ISCA Nov/Dec Newsletter 2008

november/december 2008 IScA report �

An EvEr ChAnging ClimAtE It is an honor and a privilege to once again serve this great profession as President of the ISCA. In this capacity, I am truly blessed to be surrounded by so much talent with the current Board of Directors, Executive Committee, Members of the various committees, and the ISCA members. With the leadership of our Executive Director, Pat McGuffey and LMV Consulting, we are well prepared and eager to tackle the challenges this profession faces.

It is an inspiration to me, being a member of the ISCA for 23 years, to witness the strength of our membership through their unconditional love for this profession. Chiropractic, which possesses a Foundation of Truth must continue to meet future challenges with diligence, commitment and focus

during an ever changing climate. Our focus on the future will enable us to prepare to adapt to make the necessary changes to strengthen this profession for generations to come.

The ISCA is connected to national and state issues that directly affect the practice of chiropractic in Indiana. It is in all of our best interest to stay connected and communicate with each other so we may act as a unit on various issues. Familiarize yourself with the various committees we have. Do not hesitate to contact your district director, committee chair, Pat McGuffey or myself with any questions you may have. Read the newsletters from front to back. Attend the ISCA Continuing Education Seminars and special events. Help the ISCA help you stay on the “cutting edge” of today’s issues.

The ISCA has achieved great success and momentum legislatively, especially the last 4 years in regards to the Physical Therapy Issue and our own Assignment of Benefits bill. This success is due to a combined effort of the ISCA members and the leadership of our Executive Director, Pat McGuffey. Assignment of Benefits and the Physical Therapy issues have a huge impact on our profession. Please educate yourself on these issues, if you are not familiar with their significance. We will also continue to confront the numerous insurance reimbursement and audit issues including the ever changing Medicare policies.

As a member of the ISCA, it is critical to contribute any way you can when help is needed. With the upcoming legislative session, we will once again face multiple challenges. Our grassroots effort by ISCA members was extremely important in the success we achieved the last few years. Each of us must act when we are called upon. It is amazing to witness the presence we have at the state house under the Leadership of Pat McGuffey’s nearly 30 years of experience. We are outnumbered by the physical therapists, medical doctors and financially by the insurance companies. Our strength lies in our resolve to work together to protect and strengthen our profession and it’s role in healthcare.

I urge you to ACT when called upon and be sure to contribute to BackPac.

insidE this issuE

PrEsidEnt's mEssAgE Dr. Anthony Wolf, D.C.

IScA Report november/december 2008

PRESIDEnT'S MESSAGE.....................................................................................1ISCA BOARD OF DIRECTORS & STAFF InFO...................................................2ExECuTIVE DIRECTOR'S MESSAGE................................................................3DR. ROBERT TEnTAnT'S ACA uPDATE............................................................5MAnDATORy uSE OF THE nEW ABn FORM...................................................5WELCOME nEW ISCA MEMBERS! ....................................................................5FOunDATIOn FOR CHIRO PROGRESS ACknOWLEDGEMEnT.........................5OIG APPROVES SOME InTERnET ADS, BuT RISkS REMAIn.........................6CHIRO SERVICES SuBjECT TO OIG REVIEW Fy 2009..............................6WAIVER OF DEDuCTIBLE OR COPAyMEnT & OTHER AD. LAWS.................7

InSuRAnCE CLAIM PAyMEnTS LAW............................................................8F4CP CAMPAIGn InTEnSIFIES - "CHIRO CARE DELIVERS".............................9BEWARE OF OFFERInG GIFTS & OTHER InCEnTIVES TO PATIEnTS.................10MEDICARE nEWS..............................................................................................12ACA SEnDS 16,600 nEuROLOGISTS LATEST RESEARCH On nECk PAIn...123 CODInG AnD DOCuMEnTATIOn MISTAkES TO AVOID............................13ISCA FALL COnFEREnCE WRAP uP...................................................................14MEDICARE PROVIDERS MuST uSE OnLy nPI #'S On CLAIMS....................15MOST DOCTORS SuFFER FROM PAIn , WHO knEW THAT?!.................16-17ISCA CLASSIFIEDS......................................................................................18-19

november/december 2008IScA report�

PresidentAnthony Wolf, D.C.Indianapolis, [email protected]

First Vice-PresidentPeter Furno, D.C.Zionsville, [email protected]

Second Vice-PresidentRobert Tennant D.C.Shirley, [email protected]

SecretaryJames Cox II, D.C.Fort Wayne, [email protected]

TreasurerChris Bryan, D.C.South Bend, [email protected]

Immediate Past PresidentDuane Binder, D.C.Clinton, [email protected]

Past President RepresentativeMick Gallagher, D.C. Indianapolis, IN 317.571.1480 [email protected]

DIRecToRS aT LaRge

Ted FreidlineSalem, [email protected]

Lewis Myers, D.C.Valparaiso, IN219.464.4444

Michael, Phelps, D.C.Martinsville, [email protected]

DISTRIcT DIRecToRS

District oneRon Daulton, Sr., D.C.Hammond, [email protected]

District TwoGerard Hofferth, D.C.South Bend, IN574.256.1008

District ThreeGeorge Joachim, D.C.Fort Wayne, IN

District FourG. Lyman Shaw, D.C.Brownsburg, [email protected]

District FiveDerek Dyer, D.C.Huntington, In [email protected]

District SixMatt HowardMuncie, [email protected]

District SevenDiane Vuotto, D.C.Indianapolis, IN [email protected]

District eightMichael Toney, D.C.Terre Haute, [email protected]

District NineNate Unterseher, D.C.Seymour, [email protected]

aLTeRNaTe DIRecToRS aT LaRge

C.C. Paprocki, D.C.Greenwood, IN317.535.7507

John Volbers, D.C.Indianapolis, [email protected]

aLTeRNaTe DISTRIcT DIRecToRS

District oneChris HayesCrown Point, [email protected]

District TwoBill GarlBremen, IN574.546.1111

District ThreeJason RussellFort Wayne, [email protected]

District FourGarry Fuller, D.C.Brownsburg, [email protected]

District FiveDavid FrischmanWabash, IN [email protected]

District SixVacant

District SevenSheila Wilson, D.C.Indianapolis, [email protected]

District eightShaun Tymchak, D.C.Newburgh, [email protected]

District NineJohn Krawchinson D.C.Seymour, IN812.524.2273

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

Patricia McguffeyExecutive [email protected]

Lane VelayoAssociation [email protected]

Tom Johnson, cPaChief Finanical [email protected]

Debra Scott, IoMVice President of [email protected]

Stephanie HigginsDirector of [email protected]

Stacy QuasebarthDirector of [email protected]

connie VickeryGovernmental [email protected]

John LivengoodGovernmental [email protected]

Patrick RussellExecutive [email protected]

Krista [email protected]

200 S. Meridian St., Suite 350Indianapolis, IN 46225info@indianastatechiros.orgwww.indianastatechiros.org317.673.4245 phone 317.673.4210 fax

indiAnA stAtE ChiroPrACtiC AssoCiAtion stAff & info

indiAnA stAtE ChiroPrACtiC AssoCiAtion BoArd of dirECtors


I hope all of you are enjoying the Holiday Season. It was great seeing many of you at ISCA’s Fall Conference. Please let us know if there are topics or formats that you prefer. As some of our esteemed leaders say “it is your ISCA”. If we are to continue to be a strong viable Association, we will need all of you, our members, working with our staff, the ISCA Board and Committees as a team. ISCA will continue to be the strong voice for Chiropractic with your help!

One reason it is imperative for the ISCA to be a strong voice for the profession is so that we can effectively represent you in the Indiana General Assembly. The 116th Session of the Indiana General Assembly convenes january 8, 2009. There are 25 new legislators, 17 House members and 8 Senate members. The House has a democratic majority with 52 Democrats and 48 Republicans. Republicans continue to have a strong majority in the Senate with a 33 Senate members to Democrats 17. It is crucial that you either acquaint or reacquaint yourself with your Representatives and Senators. The ISCA is forwarding some key legislative proposals and will need you to educate your local legislators on their importance to you and the chiropractic profession.

One of ISCA’s priorities is to require the new Healthy Indiana Program, (HIP), insurance for the uninsured, to include chiropractic services. The 2008 legislation that implemented the HIP program contained language that prohibited HIP from discriminating against chiropractors and other healthcare professionals just as regular health insurance products are prohibited from doing. However, when the Administration promulgated the proposed rule to implement the HIP statute, they eliminated Chiropractic serves. After ISCA’s protest and challenge to the proposed rule, the Administration did amend the final rule to allow D.C.s to provide services included in HIP that are within the scope of DC’s scope of practice , i.e. physical therapy services, etc, but not chiropractic services, i.e. spinal manipulations.

