Newsletters

In this issue

1. Symposium Update
2. Ballot for Elected Directors
3. Annual Training
4. Mandatory Special Needs Plan Training
5. Disclosure of Ownership and Cultural Competency Requirement
6. Let Your Voice Be Heard! Provider Satisfaction Survey
7. 2019 Center of Excellence Applications Open November 1st
8. UCare Renames Three Products for 2019
9. Value-Based Care – Where do I start?
10. Moving or Retiring? Let us Know!

Symposium Update

The October Care Connections Symposium: Building Bridges for Integrative Care successfully facilitated conversations between medical and chiropractic doctors. The event was presented in collaboration with Twin Cities Orthopedics and held at Training Haus, located on the Viking Lakes campus, home of the Minnesota Vikings. Presentations focused on team-based care as an approach to pain management.

Industry experts representing hospitals and health systems, chiropractic providers, payers, rehabilitation professionals, and integrated medicine providers shared research and perspectives on how a team-based approach can influence the patient experience and improve long-term outcomes, along with information about the research behind solutions for provider burnout. Experts discussed how different care providers can come together across the care continuum to find the best course for pain management for each patient.

During the event, we were excited to acknowledge the great work that selected providers completed in regard to our ChiroFirst study with an awards ceremony and photo opportunity. Learn more about our ChiroFirst study.

Ballot for Elected Directors

In accordance with the Fulcrum Health, Inc. (Fulcrum) bylaws, as a network provider, you have the opportunity to vote for candidates to serve on Fulcrum’s Board of Directors. Visit https://www.surveymonkey.com/r/BallotElectedDirectors2019 to access the ballot. The ballot must be completed online on or before Friday, November 9, 2018 in order to be included in the final calculation.

Thank you in advance for your participation in the election process.

compliance

Annual Training

The focus of this month’s article will be on the training requirements set forth by the Centers for Medicare and Medicaid (CMS) and the Code of Federal Regulations (CFR).
CMS requires all organizations that provide health care services or administrative services for Medicare-eligible individuals under Medicare Advantage or Part D programs to complete annual Compliance and Fraud, Waste & Abuse Training.

The CMS trainings can be accessed through the Medicare Learning Network (MLN) Learning Management System (LMS) website here: Medicare Compliance & Fraud Waste & Abuse Training. Once registered, you will have to add the Medicare Compliance and Fraud Waste and Abuse Trainings individually.

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 to Compliance@FulcrumHealthInc.org .

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.

Disclosure of Ownership and Cultural Competency Requirement

Fulcrum is currently collecting information regarding Cultural Competence 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

Let Your Voice Be Heard! Provider Satisfaction Survey

If you have not done so already, please fill out the provider satisfaction survey that was mailed to network providers last week. Please complete the survey and return it in the self-addressed, postage-paid envelope, no later than Wednesday, November 14, 2018.

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 or need a survey mailed out to you, please feel free to contact us at info@fulcrumhealthinc.org 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!

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 .

UCare Renames Three Products for 2019

After introducing a new logo earlier this year, UCare will change the name of three of its product lines beginning January 1, 2019:

• UCare for Seniors, a Medicare Advantage plan, will be renamed UCare Medicare Plans.
• UCare Choices, Individual and Family plans available through MNsure, will be renamed UCare Individual & Family Plans.

Fairview UCare Choices, Individual and Family plans available through MNsure, will be renamed UCare Individual & Family Plans with Fairview.

The new names are effective January 1, 2019. However, you may see them in advertising and various communications preparing members and providers for the new year.

Please update your systems to reflect this change beginning January 1, 2019. When you receive communications from UCare about any of these products in the coming months, you will see both the current and new names listed to help prevent confusion.

For 2019, members in these plans will receive new member ID cards, additionally UCare Individual & Family Plan members as well as UCare Individual & Family Plans with Fairview members will receive new member ID numbers . UCare strongly recommends that providers ask to see the member’s ID card for current information and a photo ID to guard against medical identity theft. Member eligibility and benefits should be checked prior to every scheduled appointment to determine membership status, coverage status, applicable copayment, coinsurance and deductible amounts.

Value-Based Care – Where do I start?

Over the past several years, Medicare and commercial payers have moved toward value-based payment, shifting from payment on the volume of care, to payment more closely related to outcomes of care. New value-based payment models being developed will use measures of quality and cost to determine payment for providers.

Value-Based Care: Self-Assessment Quiz

Take a quick 3-question quiz to identify where you are in the continuum of health care payment reform.

1. Do you know where to find patient reported outcome measures (PROMs)?
2. Which patients are you currently using PROMs?
3. Do you have a clinic work flow process for incorporating PROMs?

Answer to #1
Patient reported outcome measures (aka Outcome Assessment Tools – OATs) can be found at ChiroCare Connect/Clinical Resources/Outcome Assessment Tools. The commonly used outcomes are the low back disability index (The Primary Care Low Back Disability Questionnaire (PCLBDQ)); neck disability index; headache disability index; Koos -Knee injury and Osteoarthritis Outcome Score; Hoos- Hip injury and Osteoarthritis Outcome Score; Lower Extremity Functional Scale, Functional Rating Index, Shoulder Pain and Disability Index; and DASH- The Disabilities of the Arm, Shoulder and Hand.

Answer to #2
Often practitioners use outcomes on Medicare, auto and work comp when all patients should be reporting outcomes to create measurable goals that can be tracked and demonstrate improvement with care.

Answer to #3

• Make sure everyone in your office and billers understand why your practice is collecting outcomes data. Involve everyone with planning and implementation.
• Educate your patients, these measures assist in the doctor determining the best care for them.
• If you are not already using outcomes on all patients, begin using the tool with new patients and returning patient exams. These measures assist with creating and tracking goals in the patient’s treatment plan.
• Begin with the most frequent patient conditions such as low back and neck disability outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875909/

In this issue

1. A Few Spots Left! Madison, WI Symposium
2. Disclosure of Ownership and Cultural Competency Requirement
3. Let Your Voice Be Heard! Provider Satisfaction Survey
4. Compliance Article
5. Fee-For-Service Banished?

A Few Spots Left! Madison, WI Symposium

Register here.

• Engaging speakers – DC’s, MD’s, and more
• Audience interactive panel discussion
• Continuing education credits
• Lunch & refreshments provided
• 1 day only – 10:00 a.m. – 5:00 p.m.

Click here to register for this exciting event!

Administration

Disclosure of Ownership and Cultural Competency Requirement

In accordance with regulatory requirements of the Minnesota Department of Human Services (DHS) and the Centers for Medicare & Medicaid Services (CMS) regulations, all payors, including Fulcrum Health, Inc. (Fulcrum) must collect and maintain information regarding disclosure of ownership and management information and cultural competency from all providers in its network on an annual basis.

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.

