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50 Volume 53

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Fall 2014

Published by The Indiana Association of Osteopathic Physicians and Surgeons, Inc.

Hello again.

I hope everyone is doing well and pressing forward with the ever challenging and gratifying practice of osteopathic medicine. My interaction with people is the enjoyable part of medicine for me and perhaps the part you most enjoy as well. I have a few things to report to Adrian L. Carter, D.O. you this quarter. I had the IOA President opportunity to see the President of the United States drive by my clinic, which sits off Highway 41. Staff and patients were very distracted that day. It was quite an experience to see the President’s motorcade as it drove him back and forth from the airport in Evansville where Air Force One landed. President Obama was visiting a steel plant near Princeton. It was an honor to have the President in our neck of the woods even if I don’t agree with his politics. Hopefully, this trip will help our state progress further on quality and higher paying jobs. More importantly, however, Governor Pence spent time talking with the President on the tarmac at the airport about HIP 2.0, which is Indiana’s version of the Affordable Care Act. There is some buzz that this could be what affordable health care could look like in the future nationally. In September, I spent time at the House of Delegates meeting of the Indiana State Medical Association (ISMA) where HIP 2.0 was brought up for a vote and support was approved. A couple of weeks later the IOA Board of Trustees approved support of HIP 2.0 as well. There was concern that supporting HIP 2.0 may be too political, however, many physicians around the state have been an integral part in preparing this health care regulation. The plan has bipartisan support in the Indiana General Assembly and appears to be equitable and affordable for about 400,000 Hoosiers without insurance.

Hopefully, Governor Pence and the citizens of our state can convince the Obama admini- (continued on page 17)

PRESIDENT’S MESSAGE

JUHASZ INSTALLED AS PRESIDENT

Robert S. Juhasz, D.O., an AOA board-certified internist from Concord Township, OH, is the 118th president of the American Osteopathic Association (AOA).

Dr. Juhasz serves as president of Cleveland Clinic’s South Pointe Hospital in Warrensville Heights, OH, where he worked his way up from an after-school job as a dishwasher. “Out of all the positions I held at the hospital, I really enjoyed being an orderly because it was an opportunity to help patients meet their basic needs and I always felt the appreciation of not only the patients but their families as well,” says Dr. Juhasz. “Many of my mentors taught me that we could improve health care by treating patients the way we would want ourselves and our families to be treated. As AOA president, I want to ensure D.O.s have the resources they need to provide the best care for their patients.”

One of Dr. Juhasz's goals as president is to facilitate more osteopathic medical research which, he says, would provide D.O.s with fact-based research to communicate their distinctiveness to (continued on page 3) IN THIS THIS ISSUE IN ISSUE Member Concerns……………………………………..…3 33rd Annual Winter Update…………………………...….4 Tips From Our Consultant……………..………………..7 WMD Update……………….…………..………….…....16 AIOA News……………….……………………….…….17 Dean’s Update…………………………………………..18 Coming Events………………………………………….19 Practice Opportunities………………………………….20

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IN MEMORIAM

EDITOR TIPS HAT TO

The IOA has learned that Paul E. Page, D.O., of Nashville, died on November 27, 2013.

Memorial contributions may be made to the Motyka Dannin Foundation.

Mark S. Cantieri, D.O., of Mishawaka, who was re-elected to the Board of Trustees of the American Osteopathic Association.

MEMBER CONCERNS REMEMBER IN PRAYER Susan M. Holec Iwasko, D.O. and Terry A. Iwasko, D.O., of Brownsburg, on the death of sister and sister-in-law, Karen Stout, on July 10.

AMENDMENT OF BYLAWS In accordance with Article XVI, Amendments, of the Indiana Association of Osteopathic Physicians and Surgeons, Inc. By-Laws, written notice is hereby given of a special meeting of members on Friday, December 5, at 1:15 p.m., at the Hyatt Regency, in downtown Indianapolis.

Proposed revisions to the By-Laws will be considered at this meeting and may be downloaded on the IOA’s website at www.inosteo.org, by clicking on Proposed Revisions to the By-Laws under the IOA tab.

IOA WELCOMES NEW MEMBER The following physician was accepted as a new member of the IOA at the Board of Trustees meeting on September 13, 2014.

ACTIVE MEMBER Garry L. Brady, D.O., LECOM (2008), Family Medicine

HOUSE OF DELEGATES The osteopathic profession in Indiana was well represented at the AOA House of Delegates meeting in Chicago in July. The IOA delegation included Ridaa Ali, MSII, Mark S. Cantieri, D.O., Adrian L. Carter, D.O., David L. Coil, D.O., Dan C. Galloway, D.O., David C. Koronkiewicz, D.O., Maureen McAteer, MSII, Susan M. Moore Riesbeck, D.O., and Angela B. Wagner, D.O. The AOA’s House of Delegates meets annually to set organizational policies and elect new officers. D.O. spokespeople were available before and during the meeting upon request to discuss policy issues.

JUHASZ INSTALLED AS PRESIDENT (continued from page 1)

to their patients, their colleagues and the world.

A pioneer in the adoption of electronic health records, Dr. Juhasz was actively involved with the implementation of the electronic medical record system at the Cleveland Clinic before many physicians used these systems. In 2005, he participated in a panel with President George W. Bush to discuss the benefits of electronic medical records.

Another project Dr. Juhasz has been instrumental in is the Ohio University Heritage College of Osteopathic Medicine (OUHCOM), Cleveland Clinic Extension Campus, which will welcome its inaugural class next year on the South Pointe Hospital campus. The extension campus will improve access to primary care physicians in northeast Ohio. Dr. Juhasz served as an associate dean at the OUHCOM, where he is an associate clinical professor of medicine. He is also assistant clinical professor at the Cleveland Clinic’s Lerner College of Medicine at Case Western University in Cleveland.

Dr. Juhasz has made a difference in his community serving as the co-chair of the physician section of the professional division of the cabinet for United Way of Lake County in Ohio in 2011 and is a Lake County Medical Reserve Corps volunteer. He also is a member of the Tri-City Chamber of Commerce and the St. Gabriel Parish community in Concord Township.

Dr. Juhasz’s commitment to providing excellence in patient care has not gone unnoticed. He has been named a “Top Doc” by Cleveland Magazine for several years, including in 2013, and appeared in the former Northern Ohio Live – Best Doctors in Cleveland listing. In addition, he was awarded the Phillips Medal of Public Service by the OUHCOM, received the Ohio Osteopathic Association’s Trustee Award and was named an Honorary Alumnus of the OUHCOM in 2008.

Upon graduating from the Kansas City University of Medicine and Biosciences’ College of Osteopathic Medicine in Kansas City, MO, Dr. Juhasz completed his internship and internal medicine residency training at what is now South Pointe Hospital. Dr. Juhasz is a fellow and diplomat of the American College of Osteopathic Internists, and a fellow of the American College of Physicians.

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TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting

ARE YOU MAKING THESE MISTAKES? Lord Harold Samuel, a real estate tycoon in Britain, coined the expression: ‘There are three things that matter in property: location, location, location.’ The three things that matter in a payer audit are documentation, documentation, documentation.

Part 1 of this article discusses physician payment errors. Part 2 (in the next issue) will discuss how physicians’ documentation affects the payments to other providers, facilities, suppliers, etc.

The Comprehensive Error Rate Testing Program (CERT) was created to calculate the Medicare fee-for-service (FFS) program improper payment rate. The CERT program considers any payment that should not have been made or that was paid at an incorrect amount (including both overpayments and underpayments) to be an improper payment.

It is important to note that the improper payment rate does not measure fraud. It estimates the payments that did not meet Medicare coverage, coding and billing rules.

