. Clinton, IN 765.832.7777 Dbinder326@aol.com First Vice-President Peter Furno, D.C. Zionsville, IN 317.338.6464 pfurno@sbcglobal.net

G. Matt Howard III, D.C. Muncie, IN 765.254.9481 mattjoanhoward@hotmail.com Michael, Phelps, D.C. Martinsville, IN 765.342.2208 mchiro@reliable-net.net

District Seven Diane Vuotto, D.C. Indianapolis, IN 317.898.6989 vuotto@insightbb.com

District Directors

District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 Flopper1968@hotmail.com

Second Vice-President Ray Nanko, D.C. Muncie, IN 765.288.3276 nankomd@ameritech.net

District One Ron Daulton, Sr., D.C. Hammond, IN 219.932.8900 reddcdr@comcast.com

District Nine Nate Unterseher, D.C. Seymour, IN 812.522.2240 drn8@live.com

Secretary Marian Klaes-Lanham, D.C. Seymour, IN 812.522.2240 drmarian@klaesclinic.com

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

Alternate Directors at Large

Treasurer Chris Bryan, D.C. South Bend, IN 574.259.3355 cwbdc@aol.com Immediate Past President Anthony Wolf, D.C. Indianapolis, IN 317.898.1100 Drtony6900@aol.com Past President Representative C.C. Paprocki, D.C. Whiteland, IN 317.535.7507 Directors at Large Ted Friedline, D.C. Salem, IN 812.883.1444 Sp9dr@comcast.net

District Three James Cox II, D.C. Fort Wayne, IN 260.484.1964 Cox.chiropractic@verizon.net District Four G. Lyman Shaw, D.C. Brownsburg, IN 317.852.3870 glshaw@juno.com District Five Derek Dyer, D.C. Huntington, In 260.356.1616 nddyerd@yahoo.com District Six Robert Tennant, D.C. Shirley, IN 765.737.1117 doct@hrtc.net

Terry Tolle, D.C. Greensburg, IN 812.663.7640 drspine26@yahoo.com John Volbers Indianapolis, IN 317.299.3330 ecchiro@cs.com 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

gtdlf@netcapade.com District Five Vacant District Six Stephen Frank, D.C. Anderson, IN 765.641.7700 sdfrank@insightbb.com District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 indysportdoc@iquest.net District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 drshaun@newburghchiro.com District Nine John Krawchinson D.C. Seymour, IN 812.524.2273 Alternates: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate District Directors are nominated and then must be approved by the Board of Directors. The Alternate District Directors at Large are recommended by the Directors at Large and approved by the board.

Indiana State chiropractic association staff & Info

2

Patricia McGuffey Executive Director pmcguffey@lmvconsulting.com

Stephanie Higgins Director of Events shiggins@lmvconsulting.com

Patrick Russell Executive Assistant prussell@lmvconsulting.com

Lane Velayo Association Manager lvelayo@lmvconsulting.com

Stacy Quasebarth Director of Communications squasebarth@lmvconsulting.com

Krista Rader Receptionist krader@lmvconsulting.com

Tom Johnson Chief Finanical Officer tjohnson@lmvconsulting.com

Connie Vickery Governmental Affairs cvickery@lmvconsulting.com

Gretchen Cox Receptionist gcox@lmvconsulting.com

Debra Scott Vice President of Operations dscott@lmvconsulting.com

John Livengood Governmental Affairs jlivengood@lmvconsulting.com

200 S. Meridian St., Suite 350 Indianapolis, IN 46225 info@indianastatechiros.org www.indianastatechiros.org 317.673.4245 phone 317.673.4210 fax

ISCA Report

March/April 2008


WHAT DO I NEED FOR CE?

(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. A person who is issued an original license after July 1,

Special thanks to the everyone that contacted their legislator Scott Auton Keith Bartley Jim Bastin Duane Binder Scott Braun Chris Bryan Roc Byrd Charles Cochran James Cox II Ron Daulton Ben Dickinson Mary Doyle Sid Dyer Derek Dyer Denise Ewing Victor Fitch Ted Freidline David Frischman Ronald Frischman Garry Fuller Peter Furno Robert Fury

Mary Anne Galli Kenneth Golden Cory Haffner Lynne Hancock Gerard Hofferth Todd Hostetler Joan Howard Matt Howard Chris Klaes Marian Klaes Stacey Conrad L. Gerald Langley Scott Little Larry Lutes Perry Lyons Jennifer McAtee Brian McCarley Brian McGuckin Pat McGuffey Brandon Osmon Shawn Pala Susan Morton-Perry

Michael Phelps Larry Phipps Michael Pisan Robert Prather Stephen Price Deanna Rehmel Richard Snider Donna Stevens Thomas Stevens Robert Tennant Terry Tolle Michael Toney Shaun Tymchak Nathan Unterseher Diane Vuotto Lee Walden Anthony Wolf Richard Wong Gary Young

Let us know if we missed your name.

March/April 2008

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 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

2008 Chiropractors of the Day

Duane Binder Adam Cline Derek Dyer Donna Fredrick Michael Gallagher Richard Hilton Matt Howard & Joan Joseph Kielur Dr. Todd John Volbers Diane Vuotto Don Warren Anthony Wolf

If you have been left off this list, please let us know and we will be sure to acknowledge you in the next newsletter.

ISCA Report

3


Executive Director's Message Patricia McGuffey

ISCA is busy working on behalf of Chiropractors and the many issues and challenges you face in your practice. The Indiana General Assembly is currently having Conference Committees where legislators meet to reconcile changes the second House makes to legislation from the House of Origin. Drawing close to adjournment, ISCA has had a very successful Session so far. We have been successful in defeating legislation that would have allowed physical therapists “Direct Access” without ensuring PTs have the proper training and education to perform spinal manipulation. Silent PPO legislation, SB 159 will require conspicuous language in a DC’s contract if a network wishes to sell a DC's discounted reimbursement rate to third parties. The network would also be required to maintain a website or toll free phone number listing all networks to which the contracting network has sold the discount. It will also require third parties who purchase the discount to include contact information on explanation of benefits statements for the network who sold the discount. Finally, the bill will prohibit aggregators from selling or leasing DC’s reimbursement rates. The bill is now in the Governor’s office awaiting his signature. SEA 316 is another bill that passed and will impact chiropractic. The legislation, as introduced, primarily focused on the regulation of veterinary medicine. However, Rep. Russ Stillwell had the bill amended at the request of his local DC and Veterinarian (DVM). As of July 1, when the law goes into effect, you are exempted from regulation by the DVM licensing law if you are a member in good standing of another licensed or regulated profession (Chiropractors) within Indiana who: (A) provides assistance requested by a DVM licensed under this article; (B) acts with the consent of the client; (C) acts within a DVM-client-patient relationship; and (D) acts under the direct or indirect supervision of the licensed DVM. This will allow DCs that are properly trained to treat animals if they work within the parameters of the new law. Your communications helped to curtail a disastrous amendment to SB 302 that would have allowed Physical therapists to have Direct Access and perform Spinal Manipulation! Rep. Frizell offered the amendment on second reading to SB302, a huge profession and occupation bill that many groups were lobbying to pass. Subsequently, SB 302 would have been very difficult to defeat if the amendment had been added. In addition, SB 302’s authors were supportive of physical therapists so they would have concurred on the changes rather than sending it to Conference Committee to reconcile the differences from one House to the other. This would have left ISCA will little recourse. Great Job, we defeated the amendment 73 to 20! We had to take a different tactic on HB 1055, our assignment of benefits bill (AOB). The bill was opposed by the Insurance industry,

