isca report: summer 2013
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SUMMER 2013
PRESIDENT'S MESSAGE: T I M E T O T H I N K
What do we have to be thankful for?
•Ouruniqueknowledgeandapproachtohealthandwellness.Wegivepatientshope!•Oureducationandunderstandingtowhatittakestobeandstaywell.•Ourfamilies,friendsandpatients,whosupportusthroughthickandthin.•Ouropportunitiestopartnerwithpatientsintheirpursuitofwellness.•Aprofessionalcareerofservice.AlbertSchweitzeroncesaidtherewasnothingmoresatisfying.
• Theopportunitytoberealpioneersinhealthcare.• Thechallengesthathelpusgrow.• Dedicatedleadersandstaff,committedtotheadvancementofthechiropracticprofession.• Bright,energetic,service-orientedstudentsinchiropracticcolleges.• Excellentchiropracticcolleges,academicians,administrators,facultyandresearchers.• Altruisticvendors,suppliersandsupporterswhodefendourprofessionastheirown.
What do we have to look forward to?
• Non-discriminationinhealthcarein2014.Alevelplayingfieldinhealthcarewhereallprovidersareequalpartners,valuedfortheuniquebenefitstheybringtothepatient.
• ExpandedMedicarecoverageforseniorsthatincludesthefullspectrumofservicesthatDC’sareeducatedandlicensedtoprovide.
• Doctorsofchiropracticfullyintegratedandengagedthroughoutthehealthcaresystem----DepartmentofDefense---VeteransAdministrationPublicHealthServiceCorps,hospitals,integrativepracticeclinicsandmultidisciplinaryfacilities.
• Aunitedchiropracticprofession,championingthebestofsafe,effective,conservative,high-touch,highsatisfaction,whole-person,patient-centeredhealthcare.
• Chiropracticscientistsengagedinalllevelsofhealthcareresearch,openinganewparadigminhealthcareresearchandpractice.
• Endlessopportunitiesforourfuture,ifweworktogether.
Inthenext10years,wewillseepositivechangesinhealthcareandwewillseethebroadintegrationofchiropracticphysiciansintoallareasandlevelsofourhealthcaresystem.Ourprofession’scommitmenttoexcellenceinconservativecareandtobringingouruniqueapproachtopatientsandthehealthcaresystemasawholewillfinallyberealizedandgreatlyappreciated.Wecandothistogether!
Lovewhatyoudoandshowit.Expectgreatthings!Never,nevergiveup!
Let’stakechiropractictothetop!
YourPresident,
RobertW.Tennant,D.C.F.I.C.C.
SUMMER 2013ISCA REPORT2
PresidentRobert Tennant, D.C., FICCShirley, IN765.737.1117doct@hrtc.net
First Vice-PresidentJames Cox II, D.C., LACFort Wayne, IN260.484.1964drj@coxchiropractic.us
Second Vice-PresidentThomas Carrico, D.C.Lawrenceburg, IN812.537.5616tcarricodc@aol.com
SecretaryMichael Phelps, D.C.Martinsville, IN765.342.2208mikephelps55@att.net
TreasurerLewis Myers, D.C.Valparaiso, IN219.464.4444lew.myers@gmail.com
Immediate Past PresidentAnthony Wolf, D.C., FICCIndianapolis, IN317.898.1100dranthonywolf@gmail.com
Past President RepresentativeRobert Clements, D.C.Kokomo, IN 765.452.1330raclements99@aol.com
DIRECTORS AT LARGE
Toby Harmon, D.C.Jasper, IN812.634.6363harmonfm@insightbb.com
Douglas Breger, D.C.New Albany, IN502.322.7411doctorbreger@yahoo.com
Frank Laux B.S., D.C. Indianapolis, IN 317.881.3333lauxclinic@sbcglobal.net
ALTERNATE DIRECTOR AT LARGE
Keith Bartley, D.C.Jasper, IN812.482.6600brtchiro@fullnet.com
Christopher Paprocki, D.C., FICCGreenwood, IN317.881.7759jpaprocki1@aol.com
Joseph Paun, D.C.,Highland, IN219.227.4033drjoe@paunwellness.com
DISTRICT DIRECTORS
District OneRonald Daulton, Sr., D.C.Hammond, IN219.932.8900reddcdr@comcast.com
District TwoGerard Hofferth, D.C.South Bend, IN574.256.1008drhof@aol.com
District ThreeJason Russell, D.C.Fort Wayne, IN260.637.1000team@optimumperformancefortwayne.com
District FourPeter Furno, D.C.Zionsville, IN317.374.9966pgf@indy.rr.com
District FiveDiane Vuotto, D.C.Indianapolis, IN317.898.6989vuottojd@comcast.net
District SixDavid Davis, D.C.Winchester, IN765.584.3665drddd@aol.com
District Seven Kristen Hartwell, D.C.Indianapolis, IN317.784.9311 iuchiro@yahoo.comt
District EightShaun Tymchak, D.C.Newburgh, IN812.858.1008drshaun@newburghchiro.com
District NineE. Curtis Harris, D.C.Franklin, IN317.736.7088drcurtisharris@cichcc.com.com
ALTERNATE DISTRICT DIRECTORS
District OneRobert Hall, D.C.Merrillville, IN219.884.3250kkracjbaby@aol.com
District TwoWilliam Garl, D.C.Bremen, IN574.546.4111w.garl@mchsi.com
District ThreeTroy Byall, D.C.Fort Wayne, IN260.414.4257troybyall.dc@gmail.com
District FourAdam Cline, D.C.West Lafayette, IN765.463.3000drcline@clineclinic.com
District FiveJoseph Fortunato, D.C.Indianapolis, IN317.257.2225josephfortunatodc@comcast.net
District SixDonna S. Cray, D.C.Muncie, IN 765.286.9020dr_donna@comcast.net
District SevenRichard Hilton, D.C., L.A.C.New Palestine, IN317.861.4300 drhilton@sbcglobal.net
District EightMichael Toney, D.C.Terre Haute, IN812.232.1464flopper1968@hotmail.com
District NineScott Auton, D.C.Franklin, IN317.346.0799scottauton@yahoo.com
INDIANA STATE CHIROPRACTIC ASSOCIATION BOARD OF DIRECTORS
INSIDE THIS ISSUE
PRESIDENT'SMESSAGE......................................................................................1ISCABOARDOFDIRECTORS................................................................................2EXECUTIVEDIRECTOR'SMESSAGE.....................................................................3NBCECONTRIBUTESGRANT...............................................................................4UPDATECONTACTINFO........................................................................................4INTRODUCINGISCA'SSECONDVICEPRESIDENT..............................................5CHOOSINGANAMEFORYOURPRACTICE..........................................................6
PROTECTYOURPATIENT'SMEDICALRECORDS.................................................7UNITEDHEALTHCARE'SLAWSUIT.........................................................................8INDUCMENTS........................................................................................................9ISCASPRINGCONFERENCE.......................................................................10-11HIPAASUMMARY............................................................................................12-14ISCACLASSIFIEDS..............................................................................................15
THE ISCA REPORT WILL BE DISTRIBUTED ONLINE FOR YOUR CONVENIENCE. PLEASE KEEP THE ASSOCIATION OFFICE UPDATED ON YOUR MOST CURRENT EMAIL ADDRESS AS WELL AS PRACTICE
AND HOME ADDRESSES SO THAT WE CAN PROVIDE YOU THE MOST TIMELY COMMUNICATIONS.UPDATE YOUR INFORMATION ON PAGE 4
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.
