In this issue
- Utilization Management Improvements Coming in Late 2018
- ChiroCare Centers of Excellence Program Update
- Preventing Claim Denial
- Emailing PHI
- Comparison of the Effectiveness of Acupuncture Treatment and Local Anaesthetic Injection for Low Back Pain
- Moving or Retiring? Let us Know!
Fulcrum Health’s strategic direction is to deliver high-quality, patient-centered, evidence-based care that also strengthens ChiroCare’s network providers practice through outcomes data, treatment decision support tools, and education. With these improvements, we will advance our efforts in paying for value-based care.
To achieve this, we are bringing our Utilization Management Program in-house. This new program incorporates concepts used in the CMS value-based model and use of outcome assessment tools, while providing additional tools and education to support better patient outcomes. The intent is to further the Triple-Aim – cost, quality, and patient experience.
Fulcrum is implementing this change to create a platform that adds quality measures to performance in addition to building a compensation system that pays for quality performance.
Enhance UM Program
- Moving from volume service to patient-centered
- Adding quality measures
- Real-time treatment decision support tools with recommendations for car
- Best practice guidelines
- Proactive coding tips
- Patient functional outcomes data collection
- Improve measures that result in positive outcomes for patients
- Improve understanding of medical risk factors
- Enhance algorithms with the addition of risk factors and functional outcomes
Additional information to come in future Newsflashs!
Thank you to the clinics who submitted an application for consideration in our ChiroCare Center of Excellence (CCoE) program.
The application deadline expired on March 31, 2018, and all submissions are completed and designation letters have been sent. An announcement with the 2018 CCoE designations will be published in July; please stay tuned for more information.
For general information about the program, visit our ChiroCare Centers of Excellence webpage. The 2019 CCoE Program will begin accepting applications November 1, 2018 through March 1, 2019.
As a reminder in order for claims to be processed they must be submitted with the correct patient information including full name, date of birth and Member ID Number.
In addition, claims must be billed with valid procedure and/or revenue codes, modifiers and diagnosis codes. If any of these are missing or invalid, the claim may be denied.
Providers should always follow the requirements listed in their provider contract and provider manual.
If you have questions, please contact provider services at 877-886-4941. For information pertaining to benefit coverage you should call the number located on your patient’s health insurance card.
This article will focus on email security and emailing patient information.
With the ease of electronic communications, like email, it is important to remember the risks that exist when using an unsecured method of communication with patients. Sending protected health information (PHI) through email is not prohibited but there are best practices to keep in mind before hitting the send button.
Under the Health Information Portability and Accountability Act (HIPAA), a patient has the right to ask their provider to communicate with them in reasonable, alternative methods. This means that if your patient wishes to receive email reminders for appointments and this is a reasonable request for your office, then the provider may honor the patient’s request to communicate via email. However, if you are using unsecured emails to share PHI, you should notify your patients. While notification of appointments is acceptable via unsecured email, your patient may feel differently about their PHI being sent unsecured.
Remember, not all emails are considered secure. If you are using a public server, you should know that many of these are not considered to be a secured email method. Unsecured emails can be more easily intercepted by unintended users which may result in PHI being received and used by an unintended recipient. Secured emails encrypt the information within the email and make it so only the intended recipient is able to view the contents.
Keep in mind the following best practices before emailing patient information:
- Educate patients about the risk of sending PHI through email
- Obtain patient consent to send health information via email (secured or unsecured)
- Offer alternative means of communication that will meet the patient’s needs
- When emailing PHI, include a disclaimer in the subject line to alert the patient that confidential information is contained within the email
For additional information on the HIPAA Privacy Rule’s guidance on emailing, please visit the US Department of health & Human Service’s website.
If you have any questions, that do not contain PHI, please direct them to Compliance@FulcrumHealthInc.org. Additionally, if you know or suspect fraud, waste or abuse is occurring in your place of business please report it immediately to Fulcrum’s compliance hotline at 1-866-714-0526. Tips can be left on this voicemail 24/7 by anyone (provider, office support staff, patients, etc.).
Comparison of the Effectiveness of Acupuncture Treatment and Local Anaesthetic Injection for Low Back Pain
An article in the British suggests that compared with local anaesthetic injection, acupuncture is more effective for the treatment of low back pain in terms of immediate effect, cumulative effect and sustained effect. The difference between the two treatments may be due to a difference in the mechanism of pain suppression. Click here for an in-depth read of this study.
It is vital that you report any practice changes to ensure that we have your current address, phone, fax, and email address. Any changes or corrections to your TIN/name combination should be communicated immediately. TheProvider Update tool within ChiroCare Connect offers a quick and electronic means to report changes. Simply select the “Billing Information Update” option within the Provider Update tool.
Please contact our Provider Services team at 877-886-4941 with any questions about submission of updates.