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ISCA Report

May/JUne 2008

President's Message Dr. Duane Binder, D.C. I am very pleased to convey to you that the Spring Conference was a huge success. We had more attendees this Spring than in previous years. Everyone that attended should be commended for taking the time and special effort to attend in spite of the snow storm that crippled the southeastern part of the state. We did not have much time to make arrangements for the Spring convention regarding location as during the transition last fall, these arrangements had not been completed. LMV made the event quite successful with only a few months of planning. We know the accommodations for meeting rooms and vendors was a little inconvenient but our staff was able to accommodate everyone and next Fall’s arrangements will even be better. The Gala event was a very pleasant change of pace with a delightful meal. Mr. Levin LePine, a hypnotist provided the entertainment with volunteers from the audience. Laughter was at a peak when he had me “dancing on stage”. I don’t believe I did that. I truly feel a good time was had by all. Next year, don’t miss this event. The Executive Committee has been in correspondence with Anthem regarding issues brought up in meeting with Anthem in January. We are attempting to hold a workshop by Anthem to better educate our members concerning audits and documentation. At the present we are waiting for Anthem’s response in determining date and location for a possible event. The Executive Committee is also planning on a “retreat” for the next Board of Directors meeting to have a special long range planning session in June. If you have suggestions please forward them to your District Representative or the ISCA office. The Speaker Committee has been meeting to better plan for our speakers at the Spring and Fall conferences. They are attempting to provide speakers on a variety of topics ranging from Pediatrics, Radiology, Soft tissue techniques, and risk management with NCMIC. Dr. Sheila Wilson is working diligently in this area.

Dr. Nanko and the Insurance Committee has been fielding numerous inquiries regarding “incident to” for some carriers. Most noted was UHC and Anthem. They are researching and attempting to convey clarification from the respective carriers. Dr. Nanko is providing additional information in his report. Medicare issues are always a major concern and the amount of effort that has been focused on documentation is endless. One other important issue is your NPI number especially if you are in a group. May 23, 2008, is the deadline that everyone has to use only your NPI number. If you are having trouble getting claims to be processed, check with the Medicare website or contact either Dr. James Cox or Dr. Chris Klaes. These Doctors can assist or direct you to get the appropriate answers. Another facet of Chiropractic practice is our philosophy. We sometimes get “lost” in the shuffling of Medical Necessity documentation and fail to completely remember that we are Chiropractors with a Philosophy on Health and that too needs to be re-enforced. To my knowledge, our CE credit system unfortunately doesn’t recognize philosophy classes but that doesn’t mean our Philosophy isn’t important. I have been approached to assist in a combined Philosophical presentation by Dr. Hoffman in September of this year. The ICAI is sponsoring this presentation at no charge to Indiana Chiropractors. The occasion for all Indiana Chiropractors to meet for Philosophical rejuvenation is a continuing dialogue in the efforts of a unified Chiropractic profession. We should embrace this opportunity and support it. Dr. Mary Grace Pennella is coordinating this program and has more information. At times, all of the adverse interactions with Managed Care and Medicare seem to confuse everyone about our real purpose of Chiropractic. We are here to provide good Chiropractic service to our patients and we must not forget that. Our dedication and devotion in administering that service to our patients is what makes Chiropractors unique in the health care system. We should be very proud of those qualities. Continuously strive to improve all aspects of your practices with professionalism and respect for your patients as well as yourselves.

Inside This Issue President's Message..................................................................................1 ISCA Board of Directors & Staff Info...................................................2 Executive Director's Message................................................................3 Liability for Employing "excluded Individiuals...................................4 What do I need for CE?........................................................................4 Submitting Duplicate MEdicare Claims..................................................6 2008 Standing Committees as directed by ISCA By-Laws..............6 Notice to Members......................................................................................6 ACA News Update ..........................................................................................7 Special Thanks to Everyone Who Contacted Their legislator.....7

May/June 2008

Laws of interest to chiropractors................................................8 ACA Legal Team: new Ama Guidelines Violoate Wilk Injunction.......9 Letter to Catherine Rudd...................................................................10 CCGPP Launches new Concensus project ...........................................11 Conduct Unbecoming: Familiarize youself with laws................14 Update on S. 2785 and Medicare Initiatives at the senate.......................14 Cyberchondriacs: Fueled by internet Reports..............................15 upcoming ISCA Events...........................................................................15 Chiros Must renew license by July 1, 2008 ..........................16 ISCA Classifieds...................................................................................18-19

ISCA Report


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

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

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

District Directors

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

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

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

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

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

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

Alternate Directors at Large

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

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

Terry Tolle, D.C. Greensburg, IN 812.663.7640 John Volbers Indianapolis, IN 317.299.3330 Alternate District Directors District One Lewis Myers Valparaiso, IN 219.464.4444 District Two Vacant District Three Vacant District Four Garry Fuller, D.C. Brownsburg, IN 317.852.8885 District Five Vacant District Six Stephen Frank, D.C. Anderson, IN 765.641.7700 District Seven Sheila Wilson, D.C. Indianapolis, IN 317.297.8800 District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 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


Patricia McGuffey Executive Director

Stephanie Higgins Director of Events

Patrick Russell Executive Assistant

Lane Velayo Association Manager

Stacy Quasebarth Director of Communications

Krista Rader Receptionist

Tom Johnson Chief Finanical Officer

Connie Vickery Governmental Affairs

Debra Scott Vice President of Operations

John Livengood Governmental Affairs

ISCA Report

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

May/June 2008

Executive Director's Message Patricia McGuffey

I hope all of you are enjoying the beautiful spring weather! ISCA’s activities have slowed very little since the close of the Indiana General Assembly Session. We continue to advocate on your behalf as well as organize regional videos and seminars, ISCA board meetings and activities, your golf outing and more. As we prepare for ISCA’s Board's Strategic Planning, please let us know if there are goals and issues you believe we need to discuss as a part of our long-range planning session. The work and planning we do is on behalf of ISCA’s members so please communicate your thoughts, needs, and concerns to us. One of the issues ISCA is pursuing on your behalf deals with a proposed rule to implement the Governors’ Healthy Insurance Plan (health insurance for the uninsured) referred to as the Indiana Check-up Plan (Plan). The proposed rule would have originally eliminated chiropractic services from the Plan. After our advocacy, the proposed amended rule would eliminate your services except to limit them to physical therapy services. We are in the process of formally objecting to the proposed amended rule and I will provide you some of our written objections in another section of the newsletter. However, it is very difficult to change a proposed rule. Unlike a statute, the legislators do not vote on it. The Administration (Governor’s Office) publishes a proposed rule and the public is allowed to comment but the Administration generally does not make any changes. At this point, we have successfully had the rule amended but we will not be satisfied until you are not discriminated against and are able to provide all chiropractic services within your scope of practice in the Plan. Please continue to voice you objections to the Governor’s office and your legislators as we believe the proposed rule is outside the law that created the Plan. I will keep you posted. ISCA also continues to communicate with Anthem regarding DCs' concerns over reduced reimbursement and other practices. We plan to meet with them again soon as a follow-up to our earlier meeting and will keep you apprised of our progress. ISCA’s legislative committee will begin meeting soon to establish our goals and positions for the next legislative session. We know we have some unfinished business as the assignment of benefits legislation will be studied this summer in a legislative interim study committee. I expect that will be a priority for the 2009 Session. However, we are interested in receiving your input so please forward your legislative issues to Dr. Matt Howard, our legislative chairman, or me and we will add them to the agenda. Since the Session adjourned, I spend a great deal of my time attending legislators’ fundraisers. It is so important that we support the candidates and legislators that support chiropractors. Please send a check to BackPAC today so we can continue to support these individuals. We are not close to reaching our goals for our PAC budget. I fear that we will not have the same impact on the Indiana General Assembly in the upcoming Session. We could have difficulty protecting the chiropractic profession unless you help us by digging deeper and making an additional BackPAC contribution. I can assure you the insurance industry and our opponents are giving campaign donations and we must do the same to remain competitive. Thank you in advance for your support and feel free to contact me if I can be of assistance at or directly at