The ISCA has legislation being introduced in the 2009 session that will provide for D.C.s to be able to provide chiropractic office services and not be discriminated against. We will post the proposed legislation on our web site as well as how to contact legislators. The web site is www.indianastatechiro.org. Also remember you can contact legislators directly by going to our legislative website called Capwiz (http://capwiz.com/la). Please educate legislators before the Session begins in january.

The other ISCA priority legislative proposal is the “Assignment of Benefits” legislation. AOB legislation has been introduced in the last two Sessions and last year it passed the House but died in the Senate when the author failed to bring it down for a vote. The proposed legislation would allow patients to assign their benefits

(payments) to insurance companies’ “out of network” healthcare providers if they choose to do so. Currently, most insurance companies mail the payment, partial payment, or denials to the patient who doesn’t have the expertise to appeal improper denials and payments. The proposed legislation would require insurance companies to follow the patients’ wishes. The AOB legislation will also be posted on ISCA’s web site with legislators contact information. Please contact your legislators about AOB legislation and ask them to pass the legislation in the 2009 Session.

As ISCA prepares to name committees for 2009, I would encourage you to volunteer your time and talents and serve on at least one committee. The Committees are as follows:

Speaker/Convention CommitteeGolf CommitteeInsurance CommitteeFinance CommitteeMembership CommitteeEthics/Grievance CommitteeBy-Laws CommitteeLegislative CommitteePublic Relations (PR) CommitteeStrategic Planning Committee

you may contact me at [email protected] or the ISCA office at 317-673-4242 or 317-673-4245 if you are willing to serve.

Our Spring Conference will be held April 17th, 18th, and 19th at the Radisson Airport Hotel. Please place that date on your calendars and plan to join your fellow ISCA colleagues. Remember you need 12 hours of C.E. credits each year for a total of 24 hours for a two year period. you may not obtain all 24 credits in one year. your attendance and support of ISCA’s conferences is crucial to our ability to work to ensure the success and excellence of the chiropractic profession.

Happy Holidays to all and I wish you a Blessed and Prosperous 2009.

ExECutivE dirECtor's mEssAgEPatricia McGuffey


Schedule a Live Demonstration at www.commvantage.com or call (866) 399-4009 for more information

reception room DVD

Schedule a live online demonstration and receive a

FREECall (866) 399-4009 today!

(A $249 Value)

Virtual Consultation®

For Patient Consultations & Report of Findings� Faster and more Powerful ROF’s

� Boost PVA Numbers

� Interactive 3D Models

� Improve Patient Compliance

� Achieved a 99% Level of Satisfaction in a November, 2005 Survey

Virtual Decompression®

For Patient Consultations� Show Degenerated, Bulging

and Herniated Discs

� Easily Explain the Benefits of Decompression Therapy

� Interactive 3D Models

� Includes Educational Video and Report Generator

� More Easily Convert Patients to Care

“I have been using both VC and VDec forsome time now…all I can say is “WOW!”Both of these programs are great. I havenever seen a report of findings tool that caneducate a patient like the VC and VDec pro-grams. They are easy to use, great graphicsand really explain care to the patients. Theyare a MUST HAVE for every Chiropractor.”

— Dr. Michael Perusich

“Thus far, my conversion rate has been an exact 100%.” — Dr. John Warner

Now with AutoDC™

AutoDC™ enables doctors to build a custom list of animations for any patient in just seconds.

It’s a great Pre-ROF tool!


wElComE nEw isCA mEmBErs!

The ISCA would like to recognize our newest members:

studEntTravis Hulbert

5th YEAr in PrACtiCEjohnnett Thatcher - Thatcher Chiropractic Clinic

Ted Thatcher - Thatcher Chiropractic Clinic

ACA to moBilizE ChiroPrACtiC PAtiEnts in rEsPonsE to oBAmA viCtorYACA Update by: Dr. Robert Tennant

Following the presidential election and in anticipation of renewed efforts to enact national health care and Medicare reform legislation, the American Chiropractic Association (ACA) announced that it will soon launch a national grassroots campaign centered on the development and activation of a chiropractic patient advocacy network.

According to ACA government relations staff, the election of Democrat Barack Obama coupled with an increased Democratic majority in both the u.S. House and Senate, make it very likely that the new Congress and White House will seek to enact significant national health care reform legislation and possibly a major overhaul of the federal Medicare program. The goal of ACA’s new patient advocacy network is to bridge the gap between elected officials and chiropractic patients.

“Imagine how much stronger and influential the profession would be if it were able to communicate with and then mobilize large numbers of chiropractic patients,” said ACA President Glenn Manceaux, DC. “A strong and well-organized patient network could be a unique grassroots tool that will be the difference between victory and defeat. It could be the weapon that places us on equal footing with our larger and typically better financed opponents.”

ACA’s data collection efforts will formally launch on a major, nationwide basis in january. Doctors of chiropractic will receive special instructions and information about ways they and their patients can participate. In addition, a special Web site will be unveiled in january that will assist in the collection of patient contact information. ACA officials assure doctors that data collection efforts will be fully HIPAA compliant.

Association leaders laid the groundwork for this project nearly two years ago when the House of Delegates approved a new association management system, capable of not only handling the growing workload of ACA’s daily business and membership needs, but also capable of housing a national database of patient e-mail addresses that can be matched with individual members of Congress.

mAndAtorY usE of thE nEw ABn form BEgAn sEPtEmBEr 1 ChAngEd to mArCh 1, 2009 The date for implementation of the new ABn form, which debuted in March 2008 and was originally required to be in use by September 1, has been changed. The new ABn form is now mandatory for use by March 1, 2009.

The ABN is a notice given to beneficiaries in Original Medicare to convey that Medicare is not likely to provide coverage in a specific case.

If your CMS-1500 claims are rejected, visit the national Plan and Provider Enumerator System (nPPES) Web site to make sure all the information for your nPI is accurate. If claims continue to be rejected, have a copy of your nPPES record in hand (available on the nPPES Web site) and contact your Medicare contractor.

For more information, see the nPI portion of the ACA Web site http://www.acatoday.org/ or visit the CMS Web site http://www.cms.hhs.gov/.

foundAtion for ChiroPrACtiC ProgrEss ACknowlEdgEmEnt

uSA Today acknowledged The Foundation for Chiropractic Progress on Friday november 7, 2008. The foundation had a half page advertisement on page 2B. The focus was on "An

Optimal Healthcare Model for the 21st Century"

To learn more please visit: www.yes2chiropractic.com


oig APProvEs somE intErnEt Ads, But risks rEmAin SUbmiTTeD by: DR. DAviD e. JoSe, eSq., kRIEG DEVAuLT LLP PHOnE: 317.238.6211 EMAIL: [email protected] WEBSITE: WWW.kDLEGAL.COM

The Office of Inspector General (OIG) recently issued an Advisory Opinion (No. 08-19) on November 5, relating to the potential application of the Anti-kickback Statute to an internet advertiser’s proposal. The advertiser specializes in creating internet platforms for “pay per call” or “pay per lead” advertising. Each chiropractor subscribing to the internet advertiser’s services is given a special telephone number and e-mail address via which potential patients who visit the internet advertiser’s website are able to contact an advertising chiropractor.

Potential patients visiting the website might be seeking services covered in whole or in part by the Medicare or Medicaid programs, which raises the questions and concerns for the OIG. While such advertising arrangements and referral services do carry potential risks, the OIG determined that this arrangement had enough protective features to avoid sanctions under the Anti-kickback Statute.

The OIG noted that the internet advertiser is not a “health care provider or supplier”, and would not be collecting health care information on the prospective patient. Also, the advertiser does not target Medicare/Medicaid beneficiaries, but its web site is generally accessible to the public as a whole. Further, the fees paid by the chiropractor subscribing to the advertising program is not dependent upon whether the potential patient actually becomes a patient of that chiropractor, nor is it dependent upon the specific services, if any, that the patient may ultimately receive from the chiropractor. Finally, the internet advertiser simply steers patients to particular chiropractors, based upon which subscribing chiropractor is closest to that patient.

While the OIG has indicated that this specific arrangement does not necessarily implicate the Anti-Kickback Statute, any advertising arrangement or marketing program must be carefully evaluated. The Anti-kickback Statute focuses upon any sort of payment or remuneration in consideration for the referral of patients. In addition, the Indiana Board of Chiropractic Examiners has imposed discipline upon chiropractors who utilize advertising arrangements proposed by marketing consultants. The marketing consultants may have a “terrific” idea, but may ignore the possibility that the content of the advertising may violate state regulatory limitations. Thus, before adopting any advertising or marketing program in order to “reach new patients” or “grow your business”, careful consideration should be given to the application of federal and state legal limitations must be carefully considered. In addition, each arrangement and potential marketing activity should be considered on an individual case-by-case basis.

If you have any questions about the Anti-kickback Statute or internet advertising risks, please contact David E. jose at (317) 238-6211 or [email protected].

