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Newsletters

The monthly News Flash newsletters contains timely and actionable information related to chiropractic care, billing and efficient delivery of quality care. You can find below recent newsletters organized by date plus a link to older issues. If you are looking for a specific article or topic, please use the site search tool in the upper right.

In this issue

  1. Save the Date
  2. Calling All Innovators!
  3. Reminder! Incentive Opportunity
  4. Learning Hub
  5. Billing Medicare Advantage Members FAQ
  6. Fulcrum’s Statement About Incentives
  7. Provider Satisfaction Survey – Coming Soon!
  8. NewsFlash and Email Communications
  9. Moving or Retiring? Let us Know!

Save the Date

Save the Date

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.

Calling All Innovators!

Change MakersIs 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.

Reminder! Incentive Opportunity

Money BagWe 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.

Learning Hub

Connect Learning HubAs 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.

Compliance

Billing Medicare Advantage Members FAQ

Magnifying glass over paperIf 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.

Questions:

Fulcrum’s Provider Services Department (877) 886-4941

Administrative

Fulcrum’s Statement About Incentives

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:

https://www.chirocare.com/chiropractic-practice-management/chiropractic-tools-forms/

Provider Satisfaction Survey – Coming Soon!

Open envelopeBe 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 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!

NewsFlash and Email Communications

If you no longer wish to receive NewsFlashes or other important electronic emails, please emailinfo@fulcrumhealthinc.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.

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!

In this issue

  1. Have you checked out the Learning Hub recently?
  2. Incentive Opportunity
  3. Financial Disclosure Forms
  4. Data Sharing
  5. Moving or Retiring? Let us Know!

Have you checked out the Learning Hub recently?

Connect Learning HubAs 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, available telephonic training session sign-up 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.

Incentive Opportunity

Money BagBeginning July 1, 2019 we will offer 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.

Compliance

Financial Disclosure Forms

Magnifying glass over paperThe financial disclosure forms (FDF) are located on ChiroCare.com and ChiroCare Connect along with policy NM007 Non-Covered Services . The forms are based on the patient’s insurance product and are to be used when/if the patient is requesting elective care or wellness care.

When starting this process, there are several considerations to be made up front:

  • Providers need to understand general benefit limitations associated with each line of business that Fulcrum Health, Inc. administers, e.g. Commercial, Medicare, Medicaid, etc.
  • Be sure to consider which patients require a pre-service organizational determination of coverage prior to a financial disclosure agreement. This determination protects the patient and ensures they are receiving all medically necessary care they need and will also notify patients if care is not a covered benefit. This requirement applies to tier assigned B and C providers for all insurance products. For A tier providers this is a requirement for Medicare and Medicaid patients only.

Please note: Minnesota Medicaid requires submission of claims for elective services in addition to an FDF. At this point the patient can to elect to pay for services not covered.

  • Please note that simply having a member sign a waiver when they first begin treatment stating that they understand they are responsible for any services not covered by their insurance is insufficient and does not fulfill your contractual obligations. In order to protect yourself and your patients, it is essential that you review our non-covered services policy as well as your provider manual to ensure that your office is complying. If you choose to not utilize Fulcrum’s FDFs you must ensure that your forms contain each required element listed in Policy NM007.
  • It is important to note that new FDFs must be reviewed and signed with the patient every 12 weeks for care not covered under their plan; or for elective care after a new acute episode that has achieved maximum therapeutic benefit.

Here are some other FDF tips :

  • Include all required elements, per policy, in the FDF
  • Complete the FDF with the patient prior to the non-covered services being rendered
  • Clearly specify the cost associated with each non-covered service
  • Update the FDF every 12 weeks
  • Use the Fulcrum FDF to cover policy requirements as other forms used are often insufficient (Standard Financial Waiver, Wellness Program Agreement, Pre-Payment Agreement, Advance Beneficiary Notice, etc.)

For providers that are required to submit a prior authorization, a common error is the lack of submitting a prior authorization for services that may be covered by insurance, or an org determination to confirm if a patient has met maximum therapeutic benefit (MTB). Per Chapter Five of the Provider Manual, Notification is required at the onset of care for new or initial episodes of treatment plans as well as ongoing treatment plans; unless the health plan has a visit waiver. An additional prior authorization request or org determination is a significant component in determining whether a continued course of treatment is medically necessary.