Access information on the ISCA Website! The ISCA provides its members with great information on it's website. As an ISCA member in good standing, log-in to access the special "Member Page" with important legislative updates, access to great resources on Managed Care and HIPAA. Don't have a login for the the ISCA website? It is easy to sign up! Simply visit our website at and click the Account Setup link under the Member Login on the far left hand side of the screen. You choose what you want your username and password to be and a message will be sent to the ISCA Headquarters that a new account has been requested. ISCA staff will activate your account within 24 hours. May/June 2008

ISCA Report


Liability for Employing "excluded individuals" Submitted By: Dr. David E. Jose, Esq., Krieg Devault LLP Phone: 317.238.6211 Email: Website:

In my last column, I described the significant surge in enforcement activity being pursued by the Indiana Attorney General’s Medicaid Fraud Control Unit (MFCU) as well as the federal CMS Office of Inspector General. The activity relates to “excluded individuals” who are employed by or have contracted with health care providers who participate in Medicare or Medicaid. As I described, there are potentially severe penalties for employing or contracting with an individual or company on the List of Excluded Individuals/Entities (“LEIE”). Until recently, many health care providers thought that a simple criminal history and licensure check of employees was sufficient. The assumption was that this would reveal any individual on the LEIE list. However, state and federal authorities are ignoring that assumption and extending the scope of their investigation to include unlicensed office personnel who may not be directly involved in providing or billing for Medicare or Medicaidcovered services. This is a dramatic extension, with potentially significant financial implications. This means that an individual hired by a health care provider to perform “back office” or other functions unrelated to patient care and services can still be the source of a civil monetary penalty claim. In the last column, I mentioned that a generally reliable way of knowing if a person is excluded is to check the Exclusion Program website at That step should be added to the background check for every prospective employee. In addition, it may be a reasonable step to perform a similar check periodically for existing employees. If the person appears on the exclusion list, you should not hire that person or contract with the entity. If an existing employee is found to be on the exclusion list, and it is confirmed that the named person is your employee, they should be immediately terminated in order to avoid further exposure. The employee or contractor should be informed of the fact that he or she is on the LEIE list, because they will have received some form of notice from the government of their exclusion. However, the first notice that the provider/employer will receive could be in the form of an inquiry from the Medicaid Fraud Control Unit. That initial inquiry will then be followed by a request for additional information and a demand for the recovery of Medicaid or Medicare funds based upon a formula that MFCU prefers to employ. You may have defenses against the demands of MFCU, and it is important that legal counsel advise you through a process such as this. The MFCU has taken the position recently that failure to check the LEIE list creates “strict liability” under the law. That is an aggressive position to take, and a provider may have defenses available to resist that interpretation. Let me know if you have any questions on this topic, or if you have any suggestions for other topics to be covered in future columns.


(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.

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.

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.

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

A person who is issued an original license after July 1, 2007 is


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.

ISCA Report

May/June 2008

We’ve Back! We’ve Got Got Your Your Back! Kevin E. Macadaeg, M.D.

Did you know that it is estimated that 44 million Americans 50 years of age and older have osteoporosis? Did you know that the most common fracture resulting from osteoporosis is vertebral fractures? The National Osteoporosis Foundation estimates that there are approximately 700,000 vertebral fractures annually. Fortunately, there is a treatment to help your patients improve their quality of life after suffering vertebral fractures. This minimally invasive procedure reduces pain, increases range of motion, protects against further collapse of the treated vertebra and, most importantly, allows the patient to return to previous levels of activity.

Jonathan P. Gentile, M.D.

To learn more about this procedure for vertebral compression fractures or for a patient referral, call Indiana Spine Group at (317) 228-7000 or toll-free (866) 947-7463. Spinal Diagnostics & Therapeutics Kevin E. Macadaeg, M.D. | Jonathan P. Gentile, M.D. | John W. Arbuckle, M.D.

Spine Surgery John W. Arbuckle, M.D.

Rick C. Sasso, M.D. | Kenneth L. Renkens, M.D. | Thomas M. Reilly, M.D.

Indiana Spine Group

Indiana Spine Group

BACK TALK Sign-up Today!

August 22-23, 2008

A Comprehensive Review of the Latest Diagnostic and Treatment Information for Spinal Disorders

One of the main reasons patients go to their physician is back pain. To more effectively care for your patients, learn the latest from world-renowned physicians. BACK TALK will provide you the most current and comprehensive evidence-based review of the diagnosis and treatment of spinal problems. For your convenience, please visit and click the physician symposium link for a conference agenda and registration form or call (317) 228-7000.

Sign-up and reserve your space today! Indiana chiropractors will receive 12 continuing education credits sponsored by Logan College of Chiropractic. Spinal Diagnostics & Therapeutics Kevin E. Macadaeg, M.D. | Jonathan P. Gentile, M.D. | John W. Arbuckle, M.D.

Spine Surgery Rick C. Sasso, M.D. | Kenneth L. Renkens, M.D. | Thomas M. Reilly, M.D.

May/June 2008

ISCA Report



Notice To Members

Speaker/Convention Committee Dr. Wilson-Chair Dr. Bryan Dr. Shaw Dr. Hoffereth Dr. Friedline Dr. Tolle Dr Cox II

To all members that meet the requirements to serve on the Indiana Board of Chiropractic Examiners - please send your resume and political affiliation to ISCA to my attention Pat McGuffey, 200 S. Meridian St, Suite 350, Indianapolis, IN 46225, An ISCA committee appointed by the President will interview potential board of examiner candidates. This will allow ISCA to be prepared when there are Board of Examiners openings.

Golf Committee Dr. Dyer Dr. Unterseher Cory Haffner -- Chair

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

Submitting Duplicate Medicare Claims National Government Services, Inc.

In recent prepay audits, the Medical Review Department is seeing a large volume of duplicate claims; specifically for Chiropractic, Psychiatric and Evaluation and Management Services. Many of these duplicate claims are for previously denied or previously reviewed (and paid) services. When a claim is suspended for review it is not appropriate to submit a duplicate claim. Submitting duplicate claims increases processing costs, processing times and potential for errors. Please review CMS Pub 100-4 Claims Processing Manual Chapter 12 for when it is appropriate to submit duplicate claims.


Insurance Committee Dr. Nanko -- Chair Dr. Furno Dr. Wolf Dr Rogers Dr Bryan Dr. Phelps Dr. Dyer Dr. C. Klaes Dr. Cox II Finance Committee Per by-laws, the treasurer is the chairperson Dr. Bryan Dr. Klaes Dr. Toney Membership Committee Per by-laws, the 1st Vice President is the chairperson Dr. Furno Dr. Hofferth Dr. Vuotto Dr. Tymchak Dr. Dyer

Legislative Committee Dr. Howard, Chair Dr. Gallagher Dr. Toney Dr. Phelps Dr. Wolf Nominating Committee Per by-laws, the immediate Past President is the chairperson. Dr. Wolf-he selects a committee of at least 5 past presidents for a total of 10 persons ---------------------------------------Dr Binder, President is Ex-officio to all committees. ---------------------------------------Those interested in joining a committee should contact either: Patrick Russell, ISCA Executive Assistant Email: prussell@lmvconsulting. com Phone: 317.673.4245 or Dr. Duane Binder, ISCA President Email: Phone: 765.832.7777

Ethics/Grievance Committee Per by-laws, the 2nd Vice President is the chairperson Dr. Nanko Dr. Friedline Dr. Daulton, Sr.