ChiroPrACtiC sErviCEs suBjECt to oig rEviEw fY2009

The Department of Health and Human Services (HHS), Office of the Inspector General (OIG), the entity responsible for identifying and reporting inefficiency in Medicare, Medicaid and other related HHS agencies, has announced in their 2009 Work Plan that they will again seek records from doctors of chiropractic, as a follow-up to previous reports on chiropractic documentation. These requests for records are expected in FY2009.

We are asking that all doctors of chiropractic who receive an OIG record request to please contact the ACA via e-mail at [email protected] for assistance in fully complying with the request.

It is critical that doctors of chiropractic include all necessary information, including the most recent exam and the most recent full history, upon receipt of an OIG record request. It is also imperative that this be done in a timely fashion (by the date specified by the OIG). We strongly recommend that doctors of chiropractic who receive an OIG record request immediately contact ACA so that we can provide essential information to help you navigate through the OIG request process.

hEAlth nEt to PAY for unPAid ChiroPrACtiC ClAimsSource: Chiropractic economics

Managed healthcare company Health net has agreed to pay $41 million in claims and fines for underpaying 88,000 New Jersey customers.

According to Banking and Insurance Commissioner Steven Goldman, Health net had short changed customers on their out of network medical claims from 1996 to 2005, and on dental, mental health, and chiropractic claims from 1999 to 2006.

The result of a state investigation, the $41 million total includes a $13 million fine, $14 million to the underpaid customers, $12 million in interest, and $2 million in other fees.

Reimbursements were mailed to current and former customers starting last month.

Health net, once known as First Option Health Plan of new jersey and Physicians Health Services of new jersey, has 120,000 policyholders in new jersey.


AirlinE trAvElErs wAnt sPinE-friEndlY sEAtsSource: SpineUniverse

Eighty-eight percent of people who had flown in North America in the last year reported they had back or neck pain – or both – after a typical flight, according to a survey conducted by SpineUniverse.

With a margin of error at 5 percent, the study revealed that 74 percent of the typical travelers surveyed said that they would pay an extra fee for a special, spine-friendly seat that doesn’t give them back or neck pain.

The survey said the travelers who suffer the most were willing to pay up to $50 more, while 20 percent would pay up to $100 more.

(a) In addition to section 4 of this chapter, a practitioner licensed to practice chiropractic is subject to the exercise of the disciplinary sanctions under setion 9 of this chapter if, after a hearing, the board regulating the profession finds a practitioner has:

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

(b) This section does not apply to the waiver of a deductible or a copayment by a practitioner if: the practitioner determines chiropractic service is necessary for the immediate health and welfare of a patient;

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

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

846 iAC 1-3-2 Code of professional conductAffected: IC 25-1-9-6.5; IC 25-10-1-1

Sec. 2. (a) Chiropractors practicing in Indiana shall conduct their practice of chiropractic in accordance with the standards set out in IC 25-10 and this title.(b) no person holding a license to practice chiropractic shall conduct such practice under any name other than his or her own unless practicing as an employee of a clinic, center, or institution.(c) To designate that they are licensed to practice chiropractic in Indiana, all licensees practicing chiropractic in Indiana shall use, in conjunction with their names, the words "chiropractic", "chiropractor", or the abbreviation "D.C." alone or in connection with other words, on all signs, letterheads, business cards, or similar items of identification, advertising, and solicitation of any kind. Provided, however, chiropractors may not use any words which would mislead the public into believing they are licensed in Indiana to practice any other licensed occupation or profession for which they do not hold an Indiana license.(d) Any identification using the word "clinic", "center", "corporation", or terms of similar import that is solely concerned with the practice of chiropractic, shall also designate that it is a chiropractic facility. Any licensee practicing in a multiple professional

health care facility shall prominently display in the facility the fact that he or she is engaged in the practice of chiropractic.(e) Every licensee practicing in Indiana shall publicly and prominently display the license issued him or her by the board or a photostatic

1.

2.

1.

2.

copy thereof in all offices, clinics, corporations, centers, and/or similar places of business wherein he or she ispracticing.(f) In the conduct of practice, no person holding a license to practice chiropractic shall engage in advertising or soliciting forpatronage that which is not in the public interest. Advertising or soliciting not in the public interest shall include advertising that:

is false, fraudulent, deceptive, or misleading;represents intimidation or undue pressure; ormakes claims of professional superiority over fellow practitioners or over another health science which cannot besubstantiated.

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

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

(h) A chiropractor has a duty and responsibility to his or her patients and to the chiropractic profession to promptly release a patient's records to any other chiropractor or any other health discipline practitioner designated by the patient upon written request of the patient.(i) A practitioner may advertise his or her professional services in order to advise the public of the existence and scope of the services he or she offers, so long as the advertisement is dignified and confines itself to the existence of the practice and/or the field of practice of the practitioner.(j) For the purposes of IC 25-1-9-6.5 and this rule, advertisements include the use of television, newspaper, radio, billboards,yellow pages, seminars, handbills, mailings, or other similar advertisements to the public.

IAC 1-3-2; filed Jul 28, 1983, 9:03 a.m.: 6 IR 1741; filed Dec 28, 1990, 5:00 p.m.: 14 IR 1068; readopted filed Jul 10, 2001, 2:55 p.m.: 24 IR 4236; readopted filed Oct 4, 2007, 3:34 p.m.: 20071031-IR-846070057RFA)

1.2.3.

4.

1.2.

3.

4.

wAivEr of dEduCtiBlE or CoPAYmEnt sEC. 6.5. And othEr AdvErtising lAws


insurance Claim Payments law

iC 27-8-5.7 : Chapter 5.7. Accident and Sickness Insurance; Provider Payment

iC 27-8-5.7-2: “Clean claim” defined Sec. 2.

As used in this chapter, “clean claim” means a claimsubmitted by a provider for payment under an accident and sickness insurance policy issued in Indiana that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. As added by P.L.162-2001, SEC.5.

iC 27-8-5.7-5 : Notice of deficiencies in claims Sec. 5. (a) An insurer shall pay or deny each clean claim inaccordance with section 6 of this chapter.(b) An insurer shall notify a provider of any deficiencies in asubmitted claim not more than:(1) thirty (30) days for a claim that is filed electronically; or(2) forty-five (45) days for a claim that is filed on paper;and describe any remedy necessary to establish a clean claim.(c) Failure of an insurer to notify a provider as required undersubsection (b) establishes the submitted claim as a clean claimAs added by P.L.162-2001, SEC.5. Amended by P.L.137-2002,SEC.2.

iC 27-8-5.7-6 : Payment or denial of claims; interest Sec. 6. (a) An insurer shall pay or deny each clean claim as follows:(1) If the claim is filed electronically, within thirty (30) daysafter the date the claim is received by the insurer.(2) If the claim is filed on paper, within forty-five (45) daysafter the date the claim is received by the insurer. (b) If:(1) an insurer fails to pay or deny a clean claim in the timerequired under subsection (a); and(2) the insurer subsequently pays the claim;the insurer shall pay the provider that submitted the claim interest on the accident and sickness insurance policy allowable amount of the claim paid under this section.(c) Interest paid under subsection (b):(1) accrues beginning:(A) thirty-one (31) days after the date the claim is filedunder subsection (a)(1); or(B) forty-six (46) days after the date the claim is filed undersubsection (a)(2); and(2) stops accruing on the date the claim is paid.(d) In paying interest under subsection (b), an insurer shall use the same interest rate as provided in IC 12-15-21-3(7)(A). As added by P.L.162-2001, SEC.5.

iC 27-8-5.7-7 : Permitted forms Sec. 7.

A provider shall submit only the following forms for payment by an insurer:(1) HCFA-1500.(2) HCFA-1450 (uB-92).(3) American Dental Association (ADA) claim form.As added by P.L.162-2001, SEC.5.

iC 27-8-5.7-10 : Claim payment errors Sec. 10.

(a) An insurer may not, more than two (2) years after the date on which an overpayment on a provider claim was made to the provider by the insurer:(1) request that the provider repay the overpayment; or(2) adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider.

(b) An insurer may not be required to correct a payment error toa provider more than two (2) years after the date on which a payment on a provider claim was made to the provider by the insurer.(c) This section does not apply in cases of fraud by the provider,the insured, or the insurer with respect to the claim on which the overpayment or underpayment was made. As added by P.L.55-2006, SEC.1.

iC 27-8-5.7-11 : Claim overpayment adjustment Sec. 11.

Every subsequent claim that is adjusted by an insurer for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including:(1) an identification of:(A) the claim on which the overpayment was made; and(B) if ascertainable, the party financially responsible for theoverpaid amount; and(2) the amount of the overpayment that is being reimbursed tothe insurer through the adjusted subsequent claim. As added by P.L.55-2006, SEC.2.


The Foundation for Chiropractic Progress (F4CP), the aggressive public relations effort designed to inform and educate the public regarding the benefits of chiropractic care, continues to generate positive press for chiropractic. The campaign will intensify for the remainder of 2008 and into 2009, with additional press releases, print ads and “advertorials,” public service announcements, and even an expansion into television to broaden the campaign’s reach.