Let Your Voice Be Heard! Provider Satisfaction Survey

Please look for the Provider Satisfaction Survey in your mailboxes within the next week. Please complete the survey and return it in the self-addressed, postage-paid envelope, no later than Wednesday, November 14, 2018.

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 info@fulcrumhealthinc.org 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!

COMPLIANCE

This month’s article will focus on the Disclosure of Ownership form Fulcrum asks all clinics to complete each year. This form is related to disclosure of ownership, business transactions and excluded providers.

The Disclosure of Ownership is a requirement set forth by the Code of Federal Regulations ( 42 CFR Part §455 ) and from the Minnesota Department of Human Services (DHS) and the Centers for Medicare and Medicaid (CMS). These entities require all health plans and their delegates, including Fulcrum, to ensure that its network providers submit documentation.

While Fulcrum asks for this information annually, there are additional times you may need to complete this information. The Disclosure of Ownership form must be completed at the following times: upon initial contract with Fulcrum, when your information changes, and/or upon contract renewal. It is important to remember that if there are any changes to the information listed on your Disclosure of Ownership form, you must send an updated form to Fulcrum within 35 days. While Fulcrum asks you to complete the Fulcrum Disclosure of Ownership Form, you are able to submit your disclosure form used for other health insurers when the identical information is requested.

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 to Compliance@FulcrumHealthInc.org.

Education

Fee-For-Service Banished?

Adam Boehler, Director of the Center for Medicare and Medicaid Innovation (CMMI), said at a recent briefing, “How much time do doctors spend documenting and coding for revenue? That’s a terrible system.”

He considers the top priorities to be:

• Patient – how do you build a market [that answers] consumers’ desires” in terms of high quality and low cost?
• Provider – empowered and accountable
• Payment for outcomes – “Most of the time [if] you see something wrong in the healthcare system, it’s because we’re paying the wrong way. So we’re looking at a variety of different areas where we say, ‘Does this make sense or not?’ … [For example], if you call 911 today, the ambulance isn’t paid unless it takes you to the hospital. That’s a silly incentive … Let’s pay if somebody can take care of [the patient] in the home if that works”
• Prevention – “Right now, medical care is siloed from housing, social services, and food stamps. If you were going to design the system today from scratch, you wouldn’t silo those; you’d look at the whole person.”

To read more, please visit https://www.medpagetoday.com/practicemanagement/reimbursement/74864

Where do I start?

1. Find several outcome tools on ChiroCare Connect under the Clinical Resources/Provider Tools/ Outcome Assessments Toolbox. Begin with the Neck Index and Primary Care Low Back Disability Questionnaire (PCLBDQ)
2. Use these outcomes with patients during the initial & any re-exams
3. Incorporate outcome measurable goals into treatment plan

In this issue

1. SAVE THE DATE! MN & WI Symposiums
2. PROMs – Patient Reported Outcome Measures
3. Utilization Management Improvements Coming in Late 2018
4. HIPAA Compliance Monitoring
5. Moving or Retiring? Let us Know!

SAVE THE DATE! MN & WI Symposiums

Please join us for one or both of our symposiums!

• Continuing education credits
• Engaging speakers – DC’s, MD’s, and more
• Audience interactive panel discussion
• Lunch & refreshments provided
• MN Symposium 8:00 a.m. – 4:00 p.m.
• WI Symposium 10:00 a.m. – 5:00 p.m.

Detailed agendas, invitations, and registration to follow.

Education

PROMs – Patient Reported Outcome Measures

Measurable goals and patient progress are an expectation in healthcare today. 

What is the best method to accomplish this task?

Patient reported outcomes allow for the proper management of a patient’s care plan by either demonstration of treatment success or identifying a need to adjust the treatment approach. The initial outcome assessment score establishes a baseline from which to measure progress (or lack of) through periodic re-assessment to determine if the anticipated goals are attained.

Standardized outcome assessment tools provide a common language with which to evaluate the success of chiropractic care and allows for comparisons of effectiveness to other practitioners. Improved clinical practices can be determined through different intervention approaches and tracking outcomes.

Using outcomes shows:

• Meaningful, measurable goals can be established with patients using this simple tool
• Demonstrate the value of your care
• Compare the quality of your care with your peers
• Benchmark yourself against national recognized performance measures
• Improve clinical practices approaches by tracking successes with chiropractic care
• Driving quality payment initiatives

Where do I start? 

Find several outcome tools on ChiroCare Connect under the Clinical Resources/Provider Tools/ Outcome Assessments Toolbox Begin with the Neck Index and Primary Care Low Back Disability Questionnaire (PCLBDQ).

ADMINISTRATIVE

Utilization Management Improvements Coming in Late 2018

As mentioned in previous Newsflashes, 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 care
• Best practice guidelines
• Proactive coding tips

Introduce Quality

• Collect patient functional outcomes data
• Improve measures that result in positive outcomes for patients
• Improve understanding of medical risk factors
• Enhance treatment decision support algorithms by incorporating risk factors and functional outcomes
• Additional information to come in future Newsflash’s!

COMPLIANCE

HIPAA Compliance Monitoring

This article will provide guidance on ways to monitor your clinic’s compliance with the Health Information Privacy and Accountability Act (HIPAA).

HIPAA requires organizations that handle protected health information (PHI) to regularly review the administrative, physical and technical safeguards that are in place to protect the privacy and security of the patient information. It is critical that your clinic has policies and procedures in place that address the expectations and requirements of working with PHI. A simple way to find out if your policies are effective and to gauge how well your staff are following your organization’s policies is to observe staff during their day-to-day activities. This can be achieved by conducting routine walk throughs of your organization’s facilities. A walkthrough can help you uncover potential weaknesses in your policies, procedures or day-to-day operations. Here are some tips to consider before conducting a walkthrough:

• Consider using a checklist – Remember, not every checklist will work for every clinic. Be sure to find one relevant to your staff and clinic.
• Be “anonymous” – do not announce to staff that you are going to be monitoring their activities. This gives you a more accurate view of how your office is being run on a day-to-day basis.
• Observe whether staff actions are in line with the policies and procedures already in existence.
• Do not limit your walkthrough to just office hours. Check for privacy violations after staff have left for the day (i.e. computers locked, patient records properly put away, etc.).
• Conduct walkthroughs regularly to stay in touch with how operations are being conducted. As staffing and policies change, you will want to conduct walkthroughs to ensure that staff were trained appropriately and/or that policies changes are being implemented correctly.
• If you notice any violations or variations from expectations, you will need to speak with your staff and ensure that the identified issues are addressed going forward. This may mean that your policies and procedures need to be updated to address the issues that were found.

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 any non-PHI related questions, please direct them to Compliance@FulcrumHealthInc.org.

In this issue

1. ChiroCare Centers of Excellence Named for 2018
2. Network Communication
3. Revised Provider Manual Available
4. Utilization Management Improvements Coming in Late 2018
5. Submitting Proper Claims
6. Front Desk Staff Have an Impact on Patient Satisfaction
7. Moving or Retiring? Let us Know!