ISCA Report

By-Laws Committee Dr. Howard, Chair Dr. Wolf Dr. Daulton, Sr. Dr. Shaw Dr. Unterseher

May/June 2008

ACA News Update from Dr. Tennant U.S. Senate Committee: Doctors of Chiropractic Eligible for Federal Loan Repayment Program In a report to accompany legislation reauthorizing the National Health Service Corps (NHSC), the Senate Committee on Health, Education, Labor and Pensions made it abundantly clear that doctors of chiropractic are eligible to qualify for inclusion in the NHSC Loan Repayment program. The report language, which will accompany bill S.901, is supported by both the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). “For more than 35 years, doctors of chiropractic were excluded from the National Health Service Corps because we were not mentioned explicitly as eligible providers,” said ACA President Glenn Manceaux, DC. “Many areas of the country are experiencing shortages of qualified health professionals, and doctors of chiropractic are uniquely positioned to provide high-quality, cost-effective care to the nation’s underserved communities. I applaud the Senate committee for taking this action and I look forward to chiropractic inclusion in the program.” “This is a great victory, particularly for chiropractic students who are ready, willing and able to serve in the NHSC,” said ACC President Carl Cleveland III, DC. “Chiropractic graduates enter the profession well-qualified, prepared and most eager to serve, but many are positioned to enter practice with considerable student loan indebtedness. Thanks to the Committee’s action, doctors of chiropractic—especially the next generation of doctors graduating from our colleges—will soon have an opportunity to participate in this important loan forgiveness program.” Originally enacted in 1970, NHSC allows selected health care professionals engaged in the delivery of primary care services to be reimbursed for student loans in return for establishing and maintaining their practices in geographic areas designated as “medically underserved” by the federal government. Unfortunately, the NHSC Loan Repayment program has not included doctors of chiropractic as eligible providers. In 2002, at the request of ACA and ACC, Congress enacted language that authorized a two-year demonstration program intended to explore the feasibility of opening the program to doctors of chiropractic. The demonstration program began in 2003 and was later extended through 2007.  The demonstration results are now being evaluated by the federal Health Resources and Services Administration.  Report language accompanying S. 901 becomes effective once the bill has been passed by the full Senate.  S. 901 has not yet been scheduled for further consideration.  Watch ACA publications and the association’s Web site for more information as it becomes available by visiting this link Access the full committee report by visiting  The information regarding inclusion of doctors of chiropractic can be found on page 19.  For more information on the NHSC or to discuss ACA’s ongoing legislative efforts, contact ACA Vice President of Government Relations, John Falardeau, at (703) 812-0214, or

Special thanks to everyone who 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 Gary Lyman Shaw 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.

May/June 2008

ISCA Report


Laws of Interest to Chiropractors

Contact Patricia McGuffey if you need additional information - 317-673-4245 or X-Ray Utilization 846 IAC 1-7-1 Use of x-rays Authority: IC 25-10-1-1.5 / Affected: IC 25-10-1-1.5

1. 2.

Sec. 1. A chiropractor shall not overutilize or otherwise improperly use ionizing radiation. In order to avoid overutilization of ionizing radiation, a chiropractor shall observe the following guidelines:


Any offer or advertising of free x-rays to actual or potential patients shall be accompanied by a conspicuous statement that reads "to avoid needless health hazards associated with ionizing radiation, no such free x-ray will be given unless there is a prior observable clinical need for it." (Board of Chiropractic Examiners; 846 IAC 1-7-1; filed Apr 22, 1988, 2:10 pm: 11 IR 3044; readopted filed Jul 10, 2001, 2:55 p.m.: 24 IR 4236; readopted filed Oct 4, 2007, 3:34 p.m.: 20071031-IR846070057RFA) ---------------------------------------------------------------------------------------------------------Code of Conduct 846 IAC 1-3-2 Code of professional conduct Authority: IC 25-10-1-1.5 / Affected: IC 25-1-9-6.5; IC 25-10-1-1 Sec. 2. (a) Chiropractors practicing in Indiana shall conduct their practice of chiropractic in accordance with the standards set out in IC 25-10 and this title. (b) No person holding a license to practice chiropractic shall conduct such practice under any name other than his or her own unless practicing as an employee of a clinic, center, or institution. (c) To designate that they are licensed to practice chiropractic in Indiana, all licensees practicing chiropractic in Indiana shall use, in conjunction with their names, the words "chiropractic", "chiropractor", or the abbreviation "D.C." alone or in connection with other words, on all signs, letterheads, business cards, or similar items of identification, advertising, and solicitation of any kind. Provided, however, chiropractors may not use any words which would mislead the public into believing they are licensed in Indiana to practice any other licensed occupation or profession for which they do not hold an Indiana license. (d) Any identification using the word "clinic", "center", "corporation", or terms of similar import that is solely concerned with the practice of chiropractic, shall also designate that it is a chiropractic facility. Any licensee practicing in a multiple professional health care facility shall prominently display in the facility the fact that he or she is engaged in the practice of chiropractic. (e) Every licensee practicing in Indiana shall publicly and prominently display the license issued him or her by the board or a photostatic copy thereof in all offices, clinics, corporations, centers, and/or similar places of business wherein he or she is practicing. (f) In the conduct of practice, no person holding a license to practice chiropractic shall engage in advertising or soliciting for patronage that which is not in the public interest. Advertising or soliciting not in the public interest shall include advertising that: 1. is false, fraudulent, deceptive, or misleading; 2. represents intimidation or undue pressure; or 3. makes claims of professional superiority over fellow practitioners or over another health science which cannot be substantiated.


obtains a fee by fraud or deceit; discloses, without authorization, any information about a patient revealed or discovered during the course of treatment, except as required by law; engages in advertising or soliciting which, on its face or as applied, can reasonably be construed as deceiving the public; or knowingly aids, assists, procures, or advises an unlicensed person to practice contrary to IC 25-10-1 or this title.

(h) A chiropractor has a duty and responsibility to his or her patients and to the chiropractic profession to promptly release a patient's records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient. (i) A practitioner may advertise his or her professional services in order to advise the public of the existence and scope of the services he or she offers, so long as the advertisement is dignified and confines itself to the existence of the practice and/or the field of practice of the practitioner. (j) For the purposes of IC 25-1-9-6.5 and this rule, advertisements include the use of television, newspaper, radio, billboards, yellow pages, seminars, handbills, mailings, or other similar advertisements to the public. (Board of Chiropractic Examiners; 846 IAC 1-3-2; filed Jul 28, 1983, 9:03 a.m.: 6 IR 1741; filed Dec 28, 1990, 5:00 p.m.: 14 IR 1068; readopted filed Jul 10, 2001, 2:55p. m.: 24 IR 4236; readopted filed Oct 4, 2007, 3:34 p.m.: 20071031-IR846070057RFA) ----------------------------------------------------------------------------------------------------------Additional Advertising Law IC 25-1-9-6.5 - Chiropractors; waiver of deductible or copayment Sec. 6.5. (a) In addition to section 4 of this chapter, a practitioner licensed to practice chiropractic is subject to the exercise of the disciplinary sanctions under section 9 of this chapter if, after a hearing, the board regulating the profession finds a practitioner has: 1. 2.

waived a payment of a deductible or a copayment required to be made to the practitioner by a patient under the patient's insurance or health care plan; and advertised the waiver of a payment described in subdivision

(b) This section does not apply to the waiver of a deductible or a copayment by a practitioner if: 1. 2. 3.

the practitioner determines chiropractic service is necessary for the immediate health and welfare of a patient; the practitioner determines the payment of a deductible or a copayment would create a substantial financial hardship for the patient; and the waiver is based on the evaluation of the individual patient and is not a regular business practice of the practitioner.