A new advertisement emphasizing the cost effectiveness of chiropractic care and featuring Dr. Richard Sarnat, MD, president of Alternative Medicine Integration (AMI), will debut in u.S. news and World Report and other prominent publications this fall. AMI is an independent provider association (IPA) that uses primary care physicians who specialize in a non pharmaceutical/nonsurgical approach – primarily doctors of chiropractic – utilizing a variety of complementary/alternative medicine (CAM) techniques integrated with allopathic medicine.

In the ad, called “Chiropractic Care Delivers,” Dr. Sarnat is quoted as saying, “My research, conducted over a ten-year period utilizing clinical and cost outcomes data from one of the largest insurance underwriters, suggests that the regular utilization of chiropractic could reduce the need for hospitalization, pharmaceutical usage and overall global health care costs by almost 50 percent.”

A study of AMI published in the journal of Manipulative and Physiological Therapeutics in 2004, in which DCs performed all patient examinations, treatments, and procedures at their own discretion, and recommended follow-up visits, choice of appropriate treatment, and ancillary therapies used did not require approval from an MD, found, when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame, the following decreases:

43% in in-hospital admissions58.4% in hospital days43.2% in outpatient surgeries and procedures51.8% in pharmaceutical costs

The study noted that: “The AMI experience seems to indicate that a non pharmaceutical/nonsurgical orientation can reduce overall health costs significantly and yet still deliver high quality care.”

The study was updated in 2007, covering the years 2003-2005. The results of the original study were confirmed, with demonstrated decreases of 60.2 percent in in-hospital admissions, 59 percent in hospital days, 62 percent in outpatient surgeries and procedures, and 85 percent in pharmaceutical costs.

••••

In an ad that has already appeared in uSA Today, and will continue to run periodically in the paper’s weekend edition, Dr. Sarnat states: “I have referred many patients to chiropractic care and they have benefited from [chiropractic’s] wellness approach to maintaining health. I have avoided long-term pharmaceutical usage and/or acute surgery by using chiropractic as a non-pharmaceutical, non-surgical alternative. Remember, pharmaceutical and/or surgery should be utilized as a last resort – only when more natural, less invasive modalities are unavailable or ineffective.”

The Foundation has also authored a book that carves out chiropractic’s place in the growing “greening” of health care in America – eco-friendly healthy care that is nontoxic. This means less prescription drugs, fewer surgeries, and increased natural health care approaches. According to the Foundation, these topics are another avenue to generate positive press.

Additionally, the F4CP has started an internet blog, “Chiropractic 2.0.” On this blog, DCs patients, and others interested in chiropractic care can exchange thoughts and ideas. It’s a great way for DCs to stay connected with each other and the public at large and get our message out. To join the blog, go to www.chiropractic2point0.blogspot.com.

One person alone cannot change the perception of chiropractic. However, an effort by the entire profession will make a difference. The Foundation invites donations to help build on the positive press of this campaign. If you wish to make a pledge and/or contribution, visit www.foundation4cp.com. Contributions can also be mailed to P.O. Box 560, Carmichael, CA 95609-0560.

Source: Foundation for Chiropractic Progress

f4CP CAmPAign intEnsifiEs – “ChiroPrACtiC CArE dElivErs”Campaign Helps unlock “Best-kept Secret in Health Care”

november/december 2008IScA report�0

The uS Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) continue to rigidly enforce federal rules that strictly prohibit Medicare and Medicaid providers from giving beneficiaries any sort of goods or services that might be interpreted as “prohibited inducement” to select one provider over another for covered health care services. The HHS Office of the Inspector General (OIG), the body charged with enforcement of this provision, interprets the prohibition to apply to any gift offered or provided to program beneficiaries that has a retail value of more that $10 individually, or a cumulative value of more that $50 in a calendar year.

According to section 1128A(a)(5) of the Social Security Act (hereafter “The Act), “…a person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner or supplier of Medicare or Medicaid payable items or services may be liable for civil monetary penalties (CMPs) of up to $10,000 for each wrongful act.” The statute defines “remuneration” to include, without limitation, waivers of co-payments and deductible amounts (or any part thereof) and transfers of items or services for free or for other than free market value.

“This prohibition has serious implications for the chiropractic practitioner, since even the provision of transportation to and from a chiropractic appointment as a courtesy of the Medicare patient becomes a violation of this rule if the value of that transportation exceeds $10,” said International Chiropractors Association (ICA) Medicare Committee Chair Dr. Michael Hulsebus. “This prohibition applies to both participating and non-participating Medicare providers and all providers, suppliers, etc., in the joint state-federal Medicaid program.”

The OIG applies the prohibition against inducements according to the following principles:First, the OIG has interpreted the prohibition to permit Medicare or Medicaid providers to offer beneficiaries inexpensive gifts (other than cash or cash equivalents) or services without violating the statute. For enforcement purposes, inexpensive gifts or services are those that have a retail value of no more than $10 individually, and no more than $50 in the aggregate annually per patient.Second, providers may offer beneficiaries more expensive items or services that fit within one of the five statutory exceptions:

Waivers of cost-sharing amounts based on financial need;Properly disclosed co-payment differentials in health plans;Incentives to promote the delivery of certain preventive care services;Any practice permitted under the federal anti-kick-back pursuant to 42 CFR 1001.952; or,Waivers of hospital outpatient co-payments in excess of the minimum co-payment amounts.

Third, the OIG is considering several additional regulatory exceptions. The OIG may solicit public comments on additional exceptions for complimentary local transportation and for free goods in connection with participation in certain clinical studies.Fourth, the OIG will continue to entertain requests for advisory opinions related to the prohibition on inducements to beneficiaries. However, given the difficulty in drawing distinctions between categories of beneficiaries or types of inducements, favorable opinions have been, and are expected to be, limited to situations involving conduct that is very close to an existing statutory or regulatory exception. In sum, unless a provider’s practices fit within an exception (as implemented by regulations) or are the subject of a favorable advisory opinion covering a provider’s own activity, any gifts or free services to beneficiaries should not exceed the $10 per item and $50 annual limits (Note: The OIG will review these limits periodically and may adjust them for inflation if appropriate).

Elements of the Prohibition: remunerationThe term “remuneration” has a well-established meaning in the context of various health care fraud and abuse statutes. Generally, it has been interpreted broadly to include “anything of value.” The definition of “remuneration” for purposes of section 1128A(a)(5) – which includes waivers of coinsurance and deductible amounts, and transfers of items or services for free or for other than fair market value – affirms this broad reading. The use of the term “remuneration” implicitly recognizes that virtually any good or service has a monetary value.

The definition of “remuneration” in section 1128A(i)(6) contains five specific exceptions:Non-routine, unadvertised waivers of co-payments or deductible amounts based on individualized determinations of financial need or exhaustion of reasonable collection efforts. Paying the premiums for a beneficiary’s Medicare Part B or supplemental insurance is not protected by this exception.Properly disclosed differentials in a health insurance plan’s co-payments or deductibles. This exception covers incentives that are part of a health plan design, such as lower plan co-payments for using preferred providers, mail order pharmacies, or generic drugs. Waivers of Medicare or Medicaid co-payments are not protected by this exception.

•

•1.2.3.4.5.

•

•

•

•

•

Beware of offering gifts and other incentives to PatientsProhibited Inducements in Medicare and Medicaid Draw Growing Attention

november/december 2008 IScA report ��

Incentives to promote the delivery of preventive care. Preventative care is defined in 42 CFR 1003.101 to mean items and services that (i) are covered by Medicare or Medicaid, and (ii) are either pre-natal or post-natal well-baby services or are services described in the Guide to Clinical Preventive Services published by the u.S. Preventive Services Task Force (available online at http://odphp.osophs.dhhs.gov/pubs/guidecaps/). Such incentives may not be in the form of cash or cash equivalents and may not be disproportionate to the value of the preventive care provided. (See 42 CFR 1003.101; 65 FR 24400 and 24409.)Any practice permitted under an anti-kickback statute safe harbor at 42 CFR 1001.952. For example, anti-kick-back statute safe harbors exist for warranties; discounts; employee compensation; waivers of certain beneficiary coinsurance and deductible amounts; and increased coverage, reduced cost-sharing amounts, or reduced premium amounts offered by health plans.

•Waivers of co-payments amounts in excess of the minimum co-payment amounts under the Medicare hospital outpatient fee schedule.

InducementThe Act bars the offering of remuneration to Medicare of Medicaid beneficiaries where the person offering the remuneration knows or should know that the remuneration is likely to influence the beneficiary to order or receive items or services from a particular provider. The “should know” standard is met if a provider acts with deliberate ignorance or reckless disregard. no proof of specific intent is required. (See 42 CFR 1003.101)

The “inducement” element of the offense is met by any offer of valuable (i.e., not inexpensive) goods and services as part of a marketing or promotional activity, regardless of whether the marketing or promotional activity is active or passive. For example, even if a provider does not directly advertise or promote the availability of a benefit to beneficiaries, there may be indirect marketing or promotional efforts or informal channels of information dissemination, such as “word of mouth” promotion by practitioners or patient support groups. In addition, the OIG considers the provision of free goods or services to existing customers who have an ongoing relationship with the provider likely to influence those customers’ future purchases.