SUMMER 2013 ISCA REPORT 3
EXECUTIVE DIRECTOR'S MESSAGE: PATRICIA MCGUFFEY, ESQ.
Greetings,
Ihopeallofyouareenjoyingyoursummer!YourISCAisworkinghardonyourbehalf.TheISCAhasprovidedtestimonytoCMS(FederalGovernment)askingthemtomakesureiftheHIPprogrambecomesthevehiclefortheimplementationofAffordableCareAct’s(ACA)Medicaidexpansion,tomakesurethatspinaladjustmentisincludedintheHIPprogram.
Inaddition,wehavetestifiedbeforetheHealthFinanceCommissionandimploredthelegislatorstoensurethattheACA’sHealthcareexchangeincludeschiropractictreatmentservices.
Ourworkneverends!NumerousLegislativeinterimstudycommitteesaremeetingtodeterminelegislationtobeforwardedinthe2014legislativesession.YourISCAistheretoprotectyourinterests.Inaddition,legislatorsarehostingfundraisersonadailybasistoraisemoniesfortheirreelectioncampaigns.TheISCAistheretosupportthelegislatorsthatsupportchiropracticbecauseofyourgenerousdonationstotheBackPAC.
Also,IrecentlyattendedtheNationalAssociationofChiropracticAttorneys'(NACA)seminar/meetings.Ilearnedaboutthelawsuitsthatarebeingforwardedonyourbehalfthatarechallenginginsurancecompanies'discriminatorypracticesagainstchiropractors.Inaddition,weweremadeawareofallthecuttingedgelegalissuesfromadvocacyformoreMedicarecoverageforchiropractictreatmentservicestosocialmediaandwhatchiropractorsneedtoknowinordertobecompliantwithanti-trustHIPPAlaws(seelaterinthenewsletter,theNACAresolutionsupportingMedicarecoverageforchiropractictreatmentservices.)Ialsolearnedwhatthemajormalpracticeclaimsareinordertoalertourmembershipandtoensureyouarenotinjeopardyofamalpracticeclaim.
Regardlessofallourwork,wecouldnotbesuccessfulwithoutyoursupport!YoursupportoftheISCABackPAC,legislativeassessment,aswellasyourmembershipiscrucialtooursuccess.Thankyoutoallofyouwhoprovidesupportthroughyourmoniesandyourtime.YoumaketheISCAoneofthebestchiropracticassociationsinthecountry.OurlawsaretheenvyofourchiropracticcommunitythroughouttheUSandthenation.Thanksforallyoudoonbehalfofthenoblechiropracticprofession.
PleasecontactmeifyouwouldliketobemoreinvolvedintheISCAthruserviceontheBoardoracommittee.Inadditionwewelcomeallfeedbackonhowwecanimproveorwhatwecandotobetterserveyou.Thanksforyourgeneroussupportandhappysummer!
YoursinChiropractic,PatriciaMcGuffey,Esq.ExecutiveDirector
SUMMER 2013ISCA REPORT4
NATIONAL BOARD OF CHIROPRACTIC EXAMINERS CONTRIBUTES GRANT IN SUPPORT OF FOUNDATION FOR CHIROPRACTIC PROGRESS
CARMICHAEL, Calif. – May 30, 2013 – TheFoundationforChiropracticProgress(F4CP),anot-for-profitorganizationdedi-catedtoraisingawarenessaboutthevalueofchiropracticcare,ispleasedtorecognizetheNationalBoardofChiropracticExaminers(NBCE),theprincipaltestingagencyforthechiropracticprofession,foritsgrantinsupportoftheF4CPpositivepresscampaign.Thegenerouscontributionwillbringattentiontotheadvantagesofchiropracticeducationviapressmateri-als.
“WeareexcitedtopartnerwiththeFoundationforChiropracticProgressandtheAssociationofChiropracticCollegestopro-motechiropracticasacareerchoice,”saysDr.NormanOuzts,president,NBCE.“Ourfutureisdependentuponnewpeopleenteringourprofession.”
Establishedin1963,theNBCEisanot-for-profitorganizationthatdevelops,administers,analyzes,scoresandreportsre-sultsofstandardizednationalexaminations.TheNBCEestablishesandmaintainsconsistenthighstandardsofexcellenceinthechiropracticprofessionandchiropracticeducationthroughsuperiorexaminations.
GratefultohavegainedthesupportoftheNBCE,KentS.Greenawalt,chairman,F4CP,states:“SimilartotheF4CP,theNBCEisdedicatedtoadherenceofthehigheststandardsinadvancingthechiropracticprofession.Iamthrilledthattheorganizationhaselectedtosupportourcampaign--andhopefulthatotherswillfollowitsleadandinvestinthefutureofchiropractic.”
About The Foundation for Chiropractic ProgressAnot-for-profitorganization,theFoundationforChiropracticProgressinformsandeducatesthegeneralpublicaboutthemanybenefitsassociatedwithchiropracticcare.TolearnmoreabouttheFoundation,pleasevisitusonthewebatwww.yes2chiropractic.comorcall866-901-F4CP(3427).
UPDATE YOUR CONTACT INFORMATION - Return to: ISCA 200 S. Meridian Suite 350 Indianapolis, IN 46225
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The ISCA Report will be distributed online for your convenience. Please keep the Association office updated on your most current email address as well as practice and home addresses so that we can provide you the most timely and cost effective communications.
UPDATE YOUR RECORDS
SUMMER 2013 ISCA REPORT 5
Dr. Thomas Carrico sees these as important times to be involved in the Association.
“Theseareexcitingtimesinhealthcare,”saysDr.Carrico.“ISCAmembershaveadirectimpactonhowchiropracticwillbeincludedinthehealthcaresystemtoprovidepatientsthebest,mostcost-effectivecare.ItisimportantthatallIndianachiropractorssupporttheprofessionthroughmember-ship.”
InvolvedwiththeAssociationformorethan30years,Dr.Carricoseesmembershiphavingbenefitateverystageofprofessionaldevelopment.“Theeducationalprogramsandinteractiveconversationsthattakeplaceatseminarshavebeeninstrumentalinhelpingdevelopphilosophicalandbusinesspractices,”hesaid.
Dr.CarricojoinedthisfallastheISCA’snewestmemberoftheExecutiveCommitteeinthecapacityoftheSecondVicePresi-dent.“Iamapersonwhohasalwaysbelievedyoushoulddoyourparttohelpthewhole,”hesaid.“Iamhumbledtobeworkingtowardasimilarvisionwithsuchhighlymotivated,educatedpeoplewhohavegoodhearts.”
Dr.Carricohasnowretiredfrompracticingbutremainsactiveinmanagingamulti-disciplinepracticeinLawrenceburg,Indi-ana.Heandhiswife,Karenareparentsofthreeadultchildren,Brian,MattandNickandarefirst-timegrandparentstotwingirls.
Heisproudofhischiropracticprofession.“Thesatisfactioncomesfromthedifferencethatwemakeinpeoples’livesandthegratitudeandappreciationthatyoureceivefrompatients.Whatmatterstohimmost,isthatotherpeoplesaythatyouhavemadeadifferenceintheirlives,”hesaid.
INTRODUCING ISCA SECOND VICE PRESIDENT DR. THOMAS CARRICO
WELCOME NEW MEMBERS
Dr.PeterDyer,Monticello
Dr.JosephEsposito,Peoria,Ill.