As added by P.L.151-1989, SEC.9.

(g) It shall be considered unprofessional or unethical conduct and grounds for discipline if any licensee:


ISCA Report

May/June 2008

information on how long insurer can go back to get money from provider on overpaid claim

ACA Legal Team: New AMA Guidelines Violate Wilk Injunction Invoking the court decision in the landmark Wilk vs. AMA lawsuit, the American Chiropractic Association 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 its concerns. “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, MD. 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 DCs from performing adequate and complete ratings,” ACA’s letter to the AMA states. ACA’s letter also reminds 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.”

IC 27-8-5.7-10 - Claim payment errors Sec. 10. (a) An insurer may not, more than two (2) years after the date on which an overpayment on a provider claim was made to the provider by the insurer: 1. request that the provider repay the overpayment; or 2. adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider. (b) An insurer may not be required to correct a payment error to a provider more than two (2) years after the date on which a payment on a provider claim was made to the provider by the insurer. (c) This section does not apply in cases of fraud by the provider, the insured, or the insurer with respect to the claim on which the overpayment or underpayment was made. As added by P.L.55-2006, SEC.1. IC 27-8-5.7-11 - Claim overpayment adjustment Sec. 11. Every subsequent claim that is adjusted by an insurer for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including: (1) an identification of: (A) the claim on which the overpayment was made; and (B) if ascertainable, the party financially responsible for the overpaid amount; and (2) the amount of the overpayment that is being reimbursed to the insurer through the adjusted subsequent claim. As added by P.L.55-2006, SEC.2.

2008 Chiropractors of the Day

ACA’s legal team is also seeking meetings with representatives of the Federal Trade Commission and the antitrust division of the Department of Justice to outline the association’s concerns. In addition, the association is identifying members of Congress who might be willing to assist in redressing the problem. The Wilk vs. AMA case was a seminal event in chiropractic history. In 1987, U.S. District Court Judge Susan Getzendanner ruled that the American Medical Association had engaged in an unlawful conspiracy in restraint of trade “to contain and eliminate the chiropractic profession.” To learn more about the Wilk vs. AMA decision, read “David vs. Goliath,” from the August 2007 issue of ACA News.

Duane Binder Adam Cline Derek Dyer Donna Fredrick Michael Gallagher Richard Hilton Matt Howard

Joan Howard Joseph Kielur James Todd John Volbers Diane Vuotto Don Warren Anthony Wolf

Thank you to our members who provided chiropractic services at the State House during Session. If you have been left off this list, please let us know and we will be sure to acknowledge you in the next newsletter.

May/June 2008

ISCA Report


Letter to Catherine Rudd: Additional comments re: LSA Document #07-648, amended By: Patricia McGuffey, ISCA Executive Director

Thank you for forwarding me the proposed amendment to rule 405 IAC 9, LSA Document #07-648. I appreciate your consideration. However, the Indiana State Chiropractic Association (ISCA) must still express our opposition to the proposed rule that continues to eliminate Chiropractic services in the Indiana Check-up plan (Plan). We believe the amended proposed rule does not follow the statute that establishes the PLAN or adhere to legislators’ intent. Please allow this letter to be included in the official record along with my previous testimony and letter. The amended proposed rule reads (8) chiropractic services, except for those services covered under the plan that are within the scope of practice of a chiropractor (e.g. physical therapy.) This violates the statute since HEA 1678 (2007) states: 1215-Chapter 44. Sec. 4 (e) “The plan must comply with any coverage requirements that apply to an accident and sickness insurance policy issued in Indiana.” One law that governs accident and insurance policies, IC 278-6-1, reads: “Professional services for which reimbursement authorized: Sec. 1. Notwithstanding any provision of any individual or group policy of accident and health insurance, or any provision of a policy, contract, plan, or agreement for hospital or medical service or indemnity, wherever such policy, contract, plan, or agreement provides for reimbursement for any service which is in the lawful scope of practice of a duly licensed dentist, health service provider in psychology, podiatrist, osteopath, optometrist, or chiropractor, the person entitled to benefits or the person performing services under the policy, contract, plan, or agreement shall be entitled to reimbursement on an equal basis for such service, whether the service is performed by a physician, dentist, health service provider in psychology, podiatrist, osteopath, optometrist, or chiropractor duly licensed under the laws of this state." In addition, IC 27-8-6-4 reads: “(b) A group or individual policy or agreement providing comprehensive accident and health benefits must reimburse an insured for services rendered by a provider licensed under IC 25-10 (Chiropractor’s licensure statute) within the scope of that provider's license in the same manner as that policy or agreement reimburses an insured for services rendered by a provider licensed under IC 2522.5 within the scope of that provider's license. The policy or agreement may not exclude or otherwise limit reimbursement for any service that a provider licensed under IC 25-10 renders under the scope of that provider's license in the diagnosis and treatment of any illness or injury.” The statute specifically prohibits discrimination against chiropractic physicians licensed under IC 25-10 from medical physicians licensed under IC 2522.5. To list as excluded from coverage chiropractic services, clearly violates the non-discrimination clauses of IC 27-8-6-1 and IC 27-8-6-4. Another Indiana insurance law is the “any willing provider” statute, IC 27-8-11-3 states “no hospital, physician,


pharmacist, or other provider designated in IC 27-8-6-1 willing to meet the terms and conditions of agreements described in this section may be denied the right to enter into an agreement”. This statute also prohibits the discrimination against Chiropractors. In addition, Chiropractors are licensed under IC 25-10-1-1 to diagnosis and analyze and treat specific conditions as well as perform urinalysis and take x-rays of the vertebral column and extremities. They are listed as physicians in Medicaid and Medicare and have direct access to patients. They may refer patients to physical therapists who do not have direct access. Any attempt to limit a DCs scope of practice to that of physical therapists would both discriminate against and restrain the trade of Chiropractors. Also, in an attempt to explain the discrimination against DCs, it was mentioned that both dental and vision services are excluded from the Plan. HEA 1678 (2007), contains specific language that excludes vision and dental service. However, the statute does contain language that allows for vision and dental supplemental plans to be included in the Plan. Chiropractors and their services are not excluded from the plan by statute, so their exclusion by administrative rule is outside the statutory authority. Chiropractors are the only providers the proposed rule “qualifies” by saying their services must be within their scope of practice and be listed as “covered services” and then limited to another healthcare providers (physical therapists) scope of practice. You have not limited a MD to Dentistry or an Osteopath to physical therapy even though there is some overlap in their scope of practice. Furthermore, you have not limited the MD or OD from performing chiropractic services which is listed within their scope of practice. It appears that DCs are the only healthcare profession that the rule would purport to discriminate against. I do apologize for repeating much of my earlier information; however, the same principles still apply. ISCA respectfully asks that you delete the clause in the proposed rule for the Indiana Check-up plan that eliminates chiropractic services (with qualifiers). We believe this clearly violates the provisions of HEA 1678, (2007). Please feel free to contact me if I may provide additional information. Once again, I appreciate the opportunity to respond and thank you for considering our request. Respectfully, Pat McGuffey, Executive Director Indiana State Chiropractic Association

