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November 2018 News Flash

November 30, 2018

In this issue

  1. Congratulations ChiroCare providers in achieving outstanding performance in patient satisfaction!
  2. Mandatory Special Needs Plan Training
  3. Due Now – Disclosure of Ownership and Cultural Competency
  4. How do I check a member’s eligibility and benefits?
  5. Where do I find Fulcrum’s Clinical Policies?
  6. 2019 Claims Submission Changes for UCare Choices Plans
  7. 2019 Center of Excellence Applications Open November 1st
  8. Patient Satisfaction – Front desk staff has an impact
  9. Moving or Retiring? Let us Know!

Congratulations ChiroCare providers in achieving outstanding performance in patient satisfaction!

Fulcrum Health is pleased to announce that its ChiroCare network has received the 2018 Guardian of Excellence Award ® from Press Ganey . The Guardian of Excellence Award recognizes top-performing health care organizations that consistently score in the 95 th percentile or above on measures of patient experience. You are truly improving the quality of our communities – and we thank you.

Presented annually, the Press Ganey Guardian of Excellence Award is recognized nationally as a symbol of achievement in health care. This award underscores Fulcrum Health’s innovative approach to physical medicine that makes it possible for health administrators to lower costs while achieving better outcomes, increasing patient satisfaction, and improving the work life of health care providers.

“People are increasingly looking to physical medicine as an effective, efficient method to address both acute and chronic pain. As the United States continues to struggle with an opioid epidemic, chiropractic care has the potential to reduce the use of costly services and impact the country’s reliance on drugs and invasive surgical procedures,” said Patricia Dennis, CEO of Fulcrum Health. “Participating in the Press Ganey survey allows us to compare the experience of patients using our ChiroCare network against national and regional data, and to identify opportunities for continued improvement. It is an honor to receive this award, and we take great pride in knowing that our providers continue to deliver care that makes the long-term health and well-being of patients a top priority.”

The Press Ganey award is an important recognition from the industry leader in measuring, understanding, and improving the patient experience. “Fulcrum Health continues to be a valuable partner in advancing the state of physical medicine,” said Patrick T. Ryan, CEO of Press Ganey. “This award is further evidence of the organization’s leadership in delivering patient-centered care. By achieving and sustaining this level of excellence, Fulcrum Health continues to demonstrate its commitment to reducing patient suffering and advancing the overall quality of health care.”

Press Ganey presents its Guardian of Excellence Award to hospitals, large medical centers, emergency departments, and rehabilitation centers, among others. For additional information, including a full list of award winners, visit www.PressGaney.org .

We will email the press kit to providers on December 10th, as well as posted on our website, with information related to this award.

Compliance

Mandatory Special Needs Plan Training

Minnesota Senior Health Options is a Special Needs Plans (SNPs) product offered by both HealthPartners and UCare. This fully-integrated Medicare and Medicaid product is designed for subscribers age 65 and over who have special health concerns and/or needs.

The Centers for Medicare and Medicaid Services (CMS) requires all doctors and staff to complete an annual Special Needs Training. Instructions, training materials, a FAQ document and tracking log are available now on ChiroCare.com .

Please plan to spend 30 to 60 minutes reviewing the materials with your staff. Then fill out the training log and keep it in your files for reference (you do not need to submit your training log to us).

The deadline for this year’s training is December 31, 2018.

Due Now – Disclosure of Ownership and Cultural Competency

Red FlagFulcrum is currently collecting information regarding Cultural Competency training. This is a requirement from 42 CFR 438.10 of the Managed Care Federal Regulation . It requires providers who provide health care services to Minnesota Health Care Programs (MHCP) members enrolled in a Managed Care Organization (MCO) must confirm compliance with the requirement of cultural competency training and accessibility for people with disabilities.

There is not a single, specified course that must be completed. There are multiple training opportunities available through a variety of sources. You do not need to validate your course choice with Fulcrum, the discretion is left to you and your clinic.

Fulcrum is requesting that each clinic complete the online form by November 30, 2018. Click here to access the online form. This online form is located on a secure, encrypted webpage.

Administrative

How do I check a member’s eligibility and benefits?

Fulcrum suggests that providers and their billing offices use the health plan provider website and portal. These resources have the most up-to-date information to help you find what you need about a member’s coverage and benefits:

You will still find the following resources on ChiroCare Connect:

  • Credentialing policies
  • Clinical policies
  • Provider Manual
  • UM transition information
  • Resources and tools for the new UM program

Where do I find Fulcrum’s Clinical Policies?

Fulcrum Health’s clinical policies are found online atChiroCare Connect . We will notify you of any changes to the clinical policies 45 days in advance of a change. We will mail, fax or email the clinical criteria upon request. If you would like a copy of the clinical policy when a denial determination has been made, a request can be made by calling Fulcrum’s provider services line at 877-886-4941 x207. You may obtain the criteria in person, by mail, fax or email.

Education

2019 Claims Submission Changes for UCare Choices Plans

Effective January 1, 2019, UCare will make changes that affect claims submission for UCare Choices and Fairview UCare Choices plans (to be renamed UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview on January 1, 2019).

UCare is implementing a new claims system platform over the next two years. The January 1 changes will help prepare for the transition, assist in streamlining claims processing and improve efficiencies of claims routing to our primary claims adjudicator.

The following changes will apply to only Individual and Family Plans effective 1/1/19:

  • New Payor ID
  • New Member ID and format

Read the full bulletin here.

2019 Center of Excellence Applications Open November 1st

Fulcrum is pleased to announce ChiroCare by Fulcrum Health Centers of Excellence (CCoE) application process is open to the entire ChiroCare network. We encourage you to take a close look at the CCoE program overview . The self-assessment tool will assist with determining your readiness to apply.

We will accept applications starting November 1 st from network providers who believe their clinics meet the Centers of Excellence criteria. The application period is open until March 1, 2019.

Current CCoE’s do not need to re-apply. Verification review of records will begin in January 2019.

If you have any questions about the ChiroCare Centers of Excellence program, please contact Dr. Vivi-Ann Fischer at 763-204-8570 or v.fischer@fulcrumhealthinc.org .

Patient Satisfaction – Front desk staff has an impact

One of the components of the Triple Aim is Patient Experience. Ensuring your patient’s have a positive experience in your clinic begins much earlier than in the treatment room. Good patient experience begins when they first call or enter your clinic. This means the front desk staff is a critical component to a positive patient experience and high patient satisfactions scores.

Below are some simple things front desk staff can do to ensure the patient feels welcome and engaged.

  • Answer the phone with a friendly voice
  • 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 their 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

A few other things that can ensure a positive patient experience are:

  • Maintain a clean and uncluttered front desk and waiting area
  • Keep loud noises to a minimum
  • 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

Moving or Retiring? Let us Know!

Address Book IconIt 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.

We appreciate your continued partnership!