4

Chamber of Commerce, Indiana Manufacturing Association, most major businesses, Unions, and the Governor’s office (a list of close to a 100 groups). The insurance and business lobby distorted the issue totally out of proportion with their “sky is falling” presentations to convince many legislators as well as businesses, labor unions, and various other entities that AOB legislation would have caused health care costs to go off the charts and networks to be destroyed. HB 1055 passed 70-33 out of the House of Representatives and then 11-0 out of the Senate Health Committee. When HB 1055 moved to the Senate Floor, the opposition had Senators file numerous confusing and conflicting amendments. These amendments would have banned balance billing, cut DCs out of AOB, and mandated out of network DCs who receive AOB to take Medicaid patients, just to name a few. After the Senate Republican Caucus discussed HB 1055 and our discussions with Senator Gard, Senate author of HB 1055, we collectively decided that she should not call down HB1055 on second reading. It was clear the bill would be amended to negatively impact DCs as many legislators were confused by the amendments and all the misinformation they received from our opponents. Our opposition presented no real proof of their position despite numerous requests from legislators to do so. They depended on rhetoric and clout to forward their position without any substantive facts or statistics. While disappointed, Senator Gard and those of us fighting for HB 1055 decided that it was better to put to rest AOB legislation for this session and pass a resolution requiring it to be studied this summer. The resolution requires the mandated benefit task force to determine whether or not AOB would increase healthcare costs and then present a report to the Health Financial Commission and Legislative Council. This will provide us an opportunity to get the facts to legislators and force our opponents to present facts. In addition, next Session will not be an election year and legislators are more likely to tackle controversial issues. Collect your data and studies and assist ISCA, as we will continue to do battle on this issue through the summer and into the next legislative session. ISCA will continue to fight the good fight but many days it does feel like we are “David against Goliath”. Many of you have contacted your legislators to encourage them to support ISCA’s proposed legislation. Your work to communicate our position with your legislators has been invaluable. Thank you for being a part of our team to educate legislators. I will list the names of DC’s that have contacted their legislators later in the newsletter. ISCA’s Legislative Alerts’ Cap Wiz link tracks each DC that has contacted specific legislators. In addition, many of you copy me on your e-mails or let me know that you have contacted your legislators. I truly appreciate your interest and support in forwarding ISCA’s legislative agenda. If I have missed your name, let me know and I will list it in the next newsletter. However, if you have not contacted your legislator, remember that we as an organization are only as good as our individual members and I urge you to help us in our legislative battles by contacting your legislators. In addition to ISCA’s efforts to forward favorable legislation, we have met with both the Indiana Department of Insurance and Anthem to discuss the many concerns you have reported to ISCA. Later in the newsletter I will print a complete summation of our meeting

ISCA Report

March/April 2008


with Anthem and our understanding of their responses. In the next newsletter we will inform you of their response. Please continue to share your insurance concerns with the ISCA office and the insurance committee chaired by Dr Robert Nanko. We will continue to work to address your concerns. I attended the ACA’s National Legislative Conference in Washington D.C. I learned about national issues facing DC’s and how ISCA can work with other states and the ACA to address those issues. The issues discussed at the conference will be summarized later in this newsletter. I hope you will put all of ISCA’s activities for 2008 on your calendar and make this the year that you will work with us to make the ISCA the best that it can be. You are truly blessed to have leaders on ISCA’s Board of Directors that work tirelessly to advocate on your behalf. They give generously of their time and resources because of their love for the profession. Please join us in those endeavors by volunteering to on an ISCA committee!

2008 ISCA Spring Conference Thanks to all who participated in the recent ISCA Spring Conference. The ISCA experienced great speakers, networking, a tradeshow and more! Dinner Gala participants included spouses for an evening of fun and a chance to be hypnotized by Kevin Lepine. Special thanks to Cory Haffner with Haffner X-Ray who was the Presentation Sponsor for the entire conference. Mark your calendars for the next opportunity to meet fellow D.C.'s from the area and learn the newest developments in the profession at ISCA's Fall Conference, October 31 - November 2 at the Sheraton North Indianapolis. If you need hand-outs from the sessions please call 317.673.4245 or email info@indianastatechiros.org - please list your first and last name for attendance verification purposes and specify which session you need hand-outs for. Please take some time to take our online survey about the conference available on our website at www.indianastatechiros.org.

March/April 2008

ISCA Report

5


IsCA Legal Counsel Submitted By: Dr. David E. Jose, Esq.

This is my first column as the newly designated legal counsel working with the Indiana State Chiropractic Association. First, I want to thank the Board of Directors of the Association for this opportunity to provide legal counsel for the Association and its members. I look forward to working with the Board as well as with Pat McGuffey and others at LMV Consulting. In this first column, I’ll tell you a little about myself, and then discuss an important issue for all health care providers. On a personal level, I grew up in Richmond, Indiana. After college, graduate school and law school, we moved to Indianapolis, where we have lived since 1981. I have given presentations to a variety of legal, medical, business and civic organizations, and I am active in several civic, educational and charitable organizations. I have been practicing law in Indianapolis for almost 27 years. I have represented individual and institutional health care clients for over 20 years. This has included working on a variety of business, regulatory, licensing, administrative and transactional issues for health care providers from throughout the state. I am a partner in the Indianapolis-based law firm of Krieg DeVault LLP. Other members of our firm will be involved in providing various services to the Association and its members, and we are committed to providing solutions for your legal problems. Krieg DeVault is a law firm with over 120 attorneys in offices located in Indianapolis, Carmel, Noblesville and Northwest Indiana as well as Chicago. The firm provides a full range of services for individuals, companies, associations and governmental authorities. With a law firm this large, we provide services in nearly every area, and the areas that may be of most interest for the Association and its members include corporate, employment, litigation, intellectual property, real estate and tax. There is a substantive issue that I wanted to address in this first column. There has been a significant surge in enforcement activity by the Indiana Attorney General’s Medicaid Fraud Control Unit as well as the Federal CMS Office of Inspector General. This activity relates to “excluded individuals” who are employed by or have contracted with health care providers who participate in Medicare or Medicaid. There are potentially severe penalties for employing or contracting with an individual or company on the List of Excluded Individuals/Entities (“LEIE”). The OIG indicated in an Advisory Opinion that the prohibitions extend to administrative and management services and individuals that are not directly related to patient care. The penalties for violating the rule are civil, but significant. They include forfeiture of Medicaid or Medicare payment used to pay an individual or entity on the LEIE, along with a civil monetary penalty of up to $10,000 and the potential for treble damages and exclusion from Medicaid/Medicare. Many providers believe that performing criminal history and licensure checks of employees is sufficient. However, that is not the case. A criminal history background check will not necessarily reveal that the employee/contractor is on the LEIE. One generally reliable way of knowing if a person is excluded is to check the Exclusion Program website at http://OIG.hhs.gov/fraud/exclusions.html. In the next column, I will provide some guidance for employment and personnel practices dealing with this issue. In the meantime, let me know if you have any questions or need any assistance on this issue. David E. Jose Krieg Devault LLP One Indiana Square Suite 2800 Indianapolis, Indiana 46204 Phone: 317.238.6211 Fax: 317.636.1507 Email: djose@kdlegal.com

6

ISCA Report

March/April 2008


Become involved in ISCA!

