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December 2018 News Flash

December 28, 2018

In this issue

  1. Accepting now – 2019 Center of Excellence Applications
  2. Press Ganey Promotional Materials
  3. Special Thanks to Fulcrum’s Advisory Committee
  4. Important Information Regarding Locum Tenens and Billing Practices
  5. Is Your Chiropractic License Up to Date?
  6. GHP Claims are Transitioning to the Quartz Claims System
  7. Fulcrum’s new utilization management (UM) program
  8. Moving or Retiring? Let us Know!

Accepting now – 2019 Center of Excellence Applications

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 invite those network providers who believe their clinics meet the Centers of Excellence criteria to apply. 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.

Press Ganey Promotional Materials

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 95th percentile or above on measures of patient experience. You are truly improving the quality of our communities – and we thank you. We encourage you to also promote this good news in your clinic and your community.

To let your community know of this achievement, we are providing you with some template tools that you can customize.

Download the promotional packet here . (This is a zip file that contains all the promotional documents)

The packet includes:

  • Copy that can be used in an email to patients and community members or in a newsletter from your clinic (if you have a regular client newsletter that you produce)
  • Copy that you can use on your website
  • A social post for Twitter and Facebook that you can customize and use on your clinic or personal social pages
  • A copy of the news release that Fulcrum has been distributed.
  • Guardian of Excellence graphic image that can be used on your website and in social media

If you have questions about any of these tools or need assistance with implementing them, please don’t hesitate to contact us at info@fulcrumhealthinc.org .

Special Thanks to Fulcrum’s Advisory Committee

Several chiropractors contribute to our continuous quality improvement initiatives by offering suggestions and serving as the voice for Fulcrum Health. They are routinely called upon to weigh in on quality improvement initiatives, provider and patient surveys, clinical tools, and administrative processes. Committee Members have proved invaluable as we advance our efforts in paying for value-based care.

Thank you to the 2018 Field Advisory Council! 

  • Michael Bawek, D.C.
  • Jeffrey Bonsell, D.C.
  • Steven Dandrea, D.C.
  • Mark Dehen, D.C.
  • Amanda Fitzgerald, D.C.
  • Joel Fugleberg, D.C.
  • Kristina Fruechtl, D.C.
  • Melissa Kolb, D.C.
  • Adam Millsop, D.C.
  • Julie Schmidt, D.C.
  • Jacob Sundberg, D.C.
  • Jeff Varner, D.C.
  • Art Volker, D.C.
  • Josh Watkins, D.C.

Compliance

Important Information Regarding Locum Tenens and Billing Practices

This month’s article will look at the use of locum tenens providers and our provider’s obligation when moving, retiring, or selling your practice. While locum tenens are allowed to bill under your name, the paperwork must be filled out completely and submitted to Fulcrum Health prior to services being rendered to avoid a violation of your contract with Fulcrum Health and possibly a violation of the False Claims Act (FCA). 

For more information on locum tenens and to request the forms, please call our Credentialing department at: 1-877-886-4941 x203

Please be aware: Any claim submitted under the credentials of a different provider than the one who provided services in order to obtain payment is considered a false claim and most likely a fraudulent practice. Violations of this requirement can cause you to be immediately termed from the network. Additionally, improper payments made to you will often times be recouped.

For providers moving or retiring, it is vital that you report any practice changes to ensure that we have your current information. Our Provider Update tool within ChiroCare Connect is a quick and easy way to report these changes. Simply select the “Billing Information Update” option within the Provider Update tool. Please be sure to let us know as soon as possible of any upcoming change.

If you know or suspect fraud, waste and/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.). 

If you have any non-PHI related questions, please direct them toCompliance@FulcrumHealthInc.org.

Administrative

Is Your Chiropractic License Up to Date?

For providers who have not renewed their chiropractic license for 2019, please ensure you renew before the states deadline. Every year, a few providers miss the deadline, and are disappointed to learn that claims will not be reimbursed for the lapsed license period. Ultimately, network participation will be terminated if the license is not renewed.

Minnesota providers, visit the Minnesota Board of Chiropractic Examiners for more information.

  • License renewal required annually by December 31st.

Wisconsin providers, visit Wisconsin’s Department of Safety and Professional Services for more information. 

  • License renewal required by December 14th of even years.

North Dakota providers, visit the North Dakota Board of Chiropractic Examiners for more information.

  • License renewal required by the first day of September of each year.

South Dakota providers, visit the South Dakota Department of Health for more information.

  • License renewal fees are due by December 31st of each year.

Iowa providers, visit the Iowa Department of Public Health for more information.

  • License renewal is generally required by June 30th of even-numbered years.

Nebraska providers, visit the Nebraska Department of Health and Human Services for more information.

  • License renewal required by August 1st of even-numbered years.

GHP Claims are Transitioning to the Quartz Claims System

Quartz is transitioning Gundersen Health Plan, Inc. (GHP) claims to the Quartz claims platform. They have stopped processing GHP claims through the legacy claims processing system beginning December 14, 2018.

Please submit any claims with dates of service in 2018 or earlier as soon as possible. As of now, they will be processing claims manually for claims submitted with 2018 dates of service or earlier. Please continue to send claims for GHP with dates of service for 2018 or earlier to the mailing address you are currently using. 

Click here for additional information.

Fulcrum’s new utilization management (UM) program

Fulcrum’s new utilization management (UM) program will start us on the journey to value-based payment by shifting the focus from service management to quality management identified through outcome assessments.

This 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 .

Fulcrum’s new UM program, called QConnect, will roll out in 3 phases: Education, Adoption, and Performance

What does the new UM program mean for me as a provider?

The Fulcrum UM program, called QConnect, will assist providers in sharing patient-centered information and validated outcome measures. These quality measures support the necessity for treatment and demonstrate the value of care.

  • Treatment Decision Support
    • Real-time treatment trial recommendations are provided based on the patient–centered information. Reporting attributes of risk factors or delayed recovery will assist with defining patient complexity.
  • Collecting Outcomes
    • QConnect assists providers with sharing validated outcome measures to identify and differentiate quality of care.
    • It also creates a measure to inform providers of their quality of care as compared to their peers. Understanding quality outcomes will assist us in identifying best practice approaches.

Watch for additional information by email and US mail!

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!