Dr.PaulaFuccillo,Fishers
Dr.JennaGogel,Huntington
Dr.GregoryHough,FortWayne
Dr.KevinKaurich,SouthBend
Dr.AlfredPinto,Mishawaka
Dr.EdwardSchmit,Portland
Dr.NathanSermersheim,FortWayne
Dr.DuaneA.Snider,Frankfort
Member TransitionsCongratulationsDrs.ShannonandJacobRobertswhowelcomedJasonMichaelRobertsintotheirfamilyinJune.
SUMMER 2013ISCA REPORT6
NACA ADOPTS RESOLUTION
CHOOSING A NAME FOR YOUR PRACTICE By: Mark K. Sullivan & Associates, P.C.
Whenchoosinganameforyourpractice,therearenumerouspointsofdecisionyou’llencounter.You’llneedtoconsidermarketing,location,practicescope,andevenneighboringbusinesses,butyoushouldalsobeawareofafewlegalconsiderations.
It’sverycommonthatwhenchoosingabusinessname,ahealthcareproviderattemptstocastaswideanetaspossible.Notonlydoestheproviderwanttobeaccessibletoalargepopula-tion,buttheprovideralsowantstobeabletomarketthepracticetoindividualswithavarietyofhealthcareneeds.Thisearnestdesiremayleadsomeproviderstochooseanamethatutilizes
wordslike‘medicine,’‘physician,’‘medical,’orothersimilarwords.ChiropractorsshouldavoidthetemptationtousesuchwordsasitmayviolateIndianalaw.
Indianalawprohibitsachiropractorfromholdinghimselforherselfouttothepublicasbeingengagedinthepracticeofmedicine.Therefore,utilizingthesetypesoftermscanprovideabasisforachargethatthechiropractorisengagingintheunauthorizedpracticeofmedicine.
Inadditiontoavoidingtheuseoftermsprohibitedbystatelaw,it’salsoimportanttoadheretoIndianalawwhenutilizingD/B/Anames.Youarenotprohibitedfromutilizingdifferentnamesifyourpracticehasmultiplegeographiclocationsorinor-dertoutilizemarketingstrategies.However,ifyouholdyourselfouttothepublicunderanamethatdiffersfromyourentity’slegalname,youmayberequiredtofileaCertificateofAssumedBusinessName.Forexample,achiropractormaychoosetoformalegalentitynamedABCHealthcare,Inc.,butmaywanttoutilizeanothernameforpracticeslocatedindifferentareasofthestate,suchasABCHealthcareofSouthernIndianaorABCHealthcareofNorthernIndiana.InordertoproperlyusetheseD/B/Anames,thechiropractorshouldensurethattheCertificatesofAssumedBusinessNameareproperlyfiled.
Thesearejustafewexamplesofthevariouslegalconsiderationstoaddressbeforenamingyourcompany.Inordertoavoidpotentialheadachesdowntheroad,it’simportanttothinkabouttheselegalpointsbeforethebusinesscardsareprintedandthesignabovethedoorisordered.Ifyouhaveanyquestionsaboutnamingyourpractice,utilizingD/B/Anamesproperly,orotherformationalconcerns,youcancontacttheattorneysatMarkK.Sullivan&Associates,P.C.
Executive Director Patricia McGuffey attended the National Association of Chiropractic Attorneys (NACA) conference in June. The NACA joins other associations’ across the nation in adopting a resolution regarding EMS in Medicare. The resolution is described below:
National Association of Chiropractic AttorneysResolution,BEITRESOLVEDthat:TheNationalAssociationofChiropracticAttorneysnotestherecentreleasefromtheU.S.DepartmentofHealthandHu-manServicesbywhichitseekstogaininformationpertainingtothepossibleexpansionofMedicarecoveragetoincludeEvaluationandManagementServicesprovidedbyDoctorsofChiropractic.Webelieveallintheprofessionwillrecognizetheimportanceofthisdevelopment.WethereforecallonallinterestedchiropracticorganizationstocoordinatewiththeAmericanChiropracticAssociationinitseffortstoformulatearesponsibleandeffectiveresponsetotheHHSrequestandquestions.
SUMMER 2013 ISCA REPORT 7
PROTECT YOUR PATIENT’S MEDICAL RECORDS: THE NOTICE OF PRIVACY PRACTICEBy: Stephanie T. Eckerle, Esq., Plews Shadley Racher & Braun
TheHealthInsurancePortabilityandAccountabilityActof1996(“HIPAA”)isacriticallawthateverychiropractorshouldunderstand,especiallyinlightofthepenaltiesimposedforfailuretocomplywithHIPAAandtheauditsnowbeingconductedbytheU.S.DepartmentofHealthandHumanServices(“HHS”).SinceHIPAAhasbeenimplemented,HHShasreceivedover81,790HIPAAcomplaintsandover20,056ofthosecomplaintshaveresultedininvestigationandcorrectiveactions.Moreover,privatemedicalpracticesarethemostcommontypeofcoveredentitythatarerequiredtotakecorrectiveactionbyHHSinordertocomplywithHIPAA.
OneofthemostbasicaspectsofHIPAAthatallchiropractorsshouldcomplywithisprovidingtheirpatientswithaNoticeofPrivacyPractice(the“Notice”).In2010,theNoticewasoneofthetopfiveissuesinvestigatedbyHHSincasesthatresultedinthecoveredentityhavingtotakecorrectiveactiontocomplywithHIPAA.TheNoticeprovidesyourpatientswithinformationabouttheusesanddisclosuresoftheirprotectedhealthinformation.YourworkforceshouldalsounderstandtheNoticeasitisabasicoutlineofwhattheycanandcannotdowithapatient’smedicalrecords.AsrevealedbyHHSinvestigations,however,notallcoveredprovidersaregivingpatientsaproperNoticeandtheyarepayingtheprice!
Does HIPAA Apply to Me? Mostlikely,yes.HIPAAappliestoallhealthcareprovidersthattransmitanyhealthinformationinelectronicforminconnectionwithatransactioncoveredbyHIPAA.Thiswouldincludeanychiropractorthattransmitshealthinformationinelectronicformforhealthcareclaims,healthcarepayments,coordinationofbenefits,determiningeligibilityinahealthplan,healthplanpremiumpayments,referralcertifications,firstreportsofaninjuryandothertransactions.
Must I Have a Notice of Privacy Practice?Yes.Ifyouhaveadirecttreatmentrelationshipwithyourpatients,whichyoumostlikelydo,aNoticeofPrivacyPracticemustbeprovidednolaterthanthedateofthefirstservice,includingservicesdeliveredelectronically,tothepatient.Inaddition,ifyouhaveanoffice,youmustposttheNoticeofPrivacyPracticeinaclearandprominentlocationandhavecopiesoftheNoticeofPrivacyPracticethatpatientscantakewiththem.Ifyoumaintainawebsite,youmustalsoposttheNoticeofPrivacyPracticeonyourwebsite.
May I Email The Notice of Privacy Practice to My Patients?Maybe.YoumayonlyemailtheNoticeofPrivacyPracticetoapatientifthepatientagreestosuchelectronicnoticeandthatagreementhasnotbeenwithdrawnbythepatient.
Should Patients Sign an Acknowledgement That They Received the Notice of Privacy Practice? Yes.EverypatientshouldberequiredtosignasimpleacknowledgmentstatingthattheybothreceivedandreadtheNoticeofPrivacyPractice.