Notice To Members

Many volunteer positions available!

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, pmcguffey@lmvconsulting.com. An ISCA committee appointed by the President will interview potential board of examiner candidates. 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

The Indiana State Chiropractic Association is now recruiting members for the following: Membership Committee Per by-laws, the 1st Vice President is the chairperson Dr. Furno Golf Committee Dr. Dyer Speaker/Conference Committee Dr. Cox - Chair Dr. Shaw Dr. Wilson Dr. Friedline Finance Committee Per by-laws, the Treasurer is the chairperson Dr. Bryan Dr. Klaes Dr. Toney Ethics/Grievance Committee Per by-laws, the 1st Vice President is the chairperson Dr. Nanko Dr. Friedline Dr. Daulton, Sr. By-Laws Committee Dr. Howard Dr. Wolf Dr. Daulton, Sr. Dr. Shaw Dr. Unterseher Legislative Committee Dr. Howard Dr. Gallagher Dr. Toney Dr. Phelps Dr. Wolf Nominating Committee Per by-laws, the 1st Vice President is the chairperson Dr. Wolf Other Volunteer Positions Those interested should contact either: Patrick Russell, ISCA Executive Assistant Email: prussell@lmvconsulting.com Phone: 317.673.4245 or Dr. Duane Binder, ISCA President Email: dbinder326@aol.com Phone: 765.832.7777

March/April 2008

ISCA Report

7


Medicare Update

Submitted by James M. Cox II, D.C. Good news is coming to us from Medicare. The CERT, national random audit results have dropped the Chiropractic Error rate from 16% to 7%. This is a good trend for us nationally. The OIG (office of inspector general), that began all the audits for Medicare, may be notifying you of request for records. The ACA is strongly urging you to contact them in regard to these requests. If you are contacted by the office of inspector general for records please contact ISCA or me, cox.chiropractic@verizon.net, and we can help you through this process. If you are being audited by anyone including Medicare, make sure you appeal to the highest level you can. Please check out the Medicare lecture at the spring seminar. This is an ACA supported lecture and should help us gain further understanding of what Medicare wants. May 23, 2008 is the date for using NPI ONLY for Medicare. After that date they DO NOT want any more legacy numbers. If you have questions on this please let the ISCA know and we can help you though this. I will remain as the Medicare Representative for the state. Please let me know what I can do to help. Respectfully submitted. James M Cox II D.C., ISCA District 3 Representative www.coxchiromed.com cox.chiropractic@verizon.net 260-484-1964 fx260-471-1817

New AMA Guidelines Violate Wilk Injunction, Says ACA Legal Team Invoking the court decision in the landmark Wilk vs. AMA lawsuit, the American Chiropractic Association (ACA) has asked for an immediate withdrawal of restrictive language in the American Medical Association’s "Guides to the Evaluation of Permanent Impairment, 6th Edition" that limits evaluations by doctors of chiropractic to the spine only. ACA has also contacted the Federal Trade Commission and the U.S. Department of Justice regarding concerns about the new guidelines. "In our view, the action of the AMA in issuing this standard unlawfully restricts competition and excludes a competitive rival, i.e. doctors of chiropractic from the provision of impairment ratings," writes ACA General Counsel Thomas R. Daly in a Feb. 13 letter to AMA Executive Vice President Michael D. Mabes, M.D. "We note that neither the ACA, nor any other major chiropractic group, was approached or provided input in the standard setting process that established this new restriction." The language in question is published on page 20 of the AMA guide in a section titled "Fundamental Principles of the Guides." Specifically, Item 6 of Table 2-1- states: "A licensed physician must perform impairment evaluations. Chiropractic doctors, if authorized by the appropriate jurisdictional authority to perform ratings under the Guide, should restrict rating to the spine." "This new standard has a devastating effect on doctors of chiropractic in that it will be used to prevent doctors of chiropractic from performing adequate and complete ratings," ACA’s letter to the AMA states. "It targets doctors of chiropractic for exclusion or elimination from this important service which they currently provide under state law in competition with medical doctors." ACA’s letter also reminds the AMA of the Wilk decision and states that the "recent action which implements a new and onerous restrictive standard on the practice of doctors of chiropractic violates existing antitrust law as well as the provision of the permanent Wilk injunction." ACA’s legal team is also seeking meetings with representatives of the Federal Trade Commission and the anti-trust division of the Department of Justice to outline the association’s concerns. In addition, ACA is identifying members of Congress who might be willing to assist the association in its efforts to redress the problem.

8

ISCA Report

March/April 2008


Prepayment Review of Chiropractic Services Carrier Chronicles National Government Services Medical Review will be implementing a prepayment review of chiropractic services in the near future to evaluate for inappropriate billing of these services. Indiana and Kentucky providers will receive an Additional Development Request (ADR letter) detailing the specific documentation being requested for the billed services. Providers who fail to provide the requested supporting medical documentation timely will receive a full claim denial. Providers billing Chiropractic Service Codes will continue to receive Additional Development Requests (ADRs) for these services until the Payment Error Rates (PER) and/or Claim Error Rates (CER) fall to an acceptable level (usually less than 10%). The ADR letter details the specific documentation requested for the billed services. Please reference the Post Office Box Consolidation Crosswalk [1] for the correct address for documentation submission. More information on Chiropractic Services and Medicare Coverage Guidelines is found in the Local Coverage Determination [2](LCD) for Chiropractic Services. Members receiving these types of requests should contact Dr. Jim Cox II at cox.chiropractic@verizon.net or Dr. Chris Klaes at drchris@klaesclinic.com.

U.S. House Introduces Resolution Calling for Immediate Commissioning of Chiropractors into Armed Forces Reprinted from the American Chiropractic Association website

U.S. Reps. Neil Abercrombie (D-Hawaii), Thelma Drake (R-Va.), Robert Brady (D-Penn.), and Ron Paul (R-Texas) have introduced a resolution, backed by the American Chiropractic Association (ACA), that calls for immediate establishment of a career path for doctors of chiropractic as commissioned officers in the U.S. Armed Forces. House Concurrent Resolution 294 states that although the Secretary of Defense has statutory authority to commission doctors of chiropractic as military officers, the Pentagon has failed to do so. The resolution specifically expresses the view of Congress that the Secretary of Defense take immediate steps to appoint doctors of chiropractic as commissioned officers in the military health care system. A concurrent resolution is a formal proclamation that states the opinion of Congress, and does not require the president's approval and thus does not have the force of law. “Chiropractic inclusion in the officer health care corps of the Armed Forces is long overdue,” says ACA President Glenn Manceaux, DC. “With passage of this resolution, not only will our men and women in uniform have access to the best treatment options available for musculoskeletal pain, but chiropractic inclusion can significantly decrease military health care expenditures by reducing the number and prevalence of chronic structural injuries.” According to Reps. Abercrombie and Drake, military personnel in combat theaters of operation are in urgent need of access to the widest possible range of health care options, especially for nueromusculoskeletal conditions. Furthermore, a 2007 report from the Veterans Health Administration indicates that nearly 45 percent of veterans returning from the Iraq and Afghanistan who have sought VA health care did so for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for the report. For years, the American Chiropractic Association (ACA) has championed the effort to more fully integrate chiropractic care—a proven and cost-effective health care choice—into the military and veterans’ health care systems. According to Dr. Manceaux, ACA is committed to working with Reps. Abercrombie, Drake, Brady, Paul and other pro-chiropractic members of Congress, to ensure that the members of the U.S. Armed Forces receive unrestricted access to the chiropractic benefit. Doctors of chiropractic and those interested should contact their member of Congress immediately and ask them to cosponsor House Concurrent Resolution 294. For more information on the recent congressional session, or to discuss ACA’s ongoing legislative efforts, contact ACA Vice President of Government Relations, John Falardeau, at (703) 812-0214, or jfalardeau@ acatoday.org.

