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SUMMER 2012

PRESIDENT'S MESSAGE: So, how do I see the future of chiropractic? In short, very positively! We care for the whole person and counsel patients on exercise, diet, nutrition, stress reduction, risk avoidance and lifestyle modification. After a few well planned visits, chiropractic patients often note feeling better than they have in months or years. They frequently say that DCs work “with them” instead of “on them”, explaining their problem and care in a way that allows them to partner with the doctor in their quest for health and wellness. When tens of thousands of new patients gain health care coverage within the state of Indiana and DCs are broadly included-------there will not be enough DCs to handle the demand. This increased demand has been seen with the inclusion of DCs in the military as patients have become aware of the availability and benefits of chiropractic. Health care reform will increase this demand again, but on a much larger scale. We are also working on a Federal level with Medicare Demonstration results to expand DC services covered under Medicare. Full-scope coverage of chiropractic services for this rapidly enlarging Medicare population will further propel chiropractic to its rightful place in health care. Doctors of chiropractic are in the right place at the right time, but we must seize the day. This transformation of health care will require all of us to be engaged. Your help will make a critical difference. We ask you to do three things to help us achieve this positive vision for our profession and our patients. • Join our state association and our national association today, and become a long-term supportive member. If you are a member, recruit others to join. We must rally our doctors to action now. • Read your state and national publications and study the ISCA’s Chiropractic Scientific Review (CSR)* to understand the critical issues, our important initiatives and how you can help. We must all be well informed. • Make the commitment today to yourself, your family, your patients and our profession to join the chiropractic family team and do everything you can to help level the health care playing field and bring the best of health care to our patients within this state of Indiana. See a positive vision for chiropractic and a transformation of health care in Indiana, and help us make it happen. Together, we can do this! Your President Dr. Robert Tennant *For your free copy of the CSR, go to www.indianastatechiros.org, log onto the “Members Only Section.” On the “Members Only” home page, you will find a link to the CSR and other informative position papers.

Mark Your Calendar, Register Today for the 2012 ISCA Fall Conference Have you marked your calendar for the 2012 ISCA Fall Conference, November 2-4 at the Renaissance North, 11925 North Meridian Street. David R. Seaman, DC, MS, DABN headlines the conference speaking on Clinical Nutrition for Pain and Inflammatory Diseases. Joining Dr. Seaman are Kevin D. Jardine, DC, ART, CSCS, CSTI, MedAc and Ted A. Arkfeld, DC, MS, CPC. Dr. Jardine will speak on Integrative Evaluation Treatment and Rehabilitation for Neuromusculoskeletal Conditions and Dr. Arkfeld presents the Risk Management Session: Correct Coding Pays. David Vaughn, Provider Outreach and Education, WPS Medicare presents a second Risk Management program at the seminar: Chiropractic Care as It Relates to Medicare. For a complete schedule of programs and agenda of the conference go to page 10 of this ISCA Report. You can also register online at www.indianastatechiros.org or contact Cathy Orosz, Association Manager at the ISCA office 317-673-4245 ext. 156 or 800-572-8002.

Early Bird Registration ends Friday, October 19! Make your reservations today!


INDIANA STATE CHIROPRACTIC ASSOCIATION BOARD OF DIRECTORS President Robert Tennant, D.C., FICC Shirley, IN 765.737.1117 doct@hrtc.net

District Seven Diane Vuotto, D.C. Indianapolis, IN 317.898.6989 vuottojd@comcast.net

District Four

DISTRICT DIRECTORS

District Eight Shaun Tymchak, D.C. Newburgh, IN 812.858.1008 drshaun@newburghchiro.com

District Five David Frischman, D.C. Wabash, IN 260.563.8476 wccincpc@gmail.com

Second Vice-President Peter Furno, D.C. Zionsville, IN 317.374.9966 pfurno@sbcglobal.net

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

District Nine Toby Harmon, D.C. Jasper, IN 812.634.6363 harmonfm@insightbb.com

District Six

Secretary Michael Phelps, D.C. Martinsville, IN 765.342.2208 mikephelps55@att.net

District Two Gerard Hofferth, D.C. South Bend, IN 574.256.1008 drhof@aol.com

ALTERNATE DIRECTORS AT LARGE

Treasurer Lewis Myers, D.C. Valparaiso, IN 219.464.4444 lew.myers@gmail.com

District Three Jason Russell, D.C. Fort Wayne, IN 260.637.1000 team@ optimumperformancefortwayne.com

First Vice-President James Cox II, D.C., LAC Fort Wayne, IN 260.484.1964 drj@coxchiroacu.com

Immediate Past President Anthony Wolf, D.C., FICC Indianapolis, IN 317.898.1100 drtony6900@aol.com Past President Representative Robert Clements, D.C. Kokomo, IN 765.452.1330 raclements99@aol.com DIRECTORS AT LARGE Thomas Carrico, D.C. Lawrenceburg, IN 812.537.5616 tcarricodc@aol.com

Douglas Breger, D.C. New Albany, IN 502.322.7411 doctorbreger@yahoo.com Frank Laux B.S., D.C. Indianapolis, IN 317.881.3333 lauxclinic@sbcglobal.net

District Four E. Curtis Harris, D.C. Franklin, IN 317.736.7088 drcurtisharris@embarqmail.com District Five Derek Dyer, D.C. Huntington, IN 260.356.1616 drderekdyer@gmail.com District Six David Davis, D.C. Winchester, IN 765.584.3665 drddd@aol.com

Scott Auton, D.C. Franklin, IN 317.346.0799 scottaauton@yahoo.com

Donna S. Cray, D.C. Muncie, IN 765.286.9020 dr_donna@comcast.net

Christopher Paprocki, D.C., FICC Greenwood, IN 317.881.7759 jpaprocki1@aol.com ALTERNATE DISTRICT DIRECTORS District One Joseph Paun, D.C. Highland, IN 219.227.4033 drjoe@paunwellness.com

District Seven Kristen Hartwell, D.C. Indianapolis, IN 317.784.9311 iuchiro@yahoo.com District Eight Michael Toney, D.C. Terre Haute, IN 812.232.1464 flopper1968@hotmail.com District Nine

Keith Bartley, D.C. Jasper, IN 812.482.6600 brtchiro@fullnet.com

District Two William Garl, D.C. Bremen, IN 574.546.4111 w.garl@mchsi.com District Three George Joachim, D.C. Fort Wayne, IN 260.492.8811 drgeorge@aaronchiro.com

ALTERNATES: The ISCA by-laws allow for the Directors at Large and the District Directors to have Alternate Directors. The Alternate At Large Directors may reside anywhere in the state. The Alternate District Directors must reside within their district. There are 9 districts and their boundaries are the same as per the national census. This is done to keep the Districts in line on a proportional basis. When the Directors are not present, the Alternate Directors have the full voting powers as the Directors and may take their place at any meetings. This system was initiated to involve more people in the association’s decision-making process and to serve as a training ground for future board members. The Alternate Directors at Large are nominated by the Directors at Large and then must be approved by the Board of Directors. The District Director Alternates are recommended by the District Directors and approved by the board.