Providers may not bill the patient, or the payor, for the applicable non-covered services if they fail to obtain appropriate documentation as described above. In these cases, the liability of payment falls to the provider. Failure to follow these billing guidelines will often prompt a patient to file a complaint with their health plan and is viewed by Fulcrum, as well as our health plan customers, as a violation of your provider contract. Additionally, failure by the provider to obtain and/or produce acceptable forms upon request could lead to corrective actions or change in network participation status.

Please contact Alexus with any questions regarding the Financial Disclosure Form, billing for non-covered services, authorization protocol calls or how to appropriately transition a member from active to wellness treatment.

Alexus Jones
CAG/Compliance Coordinator
A.Jones@fulcrumhealthinc.org

763-204-8548

Education

Data Sharing

Open envelope“Consumers face many barriers to being informed purchasers of healthcare when they do not have access to price and quality information in the healthcare system” said Frederick Isasi, executive director of Families USA.

While chiropractic care may be less complicated to communicate costs to patients compared to other health care, our compliance article indicates there are still many opportunities for improved communication with patients. Informed decisions regarding cost and quality information can assist patients and other stakeholders with understanding the value of conservative care first. Fulcrum is leading the way to demonstrating the value of chiropractic care through our collection of quality outcome data.

https://www.healthdatamanagement.com/news/stakeholders-say-data-sharing-is-critical-to-lowering-healthcare-costs

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!

In this issue

  1. Fulcrum’s Infection Prevention Study published!
  2. Fulcrum Health Is A National Level Advocate
  3. Informed Consent
  4. Review Billing Practices
  5. Patient Communication
  6. Moving or Retiring? Let us Know!

Fulcrum’s Infection Prevention Study published!

Thank You!We are excited to announce that our Infection Prevention Study was published in the online issue of Chiropractic Economics! Read more on the study here .

Thank you to the 30 clinics who volunteered to be part of a study looking at what infection control practices would best suit the chiropractic offices. The clinics received testing product kits that included hand sanitizers, gloves, sharp containers and table disinfectants. After testing they supplied opinions on the products and had the clinics retested for potential infectious organisms.

Some key discoveries were the need for hand sanitizers in every room and to check the expiration date, products for table disinfectants, cleaning toys, disposal of sharps before they become ¾ full and keep clean linens in a closed cabinet.

Fulcrum Health Is A National Level Advocate

PMMAWe are excited to announce that Fulcrum Health’s CEO, Patricia Dennis, has been newly elected to AAPAN’s Board of Directors! This designation allows her to serve as a professional advocate to network providers. Click here to read more. She is also a Board Member of PMMA.

The Physical Medicine Management Alliance (PMMA) is an AAPAN Board Committee that consists of organizations representing care management companies who specialize in physical medicine, musculoskeletal care and wellness. These organizations focus on partnering with provider specialists to facilitate care delivered via specialty services that include, but are not limited to, Physical and Occupational Therapy, Chiropractic Care, Podiatry, Speech Therapy and Integrative Care.

PMMA Provides:

  1. Industry leadership and guidance in musculoskeletal and therapeutic care management
  2. Singular, authoritative voice representing common interests
  3. Robust advocacy at the federal and state legislative and regulatory levels
  4. Influence and input on public policy
  5. Insights and opportunities for dialogue between industry leaders
  6. Educational and marketing efforts focused on promoting the value proposition of evidence-based conservative care to stakeholders
  7. Collaboration with synergistic associations to leverage advocacy efforts

Their most recent publications:

Please visit our website to learn more – Articles can be found here.

PMMA’s affiliation with the American Association of Payers, Administrators and Networks (AAPAN) further strengthens Fulcrum’s positioning as a successful industry advocate on both the federal and state levels.

Compliance

Informed Consent

Informed consent is a topic that’s often talked about. It is through this discussion that doctors are able to educate patients about recommended treatments.

Doctors may be accused of negligence or battery if they fail to obtain the patient’s proper informed consent before rendering treatment, and they may be sued for not providing information regarding potential complications.