2013 Improper Payments Report The glass is more than half full! According to the Medicare Fee-For-Service 2013 Improper Payments Report, the estimated 2013 Medicare fee-for-service (FFS) compliance rate – the percentage of Medicare dollars paid correctly – was 89.9 percent. According to the report, based on claims submitted during the 12-month period from July 2011 through June 2012, Medicare paid an estimated $321.4 billion correctly for the claims submitted during the sampled timeframe.

If my math is correct, it also means that the percentage of Medicare dollars paid incorrectly was 10.1 percent.

Extrapolated, this means that Medicare paid an estimated $36.0 billion incorrectly between July 2011 and June 2012.

The most common cause of improper payments during the 2013 report period (accounting for 56.8 percent of total improper payments) was lack of documentation to support the services or supplies billed to Medicare.

The complete report is available on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-CompliancePrograms/CERT/CERT-Reports-Items/Downloads/MedicareFee-for-Service2013ImproperPaymentsReport.pdf Methodology After the CERT program identifies a claim as part of the sample, it requests the associated medical records and other pertinent documentation from the provider or supplier who submitted the claim via letter. CERT makes phone calls to validate the provider’s or supplier’s contact information and to address their questions or concerns about the request.

The CERT program sends at least three subsequent letters if the provider or supplier fails to respond to the initial request.

For some claim types (e.g., DMEPOS, clinical diagnostic laboratory services), in addition to the initial request sent to the billing provider and supplier, the referring provider who ordered the item or service also receives a request for documentation. This is done because sometimes the referring provider maintains the documentation to support the medical necessity of the services billed.

Since physicians drive the care of the patient, your documentation also affects payments to hospitals, home health agencies, durable medical equipment suppliers, etc. This will be covered in Part 2 of this article (in the next issue).

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For Part B claims (excluding claims submitted by suppliers of Durable Medical Equipment, Prosthetic, Orthotic, and Supplies [DMEPOS]), the sample included 17,130 claims.

Error Categories The CERT’s medical review professionals, including nurses, medical doctors, and certified coders, reviews the claim and submits documentation to make a determination of whether the claim was paid or denied appropriately.

Before reviewing documentation, the CERT program examines the CMS claims systems to check for (1) Medicare beneficiary eligibility, (2) duplicate claims, and (3) Medicare as the primary insurer.

When performing claim reviews, the CERT program checks for compliance with Medicare statutes and regulations, billing instructions, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and provisions in CMS instructional manuals.

Once an improper payment is identified, the reason for the improper payment determines the error category for the claim. There are five major error categories.

No Documentation Claims are placed into this category when either the provider or supplier fails to respond to repeated requests for the medical records or the provider or supplier responds that they do not have the requested documentation.

Insufficient Documentation Claims are placed into this category when the medical documentation submitted is inadequate to support payment for the services billed. In other words, the CERT contractor reviewers could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.

Claims are also placed into this category when a specific documentation element that is required as a condition of payment is missing, such as a physician signature on an order, or a form that is required to be completed in its entirety.

Medical Necessity Claims are placed into this category when the CERT contractor reviewers receive adequate documentation from the medical records submitted to make an informed decision that the services billed were not medically necessary based upon Medicare coverage policies.

Incorrect Coding Claims are placed into this category when the provider or supplier submits medical documentation supporting (1) a different code than that billed, (2) that the service was performed by someone other than the billing provider or supplier, (3) that the billed service was unbundled, or (4) that a beneficiary was discharged to a site other than the one coded on a claim.

Other Claims are placed into this category if they do not fit into any of the other categories (e.g., duplicate payment error, non-covered or unallowable service).

Results for 2013 The table below outlines the improper payment rate and projected improper payment amount by claim type for FY 2013. The reporting period for this improper payment rate is July 1, 2011-June 30, 2012.

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Inpatient Hospitals Durable Medical Equipment Physician/Lab/Ambulance Non-Inpatient Hospital Facilities Overall

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Improper Payment Rate 8.0% 58.2% 10.5% 8.2% 10.1%

Improper Payment Amount $9.4B $5.7B $9.5B $11.4B $36.0B

2013 Improper Payment Rates and Improper Payments by Provider Type: Part B Number Improper of Provider Types Payment Claims Billed to Part B in Rate Sample Family Practice 13.7% 946 Hematology/Oncology 3.6% 420 Internal Medicine 15.3% 1,940 Nephrology 9.5% 297 Neurology 12.4% 193 Nurse Practitioner 7.7% 331 Obstetrics/Gynecology 11.0% 71 Orthopedic Surgery 10.0% 327 Physician Assistant 12.1% 218 Psychiatry 22.1% 257 Pulmonary Disease 18.1% 288 Urology 7.5% 259

Type of Error No Doc

Insufficient Medical Incorrect Other Doc Necessity Coding

1.5% 3.8% 4.1% 0.8% 0.0% 8.1% 0.6% 0.0% 0.0% 0.0% 0.4% 0.3%

59.5% 59.6% 53.4% 65.4% 52.2% 46.4% 18.6% 54.8% 55.7% 69.9% 61.3% 68.6%

0.4% 5.5% 1.7% 0.0% 0.0% 2.5% 0.0% 9.3% 0.0% 0.0% 0.0% 0.7%

36.0% 31.0% 40.4% 33.8% 47.2% 42.6% 80.7% 25.0% 44.3% 30.1% 38.3% 30.3%

2.6% 0.0% 0.5% 0.0% 0.7% 0.3% 0.0% 10.8% 0.0% 0.0% 0.0% 0.0%

CERT Error Examples WPS (Wisconsin Physician Services), the J8 Medicare Administrative Contractor (MAC) includes great information related to the CERT findings for J8 (Indiana and Michigan) physicians and other qualified health care professionals (new term for NPs, PAs, CNS, etc.). By using this data, physicians can perform self-audits to ensure the practice is not making the same mistakes.

WPS posts specialty specific CERT error examples for various specialties. The most recent CERT information includes the following examples for family practice (specialty 08).

Insufficient Documentation Note the biggest problem in this section continues to be lack of signature. Sad to think that a large portion of the 59.5% error rate for family physicians could be resolved if the physicians would simply sign progress notes, procedure reports, test orders, etc. Once a missing signature is identified, the documentation is not further reviewed to determine whether other errors are present. •

Billed CPT 99215-25 Missing a valid provider signature to support office encounter. CERT received typed office visit with unacceptable co-signature by an unknown person. Follow-up request returned duplicate invalid co-signed note. No response to request for physician signature attestation statement.

•

Billed CPT 99222 and 99233 Missing the signature of the physician who provided services inpatient services for billed dates.

Submitted were notes for date of service, unsigned and with no history or physical exam. Requested valid

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signed progress notes; and received a note dated stating, “Not a patient at this facility,” another note stating, “patient was hospitalized on 11/23/11-11/30/11, attached are the records,” and also a note stating, “OK send refund request.” Received duplicate records and no attestation from request.

Billed CPT 45385 - Lesion removal colonoscopy-ablation and lesion removal colonoscopy by snare technique Missing the provider’s signature on the procedure report. Following a Medical Review Specialist call for typed notes and attestation, none was submitted.

•

•

Billed CPT 85610 - Prothrombin Time.

Received Coumadin Flow sheet and office visit note that supports medical necessity and received a note from stating, “Lab order under” “next PT/INR” (on flow sheet). Missing the physician's authentication on flow sheet to support intent to order the test. No order received to support service billed.

•

Billed CPT 62311 and J3301 - Epidural steroid injection Submitted copy of progress note, describing medical necessity for injection, and procedure note for DOS billed. Notes contained name of provider; however, missing signature to support medical necessity and documentation of the procedure. No response to follow up request for attestation statement.