ISCA Report

March/April 2008

Council on Chiropractic Guidelines & PRactice Parameters Launches New Consensus Project By Dr. Mark Dehen, CCGPP Chair

Over the last few years many of you have heard the cries of our fellow chiropractic practitioners in California over the revisions in their Workers Compensation system. In 2004 the California legislature adopted the American College of Occupational and Environmental Medicine (ACOEM) guidelines for use in that system. Only those interventions recommended in the ACOEM guidelines are now reimbursable under California law. The only exception available under this law is that the ACOEM guidelines may be supplemented by other nationally published guidelines. In December of 2007 Gary Globe, DC, MBA, PhD, who is serving as the California Chiropractic Association (CCA) representative on the California Workers Compensation Advisory Board, contacted the CCGPP for assistance. Dr. Globe indicated that there was a brief window of opportunity for the chiropractic profession to provide a nationally published supplemental guideline to clarify weaknesses in the ACOEM guidelines as it pertains to chiropractic care for low back and chronic pain conditions. However, for this opportunity to be realized, that supplement had to be available for the next regularly scheduled meeting of the California Workers Compensation Advisory Board on March 19, 2008. As many of you are aware, in September, 2007 the CCGPP's Rapid Response Team initially penned a letter to United Healthcare demonstrating the inappropriateness of their newly adopted policy of non-coverage for chiropractic care of pediatrics and headaches. That letter was subsequently endorsed by the ACA, ICA, FCER, COCSA, ACC, etc. In response to that letter, in October, 2007 United Healthcare suspended both policies for additional review. They have recently announced they have retracted the pediatric policy altogether and have reworked the headache policy. Due to the rapidity and success of this response, Dr. Globe was prompted to contact the CCGPP for assistance with the California Workers Compensation situation. The CCGPP at its inception was charged with the evaluation of any guidelines, parameters, protocols, best practices, and standards of practice. This also means taking a stand for the profession when a problem or potential assault is noted. Therefore, the CCGPP accepted the California challenge and has undertaken a new initiative. We are currently involved in a Delphi process to generate consensus opinion of Doctors of Chiropractic from across the country regarding the care of low back pain, especially chronic pain. After conducting its extensive literature synthesis on low back conditions initially posted on the Internet in May of 2006, the CCGPP is acutely aware that there is inadequate literature on various areas of common chiropractic practice. Many of those studies that do exist have a medical bias that needs to be tempered with a chiropractic lens, as provided by the CCGPP's team of low back experts. The purpose of the Delphi technique is to elicit information and judgments from participants to facilitate problem-solving, planning, and decision-making. It does so without physically assembling the contributors. Instead, information is exchanged via mail, FAX, or email. It is structured to capitalize on the merits of group

March/April 2008

problem-solving and minimize the liabilities of group problemsolving. Consensus derived from a rigorous Delphi process is considered to be expert evidence, and while not as highly valued as some forms of research, it is nevertheless widely used and accepted, particularly in addressing areas where high quality research is lacking. Indeed, other national guidelines have used medical expert opinion to address issues of chiropractic care when more definitive literature was not available. The purpose of the CCGPP conducting the present Delphi process was to look at the same literature base others have, through a chiropractic expert perspective. The Delphi technique requires a Coordinator to organize requests for information, information received, and to be responsible for communication with the participants. The Delphi technique requires an efficient communication channel to link the Coordinator with each of the participants. Therefore, this Delphi process is being undertaken in an effort to clarify the role of chiropractic in these areas of care, especially as they are impacted by the Workers Compensation system and their incorporation of external guidelines, e.g. ACOEM, ODG, etc. CCGPP solicited seed panelists from chiropractic's national organizations, e.g. ACA, ICA, etc., and from the state associations through COCSA. These 39 panelists are all actively involved in chiropractic practice from across the country with a diverse variety of philosophy, technique and practice situations. As background material, those panelists were provided the CCGPP's Low Back literature synthesis, along with Dr. Gert Bronfort's recent study published in the Spine Journal. After reviewing the ACOEM guidelines, the CCGPP's Seed Committee then developed 27 seed statements defining areas of concern within those guidelines. Those seed statements were then submitted to the panel for review and comment. After the first round of review, there was greater than 80% consensus on 24 of the 27 seed statements. On the 3 outstanding seed statements, the panelist's comments were reviewed by the Seed Committee and utilized to revise those statements. Those revised seed statements were then submitted to the panelists for a second round of review and comment. After the second round, the 3 remaining outstanding seed statements again achieved greater than the 80% threshold for consensus that the Seed Committee had required at the outset of the project. The Seed Committee is currently in the process of incorporating the acquired commentary into a final consensus report. The CCGPP is hopeful of having the final version available by the beginning of June for use in the California Workers Compensation process. That consensus report will also be posted on the CCGPP's website when it is available. The CCGPP Scientific Commission Chair, Dr. Cheryl Hawk, also has a verbal commitment from the Journal of Manipulative and Physiological Therapeutics to publish the available literature syntheses chapters, inclusive of this consensus report, in the November/December 2008 issue.

continued on Page 12

ISCA Report


CCGPP Launches New Consensus Project Continued... CCGPP has studiously avoided entering into the "guidelines" development process for a number of years, especially following the furor raised over the "Mercy" guidelines. They were widely condemned, particularly by those who never took the time to read them or learn how to properly apply them to obtain the care their patients needed. However, "Mercy" was a long time ago, given the pace of change in health care over the last decade and a half, and the literature needed to be updated. Third party payors, government agencies, other guideline organizations, patients, and yes, even DC's now want to know what kind of care is supported by evidence. Our profession's refusal to address this issue has led to the inevitable result that MD's, insurers and bureaucrats are now deciding what reasonable chiropractic care should be, based on their interpretation of the currently available scientific literature. We must remember that we exist as a profession to provide a service our patients need and want and not to advocate for what is best for our own benefit. Need proof? Our market share has not increased (and some would argue it has declined) despite the greatest increase in the use of CAM in recent history. We continue to have little cultural authority, meaning in part that the public still does not clearly understand our role and areas of expertise in the health care market. Physical therapists are publishing widely accepted papers on indications for manipulation of the low back, and have made it clear that they intend to take over chiropractic's traditional place in the health care market. The good news is that there is a great deal of evidence for what we do, as revealed by the CCGPP Low Back Literature Synthesis, as well as the subsequent CCGPP condition related chapters. The crisis in California (where nearly one-quarter of US doctors of chiropractic practice) has provided an opportunity to address what many of us consider to be mis-interpretation of the scientific literature, and to instead re-interpret the scientific literature viewed through a chiropractic lens. This Delphi process was in part developed by the CCGPP in response to what we heard at COCSA in Baltimore in 2006, where one of the primary concerns voiced by our critics during our round table discussion was that not every aspect of chiropractic practice had yet been subjected to randomized controlled trials. Now some of those same critics have already begun to naively criticize this effort as "unscientific." Nothing could be further from the truth. CCGPP conducted a multi-year, scientific evaluation of the current literature based on internationally accepted standards and resulting in the aforementioned Low Back Literature Synthesis. We also included additional, newly released research, published in interim since the completion of the Low Back Literature Synthesis. This formed the framework for the subsequent Delphi consensus process, which is widely viewed as an appropriate, defensible and scientific methodology for addressing areas where scientific literature is lacking. The issue of "dosage" is a perfect example of the need for a scientific consensus process. Patients, insurers, DC's and others want to know what reasonable parameters of chiropractic care are for a given condition. Is it short trials of treatment to see if it helps, or 75 visits and year-long contracts? Most published