Components of informed consent include a discussion about the risks, benefits and alternatives of the proposed treatment. After the discussion, the doctor should have the patient sign a document that confirms the discussion and that the patient was given the chance to ask questions and have them answered.

An effective informed consent process should include these steps:

  • Provide the patient with sufficient time and information to make decisions about the risks, benefits and anticipated outcomes of the proposed treatment.
  • Present the patient with alternatives, including referral options or receiving no treatment at all. If you make a recommendation, explain your reasoning and why you believe it is a valid suggestion.
  • Discuss any foreseeable risks or complications that may arise from the proposed course of care, as well as the potential risks if the patient refuses care.

Make sure to document both the discussion and the patient’s decision, including a written informed consent (or refusal) to support the verbal response.

You should note the following in your records (and provide the patient with a copy):

  • Names of individuals present (patient, family, caregiver) during the discussion.
  • The treatment recommended.
  • Potential risks that were discussed of not following the treatment.
  • Any questions the patient or related parties asked and the answers you provided.

In the case of refusal, also note:

  • The patient’s reason for refusal of the recommended care.

If the patient returns for further treatment, continue to:

  • Advise the patient about the condition and risks, as long as the condition exists and the patient refuses treatment.
  • Advise the patient if other conditions may be affected by their continued refusal of the recommended treatment.
  • Document that the patient continued to refuse the recommended treatment.

NCMIC offers information on informed consent:

https://www.ncmic.com/learning-center/articles/risk-management/documentation/informed-refusal-is-as-important-as-informed-consent/

Education

Review Billing Practices

UpdateEffective July 1, 2019 , eviCore will enforce best practice standards when submitting replacement or voided paper claims.

Specifically, when resubmitting a claim, the appropriate bill frequency code along with the original claim number will be required.

The available codes include:

  • 7 – Replacement of a prior claim
  • 8 – Void/Cancel of prior claim
  • The bill frequency code is not required for original claim submissions.

The bill frequency code should be entered into the “Resubmission Code” area of box 22 and the claim number from the original claim’s Remit should be entered into the “Original Ref No” area of box 22.

Please review your billing practices prior to July 1, 2019 to ensure that your office staff is aware of the correct use of codes. Claims received on or after July 1, 2019 with the words, “CORRECTED”, “VOID”, or similar terminology stamped or written on the claim, will be denied as a duplicate submission.

The National Uniform Claim Committee (NUCC) has developed a CMS-1500 Reference Instruction Manual detailing how to complete the claim form in a nationally standardized manner. To access the instruction manual visit, www.nucc.org.

If you have any questions regarding this message, please call (877) 638-7719.

Patient Communication

QuizSee below for a fun but important quiz on the value of doctor-patient communication

You will be presented with videos and statements containing advice, which you will then mark as ‘helpful’ or ‘unhelpful’. A rationale behind the correct answer will then appear.

A second video will also be presented after you answer. Please note that it may contain examples of either helpful or unhelpful advice, opposite to that of the first video. After viewing the second video, you may move onto the next question.

Start Quiz Here!

http://www.lowbackpaincommunication.com/

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!

In this issue

  1. AcuNet Network Expansion!
  2. Fulcrum Health’s Annual Meeting is This Week
  3. Non-Covered Chiropractic Services
  4. Medical History Communication
  5. CMS to launch new direct-contracting pay models in 2020
  6. Moving or Retiring? Let us Know!

AcuNet Network Expansion!

Great River SymposiumFulcrum’s licensed acupuncturist, Deb Zurcher, DC, LAc, attended the Great River Symposium this month. She enjoyed meeting with fellow acupuncturists to discuss the need to expose acupuncture to a broader audience and to learn about new approaches to enhance our AcuNet providers practice . Together we have the power to do more. Dr. Zurcher looks forward to working with you as a provider in the AcuNet network!

If you or a colleague are interested in becoming an AcuNet provider :

  • No fee to join, no membership dues, no annual costs to participate
  • Receive referrals from ChiroCare, Fulcrum’s chiropractic network and from our online directory.

Please visit our AcuNet website, https://www.acunet.org/ to learn more and join today!

