In this issue
- Save the Date
- Calling All Innovators!
- Reminder! Incentive Opportunity
- Learning Hub
- Billing Medicare Advantage Members FAQ
- Fulcrum’s Statement About Incentives
- Provider Satisfaction Survey – Coming Soon!
- NewsFlash and Email Communications
- Moving or Retiring? Let us Know!
Fulcrum Health is excited to present our Symposium and Awards Dinner on November 21, 2019 at US Bank Stadium!
In addition to the informative speaker line-up, there is an optional 45 minute stadium tour which may include the field, Vikings locker room, Vikings interview room and other highlights like the Press Box, a suite, club spaces, and the operable doors.
Attendee registration opens August 19th.
For more information, please visit our event website at fulcrum2019.voicehive.com.
Is your clinic working to change the way it delivers patient-centered care?
Or towards a successful team-based care approach?
If so, then Fulcrum Health would like to recognize you for your efforts at our upcoming symposium !
As a provider, you can apply for one or both awards with the award recipients recognized at our November 21st symposium at US Bank Stadium .
Our selection committee will review the applications using specific criteria and notify the winners in mid-September.
Apply here today!
Deadline for submission is September 3, 2019.
We are now offering an incentive for eligible clinics in the A and CCoE assigned tiers based on clinical outcome submissions. In addition to the financial incentive, submitting your clinical outcomes shows how you compare to your peers and generates shared learning from colleagues. More information on the incentive and the eligibility guidelines are available in the Learning Hubunder the Incentive tab.
As of 6/1, the Learning Hub has been updated based on provider feedback and additional resources. If you have not been to Fulcrum’s Learning Hub to see the latest enhancements or are a first time visitor, please click here .
In Fulcrum’s Learning Hub you will findQConnect login access, informative videos, sign-up availability for a telephonic training session with a QConnect Specialist, and important education materials.
This resource will continue to be updated based on enhancements and new educational learnings so please check the site regularly.
As a reminder, for B and C tier assigned providers, the use of Fulcrum Health’s utilization management program, QConnect, is required to obtain authorization to prevent interruption to claims payments.
If you have questions regarding the billing of non-covered services for Medicare members, please read our helpful FAQ located here .
Several key points to remember are as follows:
- For potentially non-covered services for Medicare Advantage members, e.g. maintenance care spinal manipulations, providers must first obtain an authorization denial prior to the service being rendered in order to bill the patient even if they are confident the care is maintenance in nature and excluded from the patient’s coverage. Failure to obtain the organization determination denial will prohibit the provider from billing the patient.
- Once an authorization denial is submitted, you may then use Fulcrum’s Financial Disclosure Form (Medicare member version).
- As of 2014, CMS has deemed the Advance Beneficiary Notice (ABN) insufficient for Medicare Advantage members.
- If this is a never-covered service, you may go straight to the Financial Disclosure Form (FDF) process, but recall that this form needs to be signed by the patient prior to the service(s) being rendered. You should use Fulcrum’s FDF available on our website to ensure compliance with CMS regulations.
Fulcrum’s Provider Services Department (877) 886-4941
At Fulcrum we affirm that:
- Utilization Management decision making is based only on appropriateness of care, service, and the existence of benefit coverage.
- Fulcrum does not specifically reward practitioners or other individuals for issuing denials of coverage.
- Incentive programs are not utilized to encourage decisions that result in under-utilization.
Providers can find this statement here:
Be on the look out for the Provider Satisfaction Survey in your mailboxes in mid-August!
Please complete the survey and return it in the self-addressed, postage-paid envelope, no later than Friday, October 4, 2019.
We value your opinion. The feedback we gather from this annual survey helps identify areas of interest and of concern to the ChiroCare by Fulcrum Health network. We also use your responses to assist in the development of new programs, supporting materials, and educational opportunities.
If you have any questions, feel free to contact us at email@example.com or (763) 204-8570 and we’ll be happy to assist you. Thank you for taking the time to share your feedback and ideas with us!
If you no longer wish to receive NewsFlashes or other important electronic emails, please firstname.lastname@example.org and state that you no longer wish to receive the publication, and include your name, provider group name, and Tax ID #.
Please note that per Fulcrum’s contractual agreements, this publication needs to be received by at least one individual within your clinic.If someone in your organization would like to be added to the NewsFlash distribution list, please click here . Typically, you will only receive 1-2 emails per month.
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.