literature on this subject is based on treatment restrictions which do not realistically reflect actual practice, but reflect necessary limitations imposed by clinical study protocols. Accordingly, the most appropriate and valid methodology for addressing the gaps between scientific studies and clinical practice is a rigorous consensus process. We chose to use the Delphi process because of its economy in terms of both costs and timeliness. We chose to ask every state association and national organization in the country to provide participants who were conversant with using published literature, represented a wide variety of practice styles, philosophies and locals, and who were willing to work collegially to try to reach accord. Is the end result what we wanted? No, if the goal was the ability of the individual chiropractor to practice unfettered by any constraints (and we are unaware of any other health care profession with such a privilege). But if the goal was to draft a guideline which reflects the mainstream of chiropractic practice, provides advice and benchmarks for extending trials of treatment, and most importantly safeguards our patients' rights to demonstrably effective, conservative chiropractic care, then we believe this is a good start. We anticipate that this type of consensus process will eventually have national impact, as New York, Ohio and other states are also incorporating the ACOEM or other guidelines into their Workers Compensation systems. As an example, the CCGPP was contacted in early March by the ACA to participate in their recently established Guideline Review Task Force. This task force has been established in response to a request by the ACA Delegate in Tennessee, Dr Michael Massey. BCBS of Tennessee has requested a critique of the Milliman Care Guideline, 12th Edition, as it applies to chiropractic care. Once that review has been completed, the task force members are hoping to again put together an intraprofessional coalition to sign onto the review, such as was done with the successful effort to convince United Healthcare to change its Pediatric and Headache Guideline. It is the hope of the involved parties that this review will be used to enter into a collaborative effort with Milliman and Robertson to improve their product, beyond its application to BCBS of Tennessee. For further information or if you are interested in assisting with this process, please visit the CCGPP website at Ultimately, the CCGPP views this type of consensus development as one of the next phases of the progression from the literature syntheses to the "best practices" development process we have dubbed the "Chiropractic Clinical Compass". This is also another example of the CCGPP's Rapid Response Team model, where the fluidity of our organization is able to mobilize our teams of experts and effectively address an immediate issue. However, we were only able to conduct this process due to the generous donation of time by all participants, or the generosity of the institutions at which they are employed.

ISCA Report

May/June 2008

I just need 30 seconds of your time...

The picture above is of my daughters Lydia and Vivian. They are my shameless attempt to grab your attention, so I can tell you why Haffner X-Ray is different than our competition. Haffner X-Ray donates $2500 annually to fund scholarships for local chiropractic students. We supply equipment for the “Doctor of the Day” program at the state capitol building to bring chiropractic awareness to state representatives. Haffner XRay gives thousands annually to both state associations to help offset the costs of conventions, lobbying, speakers and annual dues. Finally, we believe in chiropractic! Next time you place an order, please ask yourself, “Does my current supplier actively support the profession locally? Do they give back to the chiropractic community? Most importantly, do they BELIEVE in my profession?” I think you will find our competition’s answers to all these questions to be revealing. As economic times tighten, I also understand the need to be competitive. If you’re currently placing orders with another company and would like to make the switch, give us a call. In nearly every case we can at least meet the price you’re currently receiving and put you on our new delivery route system. Thank you for your time and your business. Cory Haffner, President

Haffner X-Ray Co. (317) 773-5171 or (800) 382-2722 “Serving the Profession Since 1967”

May/June 2008

ISCA Report


Conduct Unbecoming: Familiarize yourself with laws governing your professional conduct Stephen Perle, DC, MS “Doctors of chiropractic should maintain the highest standards of professional and personal conduct, and should comply with all governmental jurisdictional rules and regulations.” -Tenet II, ACA Code of Ethics Doctor, when are you not a chiropractor? While it might be convenient to think of yourself as “on duty: and “off duty,” this just isn’t the reality of life. First of all, I believe most of us think of being a chiropractor as fundamental to who we are. But if you do think you have an offduty life, keep in mind that regulatory agencies, the public and your peers (both inside and outside ACA) will judge you based on your personal conduct. Doctors of chiropractic who are convicted of crimes unrelated to their practices are likely to have their practice licenses suspended or revoked. This is based on the common belief that professionals who don’t know right from wrong in their personal lives are unlikely to have a moral compass to help chart an ethical course in their professional responsibilities, either. Someone who is untrustworthy in one domain is often (and rightly so) not trusted in other domains. Sometimes deciding whether an action is good or bad can be challenging. In such cases, use this simple test: Think about whether you would want a story about your behavior on the front page of the newspaper. At one time in history, the punishment for many crimes was simply to expose the criminal to public

ridicule, scorn and even shunning, e.g., the pillory, stocks or wearing a sign naming the crime. Would we expect our patients to understand, forgive and forget if, for example, the newspaper reported our drunk driving, theft, arson, murder – even though these crimes are unrelated to our practice? Of course not. Thus, to avoid the harsher judgment that comes with being professional, our personal conduct in public must always be exemplary…and our professional conduct must always be superior. It’s easiest to avoid inappropriate behaviors by simply not violating any government rules and regulations. This applies to our jobs as chiropractors as well as any roles we play as public servants. I teach ethics and risk management around the county. To prepare for these seminars, I search the Web sites of state chiropractic boards. During my seminars, I have met many doctors who are unaware of the state and federal rules and regulations that govern their profession. Remember that ignorance is not a valid defense. Fortunately, the Internet has facilitated the accessibility of information from state licensing boards. I recommend visiting your state board’s web site regularly to stay up to date on rules and regulations, and also maintaining membership in your state association. To find state board web sites, visit the Federation of Chiropractic Licensing Boards online at

Update on S. 2785 and Medicare Initiatives at the Senate Melissa Sinden, Assistant Director, Government Relations, ACA

S. 2785, the Save Medicare Act of 2008, was introduced just before Easter recess by Senator Stabenow (D-MI). The legislation continues the 0.5% increase to the Medicare Physician Fee Schedule thru the end of 2008 that would otherwise expire at the end of June. In 2009, the legislation provides a 1.8% update to the MPFS. This legislation is currently in the Senate Finance Committee and has 14 co-sponsors. Another Medicare initiative of note is a proposal that was outlined by Senate Finance Committee Chairman, Senator Baucus (D-MT). ACA was at a closed door roundtable when the Chairman discussed his proposal for delaying the cuts that are facing the Medicare Physician Fee Schedule on July 1, 2008. He is proposing a potential 1.1% increase in payments through the end of 2009. Senator Baucus also stated that he would not allow the 21% payment cuts physicians face in 2010 to occur. Additionally, the Senator hopes to increase or expand the physician quality reporting initiative (PQRI) and wants to link reimbursements to quality of care as provisions of the Medicare package, which he hopes to have on the Senate floor by mid-May. There are a number of additional provisions the Chairman would like to see in the bill but given the environment, this could be a difficult task. Given the short Congressional calendar, and the environment in the Senate, it is hard to predict exactly what will happen. Most can agree that there will likely be a fix to the fee schedule prior to July 1st but it is unclear at this point what other measures have a chance of getting through.