INSIDE THIS ISSUE PRESIDENT'S MESSAGE.....................................................................................1 ISCA BOARD OF DIRECTORS & SOCIAL MEDIA LINKS...................................2 EXECUTIVE DIRECTOR'S MESSAGE................................................................3 MULTI-DISCIPLINARY PRACTICES IN INDIANA.................................................4 DR. PHIL AND THE DR. OZ SHOW FEATURE CHIRO CARE................................4 THE ISCA IS HARD AT WORK FOR YOU!......................................................5 ISCA AND ACA INVESTIGATE ALTERED CLAIMS..........................................5 CHIROPRACTIC BEFORE SURGERY FOR CHRONIC LBP................................7 AVOID DEACTIVATION BY MEDICARE.................................................................8

SUPREME COURT UPHOLDS HEALTH REFORM LAW.....................................9 ISCA FALL CONFERENCE NOVEMBER 2-4, 2012....................................10-12 TOP 10 REASONS MEDICAID CLAIMS DENY............................................13 MARK YOUR CALENDARS: ISCA FALL CONFERENCE: NOV. 2-4, 2012..........16 WPS TAKING OVER AUGUST 20.................................................................14 A GENERAL OVERVIEW OF "INCIDENT-TO"......................................................15 VICARIOUS LIABILITY.........................................................................................17 THE TIME IS NOW!...........................................................................................18 ISCA CLASSIFIEDS.............................................................................................19

INDIANA STATE CHIROPRACTIC ASSOCIATION SOCIAL MEDIA LINKS

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EXECUTIVE DIRECTOR'S MESSAGE: PATRICIA MCGUFFEY, ESQ. I hope all of you have enjoyed your summer. Your ISCA team has been busy at work on your behalf. Some of the activities that we have undertaken include: • Attended more than 50 legislative fundraising events on your behalf. • Worked with ISCA’s Legislative and insurance committees to develop position papers and information to send a letter, fact sheet (on page six) and survey to all legislative candidates. • Sent materials to ISCA’s District Directors to assist them with setting up meetings with members in their District to contact and meet with their local legislators regarding ISCA’s priority legislative issues. • Met with both gubernatorial campaigns to share ISCA’s policy positions. • Attended the National Association of Chiropractic Attorneys (NACA) meetings to gather information that will be helpful to you with your practice as well as assist with our legislative program. • Organized and attended numerous lunches and meetings with legislators and candidates to share the ISCA story and the issues important to you - our members. • Worked diligently to finalize an excellent fall conference and spring joint conference. These are just a few of the activities we have been involved with on behalf of our chiropractic family. As you will be able to see from the Association Manager, Cathy Orosz’s report, on page five, the ISCA office is always here to answer your professional questions. Many of you may believe that when the legislative session ends that our work on legislative issues also draws to a close. However, that is when the real work begins! It is during the interim when most of the detail work is done by members of the Indiana General Assembly and your ISCA. Indiana lawmakers spend the summer and fall reviewing some of the thorniest issues that tripped them up during their 2012 session as well as other pressing issues that have come to their attention. The summer study groups often set the basis for action that will be taken in the 2013 legislative session. That is why the ISCA has been paying close attention to the summer study committees that are meeting now and we will be closely monitoring committees such as the Health Finance and Medicaid Oversight Commissions. We want to make sure that your interests are represented! BUT, WE NEED YOU! As diligently as the ISCA staff may work to serve you, we need your help. It is so important that you meet with your local legislative candidates to share the chiropractic story and our priority legislative issues. We will be happy to assist you with setting up the meetings and make sure you have all materials needed to educate your local legislators. If we are to be successful, we must work as a team. PLEASE SHARE our two key legislative issues with your legislators. The two main points to explain are (1) the ISCA opposes PTs having direct access to patients unless they are prohibited from performing spinal adjustments/manipulations. All healthcare providers should receive the education and training a chiropractic physician receives to perform spinal adjustments/manipulations. (2) Also, we ask that legislators make sure that any law proposed dealing with health care provide parity for reimbursement for all chiropractic treatment services and not discriminate against chiropractic physicians whether it be in a State health plan such as Medicaid or the Healthy Indiana Program (HIP) or private insurance plans. The ISCA is here to serve you and we hope that you will not hesitate to contact our office if we can serve your practice needs. We are excited about the things we have accomplished together and believe that chiropractic is centered well to move to the forefront to meet the health care needs of all Hoosiers. Thanks for being a supportive ISCA member! I look forward to seeing all of you the first weekend in November for our fall conference.

SUMMER 2012

ISCA REPORT

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Multi-Disciplinary Practices in Indiana By: Mark K. Sullivan & Associates, P.C.

Multi-disciplinary practices are on the rise in the State of Indiana - with good reason. These types of practices broaden the scope of the services the chiropractor can offer by forming collaborations with physicians, nurse practitioners and other healthcare providers. As with the start of any new entity, forming this practice can have its challenges. The first challenge is the fact that every state has different laws regulating the “practice of medicine.” Some states completely prohibit a chiropractic entity from hiring a physician, while other states place limitations on such hiring. Indiana’s approach to the practice of medicine allows chiropractors the opportunity to form multi-disciplinary practices in this state so long as the employment or other contractual relationship with a physician permits the physician to maintain control over his or her medical decisions and judgment. The next challenge a chiropractor may face in forming the multi-disciplinary practice is determining what types of professionals to hire. If a chiropractor is seeking to bring in new professionals into the office – for instance, a physician and nurse practitioner - it’s imperative that the chiropractor understand the scope of each professional’s license and what they are permitted to do. In addition, an appropriate collaboration agreement must be in place between any physician and any non-chiropractic professional operating under their supervision. The final challenges facing chiropractors will be the credentialing process for the new multi-disciplinary practice. While it may be ideal in terms of transition, ease, and cost to simply add a physician and nurse practitioner to your existing chiropractic entity, the reality is that your multi-disciplinary practice is a new entity and should be treated as such. Therefore, a new legal entity should be formed, as well as new tax identification numbers and other appropriate credentialing. Our office has assisted chiropractors across the state in forming their new multi-disciplinary practices. Please feel free to contact us with questions.

May 14, 2012: A Big Day for Chiropractic! “Dr. Phil” and “The Dr. Oz Show” Feature Chiropractic Care on Same Day! Wednesday, May 14, 2012 was a truly momentous day for chiropractic, as both the popular syndicated daytime talk shows Dr. Phil and The Dr. Oz Show featured segments about chiropractic care. On Dr. Phil, Parker President Dr. Fabrizio Macini presented concepts of wellness and how chiropractic integrates into a healthy lifestyle. On Dr. Oz, New York City chiropracticor Dr. Steven Shoshany appeared to talk about the significant advantages of chiropractic for the treatment of chronic back pain and as a safe and effective alternative to surgery. Besides discussing chiropractic wellness, Dr. Mancini spoke about his new book, The Power of Self-Healing: Unlock Your Natural Healing Potential in 21 Days!, which includes information about living the chiropractic lifestyle of health and wellness. “I’m so glad to have had this opportunity and I’m thrilled that so many people around the world heard about chiropractic and the body’s natural ability to heal,” said Dr. Mancini. “This was a tremendous victory for our profession. There is a movement starting and the time is now to get the message of chiropractic and natural healing to the masses.” Dr. Mancini explained that chiropractors see patients as well, not as sick individuals. “The difference between chiropractic and the ‘sick care system’ in the U.S. is that we assume the patient is well and not sick,” said Mancini. “My job is to try to figure out any possible way to naturally facilitate that self-healing inside of yourself and address the cause of the problem, not just manage symptoms.” After the show, numerous people working on the set asked how they could find a local chiropractor or remarked how much they had learned about chiropractic. Visit drphil.com to find more information about the episode.

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ISCA REPORT

SUMMER 2012


The ISCA is Hard at Work for YOU!