Must the Notice of Privacy Practice Contain Certain Elements?Yes.HIPAAisveryspecificaboutwhattheNoticeofPrivacyPracticestates.Forexample,allNoticesmustcontainaheaderwiththefollowinglanguage,“THISNOTICEDESCRIBESHOWMEDICALINFORMATIONABOUTYOUMAYBEUSEDANDDISCLOSEDANDHOWYOUCANGETACCESTOTHISINFORMATION.PLEASEREVIEWITCAREFULLY.”TheNoticeofPrivacyPracticemustalsodescribehowthechiropractorcandiscloseprotectedhealthinformationbothwithandwithoutthepatient’swrittenauthorization.Forexample,thechiropractormaybeabletodiscloseprotectedhealthinformationfortreatment,paymentandhealthcareoperationswithoutthepatient’swrittenauthorization.Yourstaffshouldalsobetrainedandunderstandwhenitisappropriatetodiscloseprotectedhealthinformationwithoutoralternatively,with,awrittenauthorizationfromthepatient.TheNoticeofPrivacyPracticemustalsoexplainapatient’srightswithrespecttotheirownprotectedhealthinformation.Forexample,apatienthastherighttoinspectandcopytheirmedicalrecordsor,incertaincircumstances,amendtheirmedicalrecords.
Should the Notice of Privacy Practice Name a Specific Contact Person in My Office?Yes.TheNoticeofPrivacyPracticemustcontainthenameortitleofacontactpersonandtheirtelephonenumberincasepatientshavequestionsabouttheNoticeortheirmedicalrecords.Furthermore,theremustbeastatementthatapatienthastherighttocomplaintothechiropractorortheSecretaryofHHSiftheybelievethattheirprivacyrightshavebeenviolated.
Does HHS Penalize Covered Entities for Failure to Provide a Notice of Privacy Practice?Yes.HHSmaydiscoverthatyoudonothaveaNoticeorfailtocomplywithotheraspectsofHIPAAthroughacomplaintoranHHSaudit.Forexample,amentalhealthcenterdidnotprovideaNoticeofPrivacyPracticetoafatherorhisminordaughter,apatientatthecenter.ThiswasdiscoveredduetoacomplaintlodgedwithHHS.Asaresolution,thementalhealthcenter’spolicieswererevisedsothataNoticewasgiventopatientsduringtheintakeprocessandthepatientswereaskedtosignanacknowledgementform.
Itiscriticalforallchiropractorstocreateacultureintheirofficewherebyallemployeesunderstandhowtosafeguardapatient’sprotectedhealthinformationincompliancewithHIPAA.Thiscanbedonethroughmultiplechannels,includingtrainingyourworkforce,ensuringyourpatientsunderstandprivacyexpectations,implementingphysicalandelectronicsafeguardstoprotectmedicalrecordsandtakingallthreatenedandactualbreachesofprotectedhealthinformationveryseriously.Inaddition,theNoticeofPrivacyPracticeisjustoneofmanystepsthatchiropractorsshouldtaketocomplywithHIPAAandtoensurethattheyareimplementingthebestbusinessandhealthcarepractices.IfyouwouldlikemoreinformationabouthowyoucancomplywithHIPAA,pleasecontactStephanieT.Eckerle.StephanieisanattorneyatPlewsShadleyRacher&BraunLLPandcanbereachedat317-637-0700oratseckerle@psrb.com.Stephanieregularlycounselsawidevarietyofhealthcareclientsincorporateandregulatorymatters,includingcompliancewithvarioushealthcarelawssuchasHIPAA.
SUMMER 2013ISCA REPORT8
ACA, COCSA, OTHER PLAINTIFFS DEFEAT UNITEDHEALTHCARE’S MOTION TO DISMISS CLASS ACTION LAWSUITProfession Can Now Pursue Alleged ERISA Violations
Arlington,Va.—TheAmericanChiropracticAssociation(ACA)todayannouncedthatit,alongwithotherplaintiffsinaclassactionlawsuitagainstUnitedHealthcare(United),defeatedamotiontodismissthecase.Amongco-plaintiffsinthelitigationaretheCongressofChiropracticStateAssociations(COCSA),theMissouriStateChiropractorsAssociation(MSCA)andtheOhioStateChiropracticAssociation.
ThedecisionbytheU.S.DistrictCourtfortheDistrictofNewJerseyupheldtheviabilityoftheplaintiffs’central,underlyingclaimsagainstUnitedanditsco-defendants,includingtheinappropriaterecoupmentofreimbursementspreviouslypaidtoproviders.Attimes,themoneyisrecoupedfrompatientaccountsthatarenotactuallyinvolvedintheallegedoverpayment—aclearviolationofERISA.
Thedefeatofthedefendant’smotiontodismissnowallowsplaintiffstopursueinjunctiverelieffortheinappropriateandabusivepracticeslongfoughtbythechiropracticprofession,whichhaverestrictedpatientcareand,theprofessionbelieves,harmedthecareersofdoctorsofchiropractic.Thesepracticesinclude:
•InviolationofERISA,appealrightshavebeeninconsistentlyaffordedtopatientswhenthecareauthorizeddiffersfromthedoctor’scareplan.
•InadeliberateefforttoavoiditsobligationsunderERISA,Optum,aco-defendantinthecase,refusestoallowproviderstorequestaparticularnumberofvisitsorprocedures,ortosubmitadequateclinicalinformationnecessaryforutilizationreview.
•Providersaresubjectedtothreateningcommunicationsinanefforttopressurethemtoreduceutilizationrates.
•Optumreliesonstatisticallyinvaliddatatodetermineaverageutilizationrates.Itfurthermanipulatesdataandpressuresproviderstoreducecare,therebyovertimecontinuallyreducingwhatisreportedasthe“communitystandard”forproperlevelsofcare.
•Eventhoughdoctorsonlyprovidetheservicespre-authorizedbyOptum,thenetworkcontinuestodeclaretheaveragesderivedfromthoseauthorizationsinappropriateandtheypressureproviderstofurtherreducecare.
“Thecourt’sdecisiontorejectUnited’smotiontodismissisagroundbreakingvictoryfordoctorsofchiropracticandtheirpatientsacrossthecountry.Theprofession’scriesforanendtoUnited’sattemptstointimidateandcoercepatientsandprovidershavebeenheardandvalidatedinacourtoflaw,”saidACAPresidentKeithOverland,DC.“Plaintiffsarenowfreetocontinuetheirfightfortheirpatients’rightstoreceivemedicallynecessarycare,andtoholdinsurersaccountableinrespecttoreimbursingprovidersforcarepatientshavepaidforthroughtheirinsurancepremiums.”
"Thisdecisionisamulti-facetedvictoryfortheprofession,”saidCOCSAPresidentKateC.Rufolo-Dreher,DC.“Itisanimportantstepinthisparticularlawsuit,andtheactiontakeninthelitigationtodatemarksanextremelyimportantstepfortheprofessionandthepatientswecarefor."
Thelitigation,filedonJan.24,2011,representsanationwideclassofhealthcareproviderswhoweresubjectedtoUnited’simproperrecoupmentofpaymentsforservicesprovidedtoUnitedsubscribers.ACAjoinedthelawsuitinApril2011.
Thecourt’sdecisionalsoallowsplaintiffstomoveforwardtoclasscertification,thenextstepinthislandmarklitigationfortheprofession.
The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit www.acatoday.org.