Fulcrum Health’s Annual Meeting is This Week

Annual MeetingThis is a friendly reminder that Fulcrum Health’s Annual Meeting will take place this Thursday May 2, 2019, at our Plymouth, Minnesota office at 8:00 a.m. In an effort to be good stewards of our resources, this meeting will be available via phone. Please call (763) 204-8575 Ext. 8541.

Annual Meeting minutes will be made available onChiroCare.com following the meeting. In our May newsletter we will provide a link.

Click Here to access our 2018 Annual Report.

Compliance

Non-Covered Chiropractic Services

In our series, we continue on the subject of Non-Covered Chiropractic Services. We would like to address Fulcrum’s policy around this process. Our policy states that contracted Fulcrum Health network providers must comply with all administrative requirements for billing members for non-covered services.

The policy, which reflects state and federal regulations, speaks to the specific purposes and procedures for obtaining written consent to evidence that providers have adequately notified patients and obtained documented acknowledgement of member liability for non-covered services for which they will be billed. Not performing this process according to policy increases your risk of potential regulation violations as well as creating issues on the back end, including appeals and complaints/grievances by the patient, and may result in services falling to provider liability.

A good number of issues and investigations we work on a daily basis could be mitigated by a thorough understanding of these requirements on the part of providers. Please review the policy carefully and reach out to us if you have any questions. The current version can be found here.

If you have any questions on the OIG Workplan, CMS regulations and/or Fulcrum’s policy, please feel free to contact Lariza Carlson at l.carlson@fulcrumhealthinc.org.

Education

Medical History Communication

Doctors transmit a message of caring and concern to patients when they can speak confidently about specific medical record information. Let your patients know you have viewed their medical history by verbally reviewing it with them. This simple step shows you care and improves patient satisfaction. Improving patient satisfaction is one of the three components of the Triple Aim.

Tips for improved medical history communication:

  • Regularly refer back to the patient’s chart when discussing their current condition. If symptoms are recurrent, make sure to share that observation with the patient.
  • Review the patient’s medical chart prior to entering the exam room. Patients appreciate the fact that their care provider knows about them and remembers them.

Ex. “I was looking through your chart this morning. When you were here

three months ago, we talked about XYZ. How is that going?”

  • If an error is found in the medical history portion of the chart, be sure to correct it promptly. Patients will become frustrated if they need to correct the same error over multiple visits.

CMS to launch new direct-contracting pay models in 2020

HHS (Health and Human Services) launched an ambitious, double-pronged strategy to shift primary care from fee-for-service payments to a global fee model where clinicians and hospitals could assume varying amounts of risk.

The first model aims at small primary-care practices, offering two options with a flat monthly fee per patient. Bonuses or penalties will depend on their ability to keep their patients “healthy and at home,” said Adam Boehler, director of the CMS’ Center for Medicare and Medicaid Innovation, or CMMI.

Larger practices and health systems would have additional choices, which could be very lucrative but pose steeper risks. Under the first “professional option,” providers would assume 50% of the risk, including savings and losses. Under the “global option,” providers would take on full risk.

For more information, visit: https://www.modernhealthcare.com/payment/cms-launch-new-direct-contracting-pay-models-2020?utm_source=modern-healthcare-alert&utm_medium=email&utm_campaign=20190422&utm_content=hero-readmore

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!

In this issue

  1. Meet Our Licensed Acupuncturist! Deb Zurcher, D.C., L.Ac.
  2. 2018 Provider Quality Bonus
  3. Fulcrum Health Annual Meeting
  4. Non-Covered Chiropractic Services
  5. New Regulatory Requirements – CMS Preclusion List
  6. Radon Testing Reminder
  7. Moving or Retiring? Let us Know!

Meet Our Licensed Acupuncturist! Deb Zurcher, D.C., L.Ac.