ChiroCare Centers of Excellence Named for 2018

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.

Network Communication

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:

• NewsFlash
• Special Bulletin
• Credentialing / Recredentialing
• Surveys
• ChiroCare Centers of Excellence
• Ballot for Elected Directors
• Invitations to Fulcrum Health educational events

ADMINISTRATIVE

Revised Provider Manual Available

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.

New contact information
Credentialing: (877) 886-4941 x203 or credentialing@fulcrumhealthinc.org
Contracting: (877) 886-4941 x205 or contracting@fulcrumhealthinc.org

You may view and/or download a printed version of the manual by logging onto ChiroCare Connect.

Utilization Management Improvements Coming in Late 2018

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

Introduce Quality

• 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!

COMPLIANCE

Submitting Proper Claims

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
• NPI
• 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.

Education

In this issue

1. Utilization Management Improvements Coming in Late 2018
2. ChiroCare Centers of Excellence Program Update
3. Preventing Claim Denial
4. Emailing PHI
5. Comparison of the Effectiveness of Acupuncture Treatment and Local Anaesthetic Injection for Low Back Pain
6. Moving or Retiring? Let us Know!

Utilization Management Improvements Coming in Late 2018

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

Introduce Quality

• 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!

ADMINISTRATIVE

ChiroCare Centers of Excellence Program Update

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.

Preventing Claim Denial

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.

COMPLIANCE

Emailing PHI

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.).

Education

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.

In this issue

1. Fulcrum Health’s Symposium is a Success!
2. Fulcrum’s 2017 Annual Report is Now Available
3. Credentialing Improvements Coming Soon!
4. False Claims Act & Billing as the Servicing Provider
5. Audit Protection – Webinars
6. 2018-2019 ACA CPT & RUC Advisor Fellowship
7. Moving or Retiring? Let us Know!

Fulcrum Health’s Symposium is a Success!

As an added value to our network providers we held the event, “Care Connections: Building Bridges for Integrative Care ,” which took place May 17 at the Sheraton Hotel in Bloomington, MN and included 5 free CE credits.

Discussions focused on how conservative care is a successful option for pain management when traditional medical procedures don’t offer relief, as well as methods for doctors and chiropractors to work together to find the best course for pain management without reliance on opioids. Several industry experts spoke at the event, representing hospitals and health systems, chiropractic care, payers and insurers, rehabilitation and integrated medicine providers.

We addressed topics of growing interest among health care providers and consumers who are calling for treatment options that reduce reliance on opioids.

“Real items we can take back to the clinic today”

– Symposium Attendee

Key takeaways for attendees included:

1. Motivational interviewing builds rapport with patients and helps doctors gather clinical and lifestyle information in a conversational manner. This type of patient engagement enhances communication and relationships with patients, leading to trust and patient satisfaction, as well as improved outcomes.
2. Strategies to increase patient commitment to change include using “change talk” (statements and/or behavior that reflects movement toward changing a targeted behavior), a focus on patient readiness to change, and understanding the stages of change.
3. Patients stress the importance of alternative care methods and the positive impact of chiropractic care. Patient guests shared emotional stories highlighting the improved quality of life they were able to achieve through Fulcrum network providers.
4. Findings show that opioids can cause patients to become hypersensitive and make pain worse in the long-term, which makes it beneficial for patients to learn self-care. Doctors must create realistic expectations about the recovery process to help manage patient expectations about pain and recovery. Pain will decrease with chiropractic care, allowing the patient to think differently about pain and increase their ability to self-manage.

“We live in a world so focused on opioids that sometimes people forget there are other non-pharmacologic, conservative treatment options that can be used prior to or in combination with opioid pain medications. Our symposium was meant to reinforce that there are effective, evidence-based, low-risk, conservative care options for managing pain that can help people in ways that truly improve their quality of life,” says CEO, Patricia Dennis. “We examined how chiropractic networks use a multi-modality approach to overall patient health and wellness and chronic pain management, and we also offered patients a unique opportunity to share their struggles and stories of how physical medicine has impacted their lives for the better.”

For more information and to view testimonials and the summary, visit our Fulcrum Health Symposium page.

Watch for additional events coming soon!

Fulcrum’s 2017 Annual Report is Now Available

An electronic version of Fulcrum’s 2017 Annual Report is now available.

Please feel free to view/download it on our Media Room webpage at FulcrumHealthInc.org .

Credentialing Improvements Coming Soon!

We are pleased to announce that Fulcrum Health will soon begin processing credentialing applications in-house rather than outsourcing to a vendor. Initial credentialing is the collection and evaluation of a practitioner’s application and supporting documents to join Fulcrum’s network. Recredentialing is a similar process which is conducted every 3 years and is used for determining continued participation. Fulcrum is making this change to improve service to our network providers by maintaining a transparent credentialing process with clear instructions, timely processing of applications, and prompt response to inquiries.

Watch for updates in future News Flash articles.

COMPLIANCE

False Claims Act & Billing as the Servicing Provider

This month’s article will look at the importance of billing for services as the servicing provider and how billing under another provider’s name is a contract violation with Fulcrum Health and may possibly be a violation of the False Claims Act (FCA). Violations of this requirement may result in immediate termination from the network. Additionally, payment to the provider may be recouped.

Services provided to a member must be billed by the provider that provided the procedure(s). The exception to this rule is a valid locum tenens agreement between the provider and Fulcrum.

In the situation where a clinic has network and non-network providers practicing, some patients may not be able to see all providers if insurance is being billed. If a patient sees a non-network provider, that provider may not bill under the name of another provider in that clinic who is a network provider with the patient’s insurance company. Regardless of network status, all claims must be submitted under the name of the treating or supervising provider. If claims are submitted under a different name, this may be considered potential fraud and a violation of the FCA.

In 31 U.S. Code § 3729 it states:

“ (1) In GENERAL. — Subject to paragraph (2), any person who—

(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;

(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim…

…is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 ( 28 U.S.C. 2461 note; Public Law 104–410   [1] ), plus 3 times the amount of damages which the Government sustains because of the act of that person.”

Proper billing does not just apply to government programs, like Medicare. Typically, private insurance companies adhere to these same standards across all lines of business. For more information on Fulcrum requirements, please review your signed provider contract and the 2018 Provider Manual.

If you have any questions, not containing PHI, please direct them toCompliance@FulcrumHealthInc.org . Additionally, 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.).