SUMMER 2013 ISCA REPORT 9
Sometimes,beinginpracticeanddealingwithregulatoryagenciescanfeellikebeingaboutfouryearsold:wegettold“No!”or“Youcan’tdothat!”—butaren’tgivenenoughclearinformationtounderstandwhy.
Caseinpoint:youcan’tofferinducements—eventhemostinnocent-seemingdiscount–tofederallyinsuredpatientsto“help”themreceivecarefromyourpractice.Incaseyoumissedthisruling,itwassetforthbytheOfficeoftheInspectorGeneral(OIG)backin2002.Here’swhattheysaid:
“Undersection1128A(a)(5)oftheSocialSecurityAct(theAct),enactedaspartofHealthInsurancePortabilityandAccountabilityActof1996(HIPAA),apersonwhooffersortransferstoaMedicareorMedicaidbeneficiaryanyremunerationthatthepersonknowsorshouldknowislikelytoinfluencethebeneficiary’sselectionofaparticularprovider,practitioner,orsupplierofMedicareorMedicaidpayableitemsorservicesmaybeliableforcivilmoneypenalties(CMPs)ofupto$10,000foreachwrongfulact.Forpurposesofsection1128A(a)(5)oftheAct,thestatutedefines“remuneration”toinclude,withoutlimitation,waiversofcopaymentsanddeductibleamounts(oranypartthereof)andtransfersofitemsorservicesforfreeorforotherthanfairmarketvalue.(Seesection1128A(i)(6)oftheAct.)Thestatuteandimplementingregulationscontainalimitednumberofexceptions.”
WhatdoesthatmeaninplainEnglish?Basically,youcan’tgiveawayordiscountyourservices,andyoucan’twaivedeductiblesorcopays.Doctorswhodothis(and,sadly,therearemanykindheartswhodojustthissortofthingwiththeverybestofintentions)areputtingtheirpractices—andtheirlicenses—atrisk.
Whathappensifyoudo?TheFedsaren’tkiddingonthisone.Whentheyauditapracticeanduncoveranykindofinducement,theycanslamyouwithupto$10,000infinesforeachwrongfulactorlineitem.ConsiderhowmanylineitemstherecanbeonjustoneCMS1500form!
Wearenottalkingpocketchange!
SowhatdoyoudowithaMedicarepatientwhoisonafixedincome?Easy:becomeaproviderwithChiroHealthUSA.WithChiroHealthUSA,youcantransitionMedicarepatientstoourfeescheduleforallnon-coveredservices.(Exams,x-rays,therapiesandextremityadjustments)
UsingyourChiroHealthUSAproviderfeeschedulestreamlinesyourpracticeandmakesitmoreaffordableforyourpatients.Mostimportantly,itkeepsyoulegal—andwithauditsontherise,runningafouloftheOIGisarisknooneshouldrun.
Why?Yes,theansweristhesameasitwaswhenyouwerefour:becausetheysaidso.
IfthissoundslikeaperfectwaytokeepyousafewhileyoucareforyourMedicarepatients,itis.LearnmoreabouthowChiroHealthUSAcanhelpyourpracticewithlessriskandmoresatisfaction.Joinusonafreewebinarthatwillgiveyouallthedetailsabouthowyoucanbecomeaprovider.Gotowww.chirohealthusa.comtoregistertoday.(More webinar information below)
Dr. Foxworth is a certified Medical Compliance Specialist and President of Chi-roHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. Dr. Foxworth is a 1984 Honors Graduate, (Cum Laude), of Cleveland Chiropractic College in Kansas City, MO. He served as Staff Chiropractor for the G.V. Sonny Montgomery VA Medical Center 4 years and is a member of the American Chiropractic Association and a 3 term past-president of the Mississippi Chiropractic Association. He was voted by his peers as Chiropractor of the Year for several years and is currently a Fellow of the International College of Chiropractic. He was appointed to the Mississippi State Board of Health by Governor Kirk Fordice and again by Governor Ronnie Musgrove and served 12 years, two of them as Chairman. You can contact Dr. Foxworth at 1-888-719-9990, info@chirohealthusa.com or visiting the ChiroHealthUSA website at www.chirohealthusa.com
JointheIndianaStateChiropracticAssociationandCertifiedMedical
ComplianceSpecialistDr.RayFoxworthonTuesday,September10th,at2:15PMEDTforastatewidewebinarforIndianaChiro-practorsOnly.
Doctor,you'vespenthoursandhoursincontinuingeducationclasseslearninghowtodocumentcorrectly,codecorrectlyandbillcorrectly.Spend45minuteslearninghowtoDISCOUNTcorrectly.
Thereisarightwayandawrongway.Doingitthewrongwaycancostyou.
Dualfeeschedules,impropertimeofservicediscountsandOIGviolationsforofferinginducementsputyouatseriousrisk.Therisksarerealandthesolutionissimple.Webinarislimitedtothefirst100clinics.RegisterNOW!SystemRequirementsPC-basedattendeesRequired:Windows®7,Vista,XPor2003Server
Mac®-basedattendeesRequired:MacOS®X10.6ornewer
MobileattendeesRequired:iPhone®,iPad®,Android™phoneorAndroidtablet
Reserve your Webinar seat now at:https://www3.gotomeeting.com/register/471197734
LEARN ABOUT THE CHIROHEALTHUSA BENEFIT NOW AVAILABLE TO ISCA MEMBERS - JOIN US FOR A WEBINAR ON SEPTEMBER 10
INDUCEMENTS…By Dr. R. A. Foxworth, FICC, MCS-P
SUMMER 2013ISCA REPORT10
ISCA SPRING CONFERENCE: APRIL 12-14, 2013
ThebandNEXUSentertainedwhileISCA/ICAIleaders(fromleft)PatriciaMcGuffey,ExecutiveDirectorandDr.MaryGracePennellacelebrated.
Dr.KirkSteketeeprovidedthekeynoteaddressattheconference.
LeadershipfrombothISCAaddressedattendeesduringaspecialmembershipluncheon.
(picturesfromLeft),PatriciaMcGuffey,Dr.RobertTennant,Dr.andMrs.Paprocki,Dr.CoxSr.,Dr.MaryGracePennellacelebratethefirst-everevent.Dr.KirkSteketeedrawsnamesduringaspecialeveningraffle.
ISCA SPRING CONFERENCE: APRIL 12-14, 2013
SUMMER 2013 ISCA REPORT 11
ISCA SPRING CONFERENCE: APRIL 12-14, 2013 ISCA SPRING CONFERENCE: APRIL 12-14, 2013
INAUGURAL ISCA/ICAI JOINT SPRING CONFERENCE: APRIL 12-14, 2013
“Workingtogetherwearestronger.Workingtogetherwecandosomuchmore.”
ThesearethewordsofKeynoteSpeakerDr.KirkSteketeewhoaddressedthemorethan150participantsattheISCA/ICAIJointSpringConference,April12-14,2013attheCrownePlazaIndianapolisAirport.
Thefirst-evereventjoinedtheeffortsoftheIndianaStateChiropracticAssociation(ISCA)andInternationalChiropracticAssociationofIndiana(ICAI)inaJointConferenceCommitteecomposedofDr.JamesCox,II,Dr.JonJ.Ferguson,Dr.MaryGracePennella,Dr.DuaneBinderandPatriciaMcGuffey,ISCAExecutiveDirector.
