Clarification on ChiroCare’s Provider Services Phone Number; Mandatory CMS Compliance and FWA Training; Are You Ready for Expedia-Type Health Care?; Protect Your Heart with Sufficient Sleep
Clarification on Provider Services Phone NumberLast week, the “Thought for the Week” in our News Flash newsletter included a phone number for ChiroCare’s clinical peer reviewer. We would like to clarify that the ChiroCare clinical hotline is limited to peer-to-peer discussions about authorization denials or modification determinations. For all other authorization questions, please call our Provider Services Team at 877-886-4941 and a representative will be happy to assist you.
Mandatory CMS Compliance and Fraud, Waste and Abuse TrainingAs of January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) regulations require all first tier, downstream, and related entities (FDRs) to complete general compliance and fraud, waste and abuse (FWA) training within 90 days of hire/contracting. FDRs include providers and staff. This training is good for one calendar year and needs to be completed annually.
To help FDRs complete this training, CMS has created a FWA training module. CMS requires FDRs to complete this training and has presented two options to meet this requirement:
- A FDR may complete the general compliance and FWA trainings on the CMS Medicare Learning Network. After completing the trainings, the trainee must enter their name and date into the generated certificate which can then be printed off and saved for a minimum of 10 years, per CMS.
- The general compliance and FWA trainings through CMS can be used in addition to an existing training in the organization. Please note that the CMS trainings cannot be edited in any shape/way/form to ensure that the necessary information is being conveyed. The trainee must complete the certificate from the CMS training and retain the record for a minimum of 10 years.
For additional information, check out
Compliance and Fraud, Waste and Abuse Frequently Asked Questions (FAQs). All of the training information presented here is also available on ChiroCare.com.
Are You Ready for Expedia-Type Health Care?Consumerism is a buzz word frequently used in health care today – and with good reason. Many consumers have high deductibles and are actively looking for value-based care. Consider that in the future, provider report cards may look more like Expedia, allowing the consumer to compare costs, services, and outcomes of providers so they may feel empowered to choose the doctor that best meets their needs. This increase in transparency is as important ever, as patients are assuming more responsibility for spending their health care dollars.
CMS is pushing for changes that require quality metrics for payment rather than the fee-for-service model, and has begun pilot testing with medical groups.
There are a number of action items you can do now to begin preparing for this transition.
- Begin using an outcome tool, such as the Oswestry or Revised Oswestry, to measure functional outcome improvement
- Spend some time walking through the Outcome Assessment Toolbox that is available on ChiroCare Connect (ChiroCare Connect > Clinical Resources > Provider Tools > Outcome Assessment Toolbox)
- Check in with your patients by conducting an in-house patient satisfaction survey. A survey example is available on ChiroCare.com.
- Pay attention to services that do improve outcomes (such as active care instruction), and begin to question performing services that will not change outcomes and can drive up your cost in comparison to your peers. One example is X-rays – should they be required or are they just nice to have? Other examples are the number of visits and the number and duration of passive therapies – does the patient truly need two therapies or is one just as effective? Best practice research indicates using passive therapies for short durations to control acute pain, such as 2-6 weeks; and seldom is more than one is necessary.
Protect Your Heart with Sufficient SleepFebruary is National Heart Month. We have heard for years that lifestyle factors such as physical exercise and stress management, and food choices such as tomatoes and dark chocolate, can lower the risk of heart disease. Did you know sufficient sleep duration also plays a role?
The MORGEN study, published in the Netherlands in 2013, analyzed nearly 18,000 men and women and how their health behaviors were linked to the later risk of heart attacks or cardiac deaths. Researchers found the contribution of sufficient sleep duration (at least seven hours per night), in addition to sufficient physical activity, a healthy diet, moderate alcohol consumption, and not smoking, lead to a lower cardiovascular disease risk.
Overall, getting sufficient sleep lowered the risk of heart disease by 22 percent and fatal heart attack by 46 percent. When added to the other four lifestyle factors analyzed, the risk of heart disease decreased by 65 percent and fatal heart attack by 83 percent.
In honor of National Heart Month, check out additional heart-healthy tips at heart.org.
Thought for the Week
“With a healthy heart…the beat goes on.” -Unknown
Posted under: Weekly News Flash