Education

Audit Protection – Webinars

Take advantage of our Webinars from coding and audit expert, Dr. Gwilliam providing insight to what auditors look for when reviewing documentation and record-keeping, such as:

• Establishing medical necessity
• Treatment plan development and re-evaluation
• Demonstrating patient progress

• Create care plans that establish need for care
• Learn how payers and auditors use treatment plans and measurable goals to determine if care is payable

• Learn how and why to update treatment plans at a re-evaluation
• Tell the story of ‘patient progress’ using measurable goals of Outcome Assessment Tools

• Learn how to document patient progress
• Assessments updates for daily visits
• Recording the ‘patient progress’ story with your SOAP notes

2018-2019 ACA CPT & RUC Advisor Fellowship

ACA seeks applicants for its CPT/RUC Advisor Fellowship for the 2018-2019 program year. The program provides future health policy leaders with a deeper understanding of code development and valuation, coding guidance, payer engagement and payment reform. The program involves a year-long learning opportunity, which includes engagement in the CPT and RUC processes.

Interested ACA members are encouraged to complete and submit their application by Friday, June 15 . Notifications will be made in mid-August. To apply, click here .

Moving or Retiring? Let us Know!

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.

We appreciate your continued partnership!

In this issue

1. You Are Invited! Fulcrum Health’s Symposium & Annual Meeting
2. Improving the Patient Experience
3. Protecting PHI
4. Don’t forget! May is Mental Health Month
5. The Simple Power of Hand-Washing – TED Talks
6. Moving or Retiring? Let us Know!

You Are Invited! Fulcrum Health’s Symposium & Annual Meeting

This year, in conjunction with our Annual Meeting, we hope you will join us for our Symposium focusing on Building Bridges for Integrated Care. This Symposium and the 5 continuing education credits are complimentary as one of the many benefits of being a Fulcrum Health provider network member!

Please register at http://www.fulcrumsymposium.eventbrite.com/
Space is limited and filling fast!

Fulcrum’s Symposium & Annual Meeting
Care Connections: Building Bridges for Integrated Care
May 17, 2018
Sheraton Hotel, Bloomington

5 Continuing Education Credits

Agenda (Subject to Change)

Members: Please join us from 10:00 a.m. – 10:30 a.m. for our Annual Meeting.

Improving the Patient Experience

At Fulcrum Health, we support a comprehensive approach to improving the patient experience and have adopted a guiding principle to put patients first.

Putting patients first means:

• Safe care
• High quality care
• High value care
• Overall patient satisfaction

In partnership with Press Ganey, a third-party vendor that supports health care providers in understanding and improving the patient experience, we evaluate our patients’ feedback using a quarterly Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) survey. We then use these findings to drive improvement initiatives within the organization. This tool also enables us to compare our network patient satisfaction ratings with regional and national providers, including medical doctors, hospitals, health care systems, and health plans, among others. The Press Ganey Guardian of Excellence Award recognizes leading health care organizations that perform in the top 5 percent of clinics reporting patient satisfaction data. We are pleased to announce that Fulcrum Health is a 2-time recipient of this award.

In 2017, we continued our quality initiative of improving the patient experience by providing network education resources on infection prevention such as newsletter articles and electronic training materials. By taking these steps, we hope to further enhance the patient experience and safety at our network clinics. Preliminary results indicate this important initiative and the corresponding education had impact on the patient experience. Safety practices rose from 78.02% to 80.2% and the national percentile ranking rose from 40% to 51%, hitting our goal of achieving over the 50 th percentile.

2017 Patient Satisfaction Results

Total number of responses = 5,180

Gender

• Male 31%
• Female 69%

Age Distribution

• 18-34 9%
• 35-49 19%
• 50-64 34%
• 65-79 31%
• 80+ 8%

Key Takeaways

• 97% of respondents said “Yes, definitely” when asked if the office staff or receptionists treated them with courtesy and respect, compared to 95% nationally
• 96% of respondents reported they would definitely recommend the provider’s office to family and friends, as compared to 91% nationally
• 99% of respondents stated they were treated with respect during their most recent visit, compared to 79% nationally
• 98% of respondents said “Yes” when asked if they saw the provider within 15 minutes of their appointment time, compared to 84% nationally
• 97% of respondents said “Yes, definitely” when asked if the provider gave them easy-to-understand instructions, compared to 93% nationally
• 89% of respondents ranked ChiroCare providers at either a 9 or 10 out of 10, compared to 86% nationally

COMPLIANCE

Protecting PHI

According to HIPAA Journal, there were at least 477 data breaches in 2017 affecting upwards of 5 million people. A data breach is confirmed incident where PHI, of one or more individuals, is accessed or used inappropriately. Compared to 2016, the occurrence of data breaches rose 6%. The two biggest causes of data breaches; hacking and insider errors, are issues that can be addressed proactively to help reduce the risk.

One of the biggest IT hacking methods causing a data breach is accomplished through “phishing” (fraudulent email) schemes.

Here are a few ways to identify if an email is a potential phishing scheme:

1. Often, phishing emails contain bad grammar, spelling errors or greetings such as “Dear Customer.”
2. Hover over the “From” email address. If the email address looks suspicious, it may be a sign that this is a phishing email.
3. If the email is asking for personal information such as bank routing numbers, social security numbers or patient information it is likely a scheme. Requests for information of this nature are not sent over email due its sensitive nature.
4. If there is a website link included in the message, hover over it with your mouse and it will show you the full website address. If it looks suspicious, it is possible that this is a phishing attempt.

If you believe you are the victim of a phishing attempt, there are a few things you can do to protect yourself and your clinic.

1. Do not click on the links or attachments in the suspected email. Once they have been clicked, it is possible that malware is now on your network and any PHI on the same network may be at risk.
2. Via telephone, attempt to contact the company that the email came from to verify that it is from them and is a legitimate request.
3. Do not forward the email to other co-workers. This will only increase the likelihood that someone will click on the link/attachment.

For additional information on how to avoid cyber-attacks like phishing, please visit the United Sates Computer Emergency Readiness Team’s website.

To help reduce the risk of an insider (employee, contractor, vendor, etc.) error, you must take proper steps to ensure that all staff are aware of the requirements.

1. Develop policies and procedures that outline the requirements for maintaining and accessing PHI and highlight the importance of accessing on the minimum amount of information needed to complete a job.
2. Conduct routine audits through your electronic medical records (EMR) system to ensure that staff are only accessing the information the absolutely need. If you are not sure how to conduct such an audit, please contact your EMR vendor.
3. Have valid and current Business Associate Agreements (BAA) in place for vendors and/or contractors that have access to your PHI. This will help protect you should they cause a data breach.
4. Have a PHI Risk Assessment protocol in place in case an incident ever occurs.

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 any questions, not containing PHI, please direct them to us at Compliance@FulcrumHealthInc.org.

Education

Don’t forget! May is Mental Health Month

With chiropractic care becoming a standard point of entry for patients, chiropractors can play an important role in identifying signs of depression. The U.S. Preventive Services Task Force recommends all adults be screened for depression, and those who screen positive for depression be appropriately referred for assessment and management.