“TheinauguralJointConferenceprovidedanexceptionalvenueformembersoftheISCAandICAItocombinetheirstrengthsandtalents,”saidISCAPresidentDr.RobertTennant.“Theeventfueledanewenthusiasmandenergyfortheprofession.”
Theeventbroughttogetheragreatline-upofspeakersincludingDr.PatrickGentempo,Dr.JeffreySpencerandDr.TerryRobertYochum.
OnSaturday,April13,conferencemeetingsconcludewithaspecialISCA/ICAIFamilyReunionGetTogether,whereconferenceattendees,theirspousesorsignificantothersaswellasnon-attendeescelebratedandmixedandmingledwithcolleaguesfrombothAssociations.NEXUSprovidedthemusicalentertainmentandparticipantsdinedonaspecialfamilyreunionindoorpicnic.
SpecialthanksgoestoAnabolicLabs,ASEA–RedoxSignalingMole,CancerTreatmentCentersofAmerica,CentersforDiagnosticImaging,Chirotouch,CLA–InsightDiagnosticCo.,Erchonia,FoundationforChiropracticProgress,FootLevelers,Freeform,FutureHealthSoftware,HaffnerX-RayCo.,LeannaBrennanCoaching,LifeUniversity–CollegeofChiropractic,Lubrisynhu,PalmerCollegeofChiropractic,RealTimePainReleif,RPSImaging,NHD,SmartviewImagingandStandardProcess.
Mark your calendar for the ISCA Fall Conference, October 18th- 20th at the Caribbean Cove in Indianapolis. The event brings together a great line-up of speakers including Dr. Mario Fucinari, Dr. Thomas Hyde and Ronda Nelson, PhD.
(fromleft)Dr.PatrickGentempo,Dr.JefferySpencerandDavidVaughnwerespeakersatthefirst-everevent.
SUMMER 2013ISCA REPORT12
Thefederalgovernmenthaspublisheditslongawaitedfinalregulationsimplementingthe“HealthInformationTechnologyforEconomicandClinicalHealth(HITECH)Act,”enactedaspartofthe“AmericanRecoveryandReinvestmentActof2009”(ARRA),describedbytheheadoftheOfficeforCivilRights(OCR)intheDepartmentofHealthandHumanServices(HHS)as“themostsweepingchangestotheHIPAAPrivacyandSecurityRulessincetheywerefirstimplemented.”Ingeneral,thenewrulesexpandtheobligationsofphysiciansandotherhealthcareproviderstoprotectpatients’protectedhealthinformation(PHI),extendtheseobligationstoahostofotherindividualsandcompanieswho,as“businessassociates,”haveaccesstoPHI,andincreasethepenaltiesforviolationsofanyoftheseobligations.TheAmericanMedicalAssociation(AMA)willbepublishingmoredetailedguidanceconcerningtheimpactoftheserulesonphysicians.ThefollowingoutlinesthechangesphysicianswillneedtoconsiderastheyimplementthenewHIPAArequirementsnecessarybytheSeptember23,2013,compliancedate.Therearethreeareasthatphysicianswillneedtofocusontocomplywiththenewrules:•Privacy,Security,andBreachNotificationpoliciesandprocedures(andinsomecases,newworkflowsandforms);•NoticeofPrivacyPractices(NPP);and•BusinessAssociate(BA)Agreements.
Thefollowingsummaryprovidesahelpfuloverviewofthestepsphysicianswillneedtotakeineachoftheseareastomeetthenewrequirements.Physiciansalsoshouldbefamiliarwiththeirstatepatientprivacyandconfidentialitylaws,whichmaybemorestringentthanHIPAA.
PrivacyandSecurityPoliciesandProceduresThenewruleswilllikelyrequirechangestoaphysicianpractice’sHIPAApoliciesandproceduresinatleastthefollowingareas:
•Breachnotificationrequirements–TheobligationtonotifypatientsifthereisabreachoftheirPHIisexpandedandclarifiedunderthenewrules.Breachesarenowpresumedreportableunless,aftercompletingariskanalysisapplyingfourfactors,itisdetermined,thatthereisa“lowprobabilityofPHIcompromise.”Thephysiciansmustconsiderallofthefollowingfourfactors:
•thenatureandextentofthePHIinvolved–issuestobeconsideredincludethesensitivityoftheinformationfromafinancialorclinicalperspectiveandthelikelihoodtheinformationcanbere-identified;
•thepersonwhoobtainedtheunauthorizedaccessandwhetherthatpersonhasanindependentobligationtoprotecttheconfidentialityoftheinformation;
•whetherthePHIwasactuallyacquiredoraccessed,determinedafterconductingaforensicanalysis;and
•theextenttowhichtheriskhasbeenmitigated,suchasbyobtainingasignedconfidentialityagreementfromtherecipient.
Thisrebuttablepresumptionofbreachandfourfactorassessmentofthe“riskofPHIcompromise”replacestheprevious,moresubjective“significantriskoffinancial,reputational,orotherharm”analysisforestablishingabreach.Thenewrulesfurtherclarifythatthereisnoneedto
haveanindependententityconducttheriskassessmentandindeed,noriskassessmentneedbeconductedatallifthebreachnotificationismade(although,physicianswillwanttoundertakeanappropriatereviewandstepstomitigatetheharmandreducethelikelihoodoffuturebreachesinanycase).ThenewrulesfurtherconfirmthatthebreachnotificationrequirementmaybedelegatedtoaBA,andphysiciansareencouragedtocoordinatewiththeirBAssothatpatientsreceiveonlyonenotificationofthebreach.
ThenewrulesdonotmodifytheactualreportingandtimeframerequirementsforBreachNotification;thatis,coveredentitiesmuststilladheretorequirementsforindividualnotification,HHSnotification,andwhereapplicablemediapostingofthebreach.
•Disclosurestohealthplans–Atthepatient’srequest,physiciansmaynotdiscloseinformationaboutcarethepatienthaspaidforout-of-pockettohealthplans,unlessfortreatmentpurposesorintherareeventthedisclosureisrequiredbylaw.ThischangeupdatesthepreviousHIPAAPrivacyRulegoverningpatientrequestsforrestrictionsontheuseordisclosureoftheirPHI.Previously,whilephysicianscouldrefusetoabidebyanysuchrequest,thenewrulerequiresphysiciansandotherhealthcareproviderstoabidebyapatient’srequestnottodisclosePHItoahealthplanforthoseservicesforwhichthepatienthaspaidout-of-pocketandrequeststherestriction.Ofallthechangesmadebythenewrules,thischangeislikelytohavethegreatest
THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)Omnibus Final Rule Summary - American Medical Association
CONTINUED ON PAGE 13...
SUMMER 2013 ISCA REPORT 13
AMA STORY CONTINUED...
•Marketingcommunications–Thenewrulesfurtherlimitthecircumstanceswhenphysiciansmayprovidemarketingcommunicationstotheirpatientsintheabsenceofthepatient’swrittenauthorization.Generallyspeaking,theonlytimeaphysicianmaytellapatientaboutathird-party’sproductorservicewithoutthepatient’swrittenauthorizationiswhen:
1)thephysicianreceivesnocompensationforthecommunication;2)thecommunicationisface-to-face;3)thecommunicationinvolvesadrugorbiologicthepatientiscurrentlybeingprescribedandthepaymentislimitedtoreasonablereimbursementofthecostsofthecommunication(noprofit);4)thecommunicationinvolvesgeneralhealthpromotion,ratherthanthepromotionofaspecificproductorservice;or5)thecommunicationinvolvesgovernmentorgovernment-sponsoredprograms.Physiciansarealsostillpermittedtogivepatientspromotionalgiftsofnominalvalue(e.g.,pamphlet).