Are you making the Association work for you? The Association’s professional staff and leadership work tirelessly to keep you informed on the key issues facing Indiana’s chiropractors. Are you aware of everything available to you as an ISCA member? Earlier this year, we implemented a weekly schedule of “Back Talk” promotions. Weekly, we spotlight one top-of-mind issue or member benefit to stay in front of our members to assure they are informed and engaged. Valuable resources are right at your fingertips on the Association website. Members can keep informed on upcoming education events and conferences, association news as well as take advantage of informational resources available on the website. Through the hard work of our leadership, the ISCA proudly makes available to its members the Chiropractic Scientific Review (CSR). This compilation is imperative in understanding the profession’s key initiatives and how you can get involved. For your FREE copy of the CSR, go to www.indianastatechiros.org, log onto the “Members Only” section. In this section, you will find a link to the CSR and other informative position papers. The ISCA is proud of its membership and the profession. Look forward to hearing more about upcoming plans to promote October as “National Chiropractic Health Month (NCHM) 2012! As ISCA’s Association Manager, I am here to serve you and make sure your voice is heard. Please contact me at 800-5728002 or info@indianastatechiros.org to let me know how you would like to be more involved in our efforts or with any suggestions on how to make your membership more valuable. Cathy Orosz ISCA Association Manager Phone 317-673-4245 COrosz@LMVconsulting.com

ISCA and ACA Investigate Altered Claims

By: Thomas Carrico, DC, ACA Insurance Liason, ISCA Director at Large The ISCA and ACA are hearing concerns about third party administrators (TPA) and insurance carriers applying what appear to be administrative fees to claims. While in some cases, administrative fees can be a normal contractual allowance, how these fees are applied and how they are communicated to enrollees, employers and providers is very important. Also noted by the ISCA is that, some EOBs have been changed from what the doctor originally billed making the financial record of treatment inaccurate. After the TPA/carrier makes these edits to the claim and adds the administrative fees, an EOB is sent to the patient reflecting these changes. This practice appears to give the patient the impression that providers are charging the higher fees and this may deter patients from returning to the doctor to continue care. It also may cause the patient to question the difference in fees from what was provided to them by their doctor versus what is stated on the EOB from the insurer. Both the ISCA and the ACA are appealing to all chiropractic physicians in Indiana to STOP and: • Review the EOBs you have recently received (keeping in mind that you may only see these modifications on your patient's EOBs); • Compare them to the billings you have submitted; • Check if you have been affected by this practice; • Send examples to ACA using the contact information below; • If you have a copy of the patient's EOB, send this as well - this would be very helpful; (you may be able to locate some patient EOBs online). • If you have any information that indicates you may have been affected by these practices, please go to http://www.acatoday.org/pdf/fax_IR.pdf for a printable packet to use to send your information to help our investigation. Thank you for making a difference in your profession!


DEADLINE FOR ALL ENTRIES: OCTOBER 12, 2012

The DC of the Year Award gives you the opportunity to recognize that colleague who best represents the service and spirit of the chiropractic industry. They perform that extra service that distinguishes them from other Chiropractic professionals. ENTRY FEE

There is no fee to nominate a candidate for this award. However, there will be a fee to attend the ISCA Fall Conference on November 2-4, 2012. Please see the separate DC of the Year Nomination Form Entry Sheet insert included in your newsletter packet for full rules and nomination guidelines.

Fact Sheet Sent to All Indiana Legislative Candidates with Survey Chiropractic is a branch of the healing arts that is concerned with human health and disease processes. It is a drug-free, non-surgical science and, as such, does not include pharmaceuticals or incisive surgery. The practice and procedures which may be employed by Doctors of Chiropractic (chiropractic physicians) are based on the 8-year academic and clinical training received in and through accredited chiropractic colleges and include, but are not limited to, the use of current diagnostic and therapeutic procedures. Such procedures specifically include the adjustment and manipulation of the articulations and adjacent tissues of the human body, predominantly of the spinal column. Millions of patients implicitly trust their doctor of chiropractic and greatly appreciate chiropractic’s unique and safe approach to recovery from pain. Chiropractic care has some distinct advantages over more traditional forms of care because it does not involve surgery or drugs. • A preponderance of search suggests that chiropractic is the safest approach available for relief from neck pain, back pain, headaches and other muscular skeletal complaints.

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For back pain conditions, patient satisfaction with chiropractic treatment has repeatedly been shown to be significantly greater than that of conventional management, administered by a primary care physician, or an orthopedist.

The cost advantages for chiropractic are so dramatic that Pran Manga, a Canadian health economist, has concluded that doubling the utilization of chiropractic services from 10% to 20% may realize savings as much as $770 million in direct costs and $3.8 billion in indirect costs.

ISCA REPORT

SUMMER 2012


Chiropractic Before Surgery for Chronic LBP University of Pittsburgh Medical Center Health Plan Mandates Three-Month Course of Conservative Care Before Invasive Procedures The University of Pittsburgh Medical Center (UPMC) Health Plan – an HMO affiliated with the University’s School of Medicine – has announced a policy on low-back pain in which surgery will only be authorized after a course of conservative care. To be considered for surgery, patients with chronic low back pain must have: •Tried and failed a 3-month course of conservative management, which includes chiropractic, physical therapy, and medication •Completed UPMC Health Plan’s Low Back Pain Health Coaching Program, which includes a “Web-based shared decision-making tool to help members understand the pros and cons of surgery and high-tech radiology” The new policy took effect January 1, 2012. According to the December 2011 issue of UMPC Health Plan Physician Partner Update, “This policy was developed using evidence-based literature and professional society guidelines, as well as the input of external medical professionals with expertise in the area.” The Update also states: “We feel strongly that this clinical initiative will improve the quality of care for members considering low back surgery and will facilitate their involvement in the decision-making process.” In a comment on the UPMC Health Plan guidelines to Dynamic Chiropractic and Life Chiropractic College West, and current executive committee member of the Foundation for Chiropractic Progress stated: “The UPMC should be congratulated for its leadership [in] establishing policies to assure that the least invasive and most likely to be successful care strategies, including chiropractic care, are applied for a meaningful period of time before surgical considerations are made. This decision is both an important recognition of the value of chiropractic care in the acute low back pain environment as well as recognition of the clinical and economic downsides to spinal surgery in this situation.” The UMPC Health Plan – the second-largest health insurer in western Pennsylvania – is owned by the University of Pittsburgh Medical Center, one of the nation’s top-ranked health systems. UPMC Health Plan’s local provider network includes UPMC and community providers, totaling 11,500 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland. Sources: UPMC Health Plan Physician Partner Update, December 2011 Dynamic Chiropractic, “Chiropractic Before Spine Surgery for Chronic LBP,” May 20, 2012, Vol. 30, Issue 11

INDIANA STATE CHIROPRACTIC ASSOCIATION SOCIAL MEDIA LINKS

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SUMMER 2012

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ISCA REPORT

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AVOID DEACTIVATION BY MEDICARE By: Mario Fucinari DC, CCSP, MCS-P, MCS-I and Ginny Fucinari CPC, MCS-P Medicare is currently notifying providers of the procedures to revalidate their information. If you receive this request, you must respond. Failure to do so will result in deactivation of your Medicare privileges. Revalidation is the process used by the Centers for Medicare and Medicaid Services (CMS) for providers to certify the accuracy of their Medicare enrollment. In 2010, the 42 Code of Federal Regulations (CFR), chapter IV, paragraph 424.515 at http://edocet.access.gpo.gpv/cfr_2010/octqtr/pdf/42cfr424.515.pdf requires providers to confirm the accuracy of the information that was previously given to Medicare. Failure to do this will result in deactivation of the provider from the Medicare and Medicaid program. Providers must respond to revalidation requests within 60 days of the request. Do not revalidate until you have been requested by CMS to do so. Although there is a fee for Durable Medical Equipment and Ambulance providers, there is no fee for physicians to revalidate. CMS is currently targeting the following providers for revalidation: 1. Those who fail to register in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), 2. Providers in a high fraud risk area, 3. Providers not enrolled in the (EFT) electronic funds transfer program, or 4. Those who fail to update enrollment within the past five years.

Considering that chiropractic has consistently been number one in errors, it is likely that we all will feel the brunt of this requirement. Prevent deactivation or revocation by complying with Medicare’s requirements to keep your enrollment information current. If any of the following changes have occurred within your practice, you must notify Medicare: 1. Change in ownership or control of the practice – must be reported within 30 days, 2. Change in location of practice – must be reported within 30 days, 3. Change in the billing services – must be reported within 90 days, and 4. “Special payments and correspondence” address – must be reported within 90 days.