BeneficiariesThe Act bars inducements offered to Medicare and Medicaid beneficiaries, regardless of the beneficiary’s medical condition. The OIG is aware that some specialty providers offer valuable gifts to beneficiaries with specific chronic conditions. In many cases, these complimentary goods or services have therapeutic, as well as financial, benefits for patients. While the OIG is mindful of the hardships that chronic medical conditions can cause for beneficiaries, there is no meaningful basis under that statute for exemption valuable gifts based on a beneficiary’s medical condition or the condition’s severity. Moreover, providers have a greater incentive to offer gifts to chronically ill beneficiaries who are likely to generate substantially more business than other beneficiaries.

Similarly, there is no meaningful statutory basis for a broad exemption based on the financial need of a category of patients. The statute specifically applies the prohibition to the Medicaid program – a program that is available only to financially needy persons. The inclusion of Medicaid within the prohibition demonstrates Congress; conclusion that categorical financial need is not a sufficient basis for permitting valuable gifts. This conclusion is supported by the statute’s specific exception for the non-routine waivers of co-payments and deductibles based on individual financial need. If Congress intended a broad exception for financially needy persons, it is unlikely that it would have expressly included the Medicaid program within the prohibition and then created such a narrow exception.

Additional ConsiderationsWhile the OIG does not expect at this time to propose any additional regulatory exceptions related to unadvertised waivers of co-payments and deductibles, the OIG recognizes that such waivers occur in a wide variety of circumstances, some of which do not present a significant risk of fraud and abuse. The OIG encourages the industry to bring these situations to our attention through the advisory opinion process. Instructions for requesting an OIG advisory opinion are available on the OIG website at http://oig.hss.gov/fraud/advisoryopinions.html.For more information, the Special Advisory Bulletin: Offering Gifts and other Inducements to Beneficiaries, published by the HHS Office of Inspector General, can be accessed online at: http://oig.hhs.gov/fraud/alertsandbulletins/SABGiftsand-Inducements.pdf

•

•

BEWARE OF OFFERInG GIFTS COnTInuED ...

november/december 2008IScA report��

��

Chiropractic Billing revision

Medicare will only support up to four diagnosis codes in box 21 of the Form CMS-1500. CMS has directed contractors to tell providers who want or need to bill more than four diagnosis codes that they must be instructed to file the claim electronically to Medicare, until such time as the paper form is modified to accommodate more than four diagnosis codes. Specific instructions dealing with this issue will be forthcoming in an update to the Internet Only Manual.

This instruction changes the billing and coding guideline in CHIRO-001.

the guidelines now read:

Coding Guidelines1. Choose all applicable subluxation ICD-9 code(s), found under Section G, to identify the area(s) of subluxation.

Explanation:

One or two manipulations:

If you are billing code 98940, report the code that describes the subluxation in Item 21, Position 1. Item 21, Position 2 should be used for the symptom/condition/secondary diagnosis. Any additional symptoms or subluxations should be listed in Item 21 positions 3, 4. Over 4 should be listed in Item 19.

Three or more manipulations:

If you are billing codes 98941 or 98942, report the code that describes the subluxation in Item 21, position 1. Item 21, position 2 should be the symptom/condition/secondary diagnosis. Any additional symptoms or subluxations should be listed in Item 21 positions 3, 4.

If over four ICD-9 codes are listed, the additional ICD-9 codes should be placed in the narrative field of the electronic claim. The ICD-9 codes can be listed in any order in Item 19 with the x-ray date if applicable.

Providers that want or need to bill more than four diagnosis codes must be instructed to file the claim electronically to Medicare, until such time as the paper form is modified to accommodate more than four diagnosis codes.

mEdiCArE nEws ACA sEnds 16,600 nEurologists lAtEst rEsEArCh on nECk PAin

The American Chiropractic Association (ACA), working in conjunction with nCMIC, the nation’s leading provider of chiropractic malpractice insurance, recently distributed copies of a report issued by the Task Force on neck Pain and its Associated Disorders to more than 16,600 neurologists across the country. The report, a seven-year, international, multidisciplinary study, is designed to help health professionals apply the best available evidence to prevent, diagnose, and manage neck pain.

In the cover letter accompanying the study, ACA President Glenn Manceaux, DC, noted that ACA encourages evidence-based clinical practice and interprofessional cooperation in patient care. “There is growth in the referral of patients between chiropractors and neurologists and therefore, it is important that all practitioners be on the same page regarding the most current research in treating this pervasive condition.”

The Bone and joint Decade 2000-2010 Task Force on neck Pain and its Associated Disorders considered almost 32,000 citations and performed critical appraisals of more than 1,000 studies in developing its 236 page report. The Task Force is an independent research group recognized by the united nations and the World Health Organization.

In addition to its comprehensive review of the existing body of research on neck pain, the Task Force also initiated a new population-based, case-control and case-crossover study into the association between chiropractic care and vertebrobasilar artery (VBA) stroke. This Canadian study investigated associations between chiropractic visits to primary care physicians and the occurrence of VBA stroke.

The study – which analyzed a total of 818 cases of VBA stroke admitted to Ontario hospitals over a 9-year period (more than 100 million patient-years of observation) – concluded that VBA stroke is a very rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different from the risk of VBA stroke following a visit to a family physician’s office. From the study’s conclusion: “The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associate chiropractic care compared to primary care.”

Source: ACA Press Release, “ACA Targets 16,600 Neurologists with Latest Research on Neck Pain, July 9, 2008”


You want what every doctor wants – an office that runs smoothly, high satisfaction for all employees, systems and procedures in place, no compliancy issues, and financial rewards for all your hard work.

But let’s face it; coding is the language of reimbursement. you have certain numbers to describe your work and your patients’ conditions. If you don’t know every nuance of using these numbers, it can cost you thousands of dollars.

The following are three of the biggest coding and documentation mistakes that, when avoided, allow for smooth sailing.

under and Over Coding E/M ServicesEvaluation and management (E/M) Codes are one of the most important sets in your coding arsenal. you must strive to get it right and document thoroughly since codes set the tone for the care you will render to your patients.

Periodic re-evaluations carry significant weight to justify medical necessity for ongoing care. However, E/M codes are also one of the sets that are under and over coded most often. Lack of understanding among practitioners of the requirements for new and established patient E/M codes is of them the problem.

The Centers for Medicare and Medicaid Services (CMS) has set fourth clear guidelines for what’s required for documentation of these services. Because many doctors have never seen these guidelines, they tend to use whatever code feels right, or rely on the amount of time spent.

Because of this, some doctors are actually either too high or too low for the amount of work performed. It’s likely that when you review your information, and make a checklist of the items required, you will be surprised at how much work you’re doing that you’re not charging for. Or, it may indicate that you’re not documenting completely. Coding and Documenting IncorrectlyFar too often, doctors code services incorrectly. One challenge comes from taking coding advice from inappropriate sources, such as from manufacturers of products without written references.

Doctors often rely on the fact that they may know what they did to the patient and feel justified in coding the service, but the documentation in the record doesn’t correlate. Remember that "what isn’t written down, never happened,” so you must ensure all the services rendered are properly documented according to reasonable and standard guidelines.

When you bill a chiropractic manipulative treatment coding for a certain level of service, but the documentation only justifies a lower number of regions treated, it could create problems.

For example: If a treatment plan was originally designed for two spinal regions, but a third region was added on a given visit – and the higher level spinal treatment code was billed – the documentation may not be there to prove why the extra area was treated and how it correlates to the treatment plan and diagnosis codes.

These errors are most often found on a post-payment audit review, and can cost a practice thousands of dollars in repayment. This should be a reminder to ensure your daily documentation record and billing record match exactly. This includes your modalities and therapeutic procedures.

Similarly justifying necessityWhen each chiropractic visit looks the same as the last and statements like “same as last visit” pepper the daily notes, it’s difficult for a third-party reader to ascertain the necessity of each visit.

Standard guidelines dictate what must be included, and it can be very easy to get into the trap of rushing through your daily documentation. Some documentation software programs even allow you to start with the notes from the last visit, so you can modify from there. If you get rushed or lax you may be tempted to modify and move on.

Consider each visit “encounter specific” when writing your daily notes. As Medicare documentation requirements dictate, be sure you consider each of the following in your everyday documentation.

1. History:Review of chief complaint;Changes since last visit; andSystem review, if relevant.

2. Physical Examination:Area of spine involved in diagnosis;Assessment of change in condition since last visit; andEvaluation of treatment effectiveness.