ISCA Report

May/June 2008

Cyberchondriacs : Fueled by Internet reports, some patients with health anxiety go overboard with concerns William Morgan, DC This is a familiar situation for most doctors: Your waiting room is full and you are 20 minutes behind schedule when you walk into a treatment room only to be confronted by a patient with a lap full of printouts regarding various health concerns. Your favorite “cyberchondriac” has a few questions about some reports from the Internet. “According to this report, I have the symptoms of Lyme disease,” the patient announces. (Of course, Lyme disease could be substituted with hypothyroidism, Valley Fever, lupus, fibromyalgia, MS, chronic fatigue syndrome or a number of other conditions with indistinct presentations.) You weigh your options. Do you dismiss the patient’s concerns and just treat the visit as a routine chiropractic treatment? Or do you sit down and answer every question the patient has and ruin your schedule? Ideally you don’t want to do either, so consider one of these schedule saving strategies: Get the patient’s telephone number and call during a lull in patient flow. (Remember to document the conversation in the patient file) Have the patient schedule another office visit to discuss the questions. Have the patient wait in your office for a quiet period to address concerns. Interact with the patient via the internet. (Again document the interaction by printing out the emails). The information age has changed everything in our society, including the doctor-patient relationship. Certainly, using the Internet to gather information about health issues is a major trend in Western society. However, it’s frustrating to the doctor when a patient becomes self-absorbed and obsessed with the results of Internet searches, or when he or she attempts to manipulate the doctor into ordering expensive and unnecessary tests. One study, the Pew Internet & American Life Project, revealed that 113 million Americans – representing 80 percent of Internet users – search the Internet for healthcare information. Disturbingly, 6 percent of those surveyed searched the internet for health information daily. While the internet is empowering for most patients seeking health-related information, to true hypochondriacs the internet is a living nightmare: an endless quagmire of information and misinformation that they are obsessed to search. This type of compulsive behavior can be as debilitating to a patient as a physical disease. Though hypochondriacs are frequently lampooned by the media and even healthcare providers, this condition is a serious concern. In managing patients with hypochondria, the tendency is to assume that there is nothing physically wrong. Before making this assumption, ensure that the patient really does not have a serious disease. Do not tell hypochondriacs that nothing is wrong; this is not reassuring them. Rather, coax patients with health anxiety toward healthy life options such as proper sleep, exposure to sunlight and fresh air, exercise, healthy eating, smoking cessation, temperance, healthy socialization, maintaining a daily routine, and avoidance of unnecessary drugs. Also encourage them to resist compulsive internet searches. Patients with health anxiety should have periodic scheduled doctor visits – not impulsive sporadic care. Finally, if the patient’s compulsiveness surpasses the point of being just quirky to becoming obsessive, refer the patient to a behavioral health specialist.

Upcoming ISCA Events

Mark your calendars, ISCA has many great events coming up this year - you won't want to miss out! Check out for updates! ISCA GOLF OUTING September 23, 2008 Purgatory Golf Course 12160 E. 216th S. Noblesville, Indiana 46060

May/June 2008

ISCA Last Chance Seminar June 12, 2008 Holiday Inn Select Airport 2501 S High School Rd Indianapolis, IN 46241

ISCA Report

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



Still Need CE Hours? ISCA Last Chance Opportunities ISCA Last Chance Seminar

Can't make the last chance seminar? Register for ISCA’s Regional Video Viewings

Thursday, June 12, 2008 Holiday Inn Select Airport

2501 S High School Rd Indianapolis, IN 46241 You can still receive 8 hours of general continuing education for Indiana licensure before the June 30, 2008 licensing period deadline by attending the ISCA Last Chance Seminar on June 12. ISCA and Chiro Complete have once again teamed up to bring National Government Services’ (formerly Adminastar Federal) Provider Outreach Unit to a special presentation for Indiana chiropractors. This presentation by Corrine Ball, RN will be geared toward chiropractors and will focus primarily on chiropractic claims and Medicare audits. Stop wondering if the information you have is right, hear it straight from a Medicare representative. With the entire buzz about reviews and audits, you don’t want to put your clinic at risk.

D e t a i l e d i n f o rm a t i o n w i l l c o v e r • Comprehensive Error Rate Testing vs. Medical Review • Chiropractic Coverage and Correct Billing Procedures • Medical Necessity • Supportive Care vs. Maintenance Care • Documentation and more Documentation! • ABN Form and Much More. Note: This seminar is to provide instruction and education as it relates to chiropractic and Medicare. It is NOT a forum for complaints or for appealing or discussing EOBs. There are a limited number of seats, so pre-registration is encouraged. Seminar will be held at the Holiday Inn Select Airport in Indianapolis.

Pr o p o s e d Agen da and Ob jective s 7:30-8:00 Registration 8:00-10:00 Review and Comprehensive Error Rate Testing 10:00-10:20 Break 10:20-12:00 Coverage and Coding Guidelines for Claims 12:00-1:00 Lunch 1:00-2:00 PQRI and NPI 2:00-2:20 Break 2:20-4:00 Documentation Examples and Open Discussion 4:00-4:20 Break 4:20-5:00 Wrap Up, Summation and Evaluation


Receive 4 hours of Risk management continuing education for Indiana licensure before the June 30, 2008 licensing period deadline by attending one of the ISCA Regional Video Viewings at various Chiropractic Clinics throughout the state. Registration includes 4 hours of Risk Management CEUs. (For directions to a location, please call host doctor.)

dates & locations May 19 (8:30 AM - 12:30 PM) Dr. Kaiser - Host 2033 45th St. Highland 219-864-7967 May 20 (9 AM - 1 PM) Dr. Rogers' Office 632 Eastern Blvd. Clarksville 812-282-7500 May 20 (8 AM - 12 PM) Dr. Harmon’s Office 2602 Newton St. Jasper 812-634-6363 May 22 (8 AM - 12 NOON) Dr. Edwards' Office 2206 North St. Bedford 812-275-3323 May 22 (8 AM - 12 NOON) Hamilton Chiropractic 958 Kenmore Dr. Evansville 812-477-5003 May 22 (1 PM - 4 PM) Dr. O’Neal’s Office 2111 Margaret Ave Terre Haute 812-235-9752 May 22 (9 AM - 1 PM) Dr. Weimer’s Office 108 N. Landin Rd. New Haven 260-493-6565 May 29 (8 AM - 1 PM)

ISCA Report

Dr. Gerstenkorn’s Office 113317 Wicker Ave Cedar Lake 219-374-8190 June 4 (9 AM - 1 PM) Dr. Meyers' Office 3027 Mishawaka Ave South Bend 574-259-9355 June 7 (8:30 AM - 12:30 PM) Dr. Kostidis' Office Valparaiso Limited Space Available 219-464-9745 June 7 (12:30 PM - 4:30 PM) Dr. Sharpless’ Office 1810 Dogwood Kokomo 765-459-4575 June 14 (8 AM - 12 NOON) Dr. Carrico’s Office 120 Industrial Dr. Lawrenceburg 812-537-5616 -----------------------------------The ISCA is also offering the following dates at the association headquarters. May 20 (12:30 PM - 4:30 PM) May 22 (9 AM - 1 PM) June 24 (12:30 PM - 4:30 PM) ISCA Headquarters 200 S. Meridian St. Ste 350 Indianapolis 317-673-4245

May/June 2008

ISCA last chance opportunities registration form Video Viewings

Member Level A. Platinum.......complimentary B. Gold & Silver........................... C. Member (in good standing) D. Member (in arrears)............. E. Non-Member......................... F. Chiropractic Assistant............

Last Chance Seminar

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At the Door $0





















Adv. $0

There are a limited number of seats, so pre-registration is encouraged. If signing up for Regional Video Viewing, please indicate the location you are attending.