See www.cms.gov/MedicareProviderSupEnroll/downloads/GettingStarted.pdf for complete information that is to be reported and time frames for reporting. If Medicare sends revalidation or any other correspondence to the address on file and it is returned as “undeliverable,” or if the provider does not respond to the request to revalidate within the specified time period, the provider may have his or her billing privileges revoked or deactivated. Medicare does not allow the forwarding of payment or correspondence to new address. Several instances have been reported where the provider has attempted to “opt” out of Medicare. Keep in mind that as a chiropractor, you cannot opt out of Medicare. Furthermore, writing provisions on the ABN form in which you have the patient sign an attestation that you will not file claims for active care is not legal. If you see Medicare patients without being enrolled in Medicare, you will face significant fines. If you see a Medicare patient, in most instances, you must file a claim for that patient. Your status as a participating or non-participating provider has no bearing on this regulation. “Non-participating is still participating in Medicare.”

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ISCA REPORT

SUMMER 2012


Supreme Court Upholds Health Reform Law On June 28, 2012, the U.S. Supreme Court, in a controversial 5 to 4 decision, declared the Patient Protection and Affordable Care Act (PPACA) to be constitutional, including the much disputed “individual mandate” provision which requires individuals to purchase health insurance coverage. According to the American Chiropractic Association (ACA), the long-awaited court decision removes legal obstacles to the full implementation of the law on a timeline very close what was planned when PPACA was signed into law in March 2010. A critically important result of the court’s decision is the preservation of Section 2706, which establishes a “provider non-discrimination provision” applicable to all Employee Retirement Income Security Act (ERISA) health care plans, including self-insured, multi-state plans that are not subject to provider-friendly state laws. ACA worked hard to ensure the inclusion of this provision in the legislation. “Regardless of how you feel about this legislation in general, Section 2706 has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it illegal for insurance companies to discriminate against doctors of chiropractic and other providers based on the provider’s license or scope of practice,” said ACA President, Keith Overland, DC. “While the fight to fully level the playing field for doctors of chiropractic in our health care system goes on, the nondiscrimination provision, when it is fully implemented, will extend the availability of chiropractic services to several million employees at large, national firms that operate in multiple states.” Under the timetable embedded in the law, the majority of its key provisions, including the provider non-discrimination provision and the individual mandate, are scheduled to take effect no later than 2014. The Court’s ruling also means that all 50 states will be required to establish “state insurance exchanges” where eligible consumers will have an opportunity to shop and compare prices and benefits for a range of insurance policies that meet certain specified guidelines established by the federal government. A group of 26 states had joined together to challenge the law on constitutional grounds, and it was their challenge to the law that was effectively rejected by the courts.

SUMMER 2012

Only about a dozen states have moved to establish the required exchanges. States that delayed will have a hard time meeting the law’s specified deadlines, likely forcing the Department of Health and Human Services (HHS) to issue “waivers” to state governments, granting them additional time to comply fully with the law. For more than two years, ACA has worked with state chiropractic associations to prepare for the establishment of the state exchanges and, along with other groups, was successful in lobbying HHS to adopt regulation related to the exchanges that leave a significant level of authority in the hands of state governments. Safeguarding significant “state flexibility” is seen as one way to ensure that consumers have access to the services provided by doctors of chiropractic and that state laws favoring consumer choice of provider remain applicable, for the most part, in the state exchange environment. Additionally, in regard to the Medicaid expansion, a majority of the court held that the expansion is constitutional but that it would be unconstitutional for the federal government to withhold existing Medicaid funding from states that do not comply with the expansion’s provisions. The Constitution requires that states have a choice about whether to participate in the expansion of eligibility; if they decide not to, they can continue to receive funds for the rest of the program. Despite the court’s ruling, recent polls reflect substantial public concern regarding the law and in some cases, a deepening opposition to it. At this point, the only viable way to modify or repeal the law rests in the hands of Congress through a series of regulatory battles and a new round of “repeal and replace” efforts. ACA will remain fully engaged in this issue, working to ensure that all regulations implementing the law are constructed, carried out and enforced in a manner favorable to the chiropractic profession and its patients.

The ISCA serves on a The Healthcare Reform Task Force and will closely monitor all state actions regarding the implementation of the Affordable Care Act and Healthcare Exchanges.

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FALL CONFERENCE November 2-4, 2012

Renaissance Indianapolis North Hotel 11925 North Meridian Street, Carmel, IN 46032

Schedule At A Glance Friday, November 2 4:00 PM 5:00 PM - 10:00 PM 5:30 PM - 9:30 PM 6:00 PM - 8:00 PM 8:30 PM

Registration Opens Exhibit Hall Open David Vaughn: Chiro Care as it Relates to Medicare Board of Directors Dinner And Meeting Dr. Tennant’s President Suite Reception

Saturday, November 3 7:30 AM 7:30 AM - 6:00 PM 8:00 AM - 12:00 PM 8:00 AM - 12:00 PM 12:00 PM - 1:30 PM 2:00 PM - 6:00 PM 2:00 PM - 6:00 PM 6:00 PM - 7:00 PM 7:00 PM

Sunday, November 4 7:30 AM - 1:00 PM 8:00 AM - 12:00 PM 8:00 AM - 12:00 PM 8:00 AM - 12:00 PM 8:00 AM - 12:00 PM

Registration Opens Exhibit Hall Open Dr. David Seaman: Nutrition for Pain Dr. Jardine: Integrative Evaluation Saturday Lunch & Annual Meeting with Election of Officers Dr. David Seaman: Nutrition for Pain Dr. Jardine: Integrative Evaluation After Hours Reception / Vendor Pass Prize Drawing Platinum/Gold Members Dinner Registration Opens Exhibit Hall Open Dr. David Seaman: Nutrition for Preventing Disease Dr. Ted Arkfeld: Preparing for ICD-10 & HIPAA Audits Mark K. Sullivan, Andrea L. Cohen, Allie DeYoung, & Joy Long = Risk Management

Business/Business Casual Attire Preferred.

SPECIAL EVENTS

...................................................................................................... LUNCH & ANNUAL MEETING SATURDAY 12:00PM - 1:30PM Chat, network and dine with fellow conference attendees and sponsors during Saturday’s strolling luncheon. This is your time as members to be recognized and elect a new Board of Directors. We will also honor our Legislator of the Year Award, DC of the Year Award, and President’s Awards Winners, as well as those who have helped ISCA and the Chiropractic profession over the course of the year. ...................................................................................................... AFTER HOURS SATURDAY 6:00 - 7:00PM Mix and mingle with fellow Chiropractors at this networking reception after Saturday’s Fall Conference sessions have concluded. Everyone is invited! ...................................................................................................... PLATINUM/GOLD MEMBERS DINNER SATURDAY (7:00PM) Platinum and Gold Members of ISCA will enjoy a complimentary dinner as part of their Member Benefits. ......................................................................................................

HOTEL INFORMATION: RENAISSANCE INDIANAPOLIS NORTH HOTEL

11925 North Meridian Street, Carmel, IN 46032 ISCA Room Block Rate $119 Reservations: 866-905-9619 Room Block Ends: October 19 Mention “Indiana State Chiropractic Association Fall Conference” when making your reservation

----------------------------------------------------------------------------------FRIDAY, NOVEMBER 2, 2012 ......................................................................................................

David Vaughn, Provider Outreach and Education, WPS Medicare Friday 11/02/2012 -(5:30 PM - 9:30 PM) 4 hours Risk Management CHIROPRACTIC CARE AS IT RELATES TO MEDICARE Chiropractic physicians and office staff will want to attend this discussion designed to help both new and experienced Medicare providers and billers. The session will help you understand Chiropractic claim submissions medical policy (CHIRO-001), medical documentation, medical necessity and more. Other important topics covered are coding and billing guidelines, patient eligibility and beneficiary signature on file, non-covered services vs. services deemed not medically necessary.

RISK MANAGEMENT


----------------------------------------------------------------------------------SATURDAY, NOVEMBER 3, 2012

Dr. Kevin D. Jardine

......................................................................................................