March/April 2008

ISCA Report

9


Tips to Facilitate the Medicare Enrollment Process To ensure that your Medicare enrollment application is processed timely, you should: 1. Submit the 2006 version of the Medicare enrollment application (CMS-855). Effective May 1, 2006, the Centers for Medicare & Medicaid Services (CMS) revised the CMS- 855 Medicare enrollment applications. Providers and suppliers must submit the appropriate 2006 version of the CMS-855. The application version can be found in the lower left corner of the application. If an applicant submits the 11/2001 version of the CMS-855, the Medicare contractor will return your application without further review. An electronic copy of the current CMS-855 Medicare enrollment application can be found at online at: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp 2. Submit the correct application for your provider or supplier type to the Medicare fee-for-service contractor servicing your State or location. The Medicare contractor that serves your State or practice location is responsible for processing your enrollment application. Applicants must submit their application(s) to the appropriate Medicare fee-for-service contractor. A list of the Medicare fee-for-service contractors by State can be found in the download section of www.cms.hhs.gov/MedicareProviderSupEnroll. 3. Submit a complete application. When completing a CMS-855 for the first time for any reason, each section of an application must be completed in ink (blue preferable). When reporting a change to your enrollment information, complete each section listed in Section 1B of the CMS-855. Note: If you are enrolled in Medicare, but have never submitted the CMS-855, you are required to submit a complete application. Providers and suppliers should follow the instructions for completing an initial enrollment application. The attachment at the end of this document provides tips for completing each section of the CMS- 855. 4. Request and obtain your National Provider Identifier (NPI) number before enrolling or making a change in your Medicare enrollment information. CMS requires that providers and suppliers obtain their National Provider Identifier (NPI) prior to enrolling or updating their enrollment record with Medicare. A Medicare contractor will not process your enrollment application without the NPI and a copy of the NPI notification letter received from the National Plan and Provider Enumeration System or the organization requesting your NPI. The NPI notification is required with each CMS-855 application you submit. If you do not have an NPI, please contact the NPI Enumerator at https://nppes.cms.hhs.gov or call the Enumerator at 1-800-465-3203 or TTY 1-800-692-2326. 5. Submit the Electronic Funds Transfer Authorization Agreement (CMS-588) with your enrollment application, if applicable. CMS requires that providers and suppliers, who are enrolling in the Medicare program or making a change in their enrollment data, receive payments via electronic funds transfer. Reminder: when completing the CMS-588 complete each section. The CMS-588 must be signed by the authorized offical that signed the CMS-855. Note: If a provider or supplier already receives payments electronically and is not making a change to his/her banking information, the CMS-588 is not required. If you are a supplier who is reassigning all of your benefits to a group, neither you nor the group is required to receive payments via electronic funds transfer. 6. Submit all supporting documentation. In addition to a complete application, each provider or supplier is required to submit all applicable supporting documentation at the time of filing. Supporting documentation includes professional licenses, business licenses, the National Provider Identifier notification received from the National Plan and Provider Enumeration System and, if applicable, an authorization agreement for Electronic Funds Transfer Authorization Agreement (CMS-588). See Section 17 of the CMS-855 for additional information regarding the applicable documentation requirements. 7. Sign and date the application. Applications must be signed and dated by the appropriate individuals. Signatures must be original and in ink (blue preferable). Copied or stamped signatures will not be accepted. 8. Respond to fee-for-service contractor requests promptly and fully. To facilitate your enrollment into the Medicare program, respond promptly and fully to any request for additional or clarifying information from the fee-for-service contractor.

10

ISCA Report

March/April 2008


ACA News Update from Dr. Tennent United Rescinds Headache, Pediatric Policy Chiropractic profession’s unified response to “flawed” policy is effective. Following an unprecedented profession-wide campaign led by ACA, United Healthcare (UHC) announced in January that it will rescind its recent policy declaring chiropractic manipulative treatment for headaches and pediatric patients unproven and therefore, not a covered service. “We are please that UHC has decided not to implement this policy,” said ACA President Glenn Manceaux, DC. “We strongly believe that through the actions of ACA, along with the other chiropractic organizations, the profession made a compelling argument as to why this policy should be rescinded. Our members, the profession and our patients will be well served by UHC’s decision.” Since September 2007, ACA has maintained a line of communication with UHC to emphasize its members’ concerns over the proposed policy change. Furthermore, ACA joined forces with the Association of Chiropractic Colleges (ACC), the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), the Council on Chiropractic State Associations (COCSA), the Foundation for Chiropractic Education and Research (FCER) and ICA to issue a joint letter opposing what the groups described as a “flawed” and “unconscionable” policy and supporting a detailed CCGPP analysis and critique of UHC’s stance. The ACA Council on Chiropractic Pediatrics also submitted a separate response to UHC. In October, after the chiropractic profession’s swift and unified response, UHC delayed implementation of the policy pending additional review of research and information provided by the ACN Chiropractic Professional Advisory Committee (CPAC) and other chiropractic organizations. “ACA is proud to have led this effort, which serves as a very important reminder that there is strength in numbers. When all corners of the profession work together with a single vision and a single voice, there is no limit to what we can accomplish,” said Dr. Manceaux. “It also underscores the critical role research and evidence play in the reimbursement world, and the need for insurers to consult with the chiropractic profession before implementing changes that negatively affect our patients.”

HHGregg bill dies in Senate Reprinted from Inside Indiana Business

Senate leaders yesterday decided to pull the plug on House Bill 1055, affectionately nicknamed by doctors and their allies for the televisions and other expensive gadgets patients mistakenly buy with checks they receive from health insurance companies. The bill, which passed in the House, would have required insurers to send payments to doctors, hospitals and other health care providers - even if those providers are "out-of-network," meaning they have not negotiated prices with a particular health insurer. Currently, Anthem, UnitedHealthcare and some other insurers send payment to their customer, the patient, when the insurer has no contract with the particular health care provider the patient is seeing. Patients often don't realize the check is intended to be used to pay the anesthesiologist and surgeons who ended their agony during that trip to the ER for appendicitis. Instead, they go out shopping. More than one person with an unexpected windfall from his health insurer decides he will now grace his den with a 50-inch plasma TV. The Indiana Chamber of Commerce lobbied hard against the bill, saying it would lead to higher costs for employers and health

March/April 2008

insurance customers. With end-of-session alarm, the Indiana Chamber sent out an e-mail on Friday saying the bill would lead to a "HUGE Increase in Health Care Costs." The bill passed the House in January with bipartisan support. The Chamber argued that if health care providers can receive direct payments from health insurers without joining those insurers' network, insurers will have a harder time constructing these networks. Since providers almost always agree to give discounts when they join a network, having fewer providers in networks would raise prices overall. But Julie Halbig, a lobbyist for the Indiana Hospital Association, said doctors and hospitals need to join health insurers' network because they make most of their money from commercially insured patients. She also noted that more than 20 other states have adopted similar laws - without dire consequences. "If they're able to do it, I'm not sure what's the big deal," she said.