CONTACT INFORMATION Confirmations will be mailed to this address. Business Name

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Amount Last Chance Video Viewings (List Location) Seminar ____________________________________________________________________________________________________________________ Membership Level

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$ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ $ ____________________________________________________________________________________________________________________ $ Proceeds benefit ISCA BackPAC.

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Return to: Indiana State Chiropractic Association 200 S. Meridian St, Suite 350 Indianapolis, IN 46225 or by Fax: 317.673.4210 Visa


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Questions? Call 1.317.673.4245, or e-mail / Refunds at 90% until June 5. No refunds after June 5.

May/June 2008

ISCA Report


Indiana State chiropractic association classifieds PRACTICES FOR SALE Central Indiana Chiropractic practice for sale. Well established (29+ years) in a large, free standing building that boasts low overhead, ample parking space, visible signage, and high patient traffic. This practice has consistent collections in over $240,000 per year with a minimum of 400 to 500 a month. General diversified practice, fully equipped. Excellent opportunity. Practice has great growth potential. Serious inquiries only, please. Contact Seller at 765-398-2179. Posted 4/29/08 Office suite for lease in historic downtown Noblesville. Great opportunity for a chiropractor to have an office ready to go. Call 317-774-1010. Posted 3/20/08 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 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 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 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

Practices Wanted Are you sick and tired of "running the show"? Has lack of insurance reimbursement and payment hassles made you want to get out of chiropractic? If so, I may be able to help. Learn how you can stay in your own clinic and be able to do what you were trained to do, treat patients! Help is on the way! Send me an email with your name and phone number and best time to call. I have helped many practices to not only stay open but to thrive! The only way to break your fear is to take action! Want a 3 day weekend to be able to spend time with your significant other or children? You've got it! Not a misprint. I can help you! Send your information to: What appears to be the end may really be a new beginning! Posted 5/7/08

Associates Available Recent male graduate. Proficient in many techniques, including Cox and McKenzie. I am punctual, hard working and willing to learn. Looking for a fulltime associate position in the Indianapolis metro area. For more information please contact Chris via email at Posted 5/7/08 Palmer graduate. 25 years experience, excellent adjusting and people skills. Multiple techniques including Activator and Cox. References available. Call Dr. Grotzinger 317.585.4808. Posted 3/17/08 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 Kathleen Sanderford, D.C. Posted 2/14/08

Associates Wanted Having Trouble Getting Started? No Need to Sign Your Life Away! New state of the art clinic located in beautiful Fishers, Indiana. Visit www.fishersfind. com to learn more about fantastic demographics. Share space or take over entire clinic. Great opportunity - turn key office ready to go! Equipment

ISCA Report

includes Cervical/Lumbar Decompression, Digital X-ray, Cold Laser Therapy, Hill Flexion Distraction Tables, Open Bay Physiotherapy. you name it! Staff includes a Massage Therapist. Provider insurance benefits pay well. Set your own hours and share the walk-ins! Start your practice for only $3,950. Call (317) 607-0464 or email backworks@ if interested in learning more. Posted 5/7/08 Chiropractic Associate Needed Rapidly expanding Practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic, ambitious doctor is a must. Must be proficient in Cox Technique, Palmer Diversified Technique and Thompson Technique. Salary and profit share of clinic are offered. Send Resume to Dr. Danielle Kauffman 7620 E. 109th Ave, Crown Point, IN 46307 or E-mail to Posted 4/30/08 Busy Chiropractic office looking for tandem chiropractor. Must use Thompson, Activator, Cox Flexion/Distraction. Pay starts at $1000/wk. Bonus pay with practice growth. Trimboli Chiropractic is in Indiana 35 minutes from Downtown Chicago. Contact us at:, by phone (219)836-8890 or by fax (219) 836-2344. Posted 4/30/08 Central Indiana Practice seeks hard working, well skilled, caring, dedicated Chiropractor proficient in various techniques. Serious candidates only. Contact 765-398-2179 for further details. Posted 4/29/08 Busy Southern Indiana practice looking for an intelligent, ethical chiropractor with excellent adjusting skills-diversified/Gonstead. Experience is a plus. 28-30 hrs/week. Please fax your resume to 812-275-8044 or email to Posted 4/15/08 Rapidly expanding Practice in Crown Point, Indiana, is looking for full time position to be filled. Enthusiastic, ambitious doctor is a must. Must be proficient in Cox Technique, Palmer Diversified Technique and Thompson Technique. Salary and profit share of clinic are offered. Send Resume to Dr. Danielle Kauffman 7620 E. 109th Ave, Crown Point, IN 46307 or email Posted 4/7/08 Great Opportunity for an Independent Contractor in a fast growing, hard working practice on the northside of Indianapolis. Please call (317-7761061) or fax resume (317-776-1172). Posted 3/20/08 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

May/June 2008

Indiana State chiropractic association classifieds Resume to Dr. Sara Wallace 1020 E. Steger Road Crete, Il 60417 or E-mail to drsarawallace@yahoo. com. Posted 3/10/08 $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 screeningtype 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: 574254-1650 email: 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 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 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 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 Send resume and cover letter to

May/June 2008

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

Vacation Doctors 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 Kathleen Sanderford, D.C. Posted 2/14/08

Equipment For Sale Equipment for sale in southwestern Indiana Barely used, great condition, only 4years old Complete Xray package Includes all of the following for only $ 13,000 DTR High Frequency X-ray unit - generator, bucky stand, cathode and board Mini Med AFP processor and processor stand & Processor Chemical storage containers Id flasher x-ray bin floor model Calipers 1 double bank view box 2 single bank view boxes 8 - 8x10 x-ray cassettes 4 - 14x17 x-ray casstettes Also available: Metal Xray storage rack $750.00 For offers contact us at 1-765-914-8943 or 812-858-1008. E-mail us at Posted 4/1/08 ZENITH 95 Flexion Distraction table. Pancake elevation switch. Barely used burgundy cushions. No scratches, tears, or mechanical issues whatsoever. Great table in great shape. $4000 ($8395 new). GALAXY stationary adjusting table with armrests, face slot and paper attachment. Brown/tan color. Very good shape. $100. Call 765935-1000. I have pics of both tables. Posted 3/26/08 Entire chiropractic office of equipment available; 3 years old; all in excellent shape; X-ray machine, office desk, chairs, stationary tables, 1 poweractivated table, exercise equipment. Office suite for lease in historic downtown Noblesville. Great opportunity for a chiropractor to have an office ready to go. Call 317-774-1010. Posted 3/20/08

Chattanooga Triton Decompression Table. In use for only 18mo. Dr. upgrading. $4500.00 For more information contact: Bob Graham at Posted: 2/4/08 Transworld 300ma 125 kvp chiropractic Xray system complete with floor to wall tubestand with electric locks, 14x17 wallstand with grid, certified collimator and 1.0 - 2.0 140,000 HU tube. Comes complete with operator barrier, cassettes, darkroom accessories and Fischer automatic 90 second cold water film processor. $5,900 obo Call Dr. Scott Little (812) 333-2501 Posted: 1/31/08 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 Posted: 1/30/08 Wanted - D.C. looking for used Arthrostim adjusting instrument. Please contact Wes Kemp, D.C. Phone: 812-897-1700 Email: Posted: 1/23/08 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@ Posted: 1/23/08

Post a Classified Ad

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

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 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

ISCA Report


ISCA Report

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

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ISCA May/Jun Newsletter 2008  

news in chiropractic.

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