•SaleofPHI–ThenewrulesclarifythattheprohibitiononthesaleofPHIintheabsenceofthepatient’swrittenauthorizationextendstolicensesorleaseagreements,andtothereceiptoffinancialorin-kindbenefits.Italsoincludesdisclosuresinconjunctionwithresearchiftheremunerationreceivedincludesanyprofitmargin.Ontheotherhand,theprohibitiononPHIsalesdoesnotextendtopermitteddisclosuresforpaymentortreatmentnortopermitteddisclosurestopatientsortheirdesigneesinexchangeforareasonablecost-basedfee.
•Childhoodimmunizations–Underthenewrules,physiciansmaydiscloseimmunizationstoschoolsrequiredtoobtainproofofimmunizationpriortoadmittingthestudentso
longasthephysicianshaveanddocumentthepatientorpatient’slegalrepresentative’s“informalagreement”tothedisclosure.
•Decedents–Thenewrulesallowphysicianstomakerelevantdisclosurestothedeceased’sfamilyandfriendsunderessentiallythesamecircumstancessuchdisclosureswerepermittedwhenthepatientwasalive;thatis,whentheseindividualswereinvolvedinprovidingcareorpaymentforcareandthephysicianisunawareofanyexpressedpreferencetothecontrary.ThenewrulealsoeliminatesanyHIPAAprotectionforPHI50yearsafterapatient’sdeath.
•Copiesofe-PHI–Physicianswillnowhaveonly30daystorespondtoapatient’swrittenrequestforhisorherPHIwithone30-dayextension,regardlessofwheretherecordsarekept(eliminatingthelonger60-daytimeframeforrecordsmaintainedoffsite).TheymustprovideaccesstoEHRandotherelectronicrecordsintheelectronicformandformatrequestedbytheindividualiftherecordsare“readilyreproducible”inthatformat.Otherwise,theymustprovidetherecordsinanothermutuallyagreeableelectronicformat.Hardcopiesarepermittedonlywhentheindividualrejectsallreadilyreproduciblee-formats.
•EmailingPHI–Physiciansmustalsoconsidertransmissionsecurity,andmaysendPHIinunencryptedemailsonlyiftherequestingindividualisadvisedoftheriskandstillrequeststhatformoftransmission.
•Chargingforcopiesofe-PHIorPHI–Thenewrulesmodifythecoststhatmaybechargedtotheindividualforcopiestoincludelaborcosts(potentiallytoincludeskilledtechnicallaborcostsforextractingelectronicPHIandsupplycostsifthepatientrequestsapapercopy,orif
electronic,thecostofanyportablemedia(suchasaUSBmemorystickoraCD),assumingstatelawdoesnotsetalowerreimbursementrate.Therulesalsoclarifythatphysiciansmayimposeaseparatechargeforcreatinganaffidavitofcompleteness.
•Researchauthorizations–Thenewrulespermitphysicianstocombineconditionedandunconditionedauthorizationsforresearchparticipation,providedindividualscanopt-intotheunconditionedresearchactivity.Moreover,theseauthorizationsmayencompassfutureresearch.
Notice of Privacy Practices (NPP)PhysiciansmustamendtheirNPPstoreflectthechangessetforthabove,includingthoserelatedtobreachnotification,disclosurestohealthplans,andmarketingandsaleofPHI.Totheextentphysiciansengageinfundraising,theywillalsohavetoamendtheirNPPtoinformpatientsoftheirrighttoopt-outofthosecommunications.Astherulespresumetheseareallmaterialchanges,physicianswillhavetoposttherevisedNPP,andmakecopiesavailableattheiroffice,toallnewpatientsandtoanyoneelseonrequest.PhysicianswhomaintainawebsitearecautionedtoposttheupdatedNPPontheirwebsiteasrequiredbytheexistingHIPAAPrivacyrule.Thenewrulesalsoeliminaterequirementstoincludeinformationoncommunicationsconcerningappointmentreminders,treatmentalternatives,orhealth-relatedbenefitsorservicesinNPPs,buttherulesdonotrequirethatthatinformationberemovedeither.
CONTINUED ON PAGE 14...
SUMMER 2013ISCA REPORT14
AMA STORY CONTINUED...
Business Associates (BAs) ThenewrulesexpandtheuniverseofindividualsandcompaniesthatmustbetreatedasbusinessassociatestoincludePatientSafetyOrganizationsandothersinvolvedinpatientsafetyactivities,healthinformationorganizationslikee-prescribinggatewaysorhealthinformationexchangesthattransmitandmaintainPHI,andpersonalhealthrecordvendorsphysicianssponsorfortheirpatients.Thus,physiciansmustreviewtheirrelationshipsanddetermineiftheymustenternewBAagreementswiththeseentitiesorothersthatcreate,receive,store,maintain,ortransmitPHIontheirbehalf.
TheserulesalsomodifytherequirementsforBAagreements:• PhysiciansnolongermustreportfailuresoftheirBAsto
thegovernmentwhenterminationoftheagreementisnotfeasible,asHHShasconcludedthattheBA’sdirectliabilityfortheseviolationsissufficient.
• BAsarenowresponsiblefortheirsubcontractors.• BAsmustcomplywiththeSecurityandBreach
NotificationRules.• PhysiciansareliablefortheactionsoftheirBAswho
areagents,butnotfortheactionsofthoseBAsthatareindependentcontractors.
PhysicianshaveuntilSeptember23,2014,tobringalltheirBAagreementsintoconformancewiththenewrules.BAagreementsthathavenotbeenrenewedormodifiedbetweenMarch26,2013,andSeptember23,2013,willbedeemedcompliantuntilthedatetheBAagreementisrenewedormodifiedoruntilSeptember22,2014,whicheverisearlier.
Enforcement and Penalties Thenewrulesclarifythefourpenaltytiersasfollows:• Lowesttier–casesinwhichthephysiciandidnotand
reasonablycouldnotknowofthebreach.• Intermediatetier–casesinwhichthephysician“knew,
orbyexercisingreasonablediligencewouldhaveknown”oftheviolation,butthephysiciandidnotactwithwillfulneglect.
• Highesttiers–casesinwhichthephysician“actedwithwillfulneglect”andeithercorrectedtheproblemwithinthe30-daycureperiod,orfailedtomakeatimelycorrection.
HHSmustconductaformalinvestigationandimposecivilmonetarypenaltiesincasesinvolvingwillfulneglect,andisnowfreetoprovidePHItoothergovernmentagenciesforenforcementactivities.
Theassessmentofpenaltiesmustbebasedonfiveprincipalfactors:
(1)thenatureandextentoftheviolation,includingthenumberofindividualsaffected;(2)thenatureandextentoftheharmresultingfromtheviolation,includingreputationalharm;(3)thehistoryandextentofpriorcompliance;(4)thefinancialconditionofthecoveredentityorbusinessassociate;and(5)suchothermattersasjusticemayrequire.Thenumberofviolationsmaybebasedonthenumberofindividualsaffectedorbythenumberofdaysofnon-compliance.
Therulefurtherclarifiesthatthe30-daycureperiodbeginswhenthephysiciankneworshouldhaveknownoftheviolation.