The Patient Health Questionnaire ( PHQ-2 ) is a two-item self-reporting tool with a purpose to screen for depression in a “first step” approach. Patients who screen positive should be further evaluated with the PHQ-9 , other diagnostic instrument(s), or direct interview. Click here to view the 12 most common symptoms of depression.

The Simple Power of Hand-Washing – TED Talks

Myriam Sidibe, a public-health expert, gives a powerful presentation on TED.com regarding the simple power of hand-washing. As a warrior in the fight against childhood disease, her weapon of choice is a bar of soap. Check out her brief 12-minute presentation here.

Moving or Retiring? Let us Know!

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. The Provider 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!

In this issue

1. Our Promise
2. SAVE THE DATE – Fulcrum Health’s Symposium & Annual Meeting!
3. ChiroCare and AcuNet Logos updated with a new look!
4. Fulcrum Health is expanding our Acupuncture Network, AcuNet!
5. Business Associate Agreements and Non-Disclosure Agreements
6. Succession Strategies for Your Small Business
7. Moving or Retiring? Let us Know!

Our Promise

   Fulcrum Health develops innovative and inspiring ways to leverage physical medicine that not only lower health care costs, but also achieve better outcomes and increased patient satisfaction.

We are committed to developing our network providers through professional development opportunities, educating on best practices approaches, engaging in peer-to-peer coaching through our clinical officers, and supporting a patient-centered experience.

Our promise is believable because, as a nonprofit, our revenues are funneled directly into our programs, not delivered to shareholders.

If you have any questions regarding our corporate branding, please contact our corporate office at info@fulcrumhealthinc.org or 1-866-714-0524. On behalf of the team at Fulcrum Health, we thank you for working with us to improve the health and wellbeing of our communities.

SAVE THE DATE – Fulcrum Health’s Symposium & Annual Meeting!

This year, in conjunction with our Annual Meeting, we hope you will join us for our Symposium focusing on Building Bridges for Integrated Care.

SAVE THE DATE! Fulcrum’s Symposium & Annual Meeting May 17, 2018 Sheraton Hotel Bloomington Care Connections: Building Bridges for Integrated Care

5 Continuing Education Credits (pending approval)

Speakers and Panel Discussion on pain management topics:

• Expanding solutions through team-based care
• Understanding the Neuroscience of pain management
• Engaging patients in treatment plan

9:30 a.m. – 10:30 a.m. Registration
10:30 a.m. – 4:45 p.m. Symposium

Members – Please join us from 10:00 a.m. – 10:30 a.m. for our Annual Meeting

Detailed agenda and invitation to follow

ChiroCare and AcuNet Logos updated with a new look!

We are excited to announce our products visual identity has changed to be more cohesive with our corporate brand, Fulcrum Health.

Inspiration from the corporate brand along with the color palette of the product brands created the finished product logos. The new logos visually connect our products to each other and the corporate brand which creates a sense of unity.

Our network brands – ChiroCare and AcuNet are established and respected in the industry and will continue to be products we offer our customers – now with a new look!

In the coming months we will be updating business documents and the websites to reflect the updated product logos.

Fulcrum Health is expanding our Acupuncture Network, AcuNet!

In the next 12 months we will be expanding our acupuncture provider network!

This growth reflects patient demand for this treatment. Moving forward, you will begin to see acupuncture articles included in our monthly newsflash.

AcuNet is a fully-credentialed acupuncture network of Fulcrum Health that is comprised solely of LAcs in the Upper Midwest region. Fulcrum Health is a local, non-profit organization that also supports ChiroCare, one of the largest independent chiropractic networks in the Midwest. Similar to ChiroCare, the AcuNet acupuncture network utilizes best-practice approaches to provide professional education, improvement opportunities, and on-going network support to its practitioners.

All AcuNet practitioners must be certified by NCCAOM and licensed by their state’s professional licensing board. Also, it is important to note participation with AcuNet does not affect participation with any health plan networks practitioners are currently contracted with directly. If, however, AcuNet were to be chosen as the preferred acupuncture network by those plans, the LAcs practicing in a clinic would need to be active AcuNet providers for their members to use their network acupuncture benefit.

COMPLIANCE

Business Associate Agreements and Non-Disclosure Agreements

A Business Associate is defined by the Health Information Portability and Accountability Act (HIPAA) as a person, entity or subcontractor outside of the workforce that creates, receives, maintains, or transmits Protected Health Information (PHI) on behalf of a covered entity (covered entities include providers).

HIPAA requires a contract to be put in place between providers and their Business Associates to ensure that the associates protect and safeguard all PHI appropriately. Additionally, these contracts clarify liability and identify the acceptable instances in which PHI can be used and/or disclosed.

When a BAA is properly executed, it moves the liability to the vendor and can help protect you in the case of a PHI breach. However, you must still ensure that PHI is used properly and display appropriate oversight. Should a breach occur, you (as the covered entity) must work with your Business Associate to correct the issue or terminate the agreement. Failure to do so may result in shared liability between you and your business associate.

Cornell Law School defines a Non-Disclosure Agreement (NDA) as, “A legally binding contract in which a person or business promises to treat specific information as a trade secret and not disclose it to others without proper authorization.” A NDA is often used for the purposes of marketing or development and can protect confidential information or transactions. A NDA does not cover PHI and should never be executed when a Covered Entity is looking to safeguard PHI. NDA’s are not required under HIPAA since a NDA implies that no PHI is involved.

Before executing a BAA or NDA, here are some simple questions to ask yourself to determine if one or both are needed:

• Will the contracted person or entity be using PHI to fulfill their job requirements?
• Will the contracted person or entity have access to PHI?
• Are you sharing proprietary, “company secrets” with the contracted person/entity?
• Are you sharing information that is not public with the contracted person/entity?

If you answered “yes” to the first two questions, you will need a BAA with the contracted person/entity.
If you answered “yes” to questions 3 and 4, you will need a NDA with the contracted person/entity.
If you answered “yes” to all of the questions, you may decide to execute a BAA with a NDA addendum.

For more information on BAA’s, or for a template, visit the U.S. Department of Health and Human Services (HHS) website.

If you have any questions, not containing PHI, please direct them to Compliance@FulcrumHealthInc.org . Additionally, 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.).

Education

Succession Strategies for Your Small Business

Many business owners view their life’s work as their identity. But the fact is: You will leave your business.

Don’t wait to address important succession-related arrangements until it’s too late in the process. Consider seeking out professional guidance for the orderly distribution of assets based on a thoughtful approach developed well in advance of the transition.

Here are a few questions to consider:
1) Do you plan to sell, gift, or dissolve your business?
2) Is your successor a family member, key employee, third party?
3) What is the value of your business?
4) Will the sale price, less taxes, sustain your retirement lifestyle and goals?

For more information, review this short article by Fidelity on Business Succession Planning.

Moving or Retiring? Let us Know!

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. The Provider 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!