ISCA Report

11


CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME Database Company Ingenix – Used by Dozens of Insurers – at Center of Scheme Cuomo Notifies Ingenix and its Parent, UnitedHealth Group, of Intent to File Suit; Subpoenas 16 Other Companies Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation’s largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country. Cuomo also announced that he has issued 16 subpoenas to the nation’s largest health insurance companies including Aetna (NYSE: AET), CIGNA (NYSE: CI), and Empire BlueCross BlueShield (NYSE: WLP), and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries. The six-month investigation found that Ingenix operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two subsidiaries of United (the “United insurers”) dramatically under-reimbursed their members for out-ofnetwork medical expenses by using data provided by Ingenix. Under the United insurers’ health plans, members pay a higher premium for the right to use out-of-network doctors. In exchange, the insurers promise to cover up to 80% of either the doctor’s full bill or of the “reasonable and customary” rate depending upon which is cheaper. The Attorney General’s investigation found that by distorting the “reasonable and customary” rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs. “Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is,” said Attorney General Andrew Cuomo. “But when insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need.” Cuomo’s investigation also found a clear example of the scheme: United insurers knew most simple doctor visits cost $200, but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80%, covering only $62 for a $200 bill, and leaving the patient to cover the $138 balance. The United insurers and many other health insurance companies relied on the Ingenix database to determine their “reasonable and customary” rates. The Ingenix database used

12

the insurers’ billing information to calculate a “reasonable and customary” rate for individual claims by assessing how much a similar type of medical service would typically cost, generally taking into account the type of service, physician, and geographical location. However, the investigation showed that the “reasonable and customary” rates produced by Ingenix were remarkably lower than the actual cost of typical medical expenses. The United insurers and Ingenix are owned by the same parent corporation, United HealthGroup. When members complained their medical costs were unfairly high, the United insurers hid their connection to Ingenix by claiming the rate was the product of “independent research.” The Attorney General’s notice to United expressed concern that the company’s ownership of Ingenix created a clear conflict of interest because their relationship gave Ingenix an incentive to set rates that benefited United and its subsidiaries. Cuomo’s notice of intent to sue names the following potential defendants: UnitedHealth Group and its subsidiaries, United HealthCare Insurance Company of New York, Inc., United Healthcare of New York, Inc., United Healthcare Services, Inc. and Ingenix. The subpoenas served today request documents showing how the insurer computes reasonable and customary rates, copies of member complaints and appeals, and communications with members and between Ingenix and the insurer on the issue. Cuomo continued, “The lack of accuracy, transparency, and independence surrounding United’s process for setting a ‘reasonable and customary rate’ is astounding. United’s ownership of Ingenix coupled with the inherent problems with the data it is using clearly demonstrate a broken reimbursement system designed to rip off patients and steer them towards in-network-doctors that cost the insurer less money.” Consumers Union Programs Director Chuck Bell said, "Based on the findings in this investigation, it appears that United Health failed to fulfill the promises it made to cover a fair portion of medical expenses, and consumers were stuck with the bill. The current process for establishing ‘reasonable and customary’ rates is riddled with conflicts of interest and manipulations that consistently lead to patients paying more, and insurers paying less. We applaud Attorney General Cuomo for taking on this issue which is vitally important for consumers everywhere.” Cancer Care’s Associate Executive Director Ellen Coleman said, “Cancer patients and others faced with life-threatening illnesses need to know that a fair portion of the often overwhelming medical expenses will be covered by their insurance company. Insurers should fulfill their promises and

ISCA Report

March/April 2008


CONTINUED... not leave patients forced to choose between the medical care they need and the medical care they can afford. Cancer Care thanks Attorney General Cuomo for taking action on this issue and for continuing to protect the rights of patients.”

lETTER TO THE u.s. nEWS & wORLD rEPORT

By: Glenn Manceaux, DC - President, American Chiropractic Association To the U.S. News & World Report Editor:

“The litigation initiated by the Attorney General is critically important for two reasons,” said Ron Pollack, Executive Director of the health consumer organization Families USA. “First, it is essential that health services obtained outside of a network be compensated fairly and adequately. Eighteen million Americans under the age of 65 will spend more than a quarter of their family income on health care this year, and healthcare debt is the number one cause of individual bankruptcy. Second, there needs to be transparency in these payment arrangements. For these reasons, we support the efforts of the Attorney General.”

Your Jan. 21 article “Embracing Alternative Care” discussed an important and growing trend in our nation’s health care system; however, I was disappointed to find chiropractic had been omitted from the article.

The American Medical Association's President-elect Nancy Nielsen M.D. said, “The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members. Patients have a right to expect fair and accurate payment for services promised by health insurers. The AMA greatly appreciates the Attorney General’s interest and leadership in protecting consumers, and we offer our full cooperation in any effort to hold UnitedHealth accountable to New York state laws.” The Medical Society of the State of New York President Dr. Robert Goldberg said, “The Medical Society of the State of New York applauds Attorney General Cuomo and his hardworking staff for their diligent efforts in moving forward in an investigation that we believe will have long term benefits to healthcare in New York. MSSNY also applauds the Attorney General for acting on the complaints of our patients and our physician members.”

Hospital administrators can attest that by adding chiropractic to a facilities’ clinical team, both the hospital and its patients benefit from improved patient outcomes, high levels of patient satisfaction, and overall cost savings.

The Attorney General’s industry-wide investigation is being handled by Acting Deputy Chief of the Healthcare Bureau James Dering as well as members of the Healthcare Industry Taskforce, Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of the head of the Attorney General’s Healthcare Industry Taskforce, Linda Lacewell.

Today there are at least several hundred doctors of chiropractic who work within a hospital setting where they deliver nonsurgical, drug-free care to thousands of patients. One notable example of chiropractic’s successful integration includes the chiropractic department at the National Naval Medical Center in Bethesda, Maryland.

Health care delivered by a multi-disciplinary team has tremendous potential to remedy this country’s health care crisis. Now, as never before, is the time to fully embrace integrative care.