How to prevent this type of error Medicare requires that providers authenticate their medical record entries with a legible handwritten or electronic signature. Without this authentication by the performing provider, services will be denied. However, these errors are avoidable.

In cases where there is a missing signature, a signature attestation statement should be completed by the performing provider and submitted with the corresponding medical records. For cases of illegible signatures, an attestation or signature log can be used to verify the identity of the author of the medical records.

Of note, attestation statements are not acceptable for unsigned physician orders. Orders will not be considered for review if they are missing a provider signature. In these cases a progress note which documents the intent for the services to be performed should be submitted. If a progress note is missing a signature, an attestation statement should be submitted with the record.

Medically Unnecessary Service or Treatment Great news - Medical necessity accounted for only 0.4% of the family physician errors in the latest information published by WPS. •

Billed CPT 36415 Missing orders for any laboratory testing that would require the performance of venipuncture on the billed date of service. Submitted documentation included laboratory report for hemoglobin A1C and TSH. Requested valid orders and medical necessity from the ordering provider and received problem report, phone note signed and dated by the RN who ordered a TSH and hemoglobin A1C for but no signature from the ordering provider. Also received office visit note that supports medical necessity, test form signed by an RN, and laboratory reports. No valid signed and dated order by the billing provider to support venipuncture were submitted.

Per Medicare regulations, only the “treating physician” or “treating practitioner” (nurse practitioner, clinical nurse specialist or physician assistant) can request that a diagnostic test be performed for a beneficiary.

WPS recommended educating your clinical staff of these requirements and performing periodic self-audits of your medical record documentation to avoid these denials.

For more information regarding physician orders, refer to the Chapter 15, §80.6.1 of the CMS Internet-Only Manual, 100-2 (Medicare Benefit Policy Manual).

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How to prevent this type of error There was no order or progress note submitted to support the intent for the laboratory services. Therefore, the related venipuncture will also be denied. To avoid this type of error, verify that all documentation and medical necessity requirements are met prior to billing these services to Medicare. When responding to CERT requests, perform a thorough review of the records prior to submittal to be certain all elements are included to support the services billed.

Service Incorrectly Coded This is where the rubber hits the road. Physicians need to understand coding and the documentation needed to support the service rendered. This category represented 36.0 percent of errors made by family physicians for the recent reporting period.

Evaluation and Management (E/M) Services Coded to Lower Level by CERT Reviewer •

Billed CPT 99205 requires 3 of 3 key components (comprehensive history, comprehensive exam and high complexity MDM). Documentation supports code change from 99205 to 99203, with detailed history, detailed exam and moderate complexity medical decision making (MDM).

•

Billed CPT 99214 requires 2 of 3 key components (detailed history, detailed exam and moderate complexity medical decision making). Documentation supports a down code from 99214 to 99213, with expanded problem focused history (limited HPI/1 ROS) per 1995 and 1997 E/M guidelines, no exam performed, and low complexity MDM per 1995 and 1997 E/M guidelines.

•

Billed 99214 requires 2 of 3 key components (detailed history, detailed exam and moderate complexity medical decision making). Submitted documentation supports down code to 99213 with expanded problem focused history, problem focused exam and low complexity MDM.

•

Billed CPT 99215 requires two of three key components: comprehensive history, comprehensive exam and high complexity MDM. Documentation supports down code from 99215 to 99214 with detailed history and exam and moderate MDM.

•

Billed CPT 99223 requires three key components: comprehensive history, comprehensive exam and high complexity MDM. Submitted documentation supports down code from 99223 to 99221 with a detailed history, comprehensive exam, and moderate complexity MDM.

•

Billed CPT 99233 requires two of three key components: detailed history, detailed exam and high complexity MDM. Received inpatient progress note which documents expanded history and exam and low complexity MDM. This supports down code from 99233 to 99232 (requires 2 of 3: expanded history and exam and moderate MDM).

•

Billed CPT 99233 requires two of three key components: detailed history, detailed exam and high complexity MDM. Documentation supports down code from 99233 to 99232 with expanded history, expanded exam and moderate MDM.

•

Billed CPT 99239 - Hospital discharge management, more than 30 minutes. Missing time spent in discharge management. Provider submitted copy of discharge summary for billed hospital discharge day management service with no time documented. Code depends on time spent. Down code to 99238, discharge day management 30 minutes or less.

•

Billed CPT 99306 requires 3 of 3 key components: comprehensive history, comprehensive exam and high complexity MDM. Documentation supports down code to CPT 99304 with detailed history, detailed exam and moderate complexity MDM.

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How to prevent this type of error Documentation for Evaluation and Management (E/M) services must support the level of service billed and the medical necessity of the level. It is also important that handwritten progress notes are legible for review purposes.

For timed codes, providers should document the face-to-face time spent with the patient to avoid claims denials or reductions.

WPS closely monitors CERT errors in order to identify problem areas contributing most significantly to the jurisdiction's (Indiana and Michigan) error rate. As a result of CERT review findings, WPS Medicare may implement pre-payment claim edits across the jurisdiction for review of problematic codes.

If you bill these services to Medicare, WPS highly recommends performing a self-audit of your billing and documentation processes. If Medicare overpayments are discovered, you can find instructions for submitting voluntary refunds on the Payment Recovery web page.

General Tips to Consider When Performing a Self-Audit of E/M Services: • • • • •

Medical necessity is the overall criterion for payment in addition to the specific technical requirements of a CPT code.

It is not appropriate to bill a higher level of E/M service when a lower level of service is warranted.

The volume of documentation should not be used to determine the level of service.

Documentation must support the level of service reported.

In order to maintain an accurate record, document during or shortly after rendering the service.

Visit the WPS Medicare Evaluation and Management web page for articles, CMS resources, and Frequently Asked Questions (FAQs) to assist you in the proper documentation and billing of these services.

The WPS Medicare Training web page is also a great resource for upcoming educational teleconferences, on demand sessions, or in-person seminars in your area.

Also view the CMS MLN Fact Sheet: Evaluation and Management (E/M) Services: Complying with Documentation Requirements 1st Quarter 2014 (January through March) - CERT Error Summary - Not Specialty Specific The examples of findings below are reported based on the type of documentation, coding, or billing error assessed by the CERT Contractor. WPS Medicare received error findings for J8 providers in the following categories during the first quarter of 2014.

Insufficient Documentation - 80% of Total Errors Reasons for errors: •

Billed CPT 99285. Claim billed for emergency department evaluation and management service.

Submitted documentation is missing the documentation by the billing provider to support services.

Documentation initially submitted included emergency room note written by resident and concurrence statement by billing physician.

•

Claim billed for office visit evaluation and management service. Submitted documentation is missing an attestation statement to support unauthenticated progress note for billed dated of service.

•

Billed for hospital discharge day management; more than 30 minutes (CPT 99239). Missing treating physician’s clinical documentation that supports a face-to-face encounter with the beneficiary documenting time spent performing discharge day management.

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•

Billing 99226 subsequent observation care. Missing the physician’s order for Observation stay and clinical documentation by the billing provider to support billed observation service. Submitted is a progress note by the Resident physician, with a notation by the teaching physician, indicating the beneficiary examined, information reviewed and a discussion with interdisciplinary team. Claim was submitted without the -GC modifier. No order for Observation care. No GC modifier by the teaching physician. Documentation is insufficient to support service billed.

•

Billed initial observation care (CPT 99220). Missing signed and dated physician’s orders regarding the observation services the beneficiary received. Submitted documentation includes history and physical.

Requested additional documentation from the billing provider and received duplicate documentation.

•

Provider billed for subsequent nursing facility visit (CPT 99307). Missing provider's name or signature on the Physician Progress Note. Some entries in record were dated prior to this visit; whereas, other entries were undated. Unable to determine which entries were made for the billed date of service.