In this Issue

1. Fulcrum Health Headquarters is Moving!
2. 2018 Centers of Excellence Applications – Extended until April 1st!
3. Billing Members
4. Non-Covered Services
5. 3.11 Restrictions on Claims Against Members
6. CPT 2018 Code Changes for Chest X-Rays
7. Compliance
8. PHQ-2 Assessment
9. Depression Common in U.S., Women hit hardest
10. Moving or Retiring? Let us Know!

We are excited to announce our headquarters are moving to Plymouth, MN!

We will open a new headquarters location in March 2018 where we will make our home at Plymouth Woods Office Center in Plymouth, MN. The new space will accommodate a projected 20 percent staff increase throughout 2018. We are continuing expansion of our physical medicine network across the Midwest which currently features more than 2,400 providers and is available to approximately 1.7 million eligible health plan members. As part of planned staff and sales growth, we are delighted to have hired Shireen Stone as chief operating officer (COO).

The appointment of Shireen Stone to its C-suite and the relocation to the new Plymouth headquarters supports the company’s future growth plans and network expansion efforts.

Stone brings more than 20 years of health care experience in information technology, program management, process improvement, and revenue cycle operations. She will be responsible for the day-to-day operations of Fulcrum Health, as well as maintaining relationships with network providers and partners.

Prior to joining Fulcrum, Stone held leadership roles at Park Nicollet Health Services and HealthEast Care System, and most recently with CliftonLarsonAllen LLP, providing advisory services to a national base of health system, hospital and physician practice clients.

2018 Centers of Excellence Applications – Extended until April 1st!

Fulcrum is pleased to announce Fulcrum’s ChiroCare 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 and learn more about the application process here. The self-assessment tool will assist with determining your readiness to apply.

We are accepting applications from network providers who believe their clinics meet the Centers of Excellence criteria. The application period has been extended until April 1, 2018. If you have any questions about the ChiroCare Centers of Excellence program, please contact Dr. Vivi-Ann Fischer at 651-389-2006 or v.fischer@fulcrumhealthinc.org.

Current CCoE clinics are not required to send in an application but will be asked to participate in a verification review in early 2018. 

Administrative

Billing Members

Providers often place their patients at ease by explaining the examinations and treatments they are performing. However, a misunderstanding regarding insurance coverage can spark frustration for you and your patient later. Take time to speak with your patients about their benefit plans and financial responsibilities—for example:

• Advise your patient of their copayment.
• Explain your office policy on missed appointments.
• Discuss the services that may not be covered by the patient’s health plan.

Covered services, exclusions, and limitations are described in the member’s benefit contract with their health plan.

Unless otherwise noted on the Plan Summary, you may collect in advance of services, and/or, bill your patients when:

• Copayment is not collected at time of service.
• Patient exceeds their yearly benefit maximum.
• Patient is not eligible or services are not covered.
• Patient misses an appointment without canceling; and the applicable state or federal law does not prohibit billing the patient.
• Benefits were not assigned to you, and you are not able to obtain the primary health plan’s Explanation of Benefits from the patient within 90 days from the date of the primary health plan’s payment.

Non-Covered Services

We encourage you to communicate openly with your patient about all appropriate treatment options that are within your scope of professional licensure, regardless of benefit coverage limitations. You may feel that some services which are excluded or limited under your patient’s benefit plan are of value to your patient. If you provide such service, you may bill your patient only if the below requirements are met.

Commercial and Medicaid Members:

You must obtain written approval from your patient (or responsible guardian) prior to providing the service. It is recommended that Fulcrum’s Non-Covered Services Financial Disclosure Form be used to meet this requirement. The form and the Fulcrum Billing for Non-Covered Services policy can be found at www.chirocare.com in the Practice Forms and Tools section. If you elect to design your own form, it must comply with the requirements of this policy, with the form including:

1. Provider name
2. Provider address
3. Detailed list of non-covered services for which the member may be billed and the cost associated with each
4. Signature of the provider or health care representative who explained the Financial Disclosure Form and discussed available options to the patient
5. A clearly written statement indicating the patient’s understanding that the identified services are not covered by insurance and patient agrees to pay for them in full
6. Patient name
7. Patient signature
8. Date of patient signature (Must be obtained prior to the service being rendered and may not pre-date the billed service by more than 12 weeks)

Medicare members (including MSHO where the health plan sponsored Medicare policy is primary):

For services that are covered in some cases, e.g. spinal manipulations, a provider must obtain an authorization denial, prior to the service being rendered, in order to bill a Medicare patient. Execution of Fulcrum’s “Non–Covered Services Financial Disclosure Form,” cannot be used to support Medicare patient billing for spinal manipulations or any covered x-rays on the applicable Fulcrum Fee Schedule, even if the care is maintenance in nature. See the applicable Plan Summary for instructions regarding authorization submissions.

It is not necessary however, for providers to obtain a denial from the health plan or Fulcrum to bill Medicare members for services that are never eligible for payment when rendered by a chiropractor. Providers may collect for these services at the point of service, or via distribution of a bill. Prior to rendering the service however, Fulcrum does recommend that the provider use Fulcrum’s “Medicare Member Notice of Non-Covered Services” form to help ensure the Medicare patient’s understanding of financial liability, and to avoid potential misunderstandings and/or member complaints. 

3.11 Restrictions on Claims Against Members

Chiropractor shall not bill or collect payment from the member, or seek to impose a lien, for the difference between the amount paid to chiropractor and chiropractor’s billed charge, or for any amounts denied or not paid under this agreement due to:

• Chiropractor’s failure to comply with the protocols
• Chiropractor’s failure to file a timely claim
• Payor’s benefit plan or plan summary
• Breach of the agreement between Fulcrum and a payor
• Nonpayment by a payor
• Inaccurate or incorrect claim processing
• Insolvency or other failure by payor to maintain its obligation to fund claims payments, if payor is Fulcrum, or is an entity required by applicable law to assure that its members not be billed in such circumstances
• A denial based on medical necessity or prior authorization. This obligation to refrain from billing members applies even in those cases in which chiropractor believes that Fulcrum or payor has made an incorrect determination. Instead, chiropractor shall follow the claim appeal procedures as further described in the Protocols.

CPT 2018 Code Changes for Chest X-Rays

The following seven CPT codes are no longer valid:

• 71010 Radiologic examination, chest; single view, frontal
• 71015 Radiologic examination, chest; stereo, frontal
• 71020 Radiologic examination, chest, 2 views, frontal and lateral;
• 71021 Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure
• 71022 Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections
• 71030 Radiologic examination, chest, complete, minimum of 4 views;
• 71035 Radiologic examination, chest, special views (e.g., lateral decubitus, Bucky studies)

These are being replaced with the following four new chest x-ray codes:

• 71045 X-ray of chest, single view
• 71046 X-ray of chest, 2 views
• 71047 X-ray of chest, 3 views
• 71048 X-ray of chest, minimum of 4 views

Compliance

This month’s compliance article will focus on the importance of routine password maintenance and best practices.