Deb ZurcherDeb Zurcher, DC, LAc, has been a licensed acupuncturist since 2012 and has over 20 years of chiropractic clinical experience as well as 16 years as a business owner. In 2003, Dr. Zurcher founded a multi-disciplinary clinic, Eagle Creek Wellness Center, LLC, in Prior Lake, MN. Her previous roles include; Liaison Faculty in the Clinical Ed department at Northwestern Health Sciences University, Self-Management Skills Guide then Operations Manager at MOBE. Dr. Zurcher graduated from Northwestern Health Sciences University with a Doctor of Chiropractic and a Masters in Acupuncture. She earned her Bachelor of Arts degree from Gustavus Adolphus College.

To learn more about AcuNet, Fulcrum’s acupuncture network, please visit www.fulcrumhealthinc.org/acunet .

2018 Provider Quality Bonus

As Fulcrum continues its journey to value-based payments for its network providers, the company is pleased to announce that in mid-March, it distributed $1.3M to eligible network practitioners as part of its Provider Quality Bonus Program. The provider quality bonus program is designed to recognize those providers who exhibit an approach that most closely aligns with ChiroCare’s best practices and Fulcrum’s Mission, Vision and Values. It is based upon provider tier as well as the individual practitioner’s performance for services provided between January 1 and December 31, 2018. Awards to eligible practitioners reflect client mix, patient volume, billing patterns, and efficiency of treatment provided as compared to other practitioners within the network. At this time, only ChiroCare Centers of Excellence (CCoE) and high performing Category A providers are eligible to receive a quality bonus.

The quality bonus award serves as Fulcrum’s acknowledgement of practitioner’s continued effort to provide high quality, patient centered care. This quality bonus payment is compensation in addition to that already received via fee schedule based claims payments. On average, the provider quality bonus represents a 10% increase in the fee schedule for practitioners within ChiroCare Centers of Excellence (CCoE’s) and a 6% increase for Category A providers. Additionally, Fulcrum does not withhold any claims payment amounts due to practitioners.

Click here to learn more on how your clinic may become a ChiroCare Center of Excellence.

Fulcrum Health Annual Meeting

Our annual meeting will be held on May 2nd, 2019. This is an opportunity for our network providers to learn more about what Fulcrum Health is doing for you. Additional information to follow.

Compliance

Non-Covered Chiropractic Services

Non-Covered Chiropractic Services is a pertinent and relevant issue to be covered in upcoming Compliance articles. This month we will speak to the OIG Workplan specifically.

The Office of the Inspector General (OIG) recently released updates to their Workplan which serves to identify risks across various agencies (CMS, DHS, etc.) most in need of attention. These risks are prioritized and resources slated to perform audits and reviews accordingly.

T he payment of non-covered chiropractic services is an issue still active on the Workplan. As you are aware, Medicare Part B only pays for a chiropractor’s manual manipulation of the spine to correct a subluxation if there is a neuro-musculoskeletal condition for which such manipulation is appropriate treatment (42 CFR § 410.21(b)). Chiropractic maintenance therapy is not considered to be medically reasonable or necessary and is therefore not payable (Centers for Medicare & Medicaid Services’ Medicare Benefit Policy Manual, Pub. No. 10002, Ch. 15, § 30.5B). Prior OIG work identified inappropriate payments for chiropractic services. Medicare will not pay for items or services that are not “reasonable and necessary” (SSA § 1862(a)(1)(A)).

Based on these regulations, the OIG is set to review Medicare Part B payments for chiropractic services to determine whether payments were claimed in accordance with Medicare requirements. In one example, a chiropractic practice in Florida was reviewed for two calendar years for potentially inappropriate billing of chiropractic services to Medicare. Out of 21,425 services, totaling $656,051 in Medicare payments, they selected 100 services using a simple random sample which would serve as a representation of their Medicare billing. Of the 100 chiropractic services in their sample, 33 were not allowable: 31 services were medically unnecessary and 2 were not documented. On the basis of those sample results, the OIG estimated the practice received unallowable Medicare payments of at least $169,737 for those two years. This example validates the importance of the development, implementation and enforcement of policies and procedures to ensure thorough understanding of the documentation and medical necessity of billable chiropractic services. Fulcrum currently has documented policies and procedures to support our providers in the understanding of this process. Should you have any questions on the OIG Workplan, CMS regulations and/or Fulcrum’s policy, please feel free to contact Lariza Carlson at l.carlson@fulcrumhealthinc.org .