Other Changes Thenewrulesalsomakechangesthatwilllikelyaffectphysicians,butonlyindirectly.ThemostsweepingistheexpansionoftheobligationsofBAstoincludebothdirectliabilityundermostoftheHIPAAPrivacyandSecurityRules,andtheobligationtoenforcetheseruleswithrespecttotheirsubcontractors.ThenewrulesalsoimplementtheGeneticInformationNondiscriminationAct(GINA),whichgenerallyprohibitshealthplansfromusinggeneticinformationforunderwritingpurposes.
Next StepsWiththepotentialfor$1.5millionfines,nottomentionseriousreputationalinjury,thesenewrulesmustbetakenseriously.Clearly,physicianswillneedtodevelopaplantomaketheserequiredchangesinatimelyfashion.TheAMAwillprovidemorespecificguidancewithrespecttoeachofthesethreeareas,includingsampleNPPandBAagreements.
SUMMER 2013 ISCA REPORT 15
DC'S WANTED
DCNeeded(Noblesville,IN)(10milesnorthofIndianapolis)-Lookingforanaggressive,engergetic,licensedIndianachiropractortojoinawell-established,wellness-basedpracticejustoutsideofIndy.Thisisagreatprofitsharingopportunityforsomeonelookingtobuildapracticewithinapractice.Applicantmustbe
ambitious,havegoodadjustingskillsandmusthaveanopenmindtoCBP/wellnesscaretraining.Newgraduateswelcometoapply!Ifyouarelookingforthistypeofopportunityandwanttolearnmore,pleasecontactDr.AbeBeaberat317-339-8005orinfo@
hamiltoncountychiro.com.Posted3/5/13
ASSOCIATES WANTED
RapidlyexpandingLakeCounty,IndianapracticeinMerrillvillelookingtofillfulltimeposition.Fiftyminutesfromdowntown
Chicago.Enthusiastic,ambitious,growth-oriented,doctorisamust.MustbeproficientinDiversifiedandFlexionDistraction.Send
resumetochirodan@comcast.net.Posted2/26/13
ActiveChiropractic&RehabilitationClinic,Evansville,IN,www.evansvillechiro.com.MustbeopentorehabilitationandActiveReleaseTechniqueandalicensedDCinIndianawithexcellentpatientcommunicationandtechnicalskills.Sendconfidential
resumetobarbiealbrown@yahoo.com.Posted3/8/13
FulltimeAssociateposition,Bloomington,Indiana-40Kbasewithabonusplan,paidmalpractice,continuingeducationandvacation.Veryprogressiveoffice,lookingforasolidteammember.Lookingforamotivatedchiropractorwhoisreadytobuildasuccessfulpracticewiththesupportofourstaffandfacility.Veryopento
creatingamutuallybeneficialwin-winrelationship.Initialcontactandinterest,pleaseemailusatjbf@prodigy.net,attacharesume
andcoverletter.Posted5/6/13
AssociateDoctorNeeded:Busyofficewithmultiplelongtermassociates.Familypractice.ThirtyminutestodowntownChicago.Fulltime,paidvacation,$26/houraftertraining.Payincreaseafteroneyear.ProficientintheThompsonleg-checktechnique.Wearelookingforsomeonewhoisreadyandwillingtoblendinwithaveryupbeat,funandpositivestaff.Interestedapplicantsshouldemailtheirresumetoinfo@trimbolichiro.netorfaxto219-836-2344.
www.trimbolichiro.net.Posted5/7/13
Fantasticopportunitytogrowinanexistingclinicthatprovidesawiderangeofservicesfortheirpatients.Owner/DCstaysbookedandhasoutstandingreputationinarea.Greatopportunitytojoininanestablished,busychiropracticpracticeinLinton,IN.Weareseekingaself-motivated,passionate,detail-orientedassociatechiropractortoworkinouroffice.Newassociateneedstobeaskillfulmanualadjuster(Diversified),possessagreatbedside
mannerandbehard-working,dedicated,outgoingandenergetic.Thechosencandidatewillberesponsibleforpatient-treatment,
excellentdocumentation,patientexams,coordinaterehabilitation,adnsomelimitedmarketingadngohomewithina40hourworkweek.Basesalaryplusbonuses.Replytodocbrinson@gmail.com.
Posted7/19/13
Columbus,IN(50minutessouthofIndianapolis)Growingofficeseekingmotivated,dependable,organized,andgoal-orientedDCforafull-timepositionbeginninginDecember.Candidatemustbeskilledinmanualadjusting,musclereleasetechniques,andwillingtoutilizeCoxandThompsontechniques.Newgraduateswelcometoapply!Basesalarystartsat$40K.ContactDr.MandyWyant,
FamilyChiropracticandWellness,phone:812-373-3376Posted7/23/12
FRANCHISEOPPORTUNITIESAVAILABLE!GAINACOMPETITIVEEDGE&HAVEFUNINPRACTICE!Jointhefastestgrowingsubluxation-basedchiropracticgroup.AlignLifeisagrowingnationalchiropracticorganizationprovidingcomprehensive
wellnesssystems,marketingcampaigns,businessmanagementandnationalbranding.Gainthebenefitsofagroupwhile
maintainingfullownershipTurnkeyClinicConversions&StartUpOpportunities.AlignLifeFranchisehttp://TheDreamPractice.com.Don'twait!CallToday-GainProsperityTomorrow(877)254-4654.
Posted7/24/13
PRACTICE/EQUIPMENT FOR SALE
WabashCounty-SELLERFINANCINGAVAILABLEFamilypracticeatsamelocationfor30years.2,300sqftextensiontoa
residentialhome-forleaseorpurchase.Mainlinetechniques.Trainedandtenuredstaff.Fullyequippedincludingx-rayanddecompressiontables.
Ownerretiring.CallParagonGroup(800)582-1812orinfo@paragongroup.com.Posted1/14/13
TwentyfiveyearpracticeforsaleinLafayette,Indianaduetodeathofdoctor.Fulltimepracticespecializinginuppercervicaltech-nique.ModernofficebuildingwithXrayroom,consultationroomandtwotreatmentrooms.Ampleparkingandhightrafficcount.Buildingforsaleorlease.Viewofficeatclarkchiropracticlafayette.comoremailclarklinda123@gmail.comformoreinformation.
Posted3/15/13
ForSale-VT3000NerveConductionDiagnosticUnitw/DellLaptop.Comeswithallaccessories,manuals,extraelectrodesandprogramloadedontheDellLaptopthatcomeswithit.Thisunitisabout6yearsoldandworksgreat.Thelaptopalonewasmorethan$1,000!GetstarteddoingNCVsnow,don'twaittoincreaseyourofficerevenueandmakemoreaccuratediagnosis.$1000orbestoffer.MR4LaserStimUnit-MINTCONDITION!Thisunitwas$8,500new,wasonlyusedahandfuloftimesbeforewegota
packagedealonnewequipment,makingitanextrathatwedon'tneed.Comeswithallthemanuals,accessories,andafactory,high-quality,padded,carryingcase.$1000orbestoffer.MAKEUSANOFFERIFYOUWANTBOTH!Wecanbundlethemforless!Contact
usat317-272-4100andaskforJohnorJames.Posted3/19/13
FORSALE-IhaveanolderZenithHI/LOinperfectworkingconditionfor$500.Interested?ContactMikePhelpsat765-342-
2208.Posted7/9/13
INDIANA STATE CHIROPRACTIC ASSOCIATION CLASSIFIEDS
SUMMER 2013ISCA REPORT16
© 2010 Rising Tide, Kft.
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