3. Treatment given:It’s easy to get into a routine of average documentation and basic coding. However, lack of attention to detail in this area can lead to a decrease in reimbursements, or worse, problems on a post-payment audit.

you owe it to yourself and your practice to be diligent in correct coding and documentation procedures.

Source : www.chiroeco.com

•••

•••

•

3 Coding And doCumEntAtion mistAkEs to AvoidBy kathy Mills Chang


2008 fAll ConfErEnCE wrAP uP

Dr. Anthony Wolf accepting the ISCA President’s Award

from Dr. Duane Binder

The Indiana State Chiropractic Association presented numerous awards at its annual Fall Conference held at the Sheraton Hotel Indianapolis Keystone on October 31 – November 2. These honorees are successful in their personal and professional endeavors as well as advocates and leaders in their field. The ISCA is proud to have such outstanding members and influential supporters.

Dr. Duane Binder, D.C., Clinton, Indiana, earned the 2008 ISCA Chiropractor of the year honors. This prestigious award is given annually to a doctor who demonstrates exemplary contributions to the chiropractic profession, chiropractic patients and the ISCA. Dr. Binder was nominated and voted on by his peers, the ISCA Board, for his strong leadership that helped to ensure the ISCA is a successful and vibrant organization. Having over 20 years of experience, Dr. Binder has served two terms as ISCA President, was active on all of the committees and is currently serving as Immediate Past President of the ISCA. Dr. Binder has acted as a mentor and guide for both chiropractors serving on the Board as well as members of the Association. Dr. Binder continues to be active and provide leadership to the ISCA.

Dr. Anthony C. Wolf, D.C., Indianapolis, Indiana, was honored with the 2008 ISCA President’s Award. Dr. Wolf, active in the chiropractic profession for over 20 years, was selected for this exemplary award for the countless hours of work and research he has done on behalf of the Legislative and Insurance Committees and ISCA as a whole. His work testifying at legislative hearings as well as his extensive research on behalf of the chiropractic field was professional and put ISCA and chiropractic in a positive light. Whenever needed, Dr. Wolf has made himself available, donating his time, talent and treasure in order to aid the profession. He was elected ISCA President for 2009.

Dr. Raymond nanko, also earned the 2008 ISCA President’s Award for his outstanding service to the Association. In the past year, Dr. nanko served as Insurance Committee Chair and provided an invaluable job in that capacity. He also helps other ISCA members with their insurance questions and issues.

State Rep. Scott Reske (D – Pendleton) was named 2008 ISCA Legislator of the year. Rep. Reske has been a champion of chiropractic for many years. In the most recent 2008 legislative session, Rep. Reske had a hundred percent voting record, supporting the ISCA in its fight for reasonable insurance benefits and to maintain their scope of practice. Rep. Reske is not only an ardent advocate but also a firm believer of chiropractic. During the legislative session, Rep. Reske frequently visits the D.C. of the Day and encouraged other legislators to do the same.

Dr. Duane Binder accepting the D.C. of the year Award from ISCA Executive Director, Pat McGuffey

State Rep. Scott Reske 2008 Legislator of the year

Dr. Duane Binder accepting the Past President Plaque

PAST D.C.'S OF THE yEARLeft to Right: Dr. David Dyer, Dr. Robert Tennant, Dr. C.C. Paprocki,

Dr. Duane Binder, Dr. kenneth Ackles, Dr. Robert Clements


sAvE thE dAtEs

ISCA LEGISLATIVE DAyjanuary 13, 2009

2009 ISCA SPRInG COnFEREnCE April 17-19, 2009Radisson Airport Remember to visit our website for current and updated infromation at www.indianastatechiros.org!

fAll 2008 ConfErEnCE trAdE show

thank You fall Conference Exhibitors!

American Express - Open for BusinessAnabolic Labs

Denis Behm Supply, Inc.Dynatronics Corp.

Foot LevelersGraston Technique

Haffner x-RayHealth Source

Indiana Spine GroupLardex Medical, Inc./Highlanders

Logan College of Chiropracticnerz Walterman, P.C.

OuM Chiropractor ProgramSerene Balance

The Wellington Group LLCZrii


A D.C. recently stunned almost 400 M.D.s by demonstrating a technique that stops chronic pain in seconds. (The soft tissue procedure is Pain neutralization Technique™ (P.n.T.), and was written up in the American Chiropractor, 7/071. Copies are available at www.painneutralization.com.

One of the basic ideas behind P.n.T. is that many chronic pain syndromes are caused by muscular trigger points 1,2,3,5,6,7,8,10,11,13,14,15,16,17,18. These areas near the patients’ symptoms are exquisitely painful when pressed. P.n.T. is a method that turns off even the most tender trigger points within a few seconds, by triggering newly found neurological reflexes. No devices or instruments are used.

P.n.T. does not just treat trigger points like most techniques; it’s aim is actually to remove them, usually in seconds. P.n.T. does not just reduce pain; eradication of the trigger point often leads to elimination of the cause of the patient’s pain. It often disappears for good after treatment. (It doesn’t work on every patient, of course, but it works on most.)

At the november, 2007 meeting of the American College of Advancement in Medicine, in Phoenix, I asked how many people in a room full of M.D.s had chronic myofascial pain of some type. More than 75% of the hands went up, in this elite group of holistic physicians! (This happens all the time at chiropractic groups, as well.) Especially ubiquitous was chronically painful upper trapeziusmuscles.

Robert Rowen, M.D., was there, who’d written an article about P.n.T. in his nationally read “Second Opinion” newsletter. He’d said about another presentation in 2006, “An unknown chiropractor spoke about his technique for instantly relieving painful trigger points. What medical doctor would believe such claims? I listened with curiosity and healthy skepticism. Then he performed his technique on many of my esteemed colleagues including some very famous ones. The majority got immediate relief, even with very long term chronic problems.”

does Everyone have Chronic upper trap Pain?The first “patient” to come up was an M.D. with neck and upper trap pain. He had an extremely severe, chronic trigger point in his right trapezius muscle. This was gone in less then a minute with P.n.T.! He excitedly reported this to the crowd, at which point there was pandemonium! Everyone jumped up wanting to be treated!

After eliminating chronic trigger points on a few doctors, the demonstration ended. not knowing what “ex speakers” were supposed to do, I sort of wandered out into the hall. Much to my astonishment, a huge crowd followed. Was this a lynch party? Tar and feathers? no, thankfully, dozens of M.D.s asked scores of questions and begged to be treated!

Chronic Pain disappears for many m.d.s with Pain neutralization technique™ Michael Schachter, M.D., author of “What your Doctor May not Tell you About Depression” and “The natural Way to a Healthy Prostate”, said “I had pain in the right lumbro sacral area for years. I felt immediate relief after P.n.T.” Hyla Cass M.D., well known author of “Supplement your Prescription” and “natural Highs”, wrote “my own experience, besides watching the amazing results in others, was that I obtained immediate relief from chronic recurring neck and back pain. It’s not returned, weeks later.”

Bohdan Lebedowicz, M.D., an internist from Mt. Vernon, Illinois had constant lower abdominal pain following hernia surgery in 2001. His abdomen was extremely tender to palpation. He wrote “my post hernia surgical pain was absolutely eradicated in less than a minute (by P.n.T.)” joseph Rich, M.D., a member of the board of directors of A.C.A.M., was among those treated (in fact, it seems like I treated most of the board.) He wrote “the day after P.n.T. my back and sciatic pain disappeared for the first time in 5 years.”

Terri Su, M.D. of Sebastopol, CA., wrote “I had 3 whiplashes and decreased R.O.M. even after much chiropractic treatment. After P.n.T. I had greatly increased R.O.M. Wow!”

the results were ConsistentDr. Rowen wrote about this event, “I and at least 40 other doctors witnessed dozens of consecutive resolutions of chronic pain. Had I not seen it, I wouldn’t have believed a system based on simple body physiology could take away your pain so quickly.”

Gerard Pesca, n.D., a naturopathic physician and 3rd year medical student, wrote “I observed more than 50 M.D.’s treated with P.n.T. at the A.C.A.M. conference. Immediately after the treatment, each doctor said they felt at least 75 to 80% better, and many of them admitted to close to 100% improvement. The next day, I was able to catch up with approximately 12 of them and ask how they were doing since the treatment the day before. 11 of the 12 told me they felt “much better” or “amazingly better.”

