reviewing Medicare contraindications and then, of course, the other next big one was the treatment plan. The Medicare contraindications, which are very specifically written, have a number of items which I’m just going to review very quickly. Number 1 is a problem if there's articular hypermobility in the joints in the spine. What that means basically is remember, chiropractic subluxation is hypomobile. Medical subluxation is hypermobile. Then, if there's severe demineralization of the bone. The next is benign tumors of the spine. Next, if the patient has anticoagulant therapy. If you've got a lot of these patients coming in on Coumadins or other things, this is a contraindication according to the OIG. If there's any radiculopathy with progressive neurological science; if there's any kind of evidence of healed fractures or breaks or dislocations and there's unstableness in that heal site; any kind of malignancies that involved vertebral column; infections of the bones or the vertebral columns; problems with any type of cauda equina syndrome which I know a lot of chiropractors are very helpful with patients coming in with disk or cauda equina syndromes; cervical manipulations; there's vertebrobasilar insufficiency syndrome. Then, of course, there any major problems with previous arterial aneurisms near the proposed manipulation site. What takes place then is that if there is any other acute arthropathies that are present so those are the basic Medicare contraindications that the OIG looks for. Again, this comes all the way back to an old 2005 OIG report where 94% of the claims looked at had missing elements and this was one of the big elements along with the treatment plan. I want to just follow up on that before I get to Sam. Ken, that's a lot of hyperbole. How do we get the doctors to easily understand what they need to do based on that type of information so that they don’t wind up having to deal with problems with Medicare? You and I both grew up in a time of just taking care of patients, adjusting them, sending in the bill, getting paid and watching the patient get better. We're in a different environment where the doctors have to be aware of a lot of the information that we're talking about here today. How do we make it simple for them to have a clear understanding of those rules that you just described? I think one of the simplest ways for chiropractors to understand is to, again, follow the information that ChiroSecure puts out. I think with the little different blurbs and emails that ChiroSecure puts out plus the information that as given at the [inaudible 00:07:16] for example, I know that ChiroSecure was just at the MAC convention in Detroit, Michigan. I mean those are helpful. A lot of the doctors just don’t take the time to understand there are currently rules that they have to play by and the way I explained it in the seminars is that you can’t play ball game without knowing the rules for the particular game you're in. Again, it's very important that you get the information from ChiroSecure. I’m hopefully and optimistically looking that the state associations will provide regular information in their monthly magazines or newsletters or weekly emails, and again, that doesn’t again at all discount that the doctor and staff have to stay abreast of the current information that's out there. That's perfect, Ken. I appreciate that. I want to also introduce somebody that's near and dear to me as well. Dr. Sam Collins, for those of you that have already
Dr. Hoffman:
Dr. Murkowski:
Dr. Hoffman:
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