Education

Reminder to Medicare Providers Regarding Billing Beneficiaries Enrolled In the Qualified Medicare Beneficiaries (QMB) Program

Red FlagThis is an important reminder that federal law prohibits Medicare providers from collecting Medicare Part A and Medicare Part B deductibles, coinsurance or copayments from Original Medicare and Medicare Advantage beneficiaries enrolled in the Qualified Medicare Beneficiaries (QMB) program. The QMB program is a state Medicaid benefit that covers Medicare deductibles, co-insurance and co-payments.

Note: Copayments still apply for Medicare Part D benefits. For those eligible for QMB, this will be copayments at the Low Income Subsidy level.

Medicare providers must accept Medicare payment and Medicaid payment (if any) as payment in full for services given to individuals enrolled in the QMB program. Medicare providers who violate these billing prohibitions are violating their Medicare Provider Agreement and may be subject to sanctions. (S ee Sections 1902(n)(3); 1905(p); 1866(a)(1)(A); 1848(g)(3) of the Social Security Act.)

The QMB program applies to all Medicare providers, both participating and non-participating. Further, providers are obliged to accept assignment on all services to these beneficiaries, even if they would not do so otherwise. Accepting assignment means you agree to accept the Medicare and Medicaid payment as payment in full, regardless of whether Medicaid pays or not.

Providers who are not enrolled as a Medicaid provider are still subject to the QMB program limitations. Because Medicaid won’t pay providers if you aren’t enrolled with Medicaid, Medicare cost-sharing balances must be written off and may not be billed to QMB program enrollees.

At this time, there are a couple of potential ways to identify QMB individuals:

  • If you are a Minnesota Health Care Programs (MHCP) provider, you can directly query the Minnesota Department of Human Services (DHS) MN–ITS system to verify QMB eligibility.
  • You can ask the beneficiary if they are enrolled in the Qualified Medicare Beneficiaries (QMB) program through (MHCP). Medicare beneficiaries eligible for Medicaid QMB programs may have documentation, e.g., QMB eligibility verification letters from DHS they can show providers.

For more information on QMB plans, visit: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/QMB.html

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!

In this issue

  1. Payment to Reward Quality Providers
  2. Press Ganey Promotional Materials Available For Your Clinic!
  3. Fulcrum Appoints Molly Magnani, D.C. as New Board Chair
  4. 2 Weeks Only! Center of Excellence Applications Deadline Extended
  5. New Regulatory Requirements – CMS Preclusion List
  6. Radon Testing Reminder
  7. Moving or Retiring? Let us Know!

Payment to Reward Quality Providers

ChiroCare Centers of Excellence (CCoE) and high performing Tier A providers are eligible to receive a quality payment. This payment is based upon provider tier and the individual performance for services provided between January 1 and December 31, 2018, patient volume, billing patterns, and efficiency of treatment as compared to other network providers.

As Fulcrum continues its journey to value-based payments, the provider quality payment program recognizes those providers who exhibit an approach that most closely aligns with ChiroCare’s best practices and Fulcrum Health’s Mission, Vision and Values. This payment is in addition to the fee schedule based claims payments.

Distribution of this payment will take place in mid-March and funds will be electronically deposited into the banking account of record for your clinic.

Please do not hesitate to contact Fulcrum’s corporate office with any questions at 763-204-8570 or info@fulcrumhealthinc.org .

Press Ganey Promotional Materials Available For Your Clinic!

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 .

Fulcrum Appoints Molly Magnani, D.C. as New Board Chair

Dr. Magnani is currently Lead Chiropractor and serves on the Spine Steering Committee at Allina Health, where she has been employed since 1996 as one of the first chiropractors in an integrated care setting. In her position as Board Chair for Fulcrum Health, Dr. Magnani will oversee the work of the Board and ensure sound and compliant governance and management of the organization, as they continue to advance their vision to be a leader in high-quality, physical medicine networks. Dr. Magnani has served as a member of the Board of Directors for Fulcrum since 2011. She replaces outgoing Board Chair, Mark Dehen, D.C.

