In this issue
- ChiroCare Centers of Excellence Named for 2018
- Network Communication
- Revised Provider Manual Available
- Utilization Management Improvements Coming in Late 2018
- Submitting Proper Claims
- Front Desk Staff Have an Impact on Patient Satisfaction
- Moving or Retiring? Let us Know!
Congratulations to the clinics named 2018 ChiroCare Centers of Excellence (CCoE)!
This designation not only recognizes these clinics’ value-based, patient-centered care, it also celebrates their commitment to using an integrated and collaborative approach in achieving the best outcomes and quality of life for their patients.
The full list of 2018 CCoE clinics and providers can be found on our ChiroCare website.
Interested in applying for next year’s CCoE designation? Applications will open again in November. Fulcrum Health has created resources and educational materials to help your clinic prepare. Check out this Clinic Self-Assessment Tool and be sure to review CCoE identified online trainings in the Education Toolbox.
Email is our primary form of communication to network providers.
Please be on the lookout for any emails from Fulcrum Health that may address the following:
- Special Bulletin
- Credentialing / Recredentialing
- ChiroCare Centers of Excellence
- Ballot for Elected Directors
- Invitations to Fulcrum Health educational events
A revised version of the ChiroCare by Fulcrum Health manual is now available online through ChiroCare Connect. It is important for all providers to review the new provider manual, as your participation agreement with Fulcrum Health contains a compliance obligation with the provisions of the manual. The most significant change is our contact information.
You may view and/or download a printed version of the manual by logging onto ChiroCare Connect.
As mentioned in last month’s NewsFlash, Fulcrum is 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 enhanced UM Program to create a platform that adds quality measures to performance and move toward value-based payments for providers demonstrating quality.
Enhance UM Program
- Focus on quality and appropriate services based on patient needs
- Include quality measures
- Develop real-time treatment decision support tools with recommendations for care
- Share best practice guidelines
- Collect patient functional outcomes data
- Advance measures that result in positive outcomes for patients
- Improve understanding of medical risk factors
Additional information to come in future NewsFlashes!
This month’s article will provide tips to help prevent claims submissions from rejection.
Prior to submitting claims to insurance, it is important that it is reviewed to ensure that the information being submitted is accurate. Too often, claims are being rejected due to incorrect patient information.
Tips for reviewing claims prior to submission:
- Verify the following:
- Patient information
- Services being billed
- Date of service
- Provider information that is treating the patient
- List the patient’s full name as it appears on their insurance card
- The patient’s ID number, as listed on their current insurance card
- Date of birth
- Diagnosis codes
- Procedure codes
- Ensure that the provider listed on the claim is the provider that rendered the service
If a claim is not submitted correctly, and is rejected, it results in additional work for your office. When a claim is rejected, it will be routed back to your office and will need to be corrected before being resubmitted. By reviewing the claim prior to submission, you will lessen the chances of your claim being rejected.
As always, if you know or suspect FWA 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.).
If you have questions that do not contain PHI, please direct them to Compliance@FulcrumHealthInc.org.
One of the components of the Triple Aim is Patient Experience. Ensuring that your patients have a positive
experience in your clinic begins much earlier than in the treatment room. Good patient experience begins when the patient first enters your clinic. This means the front desk staff is a critical component to a positive experience and high patient satisfaction scores.
Share these tips with your staff to ensure the patient feels welcome and engaged:
- Greet the patient when s/he enters the clinic
- Welcome the patient, introduce yourself, and ask how you may help them
- Maintain eye contact and listen
- If forms are given to the patient, thoroughly explain them and how they are necessary for the doctor to provide the best treatment possible
- Inform the patient of expected wait times and the duration/cause for any delays
- Remain available until the patient transitions to the next stage of his/her visit
- Offer to walk the patient to the next destination
- Maintain a clean and uncluttered front desk and waiting area
- Minimize loud noises
- When patients are in the office, keep non-work-related conversations to a minimum
- Keep appropriate hygiene products available in the lobby such as gloves, masks, and waterless hand sanitizer
- Ensuring the patient has clear direction and follow up instructions after their office visit
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 (888) 638-7719 with any questions about submission of updates.