Upcoming ISCA Events

Mark your calendars, ISCA has many great events coming up this year - you won't want to miss out! Check out www.indianastatechiros.org for updates! 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 - Indianapolis, Indiana 46240

March/April 2008

ISCA Report

13


New article?? Article Text

An important message to our doctors‌ Many of you purchased new chiropractic tables this year from Haffner XRay. I would first like to thank you for your purchase, but more importantly remind you to file for your TAX CREDIT! Your accountants already know about the Section 179 Capital Equipment Deduction, but many do not know about the ADA Tax Credit associated with tables that elevate. You will receive an approximate 50% dollar for dollar tax credit up to $5000 on the purchase of any elevation table. For example, if you bought a $10,000 decompression package, you would get nearly $5000 in tax credit and nearly $2000 in section 179 write off. That makes your net in a new table $3000*. *consult your tax advisor and we are not accountants If you purchased last year and did not file for the ADA credit, ask your accountant if you still can. Give our office a call if you have questions or need the necessary paperwork to give to your accountant. Respectfully, Cory Haffner (800) 382-2722 www.haffnerxray.com

New DTS Triton

14

Chattanooga Adjusting tables

ISCA Report

Hill flexion tables

March/April 2008


The Price of Pain : A new study reveals that Americans are spending record amounts on treatments for their aching backs. But are these expensive fixes a waste of money? By Karen Springen | Newsweek Web Exclusive

After what seemed like a minor fall, Bruce Wilson began having back pain. That was 25 years ago. Since then the former manufacturing executive, now 60, has had seven operations—at a cost to insurance companies of $278,000. Yet Wilson's back still hurts, and he spends hundreds of dollars a month on pain relievers and other medications. Now a surgery vet, Wilson has some hard-won advice for other sufferers: "I'd tell young people with back problems that they should try the nonsurgical avenues first." When doctors recommend an operation, says the Seattle resident, "we're all too quick to agree. As a society, we all want instant gratification or instant relief." Despite a growing array of sophisticated drugs, diagnostics, physical therapies, and surgical techniques, the millions of Americans battling back pain may not be any closer to getting that quick relief than they were 20 years ago. Several recent studies indicate that even with the latest in high-tech medical intervention, effective treatments for back problems remain elusive. And in any case, the price tag is staggering. In 2005 Americans spent $85.9 billion looking for relief from back and neck pain through surgery, doctor's visits, X-rays, MRI scans and medications, up from $52.1 billion in 1997, according to a study in the February 13 issue of the Journal of the American Medical Association (JAMA). That money hasn't helped reduce the number of sufferers; in 2005, 15% of U.S. adults reported back problems—up from 12% in 1997. Not only are more people seeking treatment for back pain, but the price of treatment per person is also up. In the JAMA study, researchers at the University of Washington and Oregon Health & Science University compared national data from 3,179 adult patients who reported spine problems in 1997 to 3,187 who reported them in 2005—and found that inflation-adjusted annual medical costs increased from $4,695 per person to $6,096. Spinal patient costs were also significantly higher than for nonspinal patients. "People with back problems cost 76 percent more on average than people without back problems each year," says study co-author Brook Martin, a research scientist at the University of Washington. "We seem to be doing more and more," says Dr. Rick Deyo, co-author of the JAMA report and Kaiser Permanente professor of evidence-based family medicine at Oregon Health & Science University. "[But] there's no evidence that people are getting more pain relief." In fact, they self-reported more work limitations and poorer functioning in 2005 than in 1997, he says. "This suggests to me that we're overtreating a lot of people, and we're providing a lot of services that may not be very beneficial."

Support Expansion of VA’s Chiropractic Care Program - Federal ACA Issues Although some veterans have now gained access to a doctor of chiropractic in their local VA facility, millions of veterans still have problems accessing chiropractic care. In the more than 125 major VA health facilities without a doctor of chiropractic on staff, the chiropractic care benefit that Congress authorized for America’s veterans remains virtually non-existent as referrals off the VA campus tend to take place on an inconsistent basis. Recent VA data (Analysis of VA Health Care Utilization among US Southwest Asian War Veterans, Oct 2007”) cite “diseases of musculoskeletal system/connective system”, back pain, as the No. 1 ailment of Iraq/Afghanistan veterans accessing VA treatment. ACA-backed H.R. 1470 requires the VA to phase-in availability of chiropractic care at all major VA medical centers within the next several years. Specifically, the bill would require 75 VA major medical centers to have a chiropractor on duty before the end of 2009 and all major health care facilities to have a chiropractor on duty before the end of 2011. H.R. 1470 passed the U.S. House of Representatives in May 2007. However, the bill is still pending in the Senate. ACA encourages doctors of chiropractic and chiropractic patients to contact their U.S. senators and ask them to support this important legislation. You can call your senator at 202-224-3121. All of America’s veterans should have equal access to this important health care benefit. Veterans want, need, and deserve access to chiropractic care, and doctors of chiropractic must be fully integrated into the veterans health care system.

March/April 2008

ISCA Report

15


ISCA Anthem Letter

Letter to Anthem outlining concerns and the corresponding responses. I. Decreasing Reimbursement Concern: The ISCA voiced concern over the systematic decrease in reimbursement for chiropractic services over the past 10 years in the face of ever increasing C.O.L.A, and business overhead, together with continually increasing insurance premiums. Cost of doing business (overhead) for the average practitioner has increased from an average of 48% (1998) to an average of 60% (2007), with continually decreasing reimbursements forcing numerous practitioners into bankruptcy. Those practitioners have no option but to remain in-network for fear of losing their patient-base despite meager profit margins. Reimbursement decreases occur without due and timely notice to the field practitioner, in apparent violation of contractual language. Response: It was explained that the cost of healthcare generally was increasing 10% yearly and that the fiduciary responsibility of Anthem was to curtail those costs. As a result, Anthem has initiated a concerted effort to decrease reimbursement across the board for ALL healthcare providers equally, in a non-discriminatory manner. Furthermore, Anthem reviewed the RBRVS (Resource Based Relative Value Scale) at least once yearly in order to determine reimbursement values, however, the Conversion Factor(s) Anthem employed could not be disclosed and differed from that utilized by Medicare. However, Anthem contends, reimbursement to chiropractors in Indiana was generally higher than in the surrounding states and fell within the median (per Mercer Data Base) for similar services performed nationwide. Anthem indicated that the “any willing provider” law that allowed all healthcare providers to enter networks was one reason for increased costs as networks were large and unwieldy. In addition, Anthem suggested we review studies/surveys to determine if our rates were comparable to other practitioners. You indicated you will forward us information on how we may access that information. In addition, it was noted that reimbursement rates for Chiropractors would be reviewed to determine if adjustments are necessary. Lastly, you indicated proper notice was given for rate reductions and information was on your web site. II. Medical Necessity Definition/Determination, Treatment Guidelines, Experimental or Investigational Therapies Concern: The ISCA voiced concern that claims were being denied without proper explanation or clarification, leaving the practitioner confused and without recourse. In addition, we indicated that Anthem’s definition of “Medical Necessity” and experimental or investigational therapies are vague and confusing, given the denial of claims based on this issue. ISCA requested information on how Anthem determines Medical Necessity and what is experimental or investigational and what documentation was utilized to determine if the treatment is medical necessity or experimental. ISCA shared that the field practitioner is having claims denied based on what appears to be vague and ambiguous determinations. Notwithstanding