“As a practicing chiropractor, Dr. Magnani is an industry leader in team-based care and she knows what it takes to collaborate across the care continuum for optimal patient outcomes, which is a focus at Fulcrum Health,” said Patricia Dennis, CEO of Fulcrum Health. “In addition, Molly has a deep understanding of our organization and will play a crucial leadership role as we strengthen our care connections with traditional medicine, building bridges for integrative care.”

In addition to her role at Allina Health and Fulcrum Health, Dr. Magnani has served as the lead faculty member at the University of St. Thomas Chiropractic Leadership Institute and is a member of the Board of Trustees for Northwestern Health Sciences University. She earned a Bachelor of Art in biology from St. Olaf College, and a Doctor of Chiropractic from the National Health Sciences University in Illinois. Dr. Magnani also attended the University of St. Thomas, where she completed the physician leadership program. Dr. Magnani is certified in acupuncture and is actively involved in fitness, nutrition and women’s health, and is a frequent speaker at chiropractic conferences.

2 Weeks Only! Center of Excellence Applications Deadline Extended

Fulcrum Centers of ExcellenceWe invite those network providers who believe their clinics meet the Centers of Excellence criteria to apply. The application period is extended only until March 15, 2019. 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.

Current CCoE’s do not need to re-apply. Verification review of records began 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 .

Compliance

New Regulatory Requirements – CMS Preclusion List

Along with the new year also comes a new Centers for Medicare and Medicaid Services (CMS) requirement known as the Preclusion List.

The Preclusion List will consist of providers who are currently revoked from Medicare, under an active reenrollment bar, or have engaged in behavior for which Medicare would have revoked them for if they had been enrolled in Medicare at the time. CMS requires the removal of precluded providers on the list and a swift notification to enrollees who have received care from those providers in the last 12 months.

With this new rule, Fulcrum has implemented an ongoing review of providers on this list in addition to excluded providers. It is important to note that we will continue to review the Office of Inspector General (OIG) Exclusion List, as the preclusion and exclusion files are not entirely interchangeable. While excluded providers will be on the Preclusion List, precluded providers may not always be on the OIG Exclusion File.

For more information on how we are required to implement and comply with the newly adopted Preclusion List requirements, you can find information athttps://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/PreclusionList.html

If you have any questions, please direct them to Compliance@FulcrumHealthInc.org . Additionally, if you know or suspect fraud, waste or abuse is occurring in your place of business or have other Compliance-related concerns, 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

Radon Testing Reminder

As part of the health & wellness community, we encourage providers to educate their patients of the dangers of Radon.

Radon is a colorless and odorless gas that comes from the soil. The gas can accumulate in the air we breathe. Radon gas decays into fine particles that are radioactive. When inhaled these fine particles can damage the lungs. Exposure to radon over a long period of time can lead to lung cancer.

It is estimated that 21,000 people die each year in the United States from lung cancer due to radon exposure. A radon test is the only way to know how much radon is in your home. Radon can be reduced with a mitigation system.

To learn more about radon, please click here.

To order an inexpensive radon test kit, click here.

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!

In this issue

  1. Fulcrum’s Utilization Management Program
  2. What is the value of a ChiroCare Centers of Excellence (CCoE) designation?
  3. Accepting now – 2019 Center of Excellence Applications
  4. Board of Directors Reelection Report
  5. PHI Practice
  6. ACA Appointment
  7. Patient Experience
  8. Moving or Retiring? Let us Know!

Fulcrum’s Utilization Management Program

To keep us moving on our journey to value-based payment, the adoption phase for B&C tier providers of the ChiroCare network will begin on February 1st, 2019.

QConnect Journey to Value-Based Payment: Tier Assignment A

QConnect Journey to Value-Based Payment: Tier Assignment B & C

What is the value of a ChiroCare Centers of Excellence (CCoE) 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.

  • Provides visibility as a Center of Excellence clinic on the Find a Doc tool located on ChiroCare.com
  • Positions your clinic to be recognized for increased Pay for Performance incentives
  • Recognition as a quality clinic, facilitating trust and referrals with other care practitioners and patients
  • Opens 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

Accepting now – 2019 Center of Excellence Applications

Fulcrum Centers of ExcellenceFulcrum 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 began 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 .