•

Billed office visit E/M (CPT 99215). Missing the billing provider signed and dated attestation statement for log. Submitted documentation includes a handwritten visit note that has an illegible identification of the individual who provided or documented the service.

•

Insufficient documentation to support the Evaluation and Management service (CPT 99212) billed.

Missing legible identification of the person who documented for services provided on submitted progress note for this date. Submitted physician's office note has the typed name of the billing provider but no handwritten or electronic signature as required by Medicare regulations.

•

Billed CPT 99239 - Hospital Discharge Day Management (more than 30 minutes). Missing documentation to support face-to- face evaluation encounter between the billing physician and the beneficiary. Submitted includes electronically signed discharge summary note by the billing provider but does not support a face to face encounter.

•

Billed G0431-drug screen quantitative, multiple drug classes by high complexity test method, 80152Amitriptyline, 80154-Benzodiazepines, 80160-Desipramine, 80174-Imipramine, 80182-Nortriptyline, 80299-Quantitation of drug, 81003-Urinalysis, by dipstick or tablet reagent, 82145-Amphetamine or Methamphetamine, and 82520-Cocaine or Metabolite. Submitted documentation included, order with no beneficiary name, lab results, lab requisition, office notes that support physician’s medical management of the beneficiary with chronic pain, and lumbar disc disease, taking OxyContin and Lortab but no specific record of what specific drug/tests the physician had ordered. Missing physicians order or intent to order the above labs.

•

Missing the physician order or clinical documentation of intent of ordering the billed alcohol (ethanol), amphetamine or methamphetamine, quantitation of drug times 3, and barbiturates that includes all drugs/drug classes to be tested. Received laboratory reports, unsigned requisition for urine drug screen panel, and progress notes.

•

Billed is CPT 82607 Vitamin B-12 and CPT 82746 folic acid. Missing a valid order or progress notes with plan to order billed lab test.

•

Billed multiple lab tests. Missing the physician order or clinical records to support intent to order.

Submitted unsigned lab requisition, ABN, lab results and office notes that support medical necessity for lab testing, but no order/intent received.

•

Billed is CPT 81005 Urinalysis; Qualitative or semiquantitative. Missing the following documentation; 1) an order or progress notes with intent/plan to order billed urinalysis; 2) clinical documentation to support medical necessity.

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•

Billed for urinalysis, qualitative, creatinine, other source and Methadone drug screen performed by an independent laboratory. Missing the treating practitioner's order or plan/intent to order the specific tests billed on this claim. Submitted includes an urine drug screen report with multiple drug class results, urine PH and urine creatinine results, an authenticated office visit note for the billed DOS that supports the beneficiary history of post laminectomy syndrome, lumbar disc degeneration, radicular syndrome of lower limbs and chronic pain with medications as methadone with the start of Vicodin to be added to treatment regimen, unauthenticated letter to the primary physician and a “Follow-up Report that documents the plan for a “UDS” but does not specify the drugs or classes of drugs to be tested. Unable to determine which drug classes are to be screened an if the services billed are for confirmation or validity.

•

Missing documentation of intent to order and supporting the need for the urinalysis and urinalysis results.

Patient was seen for medication management. Documented under “Other Problems” is urinary tract infection. There is no documentation in the physician's progress note of intent to order and there are no urinalysis results. Submitted lab results include drug screen tests.

•

Billed CPT 98942-GA-AT. Missing the specific areas of subluxation per PART exam to support 5 regions of the spine that are involved and a treatment plan applicable to billed DOS which includes the recommended level of care (duration and frequency of visits), specific treatment goals and objective measures to evaluate treatment effectiveness.

•

Billed Anesthesia for diagnostic or therapeutic nerve blocks and injections (01991). Missing: 1) Billing provider signed and dated pre-anesthesia examination and evaluation; and 2) post-anesthesia record.

Submitted documentation included anesthesia record, procedure note, illegible signed pre-anesthetic evaluation with no beneficiary name on the page, and consents.

•

Billed is CPT 33249 (Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous leads, single or dual chamber) with modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study). Missing the following requested documentation: 1) documentation that the Beneficiary is enrolled in either a FDA-approved category B investigational device exemption (IDE) clinical trial (42 CFR § 405.201), a trial under the CMS Clinical Trial Policy (National Coverage Determination (NCD) Manual §310.1) or a qualifying data collection system including approved clinical trials; 2) Clinical documentation of Non ischemic dilated cardiomyopathy (NIDCM) >3 months; 3) Physician signed and dated diagnostic reports supporting a QRS duration greater than .120 and Sinus Rhythm; 4) clinical documentation supporting the Beneficiary was on stable CHF medical regimen prior to implant: ACE or angiotensin receptor blocker, beta blocker or angiotensin receptor blocker, digoxin and or a diuretic.

•

Provider billed CPT 96401, chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic on 1/18. Missing the documentation of the administration of a chemotherapy drug.

Received a copy of the order/intent to order Neulasta on day 2 of chemotherapy. Also received documentation of the administration of Neulasta (Pegfilgrastim) on 01/18, and documentation of chemotherapy administration on 01/17. Claim history shows chemotherapy services billed for 01/17.

•

Billed neuromuscular reeducation (CPT 97112-GP-59). Missing the signed and dated therapy progress note that documents treatment modalities that were performed on this date. Submitted documentation included treatment log with only dates and times documented. Submitted documentation is insufficient to support the indications and limitation and documentation requirements in the governing LCD and Medicare guidelines.

•

Billed Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber; and Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (CPT 33249, 33225, 93640). Missing clinical documentation to support the medical necessity for a biventricular defibrillator.

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•

Billed HCPCS J2469, for Palonosetron HCL, 25 mcg (10 UOS). Missing the treating physician’s signed and dated orders for the billed medication.

•

Billed is CPT J1030 and 20610 - Methylprednisolone 40 MG injection. Missing order and documentation of Methylprednisolone 40 MG injection was administered. Received a partially illegible office visit note that list B-12 as the injection, and office visit notes.

•

Billed for total hip arthroplasty with or without autograft or allograft; and insertion of non-biodegradable drug delivery implant (CPT 27130, 11981). Missing the following: 1) Treating physician’s clinical documentation that supports hip pain has been progressive despite any attempt at conservative treatment; and 2) Treating physician's documentation to support pain interferes with ADL functions, including the ability to ambulate or to go up and down stairs; or beneficiary's lifestyle; or has nocturnal pain interfering with sleep; or requires narcotics for pain control.

•

Billed for the physician interpretation of, polysomnogram; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway therapy or bilevel ventilation, attended by a technologist (CPT 95811-26). Missing physician's order for the study or intent to order the study and the required signature on the documentation supporting the billed service

•

Billed Polysomnography Testing (PSG) CPT- 95811-26. Missing: 1) referring physician’s legible, signed and dated order/referral to sleep clinic for PSG testing, 2) referring physician's legible, signed and dated progress notes/clinical evaluation prior to sleep test to assess beneficiary for signs/symptoms/complaints of obstructive sleep apnea (OSA). Received only signed PSG attended overnight CPAP titration study. No response to requests for valid orders and progress notes.\

•

Billed is shaving of epidermal or dermal lesion (single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less – CPT 11300). Missing is; 1) treating physician’s authenticated procedure note; 2) physician’s signature attestation to the unsigned procedure note. Received authenticated progress note which indicates shave biopsy was to be performed yet does not support service was provided and unauthenticated procedure note which supports biopsy.

•

Billed CPT 52332 - Cystourethroscopy. Missing is documentation to support the medical necessity.

Submitted is only the operative report. Requested additional documentation and received duplicate of the Op. procedure report, Operative report for Laparoscopic procedure and progress notes.