16

“Medical Necessity” the ISCA has received numerous reports from practitioners that ongoing treatment is suddenly denied, with further treatment categorized as “Maintenance Care”, which is not reimbursable. Lastly, ISCA requested information on what our clinicians can do to meet Anthem’s criteria for medical necessity and to determine if therapies are investigational or experimental. Response: It was stated that a R.N. reviews chiropractic claims and makes the determination of “Medical Necessity”. Should any questions exist beyond the purview of the nurse, the claim is forwarded to the Medical Director, a medical doctor, to review. Any further uncertainties are reviewed by a chiropractor (Dr. Levinson), Missouri, who makes a final determination. In addition, you will provide ISCA with information on the criteria Anthem uses to determine medical necessity and what is experimental/investigational so that we may share that information with our members. It was agreed by all that better communication and education could assist with many of these problems. Anthem indicated their willingness to present seminars for ISCA members to assist with these issues. Overall, it was agreed that communication and education would go a long way in addressing most of the concerns of the field practitioner. Anthem assured the ISCA that a concerted effort would be forthcoming regarding educational seminars, publications and access to the Anthem web site. III. Pre-Existing Clauses Concern: ISCA inquired what Anthem’s policy was regarding pre-existing condition as Dr Nanko had a patient that had not utilized their policy for more than two years but was denied coverage based on a pre-existing condition. Response: Ms. Barrabee indicated that was not Anthem’s policy and she would check into the situation for Dr Nanko. In addition, she would provide ISCA some information to share with our membership regarding their limitations on pre-existing condition. IV. Audits Concern:There have been numerous complaints from DCs regarding Anthem audits. The ISCA explained that there appeared to be a lack of “Audit Criteria” and that our DCs felt the audits were nothing more than “fishing expeditions”. The ISCA requested Anthem to provide information on audit criteria. In addition, we requested that Anthem educate DCs regarding any identified areas of inconsistency and coding and/or billing irregularities. We also requested the opportunity for our DCs to have notice of inconsistencies or the need to make changes in documentation in order for them to rectify and correct any problems before a full scale audit. ISCA suggested that Anthem resort to “target audits” instead of carte blanche review of the patient file and claims history once in possession of the records, and that the practitioner be forewarned of Anthem‘s concerns prior to audit.

ISCA Report

March/April 2008


CONTINUED... The ISCA made clear that the administrative tumult, emotional stress and anxiety thrust upon the DC, the staff and their family greatly exceeded the bounds of reason. We indicated that Anthem’s practice of demanding wide-ranging copies of patient’s files for audits created bad will on behalf of our members and was felt to be inappropriate. Response: Anthem conveyed they are receptive to reviewing the present audit criteria. In addition Anthem indicated their willingness to provide the criteria and specific areas of concern to the ISCA in order to cultivate a more cooperative and trusting relationship with not only the chiropractic profession but with all health care providers. V. Anthem/DC Contract issues Concern: ISCA raised the concern that we felt powerless to discuss reimbursement fees since we could not negotiate fees with Anthem on behalf of the chiropractic profession, nor could chiropractic members negotiate fees as potential antitrust violations of the Sherman Act, Section 1, existed. This placed the ISCA in an untenable position with regard to representing its membership regarding Anthem’s policy of continual reimbursement reductions. In effect, the chiropractic profession in the state of Indiana found itself, unable to present its case for the purpose of fee negotiation. ISCA expressed concern that the Anthem contract is presented with NO fee schedule attached and essentially on a “take it or leave it” basis. We also expressed concern that a fee schedule may only be obtained upon request, where Anthem will provide their “Applicable Anthem Rate”, which Anthem revises unilaterally, without explanation for the reductions. No opportunity for fee-negotiation is provided. Furthermore, the Anthem contract allows for unilateral change of any term of the contract, generally to the disadvantage of the provider. Most DCs have little choice as they simply cannot walk away from contracts that constitute a high percentage of their patient base because they cannot readily replace that lost business. Response: Essentially, it was stated and understood that Anthem’s position was that the only provider-choice was to withdraw from the contract regardless of the potential of loss of patient base and/or bankruptcy. Anthem indicated that information provided to the enrollees/policy holders stating that “Anthem negotiates with providers to obtain the best fees” actually means that Anthem negotiates with facility based or institutional providers and not individual providers for those fees.

March/April 2008

President Bush recently delivered his final budget request to Congress and the federal monetary blueprint contained cuts to many programs administered by the Department of Health and Human Services, including Medicare. Many legislators, especially Democrats that hold the majority in both the House of Representatives and the Senate have stated that the White House proposed cuts are doomed for failure. Rep. Pete Stark (D-CA), chairman of the House Ways and Means subcommittee on Health, even went so far as to call the Bush federal healthcare plan “Dead on Arrival.” The administration plan proposes that Medicare spending growth be lessened by $12.4 billion in Fiscal Year 2009 and by $178.2 billion over five years. The White House claims that those savings would reduce Medicare’s growth rate to five percent annually, down from the just over seven percent currently projected. Total spending for Medicare and Medicaid in fiscal 2009 would be $638.1 billion under the Bush proposal, compared with $608.7 billion in FY 2008. The largest Medicare reduction would come from slowing the growth of hospital spending by freezing payment rate increases for the next three years. This would eliminate $4 billion in Medicare growth in FY 2009, and $64.2 billion over five years. The White House budget also proposes a $1.8 billion cut in payments to hospitals that treat large numbers of uninsured and poor patients. Regarding payment to Medicare providers, including doctors of chiropractic, the Bush plan will apply a cut of 0.4% to all Medicare provider payments when general fund contributions to the Medicare system exceed 45%. Additionally, and this is outside the White House budget plan, effective July 1, the formula currently used to determine Medicare physician reimbursement rates will automatically trigger a double digit percent cut if Congress does not act. The president’s budget would not make any direct cuts to Medicare Advantage, the private sector health insurance alternative that is funded by HHS. Critics of Medicare Advantage point to the higher payments that the plans — run by private insurers — receive compared with traditional Medicare per-patient costs. Reacting to pressure on Capitol Hill, HHS chief Michael Leavitt on Monday admitted that it may indeed be difficult for legislators to address the growth of health spending, especially in an election year. “It’s very clear to me that members of Congress don’t want to deal with this,” Leavitt said of Medicare’s annual jump in costs. However, Leavitt added, “if they don’t do it now, they’ll have to deal with it later.” In the coming weeks, Congress will start hearings related to the Fiscal Year 2008 budget and later this spring; pass a budget resolution that will serve as a outline for actual funding bills that must pass before the start of the fiscal year, October 1. In past years, the majority of funding bills did not pass Congress until well past the start of the fiscal year and stopgap measures were agreed to in order to keep federal programs operating.

ISCA Report

17


Indiana State chiropractic association classifieds PRACTICES FOR SALE Retiring in progressive south central Indiana town. Turnkey opportunity in fully equipped fully staffed newly remodeled office. Serious inquiries only, please. Confidentiality agreement must be signed before any information is shared, but priced for quick sale. Send email to dcprac4sale@hotmail.com Posted 3/5/08 Practice for sale in Lawrenceburg, Indiana. 10 year old well-established practice in a rapidly growing area. $250,000 gross in 2007 on 3 days per week. General diversified practice, fully equipped, modalities, low-tech rehab, x-ray. Excellent oppurtinity. Practice has great growth potential. Motivated seller. Contact Dr. Mike at 513-266-6261. Posted 2/8/08 Associate to Owner Opportunity in 1 year Indianapolis, IN Energetic, Enthusiastic Chiropractor wanted for fabulous associateship to owner opportunity in Indianapolis. Work to learn the practice in 2008 and own the practice in 2009. This Indianapolis office which has been established for 40+ years. This practice has over 8500 patient files and has collections consistently over $250,000 with $150,000 cash flow to the doctor. Great patients. Great practice. Great opportunity to learn earn and own an established practice. Only financially secure persons need respond to indianapolisopportunity@gmail.com Posted 2/6/08 North west side of Indianapolis high traffic street, ample parking, December 2003 Universal High Freq. X-ray and processor unit included, decompression table and EMS, Att-300 intersegmental traction table. Great for PI, cash, Ins. in strip mall w/ other professionals. Priced at 50K OBO for equipment, files, furniture. Rent: $1182.00/monthly. Doctor moving out of state. For more info, please call 317-417-4392 or email officedc2000@yahoo.com. Posted 2/6/08 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 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

18

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 http://web.mac.com/binghamville/ 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 buyyourpractice@hotmail.com

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 drssconrad@aol.com 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 kormsby@sandordev.com.