A past president of A.C.A.M. and one of the founders of chelation therapy, Ted Rozema, M.D., was treated at a previous demonstration. He wrote “I had continuous back pain since fracturing the transverse process of L1-2-3-4 in 1974. After P.n.T., the pain was completely gone in a few seconds. 18 month follow up: It’s still gone. The pain never returned after that one treatment in 2006!” john Trowbridge, M.D., best selling author of “The yeast Syndrome”, wrote, “For 9 months, I suffered with left sacroiliac/lower lumbar pain. With just 1 session of PnT, my low back pain is 80% better. The next day, it was 90% better.”

numbness disappeared, Along with PainSeveral M.D.s, including an internist and a rheumatologist, “mentored” with me on the spot and studied the methods as we continued treating physicians for 13 hours. After some time, they

“most doCtors suffEr from ChroniC PAin. who knEw thAt!???”THE TRuE STORy OF WHEn A D.C. SHOWED ALMOST 400 M.D.S HOW TO TuRn OFF CHROnIC PAIn In SECOnDSC. Stephen Kaufman D.C. Denver, Co. 2008


asked if they could apply the treatment on a patient. Each doctor was immediately successful in turning off pain on their patient. Onewoman treated by the rheumatologist had long standing numbness down her arm. I explained that this was usually easy to treat, but we shouldn’t expect to see symptomatic results from only a single treatment. Almost before I completed my sentence the patient blurted out “the numbness is gone!” (It’s embarrassing to be wrong, don’t you think? Well, it was all right this time, I guess.)

here’s how P.n.t. Produces Chronic Pain relief in secondsPain neutralization Technique™ is based on very simple neurological principles, described in previous articles (available at:www.painneutralization.com) Extremely tender trigger points in muscles can be instantly eliminated by triggering an “inverse myotatic reflex” (aka Golgi tendon organ reflex 6,19,22,27) in a muscle. This regularly causes a spectacular disappearance of the trigger point that’s causing a patient’s pain, and an immediate normalization of muscle tone.

For example, the doctor finds a tender point in a muscle close to a patient’s symptom (upper trapezius trigger points may cause headaches and neck pain, the piriformis may cause sciatica, the quadratus lumborum for low back pain, etc.) One of a series of P.n.T. techniques will often consistently eliminate the tender point in the muscle, most likely in seconds. Often (but not always) the patient’s symptom will improve or disappear as well. Even chronic, long term conditions may also improve in minutes, as many doctors report. Several applications of the techniques are generally needed for lasting improvement, but in many cases one treatment is enough. The techniques are so simple that they are taught on DVD.

this demonstration wasn’t Quite Perfect. oh well.naturally, several doctors said they didn’t like the whole presentation. They claimed it needed a “Power Point” presentation”. nevertheless, even these docs added that they were impressed by the efficacy of the techniques.

Chiropractors sometimes expect medical groups to be resistant to their material, but it’s tough to argue with immediate, dramatic results. Several physicians told me they applied what they learned after the seminar and successfully eliminated chronic pain on patients. Several even sent emails weeks later to tell me the improvement they had was lasting!

“did i Put my Pants on?”I occasionally get nervous before these lectures, as I wonder “what if the techniques don’t work today? What if I look like a total idiot? What if I forget to put my pants on before I come to the stage?” Little things like that. We’ve been fortunate to have astonishing results at every demo I’ve done so far. And I haven’t forgotten to put my pants on. So far.

Over 1200 D.C.s have now learned Pain neutralization Technique™ from DVD. Many of these doctors have had instant improvement and elimination of chronic symptoms when trigger areas have been erased, including long standing sciatica, lumbar and cervical disc problems, painful and frozen shoulders, carpal tunnel syndrome, migraines, chronic abdominal pain, etc.

For more information, go to www.painneutralization.com or call Dr. Steve kaufman, D.C. 2693 S. niagara St., Denver, CO. (800) 774-5078 or (303) 756- 9567.

references

baldry, Peter. m.D. Acupuncture, Trigger Points and musculoskeletal Pain Churchill Livingstone; 3 edition (2005)baldry, Peter. myofascial Pain and Fibromyalgia Syndromes: A Clinical Guide to Diagnosis and management. (2001)baldry P. management of myofascial trigger point pain. Acupunct med. 2002 mar;20(1):2-10. Review.best and Taylor’s Physiological basis of medical Practice. (1979) edited by John brobeck. Pp. 9-80Han SC, Harrison P. myofascial pain syndrome and trigger-pointmanagement. Reg Anesth. 1997 Jan-Feb;22(1):89-101.Kaufman, Stephen, D.C. “Can Pain be Turned off instantly by Using Neuromuscular Reflexes?” Townsend Letter for Doctors, 11/2007.Kaufman, Stephen, D.C. “How to Use Spinal Nerves to Turn off Pain Instantly! “ The American Chiropractor, 9/08.Lauder TD. musculoskeletal disorders that frequently mimic radiculopathy. Phys med Rehabil Clin N Am. 2002 Aug;13(3):469-85.matthews, Gary G. Neurobiology: molecules, Cells and Systems. 2001. blackwell Publishing.Pongratz De, Späth m.Fortschr. myofascial pain syndrome--frequent occurrence and often misdiagnosed. med. 1998 Sep 30;116(27):24-9Rowen, Robert. m.D. “Permanently eliminate Pain in minutes.” Second opinion Newsletter July, 2006Schmidt, R. F. ed. “Fundamental of Neurophysiology” (1975). pp 102-114; 144-160Schneider MJ. Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis. J manipulative Physiol Ther. 1996 Feb;19(2):146-7. Sciotti vm, mittak vL, Dimarco L, Ford Lm, Plezbert J, Santipadri e,Wigglesworth J, ball K. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001 Sep;93(3):259-66.Simons DG. Undiagnosed pain complaints: trigger points? Clin J Pain. 1997 mar;13(1):82-3.Simons DG. Fibrositis/fibromyalgia: a form of myofascial trigger points? Am J Med. 1986 Sep 29;81(3A):93-8.Travell J, Rinzler, S The myofascial genesis of pain. Postgrad med. 1952 may;11(5):425-34.Travell, J. and Simons, D.G. myofascial Pain and Dysfunction: the Trigger Point manual. vol. 1 and 2. Second edition, 1999. Liponcott, Williams and Wilkins.

1.

2.

3.

4.

5.6.7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.


PrACtiCEs for sAlE

nDIAnA - Great Buy-In Opportunity! Make $100K your first year with annual increases. Full practice ownership through sweat equity. Looking for a motivated doctor to take on this great opportunity. Includes practice management (coaching) and tremendous Seller assistance in transition of the practice. Professional Practice Advisors, Inc. 800.863.9373 www.practiceadvisors.com Posted 12/01/08

InDIAnA FISHERS, In - Great practice, doctor has health issues and must sell ASAP. Make offer, priced below market. Transition included. Contact for a two page “fact sheet”. Dr. Tom Morgan [email protected], 770 748-6084. www.VolumePractice.com. Posted 11/18/08

Practice for sale in Lawrenceburg, Indiana. 10 year old well-established practice in a rapidly growing area. $250,000 gross in 2007 on 3 days per week. General diversified practice, fully equipped, modalities, low-tech rehab, x-ray. Excellent opportunity. Practice has great growth potential. Motivated seller. Contact Dr. Mike at 513-544-2699. Posted 10/24/08

WESTERn InDIAnA 12 year family practice collecting $148,016.00. Dr take home before taxes $95,191.00. Open 3-1/2 days. 4,283 total visits. 7,000 total patient draw. This is a strong agricultural rural region. A peaceful, “Andy of Mayberry”, strong family values community. Will sacrifice for $99,950.00 Pix on web! 100% financing O.A.C. Call (928) 282-8434. Posted 10/21/08

WEST CEnTRAL InDIAnA PRACTICE AnD RETIRE as a multi-millionaire, as we are doing. Since 1976 has operated as a two doctor clinic. Professional three thousand sq ft. office in high traffic growth location. Diversified, P.T., nutrition, x-ray, Cox, and A.K. practice. Practice, building, and equipment professionally appraised at $600,000. Call 812-243-2248 for financial details. Posted 9/30/08

Established, profitable 10 year old Chiropractic Practice located in upscale SW Fort Wayne, Indiana. Excellent practice facility utilizing hands on adjusting, active and passive rehab and nutrition. Will consider sale of building along with practice if appropriate. This is an excellent opportunity for a motivated individual who wants to relocate or begin solo practice. This can also be a highly effective satellite practice. If you are interested, inquiries can be directed to [email protected]. Posted 9/22/08

A growing well established chiropractic practice located close to Ft. Wayne, In. Beautiful, well equipped clinic with space to expand. The real estate has an attached live in space or could be used as a rental. Priced well below the market with an extremely low overhead in a delightful town. This is a must see opportunity for a serious doctor, or perhaps a second location for a multiple practice; call now (260)568-2129 or email [email protected]. Posted 9/22/08

MD/DC/PT practices for sell. GI 1.4M in '07. 2.5 years established. northwest Indiana. Further details upon request by email, [email protected]. Posted 8/5/08

Wayne and White counties and East Central, In. Call The Paragon Group at (800) 582-1812 or visit our website http://www.eparagongroup.com. Posted 7/09/08

AssoCiAtEs AvAilABlE

Energetic, reliable female intern is looking to preceptor with a motivated chiropractor in the Indianapolis area from jan-April 2009. I recently completed a 4-week preceptorship at a VA clinic where I adjusted patients every day. I graduate from national in April 2009 and want to enhance my clinic experience by assisting a busy clinic while I gain from your experience. Call Shelley at 815-483-3336 or email [email protected]. Posted 10/16/08