With cyber-attacks on the rise, it is more important than ever to take precautionary steps to protect yourself, your employees, your business, and most importantly, your patients’ privacy. While the Health Information Privacy and Accountability Act (HIPAA) Privacy Rules do not have explicit requirements on user passwords, there are still addressable items for covered entities, like provider offices. The HIPAA password management requirements can be found in the Administrative Safeguards of the HIPAA Security Rule §164.308(a)(5).

Requirements:

• Procedure(s) for creating, changing and protecting passwords

Best Practices:

• Passwords should be changed every 45-90 days
• Develop password requirements – capital and lowercase letters, number, special symbols, cannot reuse an old password, etc.
• Complete an office walkthrough to ensure that staff are not posting passwords in their work stations (under keyboards, posted near their computer or written on post-it-notes)
• Review your policies and procedures on an annual basis and distribute to staff
• Ensure staff are aware of the importance of protecting passwords

No plan is 100% fail-proof but by following these best practices, you can help lower your risk of potential cyber-attacks. Working with a security or information technology vendor can also provide you with additional administrative safeguards, as identified within the HIPAA Security Rule. However, should your office’s system be hacked, be sure to have a plan on what to do. Complete a Breach Risk Assessment to determine the scope of the incident and based upon the number of patients affected.

As always, if you know or suspect Fraud, Waste, and 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.).

Education

Did you know?

Providers can use the PHQ-2, two question assessment, to screen for possible depression and refer patient back to primary care for evaluation and treatment.

PHQ-2 Assessment

Depression Common in U.S., Women hit hardest

Nearly 1 in 10 U.S. adults has depression, and the rate is almost twice as high for women as men, health officials say.

National survey data showed that more than 8 percent of adults aged 20 and older suffer from low mood, according to a new report from the U.S. Centers for Disease Control and Prevention.

Among women, slightly more than 10 percent have depression, versus 5.5 percent of men. And the mood disorder affects everyday life for a majority of these people, the 2013-2016 questionnaires show.

“One of the findings that surprised us the most was that for both men and women, about 80 percent of adults with depression had at least some difficulty with functioning with daily life,” said lead author Debra Brody.

These include going to work, completing daily activities at home and getting along with other people, said Brody, of the CDC’s National Center for Health Statistics (NCHS).

“This report should make people aware how serious depression is, and that it impacts everyday life,” she added.

According to Dr. David Roane, chairman of psychiatry at Lenox Hill Hospital in New York City, “The biggest issues with depression are diagnosis and treatment.”

In most cases, primary care doctors are able to diagnose depression, he noted. “But people often don’t get adequate treatment in terms of both medication and psychotherapy,” Roane said.

However, there are obstacles to treatment, he said. For one thing, people often don’t realize they are depressed, even if they have mood problems and changes in thinking.

Also, mental health problems are still often considered taboo. “The stigma related to depression has decreased somewhat, but it’s still a major issue for someone to be diagnosed with a mental health disorder,” he said. In addition, many cases of mild depression will resolve over time, so some patients don’t want treatment.

“The problem is that if you are having functional impairment, it can be highly disruptive to your life,” he said. “Six months is a long time to suffer from depression, and I don’t recommend that.”

It has been shown before that women are more prone to depression than men, but the reasons are not known, Roane said.

Data for the report was gathered from the U.S. National Health and Nutrition Examination Surveys. The findings were published online Feb. 13 in the CDC’s NCHS Data Brief.

By Steven Reinberg

HealthDay Reporter

For more about depression, visit the U.S. National Institute of Mental Health.

SOURCES: Debra Brody, M.P.H., division of Health and Nutrition Examination Surveys, National Center for Health Statistics (NCHS), U.S. Centers for Disease Control and Prevention; David Roane, M.D., chairman, psychiatry, Lenox Hill Hospital, New York City; Feb. 13, 2018, U.S. Centers for Disease Control and Prevention’s NCHS Data Brief, online

Moving or Retiring? Let us Know!

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. The Provider Update tool withinChiroCare 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!

In this Issue:

1. What is the value of a ChiroCare Centers of Excellence designation?
2. 2018 Centers of Excellence Applications – Now Open!
3. GA, GY or GZ Modifiers Notice
4. Board of Directors Reappointment and Reelection Report
5. Security Risk Assessments
6. How and Why to Identify Measurable Goals for Patients in your Practice
7. Financial Guidance for Your Small Business
8. Moving or Retiring? Let us Know!

What is the value of a ChiroCare Centers of Excellence designation?

Healthcare in today’s world is focused on providing patient options that demonstrate high standards of quality and value. Consumers are demanding clinics that demonstrate this level of quality and affordability while primary care providers are seeking conservative care options to manage their patients’ back pain.

• Visibility as a Center of Excellence clinic on the Find a Doc tool located on ChiroCare.com.
• Position your clinic to be recognized for increased Pay for Performanceincentives.
• Recognized as a quality clinic, facilitating trust and referrals with other care practitioners and patients.
• Opportunities to participate in pilot projects demonstrating conservative care value.

The CCoE program highlights ChiroCare clinics who achieve and maintain the highest standards of patient-centered care through record keeping, documented outcome measures, and collaboration with other health care providers to achieve the Triple Aim in health care.

Attributes of Excellence

1. Comprehensive Patient Intake and History
2. Assessment and Outcome Tools
3. Cognitive Behavioral Therapy
4. Shared Decision Making
5. Conservative Imaging
6. Treatment Care Plans
7. Coordination of Care Between Practitioners or Facilities
8. Management of the Care Plan
9. Established Referral List of Practitioners and Referral Procedures
10. Active Care Instruction
11. Patient Education on homecare and prevention
12. Wellness Instruction
13. Patient-Centered Approach to Care Plans and Care Management
14. Demonstration of Collaboration with Other Practitioners

2018 Centers of Excellence Applications – Now Open!

Fulcrum is pleased to announce Fulcrum’s ChiroCare 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  and learn more about the application process here . The self-assessment tool will assist with determining your readiness to apply.

We are accepting applications from network providers who believe their clinics meet the Centers of Excellence criteria. The application period is open until March 1, 2018 . If you have any questions about the ChiroCare Centers of Excellence program, please contact Dr. Vivi-Ann Fischer at 651-389-2006 or  v.fischer@fulcrumhealthinc.org .

Current CCoE clinics are not required to send in an application but will be asked to participate in a verification review in early 2018. 

Administrative

GA, GY or GZ Modifiers Notice

Fulcrum Health is notifying providers of the billing process and necessary modifiers to use when appropriate notice of non-coverage has been given to Medicare plan members. Changes take effect accordingly: Quartz effective 1/1/18 and HealthPartners and UCare effective 3/1/18.