DR. DAVID SEAMAN

12 Hours of CE Credit Session 1 - Saturday 11/03/2012 - (8:00 AM - 12:00 PM) Session 2 - Saturday 11/03/2012 - (2:00 PM - 6:00 PM) Session 3 - Sunday 11/04/2012 - (8:00 AM - 12:00 PM) CLINICAL NUTRITION FOR PAIN AND INFLAMMATORY DISEASES A substantial body of research in recent years suggests that dietary changes and certain nutritional supplements can have profound effect on disease prevention and health promotion. Participate in this educational session and learn how this allows chiropractors to be effectively guided to apply nutrition to chiropractic practice including important issues related to pain and inflammation and rehabilitation.

8 Hours of CE Credit Session 1 - Saturday 11/03/2012 - (8:00AM - 12:00PM) Session 2 - Saturday 11/03/2012 - (2:00PM - 6:00PM) INTEGRATIVE EVALUATION TREATMENT AND REHABILITATION FOR NEUROMUSCULOSKELETAL CONDITIONS In this course, you will learn the latest evidence-led manual medicine strategies for evaluation, treatment and rehabilitation for common neuromusculoskeletal conditions. Participants will learn the importance of dynamic movement evaluations as well as gain an understanding of modern rehabilitative sciences in musculoskeletal medicine. Kevin D. Jardine, DC, ART, CSCS, CSTI, MedAc, will discuss treatment strategies including the latest in kinesiology taping and instrument assisted soft tissue therapy. Learn how recent developments in science have evolved our understanding of implementing successful rehabilitative strategies. This informative workshop will show participants that do not poses an advanced understanding of rehabilitation the steps necessary to add active care to your practice without the need for additional space or equipment.

----------------------------------------------------------------------------------SUNDAY, NOVEMBER 4, 2012 ................................................................................................... MARK K. SULLIVAN, DR. DAVID SEAMAN ANDREA L. COHEN, 4 Hours of CE Credit ALLIE DEYOUNG, Session 3 - Sunday 11/04/2012 - (8:00 AM - 12:00 PM) & JOY LONG CLINICAL NUTRITION FOR PAIN AND INFLAMMATORY DISEASES A substantial body of research in recent years suggests that dietary changes and certain nutritional supplements can have profound effect on disease prevention and health promotion. Participate in this educational session and learn how this allows chiropractors to be effectively guided to apply nutrition to chiropractic practice including important issues related to pain and inflammation and rehabilitation.

DR. TED ARKFELD

Sunday 11/04/2012 - (8:00AM - 12:00PM) CORRECT CODING PAYS – RISK MANAGEMENT Join Ted A. Arkfeld, DC, MS, CPC, one of the nation’s leading authorities in chiropractic coding and documentation for this session that covers a number of pertinent coding topics including ICD-10, documentation requirements for CPT and diagnosis and clinical impressions that support Medicare’s tier system for treatment duration. Learn how to do and get paid for: X-rays not taken in your office, functional capacity evaluations, physical medicine & rehabilitation services, time based codes, and more. The session will cover Medicare documentation requirements, documentation compliance and self-audits.

RISK MANAGEMENT

4 Hours of Risk Managment Sunday 11/04/2012 - (8:00 AM - 12:00 PM) REQUIREMENTS OF COMPLIANCE PLANS, HOW TO SET UP A MULTI-DISCIPLINARY PRACTICE, HOW TO AVOID MEETING THE CHIROPRACTIC BOARD AND DOCUMENTATION AND CODING TIPS - RISK MANAGEMENT We will be discussing the development and implementation of compliance plans to demonstrate conformity with federal regulations and laws, matters to assist chiropractors in avoiding a complaint before the Chiropractic Board, considerations in setting up a multi-disciplinary practice and current issues in documentation and coding.

RISK MANAGEMENT


ISCA FALL CONFERENCE:

NOVEMBER 2-4, 2012 |RENAISSANCE NORTH

REGISTER ONLINE AT WWW.INDIANASTATECHIROS.ORG

Questions? Call 800.572.8002 toll free, 317.673.4245.

CONTACT INFORMATION Conference confirmation will be mailed to this address. Clinic Name

Contact Name

Address City E-mail

State

Phone (

)

Platinum Members

After Oct. 19

$350

$400

Member (in good standing)

$400

$450

Non Member

$535

$585

)

Rate

Quantity

Complimentary

Gold & Silver Members

Fax (

NON D.C. RATES

12 HOUR FULL CONFERENCE RATES Early Bird

Zip

CA (up to 8 hrs)

$109

Non D.C. Guest / Student

$75

Non D.C. Guest / Student if taking in conjunction w/ 12 Hr CE registration

$45

Quantity

8 HOUR CONFERENCE RATES Platinum Members

Complimentary

Gold & Silver Members

$230

$280

Member (in good standing)

$270

$320

Non Member

$330

$380

LUNCH Lunch (1 included w/ 8 & 12 hr registrations)

4 HOUR CONFERENCE RATES Platinum Members

AFTER HOURS & LUNCHEON RSVP (Do Not Leave Blank)

Complimentary

Gold & Silver Members

$145

$195

Member (in good standing)

$165

$215

Non Member

$230

$280

$30

I WILL ATTEND: ISCA After Hours YES____ NO____ Saturday Luncheon & Membership Meeting YES____ NO____

COURSES ATTENDING (Do Not Leave Blank)

COURSE DAY & TIME

COURSES OFFERED

Friday (5:30-PM - 9:30PM) 4HRS *David Vaughn - Risk Management Saturday (8AM-12PM) 4HRS

Dr. Seaman - Nutrition For Pain

Dr. Jardine - Integrative Evaluation

Saturday (2PM-6PM) 4 HRS

Dr. Seaman - Nutrition For Pain

Dr. Jardine - Integrative Evaluation

Sunday (8AM–12PM) 4HRS

Dr. Seaman - Nutrition For Pain

*Dr. Arkfeld - Risk Management

PAYMENT METHOD

*Mark K. Sullivan Risk Management

Payment must accompany registration to be processed.

Enclosed is my check for $________________ (make payable to ISCA) Mail to: Indiana State Chiropractic Association, 200 S. Meridian St., Suite 350, Indianapolis, IN 46225

I am faxing this form with my credit card as payment. Fax form to 317.673.4210 Charge my total to: American Express MasterCard Visa Discover

Card #

CID _______

(3-digit # found on the back of the card on the signature line)

Exp. Date

Name on Card If you have a special dietary or accommodation need, please check here and we will call you.

Signature

Confirmation/Cancellation Refunds: All registrations received will be confirmed by fax and/or mail. If you must cancel for any reason, notify us in writing by October 19, 2012. to receive a 90% refund. No refunds will be given for cancellations received after October 19, 2012.