Driven, highly-motivated doctor with exceptional communication skills and a proven ability to maximize growth by building and maintaining strategic partnerships and alliances with key internal and external stakeholders. Personable and innovative problem-solver with a demonstrated record of success expanding market share utilizing expertise in both the strategic planning and tactical execution of business development initiatives. Astute and results-oriented leader with extensive experience in sales and marketing, budget development, recruiting and retention, public speaking, and customer loyalty initiatives. I’m licensed in In and ready immediately. Resume and/or phone consultations is available upon request by emailing me at [email protected]. Posted 10/16/08 Recent Palmer Graduate. Looking to relocate in Indianapolis. Techniques: Gonstead, Diversified, Activator, Thompson, Cox and ART. Additional training in PT. Diligent, competent and dynamic Chiropractor looking for an opportunity to learn from an experienced Chiropractor. Call 317-508-7127 or email [email protected]. Posted 8/5/08

Palmer graduate. 25 years experience, excellent adjusting and people skills. Multiple techniques including Activator and Cox. $300 a day base fee, references available. Call Dr. Grotzinger 317.585.4808.Posted 07/24/08

AssoCiAtEs wAntEd

Logan Basic/Activator Practitioner wanted to work in multi-specialty chiropractic office in Indianapolis, Indiana. I pay 40% of collections on any patient you treat in our office. I pay your rent, phone, internet, and utilities. I also purchase your x-ray film, pay the lease on the new high frequency x-ray machine and buy your business cards. you will have your own adjusting room and my staff files your insurance claims. We are an in-network (PPO) provider for Anthem Blue Cross, Aetna, Cigna, Sagamore and a participating provider with Medicare. Hamilton County is one of the fastest growing counties in the country with one of the lowest cost of living indexes. Three letters of recommendation from Logan faculty is required for consideration. Please send your resume and cover letter to [email protected]. Or mail to Dr. Shawn Pala, 14701 Cumberland road, suite 350, noblesville, Indiana 46060. Visit our website: www.palachiropractic.com. Posted 11/18/08

Associate doctor for Indianapolis clinic. We pay for malpractice through nCMIC and your continuing education. We work a 3 1/2 day week. 28 hours and nO Fridays! A 3 day weekend every weekend! Competitive salary plus bonus after 6 months. Call Dr. Terry Tolle 317-496-2530. Posted 9/16/08

Excellent opportunity at an established chiropractic office of 20 years in small town in southern Indiana. Work independently but benefit from successful 3 affiliated clinic's shared expertise. Email resume to [email protected]. Posted 8/15/08

vACAtion doCtors

Vacation Doctor - Palmer Graduate, 27 years experience, excellent adjusting and people skills. Multiple techniques including Activator and Cox. $300 a day base fee. References available. Dr. Dan Grotzinger 317-826-8106.Posted 11/25/08

Well Skilled, personable, efficient in patient care. Proficient in various techniques, inc. Proadjuster. Licensed from 1994. Exp:Bus.Owner/Associate/

indiAnA stAtE ChiroPrACtiC AssoCiAtion ClAssifiEds


Vac fill-in. Available for temp.or permanent work. For more information please contact 765-683-0845 or [email protected] kathleen Sanderford, D.C.Posted 7/17/08

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

Licensed doctor to cover your practice. 8 years of experience, available state wide. References available. Call Dr. Reynold at (309) 269-0317

Stable chiropractic office in NW Indiana seeks reliable vacation doctor for 1 week both in October and February. Prefer Palmer grad. Must know Palmer Package, Activator, Cox, and nimmo Trigger-Point Therapy. Prefer confident doctor who is not afraid to spend some quality time with each patient to educate and treat them. Pay is negotiable. May open up to a weekly part-time position for the right doctor. Call 219-661-8680 (ask for one of the doctors) or e-mail [email protected]

Palmer graduate, 25 years experience, excellent adjusting and people skills. References available. Call Dr. Grotzinger (317) 585-4808

Maternity leave, vacations, seminars. Indiana licensed, nCMIC insured, Logan graduate. Efficient in Diversified, Drop, Pro-Adjuster, Activator, Flexion/Distraction, Basic. Able to work state wide. Many refrences. Call Dr. Amy Roache at 317.496.0299 or email [email protected]

Indiana and kentucky licenses, OuM insured, multiple techniques, $400 per day. Call Bill Overstreet (765) 480-6283 or email [email protected]

EQuiPmEnt for sAlE

x-RAy SuITE: Chirotech 300/125 Anatomical Generator, indestructible kodak 100 processor, Custom grey oak 36 x 48 view box, earth screens, Bolan type filtration system, total floor footprint 4 x 6 feet, removable wall leading, 3 doors with sliding lead shielding, ~600 shots on new Varian tube, $11,500.00 complete or best offer. Call Dr. Gary Shaw at (317)852-3870.Posted 10/30/08

Hands Free ultra Sound Machine, Computerized Range of Motion and Muscle Test Machine, and a Rehab Exercise Machine for Back/Hip. All in great condition. Call SpinalAid at 317-272-4100.Posted 10/27/08

ABS Decompression Table: Great table in excellent condition. Very good results with table. Merged with another doctor who also has a decompression table. Option to purchase or assume lease which is already one-half paid. Call (616)566-1151.Posted 10/07/08

LIkE nEW Chirotech Elevation Table with pelvic drop piece, new Light brown leather covering in 2007, $2400.00. Like new Zenith Model 210 CI Cast Iron Hi-Lo Table with new brown leather, pelvic drop, $2500.00 Both Tables professionally refurbished by Haffner x-Ray in 2007. Contact Dr. Shawn Pala 317-770-1970 or email: [email protected].

Complete Bennett x-Ray Room Equipment & Accessories (processor needs motor)- 14x17 high frequency autotech, asking $7000.00; 4-Tier x-Ray File Shelves, $200.00; Petecto Scales, $100.00; x-Ray Copier, $200.00; 2 3-Panel Screens, $150.00, 2 Standard Therapy Tables (Walnut Finish), $300.00. Call Dr. jim Ebler at 812-397-2981.Posted 9/18/08

Transworld 300ma 125 kvp chiropractic xray system complete with floor to wall tubestand with electric locks, 14x17 wallstand with grid,certified collimator and 1.0 - 2.0 140,000 HU tube. Comes complete with operator barrier, cassettes; darkroom accessories and Fischer automatic 90 second cold water film processor. $4,000 obo. Call for details (812) 345-2375. Posted 8/6/08

2 Zenith Hi-Lo tables, older models with longer cast iron bases. Good condition without drops. $1500 for both. Contact 317-474-5574.Posted 8/1/08

Zenith Hylo, Stationary Benches, E-Stim machines, Hydroculators and covers,View Boxes, Phones, Fold-out Wall Desk, Metal Shelves, etc... Call Dr. Boruff for details. 765-437-4083 or email [email protected] 7/28/08

Zenith Hi-Lo adj maybe 80’s model $500. Gonstead pelvic bench plaid (80’s) $200. Mettler ultrasound Sonicator $75. Sentry Systems Muscle Stim Hi Volt $350. nemectron Endosan Muscle Stim $400 Equipment needs calibrated. Spine model $125, metal/wood spine $175 x-ray: dark room light $75, gloves $125, wood film holder $75, lead apron $125, shields $10, x-ray cassettes: 4 14x17 $125 ea, 5 8x10 $75 ea., 1 10x12 $85, Full Spine $125, Supports: 4 Lumbar $12ea, 8 Cervical Supports $10ea, C sp collars $10ea, Patient Gowns $4 each. Call kathleen Sanderford, D.C. 765-683-0845 or

email [email protected] in Anderson, Indiana. Posted 7/17/08Large exterior chiropractic sign, fully illuminated. Currently says chiropractic neurology center but can be adapted to suite. Please call (317) 848-6000 or email [email protected] interested. Posted 7/09/08

Save 50% on a 3 month old “ErgoWave” intersegmental traction table. Barely used (Really). 1st one to call with $900 cash takes it home. Call Dr. Lyons at 260-409-5871 (Ft. Wayne)Posted 7/2/08

Post A ClAssifiEd Ad

ISCA members may place classified ads for free and will run for two consecutive issues unless otherwise requested. non-members may place ads for $25 per ad per issue.

To place a classified ad visit us online at www.indianastatechiros.org or call 317.673.4245.

indiAnA stAtE ChiroPrACtiC AssoCiAtion ClAssifiEds

isCA report200 S. Meridian St. Suite 350Indianapolis, In 46225317.673.4245www.IndianaStateChiros.org

PRSRT STD U.S. PoSTage

PaiDinDianaPoliS, in PeRmiT no. 779

Date post:	28-Mar-2016
Category:	Documents
Upload:	indiana-state-chiropractic-association
View:	228 times
Download:	4 times

ISCA Nov/Dec Newsletter 2008

Documents