Associates Available Well Skilled, personable, efficient in patient care. Proficient in various techniques, inc. Proadjuster. Licensed from 1994. Exp:Bus.Owner/Associate/ Vac fill-in. Available for temp.or permanent work. For more information please contact 765683-0845 or katsan7@yahoo.com Kathleen Sanderford, D.C. Posted 2/14/08 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 chirostutz@yahoo.com. Posted: 1/23/08

ISCA Report

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

Associates Wanted Chiropractic Coverage Needed Maternity coverage need in Crete, Illinois (40 min. south of Chicago) starting June 2008 for 6-8 weeks. Must be proficient in Thompson, Diversified, Cox techniques and base knowledge of Activator is a plus. Send Resume to Dr. Sara Wallace 1020 E. Steger Road Crete, Il 60417 or E-mail to drsarawallace@yahoo.com. Posted 3/10/08 Attention All Chiropractors. Don't miss this opportunity! Come learn how to run a High Volume, System based office where patient care comes first. You will earn a competitive salary w/ benefits, work in a positive atmosphere with a well trained staff and have the possibility to run your own office. To learn more about this position, Contact Tiffany Root at 812-299-7000 or email resume to andersonchirosouth@yahoo.com. Visit our website acwegotyourback.com to learn more about Anderson Chiropractic. Posted 3/6/08 $50-75K Starting Base Salary + Bonus: South Bend IN Doctors needed for practices in the South Bend, Indiana region. Our rapidly expanding practices incorporate the services of Chiropractic, Massage, Physical therapy, Acupuncture, and Nutrition. Our practice concept is unique, with a heavy emphasis on patient customer service, achieved by a thorough training program for doctors and staff. Our doctors do not participate in spinal screening-type marketing; we network with the local medical community. Doctors enjoy good growth potential, advancement opportunities, CEU's, Malpractice Insurance, medical and dental benefits, and profit sharing program. Doctors must be eligible to work in the United States and possess a valid driver's license. Preventive Medicine doctors are expected to grow their clinics. $1000 Signing Bonus. Send resume to: Carrie Hannon c/o Preventive Medicine, PC 212 W. Edison Rd, Ste B Mishawaka, IN 46545. ph: 866-499-1400 ext 201 fax: 574-254-1650 email: hr@preventivemedicinepc.com www.preventivemedicinepc.com Posted 2/29/08 Christian doctor seeking Tandem Associate for busy, growing 15 year-old Hendricks County practice to help care for this rapidly growing community. Current doctor and father of 6 looking for intelligent, ethical, personable doctors who are still willing to learn, commit to long-term working relationship. Potential candidates require a passion for excellence and a burden for caring for people. Serious inquiries only. Send resume to

March/April 2008


Indiana State chiropractic association classifieds docrocbyrd@sbcglobal.net Posted 2/25/08 Busy chiropractic office in NW Indiana looking for an associate to begin as soon as possible. Please fax your resume to (219) 736-7363 or email to rhkchiro@sbcglobal.net Posted 2/13/08 Wanted! Chiropractic Neurologist / Board Certified or Eligible to join with established Chiropractic Neurologist in Indy Metro area. Please send resume to drspine26@yahoo.com Posted 2/11/08 Looking for an associate. New dr or just sick of running your own practice? We can help! Salary + bonus. 28 hour work week. No Fridays or Saturdays. Not a misprint! Give me a call! Terry Tolle 317-496-2530 Posted 1/24/2008 Established Indianapolis chiropractor looking for associate interested in joining a multi-disciplinary practice. AO experience a plus. Check us out on the web at www.PratherWellness.com. Send resume and cover letter to info@pratherwellness.com. 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 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. Woolard-SpinalLogicChiropractic.com or HealthZoneChiropracticSystems.com-317-3404368 or e-mail-drdreamers@aol.com Golden opportunity in Southeast Indiana. 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@ hotmail.com 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 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,

March/April 2008

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 BackWorks@comcast.net

or bgraham001@sbcglobal.net Posted: 2/4/08

Vacation Doctors

Transworld 300ma 125 kvp chiropractic Xray system complete with floor to wall tubestand with electric locks, 14x17 wallstand with grid, certified collimator and 1.0 - 2.0 140,000 HU tube. Comes complete with operator barrier, cassettes, darkroom accessories and Fischer automatic 90 second cold water film processor. $5,900 obo Call Dr. Scott Little (812) 333-2501 Posted: 1/31/08

Well Skilled, personable, efficient in patient care. Proficient in various techniques, inc. Proadjuster. Licensed from 1994. Exp:Bus.Owner/Associate/ Vac fill-in. Available for temp.or permanent work. For more information please contact 765683-0845 or katsan7@yahoo.com Kathleen Sanderford, D.C. Posted 2/14/08

Renaissance Decompression Table. This table is top of the line works and looks great. Moving into a new office and do not have space for this table. Motivated to sell. If interested contact me, Deborah Seng, at cma4321@hotmail.com or call at 812-738-8136 ext. 109 Posted: 1/30/08

Licensed doctor to cover your practice. Over 10 years experience. Excellent adjusting skills, Many references. Call Dr. Flynn at (317) 580-1145

Wanted - D.C. looking for used Arthrostim adjusting instrument. Please contact Wes Kemp, D.C. Phone: 812-897-1700 Email: kempchiro@sbcglobal.net Posted: 1/23/08

Licensed doctor to cover your practice. 8 years of experience, available state wide. References available. Call Dr. Reynold at (309) 269-0317 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 chirocouple@ hotmail.com Palmer graduate, 25 years experience, excellent adjusting and people skills. References available. Call Dr. Grotzinger (317) 585-4808

Equipment For Sale FLEXION DISTRACTION TABLE-manual table made by Barnes. Good shape, burgundy upholstery, extra ankle straps. $1000 or best offer, Call Dr John 299-3330 or drvolbers@comcast.net Posted 2/19/08 Chattanooga Genisys 4-channel e-stim/US combo unit with cart and sEMG cables/electrodes for sale. Just over a year old and very lightly used. Perfect working condition, just no longer need. New costs over $5000. Will sell for $3500. Please contact Dr. Brian McCarley for more details 317565-1726. Posted: 2/5/08 Chattanooga Triton Decompression Table. In use for only 18mo. Dr. upgrading. $4500.00 For more information contact: Bob Graham 616-539-7474

ISCA Report

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: 812-897-1700 Email: kempchiro@ sbcglobal.net 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. Wanted - Relaxo Hylo with hydraulic extension. Email jansenchiro@sbcglobal.net

Post a Classified Ad

ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. Non-members may place ads for $25 per ad per issue. To place a classified ad visit us online at www. indianastatechiros.org or call 317.673.4245.

19


ISCA Report

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

PRSRT STD U.S. Postage Paid Indianapolis, IN Permit No. 779

ISCA Mar/Apr Newsletter 2008  

news in chiropractic.

Advertisement