•

Insufficient documentation to support allergy immunotherapy 2 or more injections (CPT 95117). Missing the treating physician's plan of treatment and dosage regimen, including treatment schedule & length of therapy. Received the allergy immunotherapy flow sheet, progress note from 1994 which does not document a plan of care and is not signed, allergy testing results from 1994 which are not signed and a progress note dated May 2013 with the only reference to AI documented as “(1) AR- AI. (Increase) AI to 0.6 then new order.” Documentation does not meet Medicare guidelines that state in part “... (2) the physician who prepared the antigens has examined the patient and has determined a plan of treatment and a dosage regimen. Antigens must be administered in accordance with the plan of treatment” and “A plan of treatment and dosage regimen must be documented in the patient's medical record.”

•

Billed is CT scan of the neck (CPT 70490-26) for date of service 04/23. Missing a valid order for the specific diagnostic test or clinical records supporting the treating physician's intent to order a CT scan of the neck. Received are: a) an office visit note dated 03/01 supporting medical necessity for beneficiary presenting with ear pain, possible diagnosis of TMJ, instructions to use warm compresses & soft diet, with plan for “imaging” if no improvement; and b) an office visit note dated 04/19 showing beneficiary with continued ear pain and plan to consider imaging for referred otalgia.

Incorrect Coding - 14% of Total Errors Reasons for errors:

Fall 2014

HOOSIER D.O.

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•

Billed CPT 99203 requires 3/3 components (detailed history, detailed exam, and low complexity MDM).

Documentation supports a down code from 99203 to 99202 as billed with detailed history, expanded problem focuses exam, and moderate MDM per 1995 E/M guidelines.

•

Billed CPT 99204 (Requires 3/3 components; comprehensive history, comprehensive exam, and moderate MDM). Documentation supports code change to CPT 99203 with comprehensive history, detailed exam, and high MDM.

•

Billed CPT 99205 requires 3/3 components; comprehensive history, comprehensive exam, and high complexity MDM. Documentation supports down code to 99203 with a detailed history, comprehensive exam, and moderate complexity MDM.

•

Billed CPT 99214 requires detailed history, detailed exam, and moderate MDM with 2 of 3 key components. Review of note supports code change from 99214 to 99212 with problem focused history, problem focused exam, and low MDM.

•

Billed 99215, which requires 2/3 components: comprehensive history and exam and high complexity MDM. Submitted office note supports code change from 99215 to 99214 with problem focus history (discuss abnormal ECHO), comprehensive exam and moderate complexity MDM (Ordered US carotids, B/P controlled, Lipids at goal, reviewed ECHO results with possible further work up later after discussing with patient and family.)

•

Billed CPT 99215. Documentation supports code change from 99215 to 99214 with a comprehensive history, detailed exam and moderate MDM. This meets 2 of 3 components for 99214.

•

Billed initial inpatient care, 99222, which requires a comprehensive history, comprehensive exam and moderate MDM. Documentation supports code change from 99222 to 99221, with comprehensive history, detailed exam and moderate MDM

•

Billed CPT 99223 (requires 3/3 key components; comprehensive history, comprehensive exam, and high complexity MDM). Documentation supports down code to CPT 99222 with comprehensive history, comprehensive exam, and moderate MDM.

•

Billed CPT 99223. Documentation supports down code from 99223 to 99221 with detailed history, detailed exam and moderate MDM, with progress note by a PA-C with signed addendum by attending hematologist/oncologist supporting evaluation and management of beneficiary who has been hospitalized for complaints of pain after infusion, possible pneumonia and pancreatic cancer.

•

Submitted is an initial hospital care visit, CPT 99223, which requires 3 of the following 3 components: comprehensive history, comprehensive exam, and high MDM. Documentation supports down code to 99222 with comprehensive history, comprehensive exam, and moderate MDM. Beneficiary to ER post fall resulting in severe chest pain and sob. Treated with left thoracostomy, pain control via PCA, respiratory therapy and pulmonary consult.

•

Billed CPT 99233 (requires 2/3 key components; detailed history, detailed exam, and high complexity MDM). Documentation supports code change from 99233 to 99232 with expanded problem focused history, expanded problem focused exam, and moderate MDM meeting 2/3 of the required key components.

•

Billed CPT 99233 (subsequent hospital care) requires 2 of 3 key components (detailed history, detailed exam, and high MDM). Submitted documentation supports down code from 99233 to 99232 which requires 2 of 3 key components (expanded history, expanded exam, and moderate MDM). Documentation meets 99232 with (problem focused history, expanded exam, and moderate MDM) per 1995 evaluation and management guidelines.

Fall 2014

HOOSIER D.O.

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•

Billed CPT 99291. Critical care services are paid when there is a high probability of imminent or life threatening deterioration in the patient's condition and when high complexity decision making is involved in assessing, manipulating and supporting vital system functions to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration. Submitted documentation describes beneficiary who presented to ER with left leg swelling and tachycardia. Found to have acute MI; CE elevated. One episode of V Tach which resolved spontaneously. Documentation of treatment was careful IVF administration. Patient was described to be without respiratory distress, negative CP and palpitations, oriented x 3. Admitted to CCU, but does not meet requirement for critical care code. Meets ER visit CPT 99285 with comprehensive history and exam and MDM of high complexity.

•

Billed CPT 99306 (initial SNF visit) requires 3/3 components; comprehensive history, comprehensive exam, and MDM of high complexity. Medicare guidelines state that when documentation and medical necessity do not meet the requirements for billing an initial nursing facility care code the code will be rated based on the subsequent SNF visits. Documentation supports down code from 99306 to 99308 subsequent SNF visit requiring 2 of 3 components; expanded problem focused history and exam, and low complexity MDM. Submitted is an expanded problem focused history {no allergies, no meds}, expanded problem focused exam, and MDM of low complexity. Although the beneficiary has several diagnoses, the provider did not order any medications or treatment.

•

Billed for Initial Nursing Facility Care (CPT 99306) requiring 3/3 key components (comprehensive history, comprehensive exam, and moderate MDM). Submitted includes: authenticated visit note supporting an expanded history, expanded exam (limited exam of 2-7 organ systems) and moderate MDM. It is noted the signature is partially illegible but matches that found on the visit note for another DOS. Down code from 99306 to 99308 (subsequent visit) based on the documentation in the visit note for billed DOS.

•

Provider billed for CPT 99310 requiring 2/3; comprehensive HPI and exam and MDM of high complexity. Submitted documentation supports a code change from 99310 to 99309 with detailed HPI, comprehensive exam, and MDM of moderate complexity.

•

Billed 85025 for CBC with differential. Submitted physician's progress supports intent to order CBC without differential. Change code to 85027.

•

Billed for therapeutic, prophylactic, or diagnostic injection; each additional sequential intravenous push (2 UOS) (CPT 96375). Missing the signed and dated orders for one of the intravenous push medications that were given on the billed date of service. Submitted documentation consists of an authenticated progress note supporting beneficiary with “squamous cell carcinoma of the lung receiving definitive chemotherapy and radiation”; authenticated nursing flow sheet supporting the administration of two intravenous push medications; and orders for only one of the intravenous push medications given on the billed date of service. Documentation supports changing UOS from 2 to 1.

•

Billed CPT 11721 - debridement of nails; 6 or more. Missing Class Findings Modifier Q8 indicative of (2) clinical findings identified on physical exam that support severe peripheral involvement. Received podiatry encounter for evaluation of beneficiary in wheelchair for painful thick toenails that documents Class B findings of bilateral non- palpable pedal pulses, shiny skin texture, cool skin temp, and absent hair growth. Diagnosis-Onychomycosis, separate procedure debridement of toenails. Per the LCD criteria, modifier Q8 would be appropriate for meeting (2) or more of the Class B findings. Support code change from 11721 to 11721 with modifier Q8.