Top 10 reasons Medicaid claims deny – more than 1.5 million total denials in July 2012

By: Michael Phelps, DC, Medicaid Advisory Committee Rep., ISCA Secretary, ISCA Board of Directors

In July 2012, the Indiana Health Coverage Programs (IHCP) processed more than 6.5 million Medicaid claims. Of that number, more than 1.5 million claims denied. The following table shows the top 10 reasons (beginning with the most frequent) Medicaid claims were denied in the month of July 2012. To help prevent denials and speed claims processing, make sure your submissions do not contain the following errors: Description

Number of Claims

EOB EDIT 5001

Exact Duplicate

128,655

8.47

EOB EDIT 2510

Member Eligible For Medicare

89,899

5.92

EOB EDIT 7003

ProDur Alert Requires PA

77,575

5.11

EOB EDIT 4002

NDC/HRI/UPC indicates a non-reimbursable item on date of service

65,393

4.31

EOB EDIT 7000

Denied for ProDur Alert

57,863

3.81

EOB EDIT 2002

Recipient

52,140

3.43

EOB EDIT 7002

Claim denied for DUR reasons

50,742

3.34

EOB EDIT 4095

A non-surgical service is not reimbursed individually if performed in conjunction with an outpatient surgery

47,294

3.11

EOB EDIT 4021

Procedure code vs. program indicator

46,713

3.08

EOB EDIT 558

Coinsurance and deductible amount missing

46,679

3.07

Error code edit

Percent of Total Claims Denied

Provider education: Sign up for IHCP third-quarter workshops Don’t miss out! The Indiana Health Coverage Programs (IHCP) is offering valuable sessions on a variety of exciting topics. Presenters include HP, managed care entities (MCEs), and care management organizations (CMOs). Once again, you can attend online training workshops, allowing you to take advantage of this excellent training from the comfort and convenience of your own office. Session topics include: • Hoosier Healthwise Roundtable Discussion – Presented by the MCEs, Anthem, MDwise, and MHS • Healthy Indiana Plan Roundtable Discussion – Presented by the MCEs, Anthem, MDwise, and MHS • Indiana Care Select Prior Authorization Overview and Program Updates – Presented by representatives from ADVANTAGE Health SolutionsSM, Inc., and MDwise Inc. • Behavioral Health Roundtable • Provider Enrollment • IHCP Updates • Avenues of Resolution (resolving billing issues) For more information and to register, visit the Provider Education page on indianamedicaid.com. SUMMER 2012

ISCA REPORT

13


WPS TAKING OVER AUGUST 20 UPDATE ON PC-ACE PRO32 SOFTWARE

By: James Cox, DC, ISCA Medicare Advisor and ISCA First Vice President Wisconsin Physicians Service has taken over as Medicare contractor, as of Aug 20,2012, for NGS. If you are using PC-ACE Pro32 software to bill NGS right now, here is some information for you on upgrading it. If you are submitting claims thru a clearinghouse you should not have to worry about this. I. PC-ACE PRO32 BILLING SOFTWARE UPGRADE REQUIRED FOR J8 SUBMITTERS (PART B) WPS will serve as Medicare Administrative Contractor (MAC) for Jurisdiction 8 (J8), which includes the states of Indiana and Michigan. •Michigan moved to J8 effective July 16, 2012 •Indiana moved to J8 effective August 20, 2012 If you are an Indiana or Michigan Medicare provider currently using the PC-Ace Pro32 billing software, download the latest upgrade at www.wpsic.com/edi/pcacepro32.shtml. The update will need to be run on or after each cutover date in order to transition to the new Part B J8 MAC contractor numbers. However, the current upgrade on the WPS website is not effective for J8 providers until the J8 implementation dates listed above. For Indiana B PC-Ace Pro32 users, this upgrade includes a conversion capability from the NGS custom PC-Ace Pro32 program. Please be sure to create a backup file in the PC-Ace billing program you are currently using before you download this upgrade. Now available online: •The upgrade to the latest version of PC-Ace •Instructions related to the upgrade •Users Guides/Manuals It is important that each user updates their software program in a timely manner. Upgrades to the PC-Ace program are available quarterly. As software upgrades are received, please download/install the upgrades to update your program. If you are NOT currently using this program but you are interested in using this HIPAA compliant software, please contact our EDI Hotline at (866) 503-9670 or download the PC-Ace request form. ISCA will keep you apprised as new information from WPS becomes available. You will also have the opportunity to learn more about this transition and changes during a WPS presentation at our Fall Seminar November 2-4, 2012. You will not want to miss any of these seminars -- Mark your calendar and plan to attend! As always, please contact the ISCA office with your questions and comments at 1-800-572-8002 or at info@indianastatechiros.org.

October is National Chiropractic Health Month: Discover Chiropractic ... Find Your Game National Chiropractic Health Month (NCHM) kicks off in October 2012 with the theme of “Find Your Game!” “Find Your Game” means achieving optimal function at any level of fitness. That includes everyone from athletes to office workers, young and old. The ISCA and ACA encourages everyone to use the month of October to resolve to be your best, feel your best, and perform your best. The ISCA along with the ACA offer a wide range of resources to help doctors of chiropractic spread the word about NCHM among their patients and in their communities. Watch your email as the ISCA office will be sending you instructions on how to promote NCHM soon!

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A General Overview of "Incident-to"...

By: Peter G. Furno, D.C. Chair, Insurance Committee, ISCA Second Vice President With more and more doctors increasing efficiencies in a struggling economy, the goal is to provide as many valid services as possible that the standard of care allows for a given, and specific diagnosis. Inasmuch as this sounds like an answer the clinician very quickly realizes that there are laws, rules and regulations that oversee the dispensing of services in all the health care fields, if that doctor expects to be paid for services rendered and to avoid the teeth of the regulatory system. HYPOTHETICAL: In a multispecialty group practice there is a licensed medical doctor on-site at all times. The MD wants to hire a physical therapy assistant (PTA) and massage therapists to provide therapy "incident-to" the MDs services because it would be cheaper to hire them than to hire a PT. However, if a PT must be hired is it legal to then hire, say, six PTAs and bill them all incident-to the PT? Additionally, can the DC bill his/her services "incident- to" the MD if physical therapy is within his scope of practice, and can the DC bill his certified chiropractic assistant's services "incident-to" his own services? DISCUSSION: The term “incident-to” a physicians professional services means that the services or supplies are furnished as an integral (although incidental) part of the physicians professional services in the course of diagnosis or treatment. The incident-to service need not be directly linked to a specific physician action. The service can simply be part of a course of treatment; however, the provider must see the patient with sufficient regularity. But, services provided by massage therapists and/or PTAs may not be billed incident-to a physician because neither a massage therapist nor a PTA meets the qualifications of a licensed PT. The services of a PTA may be billed incident-to a licensed/ registered PT only when provided under the direct supervision of a licensed PT, not an MD (unless the MD is also a licensed/registered PT). In order to bill incident-to the following criteria must be met and must be: • An “integral” though “incidental” part of the doctors diagnosis or treatment; • Provided under the “direct supervision” of the doctor; • Performed by an employee or independent contractor of the practice; and • Customarily performed in a doctor's office, commonly rendered without charge or included in the doctors bill. Services include those ordinarily rendered by an office staff person (e.g., medical services such as taking blood pressure and temperature, giving injections, and changing dressings), and those ordinarily performed by the doctor, such as minor surgery, setting casts or simple fractures, reading X- rays, and other activities that involve evaluation or treatment of a patient's condition.

To be covered, supplies, including drugs and biologicals, must represent an expense to the practice, e.g.in a situation where a patient purchases a drug and the doctor administers it, or where the supplies in question are usually not found in an office setting, or the services rendered are usually not performed in an office setting, the cost of the drug, the supplies, and/or the services would not be covered under the incident-to provision. This does not mean that in order to be considered “incidentto” there must be a service rendered or a supply furnished by the doctor each time there is a service rendered by the PT. Such a service or supply could be considered to be incidentto when furnished during a course of treatment where the doctor has performed the initial service and subsequent services with sufficient frequency to reflect an active participation in, and management of, the patients course of treatment. However, the direct personal supervision requirement must still be met with respect to every service. Direct personal supervision in an office setting does not mean the doctor must be present in the same room with the PT; however, the doctor must be present in the office and available to provide assistance and direction. When billing “incident-to,” use the doctors name and PIN number on the Centers for Medicare and Medicaid Services (CMS) 1500 form as if the doctor had personally performed the service. There is no coverage for services provided incident-to the services of a PT because the services furnished by PTAs are not incident to the physical therapists service. Furthermore, most states permit a maximum of four PTAs to be supervised by any one PT. Physical therapy services appropriately billed incident-to a physicians service are subject to the same requirements as therapy services that would be furnished by a PT in any other outpatient setting. These rules require that the person who furnishes the service to the patient must be a graduate of a program of training for physical therapy services. Regardless of any state licensing that allows other health professionals to provide physical therapy services, Medicare is authorized to pay only for services provided by those trained specifically in physical therapy or occupational therapy. This means that the services of chiropractors, athletic trainers, massage therapists, recreation therapists, kinesiotherapists, or any other profession may not be billed as therapy services. Medicare will generally cover physical therapy services when: • The patient is under the care of a physician; • The services are furnished under a written plan of Story Continued on page 16


GENERAL OVERVIEW CONTINUED... treatment that meets specified regulatory requirements (e.g., the plan prescribes the type, amount, frequency, and duration of the physical therapy services to be provided and indicates the diagnosis and anticipated goals), with any changes to the plan being made in writing and signed by the physician or the PT; • The therapy is reasonable and medically necessary for the treatment of a patient's condition; and • There is an expectation that the patient's condition will improve significantly in a reasonable and generally predictable period of time. The written plan of treatment must be reviewed by the physician treating the patient as often as the patient's condition requires, but at least every 30 days.