When the service is not a covered benefit or not expected to be a covered benefit, a GA or GY modifier is required. When services are a covered benefit and expected to be covered, the AT modifier is required indicating the care is active treatment (acute).

Modifiers are to be used as followed below:

GA Modifier:

Use this modifier in the following instances:

• You have determined that the item or service does not meet criteria and will not be covered, you have notified the member of this information, and you have obtained written member consent prior to rendering the non-covered item or service.
• If a pre-service organization determination is made to deny coverage and a Notice of Denial of Medical Coverage has been sent to the member prior to the non-covered item or service being rendered.
• You obtained written member consent prior to rendering the non-covered item or service.

We recommend notifying members using the Fulcrum Medicare Financial Disclosure form, Medicare Member Consent for Non-Covered Service Form. While it is recommended that providers utilize this form, providers may elect to use another version of a consent form however, it must include the following elements:

1. Provider name.
2. Provider address.
3. Detailed list of non-covered services for which the member will be billed, and the cost associated with each. Note: Spinal manipulations that have not been denied through the organization determination process cannot be billed to the patient.
4. Signature of the provider or health care representative who explained the Consent Form and discussed available options to the patient.
5. Patient name.
6. Patient signature. Note: The signature must be obtained prior to the service being rendered and updated when benefits change, or a maximum period of 12 weeks has lapsed.
7. Date of patient signature. Note: The signature must be obtained prior to the service being rendered and updated when benefits change, or a maximum period of 12 weeks has lapsed.

A copy of the consent must be kept on file by the provider and provided to Fulcrum upon request.

If you bill Fulcrum for a non-covered service without the GA modifier, indicating appropriate written member consent has been obtained, the claim will be denied to provider liability and the member cannot be billed.

GY Modifier:

• Use this modifier when an item or service is never covered by Medicare and the Health Plan and is a clear benefit exclusion in the member’s health plan documents. Use of this modifier indicates to the plan that you have verbally communicated this information to the member and have clearly documented the communication in the patient’s medical record.
• If you bill Fulcrum for these never-covered services without using the GY modifier, the claim will be denied to provider liability and the member cannot be billed.

GZ Modifier:

• The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) advance notice of non-coverage was not provided to the member. DO NOT USE THIS MODIFIER.
• All claims billed with the GZ modifier will deny to provider liability and the member cannot be billed.

Board of Directors Reappointment and Reelection Report

In accordance with Fulcrum Health’s Bylaws, the board members listed below confirmed their desire to serve an additional three (3) year term beginning on January 1, 2018 and ending on December 31, 2021 as Directors of the Corporation. Election ballot forms were emailed to all voting members via Survey Monkey in October of 2017, and we are pleased to announce our reappointments and reelections. 

Congratulations to:

• Scott Giltner
• Zach Kimble, DC
• Becky McManus
• Pete Vrieze, DC
• Paul Wernick, MD

For more information about Fulcrum’s Board of Directors, visit the Board of Directors section on our corporate website.

Compliance

Security Risk Assessments

The Health Insurance Portability and Accountability Act (HIPAA) Security Rules require that covered entities, such as provider offices, conduct an annual risk assessment of their organization. This risk assessment helps ensure compliance with the physical, administrative and technical safeguards outlined by HIPAA.

While the Security Rule requires that all covered entities “Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information (EPHI) held by the [organization],” it does not provide specifics on how to conduct one or what to review in the assessment. The rule is intended to provide objectives that must be achieved. Luckily, there are many resources available to covered entities to help them get started with a risk assessment.

The Center for Medicare and Medicaid Services (CMS) has published documentation to help smaller organizations better understand and implement a risk assessment within their facility. In the seven-part series, Security Topics 6 and 7 are beneficial to smaller organizations/facilities.

Article #6 in the Security Series, “ Basics of Risk Analysis and Risk Management ,” focuses on the fundamentals of risk assessments by providing awareness of key terms, examples of process steps used to complete a risk assessment, and examples of risk management steps.

Article #7 in the series, “ Security Standards: Implementation for the Small Provider ,” focuses on conducting a risk assessment that is relevant to smaller facilities. This article provides many sample questions that smaller organizations may consider when conducting a risk assessment. This document also provides additional resources that may be utilized to conduct a risk assessment.

Another option for completing a risk assessment may be to hire an outside vendor/contractor that will come in and evaluate your facility. During a review conducted by a vendor/contractor, you can expect to provide them with access to your facility, policies and procedures. If this option works best for your organization, make sure that a Business Associate Agreement or Non-Disclosure Agreement is properly put into place. The type of agreement needed will be dependent upon what type of information the contractor/vendor will be seeing and/or using.

For more information on Security Risk Assessments, please visit the U.S. Department of Health and Human Services website .

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

Education

How and Why to Identify Measurable Goals for Patients in your Practice

We hear from many doctors struggling to identify measurable goals that demonstrate patient progress with treatment. Vague goals such as “increase range of motion” or “increase activities of daily living” are not measurable unless a numeric value is included. This lack of demonstrated progress can create questions on whether the care is medically necessary. 

Treatment goals must be specific to each individual patient’s condition, contain a measurable functional goal, and include a pain index to monitor the patient’s response to treatment. For example, if a patient identifies she can only sit for 30 minutes at a time, a short-term goal could be sitting for 1 hour at a time within 2 weeks, and the long-term goal as sitting a consecutive 8 hours or more within 6 weeks. When the measurable goal indicates the patient has stopped improving or plateaued, it signals the time to change the treatment plan, refer the patient, or transition the patient to maintenance care.

Usage of an outcome assessment tool (OAT) can assist with accurately measuring the loss or gain of functional goals and provide measurable progress. Examples of this tool include the neck and low back indexes, Oswestry, Primary Care Low Back Disability Questionnaire, Bournemouth, and Roland Morris Disability. An assortment of outcome assessment tools are located on ChiroCare Connect > Clinical Resources > Outcome Assessment Toolbox for your convenience.

Health care today is moving rapidly toward a model of demonstrating goals and progress associated with treatment, and this “value-based care” is defined by patients’ outcomes. The Centers for Medicare and Medicaid Services (CMS) has rolled out thePhysician Quality Reporting System (PQRS) as a step to collect outcomes. While this is a voluntary program today, indications are this may be a pay-for-performance model in the future.

Financial Guidance for Your Small Business

There are a variety of reasons why a small business owner may seek advice and guidance from a CERTIFIED FINANCIAL PLANNER™ professional or CFP® professional. These may include investment management, key employee retention, business succession, tax, and retirement planning. 

Fulcrum is collaborating with a subject-matter expert to highlight some of these topics in the ChiroCare News Flash throughout 2018.

To learn more about how a CFP® professional can be a valuable resource for you and your business, check out this article titled “Here’s The Difference Between A Financial Advisor And Certified Financial Planner.”

Moving or Retiring? Let us Know!

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. The Provider 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!