Medically Unnecessary Service or Treatment – 5% of Total Errors Reasons for errors: •

Billed creatinine other source (CPT 82570). This test is for validity testing and is not done to treat the beneficiary. This validity test is not reasonable and necessary

Fall 2014

HOOSIER D.O.

Page 15

•

Billed laboratory tests are not medically necessary for lack of the physician’s order; therefore, the venipuncture is not medically necessary.

•

Provider billed for Phencyclidine (PCP), Meprobamate & Methadone drug testing by column chromatography/mass spectrometry (CPT 83840, 83805, 83992, 82541). Documentation does not meet Medicare guidelines to support the medical necessity of routine drug screen testing. Per Medicare guidelines drug screening as not reasonable and necessary when performed as a routine screening measure as part of a physician’s protocol for treatment in the absence of indications as noted in LCD. Medicare does not cover diagnostic testing used for routine screening.

No documentation Was Received – 0.5% of Total Errors Reasons for errors: •

Billed Insertion of ventricular assist device, implantable intracorporeal, single ventricle with AS modifier (CPT 33979). Missing: 1) Billing provider signed and dated operative report; and 2) Signed and dated clinical documentation to support medical necessity for billed procedure. No documentation submitted to support billed services. Received a letter that states “We are unable to honor this request for the following reason(s); a thorough search of our files failed to reveal any record of this patient”.

Service Provided, But Not by Billing Provider – 0.5% of Total Errors Reasons for errors: •

Billed subsequent hospital care visit (CPT 99233). Missing the billing provider signed and dated progress note. Submitted documentation included a note that states there was no visit documented by this physician. The progress note they have is for another provider and he is not associated with the same group.

Hope, Health & Healing Community Westview Hospital, which is a part of Community Health Network, is located at West 38th Street and North Guion Road on Indianapolis’ Westside.

Community Westview is the state’s only osteopathic hospital. The practice of osteopathic medicine recognizes that the body is inherently capable of healing itself, and doctors of osteopathic medicine (D.O.s) encourage and facilitate this process. Community Westview Hospital offers patients a variety of treatment options to maintain a state of wellness while supporting a century-old osteopathic philosophy of care.

For more information on Community Westview Hospital visit us online at ecommunity.com/westview/ or call 317.920.VIEW (8439) for more information on our services.

Fall 2014

HOOSIER D.O.

Page 16

WMD UPDATE

By: Colonel Charles A. Holt, D.O. Chemical weapons...been awhile since we had to worry about them, huh? In fact, the last time they were actually used in a war was in 1988--thousands of Kurds died under Saddam Hussein's orders...remember him?

Apparently at least Sarin, a nerve agent, was used in Syria in the spring of 2013--with multiple fatalities. This got the world's attention; and it should get yours, too. There is lots of great info available from the United States government websites--many agents cause similar, if not the SAME effects as industrial chemicals in accidents-from your local pesticide spray man to train tanker car derailments.

Here is a smattering of medical/EM tidbits. A comedic hacking of television stations in 2013 involved bogus zombie attack emergency alerts. However, it highlighted yet another weakness in our EAS (emergency alert system). If you enrolled in the World Trade Center Health Registry after 9/11/2001 you may have an increased risk of prostate/thyroid cancers and myeloma.

Check out the CDC's EM 'Community Assessment Tool' and ASTHO's 'Emergency Volunteer Tool Kit'.

Lessons are still being learned from mass shootings in Colorado over the past two decades. If you hear of a nearby MASCAL--clear out your ER STAT. Send patients to other clinics/wards for evaluation and treatment by hose providers who routinely work there.

Your ER needs all the space and ITS staff to handle the incoming victims. You must DISTRIBUTE ambulance patients ASAP to VARIOUS ERs--the closest one is ALWAYS swamped with NON-ambulance victims. Set up another ICP (incident command post) at the MAIN ER, in addition to the one at the scene. Families do NOT like to be split up for care--accept this fact and deal with it.

EMS responders should have grab bags with drinking water #1/tourniquets/cric sets/oral airways/tension pneumo-thorax decompression needles, ready to take to a MASCAL scene Columbine and Aurora shooters BOTH used SECONDARY bombs/booby-traps against responders/police.

Triple Threat: earthquake causing a tsunami causing a nuclear meltdown spells FUKISHIMA in Japanese. This highlighted the fact that ALL EM partners must train QUARTERLY in some manner and always think ALL HAZARDS is the best approach. Does America have the guts for mass destruction and mass burials like in Indonesia's 2004 tsunami? Chew on this...over 500 miles of coastline and 220,000 lives were destroyed. Another triple threat, but this time a good thing: RT-PCR ( real-time polymerase chain reaction) tests can be done on flu victims. One last triple threat...the effect of disasters on expensive research facilities in the

path of destruction: lost time/effort/resources in our communities.

The 15 April 2013 Boston Marathon bombing drew renewed interest in sporting event security. Many say that merely having security guards is all SHOW and no BITE! There are many issues. In Boston, the finish line volunteers and police were facing the street NOT the crowd, where they should have been keenly observing for trouble. Stadiums have always been potential targets, yet, way too often, apparently, according to many experts, there are woefully too few appropriate security personnel.

Often those employed are under-paid/under-trained without background checks or knowledge by the stadium management of if/why they were fired from previous jobs.

Did you know that the alleged Boston bombing perpetrators' student friends (from Kazakhstan) reportedly owned a BMW bearing a vanity plate 'terrorista'? On 22 May 2013, the FBI reportedly shot a Chechen, in Orlando, FL, connected to the Boston suspects. Both Chechnya and Dagestan are reported "fertile fields for extremist recruiting".

And what about the GAO's audit of the nearly $40B (that's right--BIG B) spent on homeland security since 9/11/2001? Indiana was one of the states CRITICIZED for lack of adequate performance measures.

Typhoid fever struck a Purdue University food handler after the 2013 New Year. Also, ricin, the poisonous residue from crushed castor beans, made the news, again.

For a very scary tale, read about the alleged suspects and the final outcome, online, from your favorite news source.

The government is soon to publish ER wait times.

Healthmap Vaccine Finder--enter your address or zip code to find a provider at: vaccine.healthmap.org. The 2010 Haiti Earthquake--ten months later, as we heard, cholera broke out. Research reports overall the cholera had an attack rate of 6.1% and a fatality rate of <=1%. DHS is around 10 years old--but the exact definition is still up in the air! Salmonella outbreaks continue to occur involving children having snakes/baby poultry/frogs/turtles for pets.

Off gassing from organophosphate pesticide (ex Malathion) contaminated ER patients continues to shut down ERs and results in their staffs being admitted. We providers must do a better job of explaining the difference between flu (influenza) and stomach flu (GI flu caused by the norovirus). USA TODAY obtained restricted IG reports of reported significant security lapses at CDC bioterror labs. Low-dose vitamin D and calcium, in postmenopausal women, are of apparent no benefit in bone health. Fish oil capsules are of apparent no benefit in heart health. However, people who have eaten fish >= 2X/week have less heart disease and death from heart disease.

HOOSIER D.O.

Fall 2014

PRESIDENT’S MESSAGE (continued from page 1)

stration to approve support of HIP 2.0. I want to thank the ISMA immediate past president, current president, and other ISMA members for making me feel welcome at their House of Delegates meeting. I was honored to be with the president of the American Medical Association (AMA) and surrounding state medical association presidents. I was pleased that ISMA District I made me a delegate so I could vote on the resolutions too. Many of the issues brought up also affect us as members of the IOA. I would like to begin talking with the ISMA leadership about the IOA having a few seats at their House of Delegates meeting in order that our voice can be heard. The fact is, we agree with almost every issue they discuss at the state level. Don’t get me wrong though, we need our own organization to deal with the unique needs of osteopathic medicine in our state and nationally. Our organization also provides us with quality continuing medical education (CME) to maintain our board certifications, which is invaluable for D.O.s in Indiana and in surrounding states.