Become familiar with the terms of your payers manuals. If incident-to services are not specifically excluded or limited in the manual, they should be considered included. In the event an insurance carrier contacts you requesting information as to who did the actual “hands-on” services, advise the representative that “so-and-so did the service incident-to Dr. Xs services,” and then refer him or her to the appropriate page citation of the carriers manual that references “incident-to” services. If there is no such reference, refer to MCM 2050.1, 2050.2 and 42 CFR. 410.32, 410.34. The first citation is a reference to the Medicare Manual definition of “incident-to” services and the second reference is to the Code of Federal Regulations interpretation of "incident-to” services.

Services related to the general good and welfare of a patient or palliative services provided solely for pain relief are not considered physical therapy. If the intent is to hire a PT to render these sorts of services, consult with a competent health care attorney, in order to avoid the pitfalls of the regulatory system.

This is not meant to be legal advice, but rather a clarion call for all doctors to be aware, or to become aware, that searching for ways to survive in the present and coming health care climate can, and does, present challenges, and requires due diligence. Although PTAs work under the supervision of a PT and their services may be billed by the PT, their services are covered by the benefit for therapy services and not by the benefit for services rendered incident-to a physician.

Chiropractors may not have their services billed incidentto that of an MD even if their states scope of practice laws permit them to provide physical therapy. Private thirdparty payers are not required to follow Medicare's rules for reimbursement of physical therapy services, so it is wise to inquire from individual insurers as to what their reimbursement policies are.

Furthermore, most states permit a maximum of four PTAs to be supervised by any one PT. Physical therapy services appropriately billed incident-to a physicians service are subject to the same requirements as therapy services that would be furnished by a PT in any other outpatient setting.

Q & A by Pat McGuffey, ESQ., ISCA Executive Director QUESTION FROM ISCA MEMBER: DO I HAVE TO COLLECT SALES TAX WHEN I SELL SUPPLEMENTS IN MY OFFICE? ANSWER: The Indiana code states: IC 6-2.5-5-19 (f) Sales of drugs, insulin, oxygen, blood, and blood plasma are exempt from the state gross retail tax if: (1) the purchaser is a practitioner licensed to prescribe, dispense, and administer drugs to human beings or animals; and (2) the purchaser buys the items for: (A) direct consumption in his practice; or (B) resale to a patient that the practitioner is treating, in the case of sales of legend or non-legend drugs. However, several years ago the Department of State Revenue in a “Letter of Findings” concluded that the Revenue Regulation 45 IAC 2.2-5-27 that deals with Medical exemptions allows tax exemptions only for a “person licensed to issue a prescription and shall include only those persons licensed or registered to fit and/or dispense such devices.” They concluded Chiropractors are not licensed to issue a prescription and consequently must collect sales tax. 45 IAC 2.2-5-36 also states that inn order to resell items the practitioner must be licensed as a retail merchant, and must quote the selling price of any items separately from the charge for professional service. Therefore, the ISCA recommends that you collect sales tax and get a license as a retail merchant if you sell supplements, etc in your office. This is not a legal opinion and we encourage you to contact your attorney if you have additional questions.

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Vicarious liability

By: Peter G. Furno, D.C. Chair, Insurance Committee, ISCA Second Vice President Essentially, vicarious liability coverage, covers you if you’re sued because of the actions of someone else working in the same office. This can include your own staff, members of your group practice, other independent DCs and virtually any other health care provider of any health-related service who leases or shares space in the office. Although in the back of our mind we "know" that we are responsible for the actions of our employees, a CA or technician for instance. If one of them injures a patient, violates state regulations, or fails to protect a patient's privacy, you will be held liable for any damages they do. But, it's harder to accept the reality that you might also be held responsible for the actions of non-employees who happen to work in the same office. The rules of vicarious liability can put you at risk even if you've never seen the patient in question. You can be held responsible for overseeing the patient care provided by associates, other licensees, technicians, and everyone else even vaguely connected to your practice. If an insured is sharing space (including subleasing their own space) with any other health care professional and there is or can be any perception of an association between the practitioners (no matter how remote) by the patient or lay public, it is virtually guaranteed both parties will be named in a claim by an injured patient. This has become more of a problem in recent years, as many DCs have begun working in, or running, multidisciplinary offices. In some cases, the DC is legally considered to be an "agent" for physical therapists, massage therapists, acupuncturists, nutritionists, or other health care providers. These other providers work often indirectly (usually as independent contractors or simply as tenants leasing space) with the DC, who can be held liable for their actions. Often, these other providers fail to obtain their own insurance policies and the DC is the one with the "deep pockets" when it comes to a lawsuit. Even if you’re not ultimately held legally liable, it will still take hundreds, if not thousands, of dollars in legal fees to remove you from the case. In addition, your liability will increase if any of the other providers are authorized to perform procedures beyond your scope of practice. This may include PTs, PTAs, RNs, NPs, MDs, acupuncturists, and other providers. The growing consensus is to advise against employing or contracting with persons with licenses in ancillary medical disciplines outside of chiropractic who are able perform procedures beyond the scope of the chiropractic license. Remember, vicarious liability can occur even when no actual agency relationship exists between the doctors, who may be just sharing the burden of common expenses. However, because a reasonable person coming into the

office may view this as a group practice, the doctors may appear to have some type of agency relationship. A patient filing a medical malpractice lawsuit against one doctor in the group may, therefore, name all the other doctors alleging vicarious liability. In this case, the physicians named solely because of their apparent agency relationship may not have insurance coverage for this type of vicarious liability allegation. If a patient comes to your office and receives care from another person, that patient could sue you if there was a reason to assume that you "ran" the office, and had authority over the person providing care. It doesn't matter whether you’re simply leasing the space to another DC or provider – you could be held responsible for the actions of any person in "your" office. Keep in mind, too, that absentee owners may be subject to professional misconduct violations as well. Just because you aren't "on site" doesn't mean you aren't at risk. The same thing applies if you’re in a partnership or group practice. As a member of the group, you could be faced with vicarious liability issues should ANY member of your group practice be sued. Again, your risk is greater if the treating doctor doesn’t have an insurance policy of his or her own. This doesn't necessarily mean you need to avoid these situations, but you definitely need to protect yourself by addressing four major areas: 1. Secure competent legal counsel before entering into any type of space sharing agreement, to carefully consider your potential liability risks - even drawing up a contract outlining each person's responsibilities and specifically addressing malpractice insurance requirements. 2. Secure proof of current malpractice insurance with the same limits as your own coverage from every health care provider who works in proximity to you and has the potential to create a vicarious liability issue for you. 3. Make sure your malpractice insurance policy does not exclude vicarious liability, and your insurance company will respond should this type of situation arise. Many policies offered specify that liability applies only to the listed licensee, offering no protection for these situations. 4. Finally, notify your insurance company of any situation in your practice that might result in vicarious liability (the hiring of independent contractors, leasing or sharing space, etc.). Far better to take steps to protect yourself, your family and your practice at the outset, instead of finding out the hard way that YOU are the one left holding the bag!


The Time is NOW!