On that note, I attended my first House of Delegates meeting of the American Osteopathic Association (AOA) in July. This was the largest voting body meeting I have ever attended. For those of you who have never attended an AOA House of Delegates meeting, I would like to encourage you to go sometime during your career. It was interesting to see all the preparation, the process of bringing resolutions before the House of Delegates meeting, and the debate. The big topic discussed was osteopathic residency education and the viability of residency education. The lack of residency slots for all of the new osteopathic medical students who will be graduating in the next few years was a major concern. Another concern was that allopathic medical education is headed on a path which would limit our graduates pursuing certain specialties. Some osteopathic graduates would not be considered for Accreditation Council of Graduate Medical Education (ACGME) fellowships because they would not meet the new standards being set by the ACGME. This ultimately would affect the quality of students we would see going into our osteopathic medical schools because it would put limitations on the students as to what fields of medicine they choose. Another concern was the lack of funding for residency slots in both allopathic and osteopathic medicine especially with the number of students increasing on both sides of medicine. The ACGME was approaching this as our last chance to work with them and have a strong voice in the training of our residents. I realize not everyone was for this resolution, and many are disappointed by the decision of the AOA, however, I would direct you to the following articles to further understand the pressure being applied to our post graduate training. Please see former AOA president Norman Vinn, D.O.’s address to the AOA, Boyd Buser, D.O.’s article in the April 2014 JAOA, Cynthia Kelley, D.O.’s article in the July 2014 JAOA, and

Page 17

David Connett, D.O.s article in the July 2014 JAOA. After reviewing all of this information, and a lot of discussion, the IOA delegation voted in favor of the resolution. We were all concerned about osteopathic medical education and mostly our osteopathic medical students. We did not feel students should be limited in any way from pursuing their dreams. I would like to thank those of you who wrote to me in regard to this issue. I did take your points of view into consideration.

Lastly, thank you again for all your contributions to osteopathic medicine in Indiana. I also want to take time to promote the Marian University College of Osteopathic Medicine (MUCOM) and let everyone know that our second year students will need mentors and clinical educators to help them further their osteopathic medical education. If you are able, please contribute your time and talents to their development as osteopathic physicians by contacting Deans Evans’ office at the MUCOM. For those of you who already have made contributions of your time, talent, and/or money to this endeavor thank you once again. Please also keep the IOA staff members in your thoughts and prayers as they serve us every day. They are looking out for our best interests in order to make the IOA a better organization. Please remember to thank Erin and Debbie for all their work and efforts.

Adrian L. Carter, D.O. IOA President

AIOA NEWS The holidays are quickly approaching and the 33rd Annual Winter Update to be held December 5 – 7, 2014, at the Hyatt Regency, in downtown Indianapolis, will be here even sooner.

I always look forward to and enjoy seeing and visiting with everyone at the annual spring updates and the annual winter updates.

For those of you who are not members of the Advocates to the Indiana Osteopathic Association (AIOA), I again would like to invite you to join the AIOA and help support and promote the osteopathic profession. We will appreciate whatever help you can provide. To receive an application, please contact Debbie Coyle at the IOA office.

You also may download an application at www.inosteo.org by clicking on Advocates to the IOA under the Related Organizations tab.

Take care and I hope to see you in December.

Mike Coyle AIOA President

Fall 2014

HOOSIER D.O.

Page 18

DEAN’S UPDATE

By: Paul Evans, D.O., FAAFP, FACOFP Vice President and Dean Marian University College of Osteopathic Medicine The Marian University College of Osteopathic Medicine (MUCOM) now has two classes! The D.O. Class of 2018 of 162 students started orientation on Monday, August 4, and entered classroom activity on Thursday, August 7. This class is even stronger than last year: 51% male, 54% from Indiana and the rest from 18 other states, GPA average of 3.62 with MCAT average of 27. This class has 17% with prior graduate degrees and 7% are international (Canada, China, France, India, Mexico, and Vietnam). We had a smooth orientation that included a concert by Ben Huang, D.O.’s rock group “The Undercovers” and other events. They were great! Sunday we had our second white coat ceremony at the Indiana Roof Ballroom with about 900 participants. Adrian L. Carter, D.O., President of the Indiana Osteopathic Association (IOA), welcomed our new class into the IOA as student members and read the osteopathic oath with them after assisting our new students into their white coats.

Our D.O. Class of 2017 had orientation on Friday, August 8, and started their curriculum on Monday, August 11.

ACCREDITATION. Our COCA progress report was submitted on July 1. We defended the report on September 5 in Chicago at the COCA meeting. We are on track with our provisional accreditation milestones toward full accreditation at graduation in 2017. Our next Self Study will be submitted in November and our provisional yearly site visit will be January 22 - 24, 2015.

HOSPITAL PARTNERSHIP OUTREACH. Our priority project for this year is implementing our third year clinical education clerkships. St. Vincent Health and Community Health have committed to 90 and 60 slots per month respectively. We also have 26 other hospitals or systems who have committed to taking students. The devil is in the details for setting up this complicated network of monthly rotations with almost 150 students changing rotations every month. Our clinical dean, Charles E. Henley, D.O., and his chairs for specialty care, Patrick A. Woodman, D.O., and primary care, Richard A. Schuster, D.O., are finalizing the details and the assignments together with the educational objectives for these rotations.

We have some excess capacity built-in to cover any last minute withdrawals or changes.

PUBLIC RELATIONS. The MUCOM had a busy summer. Our students participated in a number of worthwhile activities. Students went to mission/global health trips to Kenya and Honduras. Some did research with the Ph.D. faculty at the MUCOM. Six students completed a Lily Scholars internship program in Indianapolis to very good reviews. This ten week program

emphasized the scientific process of health care pharmaceutical development and gave our students a wonderful view of the rigors and oversights (both technical and ethical) of clinical trials and new drug development.

We hope to expand this program next year.

Our faculty was hard at work too. Richard Klabunde, Ph.D., Professor of Physiology, was the keynote speaker at the international medical physiology review conference in Malaysia. There were over 450 students and many international experts attending. This was a great way to publicize the good things we are doing at Marian for osteopathic education and awareness to a worldwide audience!

RECRUITING AND HIRING. We now have over 2,185 applicants for our 162 seats, an increase of about 8% over last year and 40% over year one. The quality as measured by GPA and MCAT scores appears to be even better. We began interviewing 56 students per week starting on September 12. We plan to interview 580 candidates in order to fill our class for next year. Training for interviewers and admissions committee members is ongoing.

We hired two new fulltime clinical faculty in internal medicine and osteopathic manipulative medicine who already have already started and have a Ph.D. pharmacologist starting in January 2015. Two clerkship coordinators also have started.

We now have had many local D.O. physicians and M.D. colleagues give lectures and run case-based group discussions at the college with strong student enthusiasm for their contributions. It is a great way for osteopathic physicians to give back to the profession which helped us to become successful physicians. We have first year students forming differential diagnoses in the case review sessions. With your continuing help and support, we hope to build a strong foundation from which to provide exceptional osteopathic medical education experiences and expand the presence of our new medical school in Indiana in the years to come.

HOOSIER D.O.

Fall 2014

COMING EVENTS...

OMED October 25 – 29, 2014 Washington State Convention Center, Seattle, WA Sponsor: American Osteopathic Association Contact: AOA, (312) 202-8014 or www.osteopathic.org The Midline Course November 7 – 9, 2014 Doubletree Hotel San Francisco Airport, San Francisco, CA Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Preconference OMT Workshop: “Muscle Energy for the Lower Half of the Body” December 4, 2014 8 hours category 1-A credit anticipated, pending approval by AOA CCME Hyatt Regency, Downtown Indianapolis, IN Sponsor: Indiana Academy of Osteopathy Contact: IAO, (317) 926-3009 or www.inosteo.org

MARK YOUR CALENDARS

NOW AND PLAN TO ATTEND THE IOA 33RD ANNUAL WINTER UPDATE DECEMBER 5 - 7, 2014 HYATT REGENCY DOWNTOWN INDIANAPOLIS, IN

33rd Annual Winter Update December 5 - 7, 2014 25 hours category 1-A credit anticipated, pending approval by AOA CCME Hyatt Regency, Downtown Indianapolis, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org Introductory Course: Osteopathy in the Cranial Field February 14 – 18, 2015 40 hours category 1-A credit anticipated, pending approval by AOA CCME Sheraton Portland Airport Hotel, Portland OR Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Key Elements in Effective Osteopathic Practice February 20 – 22, 2015 16 - 20 hours category 1-A credit anticipated, pending approval by AOA CCME Sheraton Portland Airport Hotel, Portland OR Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com A Sutural Approach to Osteopathy in the Cranial Field February 20 – 22, 2015 20 hours category 1-A credit anticipated, pending approval by AOA CCME Sheraton Portland Airport Hotel, Portland OR Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com The Neurology of Posture – Maxillofacial Influences: Teeth, Eyes, Ears, Vertebrae April 17 - 19, 2015 21 hours category 1-A credit anticipated, pending approval by AOA CCME Embassy Suites Hotel, Alexandria, VA Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Annual Convention March 12 – 15, 2015 The Cosmopolitan Hotel Las Vegas, Nevada Sponsor: American College of Osteopathic Family Physicians Contact: ACOFP, (800) 323-0794 or www.acofp.org Annual Convocation March 11 – 15, 2015 Marriott Hotel, Downtown Louisville, KY Sponsor: American Academy of Osteopathy Contact: AAO, (317) 879-1881 or www.academyofosteopahy.org

Page 19

Opportunities in Medicine in Indiana (OMI) OMI is a nonprofit recruitment program connecting Physicians, Physician Assistants and Nurse Practitioners with jobs in Indiana. 

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OMIonline.org

Fall 2014

HOOSIER D.O.

HOOSIER

Page 20

PRACTICE OPPORTUNITIES AVAILABLE IN INDIANA IOA Serves as an Informal Clearinghouse for physicians seeking practice locations.

2014 - 2015 OFFICERS Adrian L. Carter, D.O. President Mark S. Cantieri, D.O. First Vice President Gaston Dana, D.O. Second Vice President Terry A. Iwasko, D.O. Secretary Patrick J. Woodman, D.O. Treasurer Angela B. Wagner, D.O. Immediate Past President TRUSTEES Brian H. Black, D.O. Mary Burden, D.O. Steven J. DeLee, D.O. Chris A. Lowery, D.O. Stephanie M. Overmars, D.O. Rachel A. Shockley, D.O. DISTRICT VICE PRESIDENTS Brian H. Black, D.O., District I Vacant, District II Vacant, District III Vacant, District IV Bruce C. Brink, Jr., D.O., District V Dan C. Galloway, D.O., District VI A.O.A. DELEGATES Thurman V. Alvey, III, D.O. Mark S. Cantieri, D.O. David L. Coil, D.O. Dan C. Galloway, D.O. David C. Koronkiewicz, D.O. Susan M. Moore Riesbeck, D.O. Angela B. Wagner, D.O. A.O.A. ALTERNATE DELEGATES Adrian L. Carter, D.O. Max E. Helman, D.O. Ben D. Huang, D.O. The Hoosier D.O. is published four times per year in the Winter, Spring, Summer, and Fall by the Indiana Association of Osteopathic Physicians and Surgeons, Inc. dba Indiana Osteopathic Association.

Editor: Deborah E. Coyle, CPS IOA Staff: Erin L. Wernert, Executive Director Deborah E. Coyle, Manager of CME Programs and Office Manager The IOA Office is located at: 3200 Cold Spring Road Evans Center, Suite 107 Indianapolis, IN 46222 (317)926-3009 www.inosteo.org

FREELANDVILLE INDIANA. The small rural community of Freelandville misses its retired physician and is hoping a new one will come to town. If interested in a solo practice, contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.

HARTFORD CITY INDIANA - Reliant Healthcare has an immediate full-time position available in our internal medicine practice. We are a small, but mighty privately-owned practice in rural Hartford City, IN. We are centrally located, only 18 miles north of Muncie, IN, 54 miles south of Ft. Wayne, IN, 82 miles northeast of Indianapolis, IN and 104 miles west of Dayton, OH. This is the ideal opportunity for someone who got into medicine to take care of patients. The doctor is looking for someone to help support her growing patient load; expand our capacity to meet our patients’ time sensitive urgent visits, follow-up’s, and educational needs. We may be in rural Indiana, but we have big time amenities with onsite staffed lab facilities, EKG, electronic medical records and utilize both R.N.’s and medical assistants on staff. If you are looking to surround yourself with a caring, supportive team, in addition to receiving a competitive compensation package, please contact Practice Administrator, Cory McConnell at (260) 729-1949 or email corymcconnell@gmail.com with your questions and CV. "Reliant"- "Trust in the Lord with all your heart and lean not on your own understanding; in all your ways acknowledge Him, and He will make your paths straight. Do not be wise in your own eyes; fear the Lord and shun evil. This will bring health to your body and nourishment to your bones." ~Proverb 3: 5-8 INDIANAPOLIS PHYSICIAN AVAILABLE FOR FAMILY PRACTICE, OCCUPATIONAL MEDICINE, OR URGENT CARE. Certified in family practice in 1999. For additional information, contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.

NORTHERN INDIANA. Mishawaka Osteopathic Clinic has an immediate opening for a physician to come into the practice. We have a well-established and large patient base. Our experienced, loyal, and well-trained staff attracts many new patients.

Currently, we have one full time and one part time D.O., an R.N., multiple medical assistants, fully staffed front office and medical records. Our Clinic has 11 exam rooms, including an office surgery/procedure room, PAP room, conference/lunch room and a large comfortable waiting room. We are a fast paced and patient friendly practice caring for families since 1969. Come join our team of patient care professionals who feel that “our patients matter.” For more information, please contact Mary Behrle, RN Staff Coordinator at (574) 323-3812 or e-mail inquiries along with your CV to mocnurse@yahoo.com.

PREMIER INDIANAPOLIS AREA FAMILY MEDICINE OPPORTUNITES AVAILABLE. Our practices are growing, and you can be busy right away. You’ll enjoy a collaborative environment with administration and your fellow physicians.

Experience the benefits of practicing in a small town environment without sacrificing any big city amenities. Our hospitals offer: supportive cultures, competitive salaries, comprehensive benefits, rapidly growing communities, full and part time options, skilled support staff at each practice and accessible specialty and sub-specialty medicine. Hospital owners: Hancock Regional Hospital, Hendricks Regional Health, Henry County Hospital, Johnson Memorial Hospital, Major Hospital, Riverview Health and Witham Health Services. Contact Suburban Health Organization, (317) 295-5279 or send an e-mail message to laurenc@suburbanhealth.com.

SOUTHERN INDIANA. Brink’s Family Practice in Princeton has an immediate opening for a physician to come into the practice. The practice has a well-established patient base with experienced, well-trained staff and an in-house lab. The practice is located in a growing community that still possesses small town friendliness and has access to large city amenities. For more information, please e-mail inquiries along with your CV to c.hurtbfp@mw.twcbc.com or contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.