By: Anthony Wolf, D.C., FICC ISCA Board Member and Legislative Chair The time is NOW! It is extremely important that ALL Chiropractors meet with your local candidates and advocate ISCA’s position on our two main legislative issues before the election. Your contact with the candidates is critical to protect and preserve Chiropractic in Indiana! Schedule a meeting with your candidate to educate them on the Indiana State Chiropractic Association’s two key issues: 1. Opposing Physical Therapists (PTs) Direct Access to patients and oppose the ability for Physical Therapists to perform spinal manipulation. 2. Supporting legislation that includes the services performed by a Doctor of Chiropractic in health care plans We have the truth and the evidence to defend what we say – but it is our professional responsibility to get the word out to our candidates if we want to see action! Twenty-five of the state’s Senators and 100 of the House members are up for reelection and since redistricting, you may have new people running for your local legislative positions. Please visit the member section of ISCA’s website at www.Indianastatechiros.org to access ISCA’s position papers on these two key issues as well as the “Chiropractic Scientific Review” (CSR) that details background and in depth information on the cost effectiveness and efficiency of chiropractic treatment. Please use the CSR to educate your legislators and leave the position papers with them so they have something to refer to during the legislative session. Let them know you will keep them informed on any issues that arise during the session. You can find your elected official by plugging in your home address at the following the link http://www.in.gov/sos/elections/ files/2012GeneralElectionCandidateAbbreviatedList15A.pdf. You should also plug in your office address if it is in a different legislative district from your home. You should meet with candidates that serve both your home and your office District if they are different. Be sure to report back to the ISCA office, Patricia McGuffey, or myself, on the outcome of your meetings. All of us, as ISCA members, are the key to stimulating our grassroots efforts. Thank you for strengthening the ISCA voice! Anthony C. Wolf, DC, FICC, ISCA Legislative Chair Patricia McGuffey, ISCA Executive Director, ESQ., ISCA Executive Director

Practice For Sale West of Fort Wayne. Attractive home office combination. $289,795 revenues. Very low overhead. Referral, family practice. Excellent financing. Contact Loren Martin, Practice Opportunities, Inc. Phone 952.953.9444 martin@practiceop.com ●Practice Sales and Appraisals ●

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ISCA REPORT

SUMMER 2012


INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS DC'S WANTED

ASSOCIATES WANTED

Seeking a Full-Time Chiropractic Associate for IN Chiropractic Office: Fantastic opportunity to grow in an existing clinic that provides a wide range of services for their patients. Owner/ DC stays booked and has outstanding reputation in area. Great opportunity to join an established, busy chiropractic practice in Linton, IN. We are seeking a self-motivated, passionate, detailedoriented associate chiropractor to work in our office. New associate needs to be a skillful manual adjuster (Diversified), possess a great bedside manner and be hard-working, dedicated, outgoing and energetic. The chosen candidate will be responsible for patient treatment, excellent documentation, patient exams, coordinate rehabilitation, and some limited marketing and go home within a 40-hour work week. Base salary plus bonuses. Retirement plan and health insurance available. To apply for this position, 1. leave a voicemail at 812-381-8364 stating why you would be a good fit with my team, 2. email your resume to docbrinson@gmail.com Only serious inquiries please. Posted 8/14/12

Associate Opportunity - Long established multidisciplinary Bloomington clinic seeking recent graduate or practicing chiropractic physician with additional skills in functional/ naturopathic medicine and acupuncture. Vibrant Big 10 college town & top-rated retirement community. Salary/commission negotiable. Beautiful facility on very busy intersection. Send resume to normhouze@comcast.net. Posted 8/15/12

Associate Wanted: Sifford Clinic of Chiropractic in Goshen, IN is seeking a dynamic, motivated, and clinically-sound chiropractor, preferably with techniques in Diversified, Cox Flexion/Distraction, and Activator, who would like to build his/her own practice within a well-established practice (23 years) . Our clinic works with a vast array of patients including industry, rehab, and family practice. We focus on muscle balancing, stabilization, and thorough spinal and extremity manipulation, while incorporating physical therapy and nutritional consulting. Our goal is to help an associate to become a better clinician and diagnostician and to transition into buying our practice. If you are looking for this type of opportunity, call Dr. Kent Sifford at 574-534-6824 during business hours or 574-339-0685 anytime for more information. Posted 6/12/12 HELP NEEDED: I am in need of a female D.C. to temporarily fill in for my associate female D.C. (maternity leave). The approximate dates would be Fridays (9 – 12:30) from mid June through mid August. Additional days could be available if desired. For more detailed information, please call Dr. Keith Berger in Anderson at (765) 649-1991. Posted 5/8/2012 Associate Wanted: Columbus, IN (50 minutes south of Indianapolis) Growing office seeking motivated, dependable, organized, and goal-oriented DC for a full-time position beginning in December. Candidate must be skilled in manual adjusting, muscle release techniques, and willing to utilize Cox and Thompson techniques. New graduates welcome to apply! Base salary starts at $40K. Contact Dr. Mandy Wyant, Family Chiropractic and Wellness, phone: 812-373-3376 Posted 7/23/12

SUMMER 2012

Associate Wanted - Odon, Indiana. Associate needed full or part time. Will consider a sale or buyout also if interested. Full spine diversified practice. Call, text or email Dr. Brian Grindstaff, 812798-1937 or drgrindstaff@wellnessfirstchiro.net. Posted 6/27/2012 Associate Wanted: Columbus, IN (50 minutes south of Indianapolis) Growing office seeking motivated, dependable, organized, and goal-oriented DC for a full-time position beginning in December. Candidate must be skilled in manual adjusting, muscle release techniques, and willing to utilize Cox and Thompson techniques. New graduates welcome to apply! Base salary starts at $40K. Contact Dr. Mandy Wyant, Family Chiropractic and Wellness, phone: 812-373-3376 Posted 7/23/12 VACATION DOCTORS Gotcha Covered! I would be honored to cover your practice while you’re away at a seminar, on vacation, or just need to take some time off. I’m in my 17th year of practice. I can adjust diversified, drop, or instrument. Excellent communicator. Willing to travel within a couple of hours of Bloomington. References (812) 333-2501 www.drscottlittle.com Posted 1/19/2012 How do you spell relief? D-R-J-O-H-N ! Call me if you need a fill in doc. My rates are reasonable and your patients will receive quality care while you are getting some much needed R&R. I am licensed in Indiana, Ohio and Kentucky. I can be contacted at 513-208-8103 or 972-822-7843. Posted 6/28/11 Take time to enjoy life knowing that your patients are taken care of and MOST IMPORTANTLY, will be here when you get back. 25+years experience. Diversified, Cox, instrument, Acupuncture, rehab. Will match treatment to yours. Available single or multiple days. Jim Edwards D.C., LAc. 812-276-3433 or email edwardsjim@comcast.net Posted 8/6/2012

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Cancer Treatment Centers of America® If one of your patients receives a cancer diagnosis, please let them know about the unique Cancer Treatment Centers of America (CTCA) treatment model. We know that your patients value chiropractic treatment, and at CTCA hospitals they can continue chiropractic care until they return to your office. CTCA combines cutting-edge conventional treatments such as radiation, chemotherapy and surgery with supportive therapies such as nutrition, naturopathic medicine, mindbody medicine and chiropractic care. This approach helps to enhance patients’ quality of life while undergoing treatment.

O U R

I N T E G R A T I V E

T E A M

I N C L U D E S :

For more information about

Chiropractic Care ■ Medical Oncology ■ Spiritual Care

treatment options at CTCA,

Radiation Oncology ■ Acupuncture ■ Mind Body Medicine

your patients can call

Metabolic Support ■ Interventional Radiology

800-234-9113 or visit Naturopathic Medicine ■ Immunotherapy cancercenter.com.

Oncology Rehabilitation ■ Nutritional Support Surgical Oncology

© 2010 Rising Tide, Kft.

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ISCA REPORT

SUMMER 2012


Summer 2012 ISCA Report