Board of Directors 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, 2019 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 2018, and we are pleased to announce our reelections.

Congratulations to:

  • Molly Magnani, DC
  • Leo Bronston, DC
  • Mark Dehen, DC

We are excited to announce the new Chair of Fulcrum’s Board of Directors, Molly Magnani, DC!

Dr. Magnani is currently practicing at Allina Medical Clinic with Internal Medicine Physicians, Podiatrists, Rheumatologists, Endocrinologists and Mental Health providers to develop optimal treatment plans and referrals for patients. Her practice includes manipulation, acupuncture, physical therapy, massage, nutritional counseling, exercise programs and outcome assessment.

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

Compliance

PHI Practice

With the ease of electronic communications, like email, it is important to remember that risks still exist when sending information to patients. While emailing patients is not prohibited, there are considerations you should take prior to hitting send.

Please Note: Sending protected health information (PHI) through email to Fulcrum Health is prohibited.

If you need to send PHI to Fulcrum Health regarding: (1) an organization determination or prior authorization, please use QConnect; (2) a response to a member complaint or appeal, fax to 763-204-8544.

We encourage providers to always use encrypted emails when sharing any treatment, billing, and appointment information with your patients. If you are using a public email 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. Sending encrypted emails makes it so only the intended recipient is able to view the contents.

Securing patient PHI is a #1 concern – so exercise caution before transmitting any PHI through email – and if you must transmit PHI through email, be sure to encrypt your email before sending.

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. 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.).

ACA Appointment

Congratulations to Dr. Leo Bronston! Leo Bronston, DC has been elected to the American Chiropractic Association (ACA) Board of Governors. The legislative, policy, corporate, business, and property powers of ACA are exercised, conducted, and controlled by the Board of Governors. In addition, Dr. Bronston is a Fulcrum Health board member.

https://www.acatoday.org/About/Board-of-Governors

Education

Patient Experience

Patient experience is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices, according to a recent Press Ganey report. According to an article in HealthLeaders , patient experience is five times more likely to influence brand loyalty than conventional marketing tools.

A few key takeaways:

  • Positive patient experience aligns with the mission of acquiring and retaining patients
  • Healthcare organizations should maximize patient feedback through multiple channels such as surveys, text, and email
  • Negative reviews online are an opportunity to improve patient experience

Click Here to read the article in its entirety.

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!

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!

In this issue

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

Congratulations ChiroCare providers in achieving outstanding performance in patient satisfaction!

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

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

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

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

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

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

Compliance

Mandatory Special Needs Plan Training

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

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

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

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

Due Now – Disclosure of Ownership and Cultural Competency

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

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

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

Administrative

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

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

You will still find the following resources on ChiroCare Connect:

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

Where do I find Fulcrum’s Clinical Policies?

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

Education

2019 Claims Submission Changes for UCare Choices Plans

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

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

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

  • New Payor ID
  • New Member ID and format

Read the full bulletin here.

2019 Center of Excellence Applications Open November 1st

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

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

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

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

Patient Satisfaction – Front desk staff has an impact

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

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

  • Answer the phone with a friendly voice
  • Greet the patient when s/he enters the clinic
  • Welcome the patient, introduce yourself, and ask how you may help them
  • Maintain eye contact and listen
  • If forms are given to the patient, thoroughly explain them and their necessary for the doctor to provide the best treatment possible
  • Inform the patient of expected wait times and the duration/cause for any delays
  • Remain available until the patient transitions to the next stage of his/her visit
  • Offer to walk the patient to the next destination

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

  • Maintain a clean and uncluttered front desk and waiting area
  • Keep loud noises to a minimum
  • When patients are in the office, keep non-work-related conversations to a minimum
  • Keep appropriate hygiene products available in the lobby such as gloves, masks, and waterless hand sanitizer

Moving or Retiring? Let us Know!

Address Book IconIt is vital that you report any practice changes to ensure that we have your current address, phone, fax, and email address. Any changes or corrections to your TIN/name combination should be communicated immediately. TheProvider Update tool within ChiroCare Connect offers a quick and electronic means to report changes. Simply select the “Billing Information Update” option within the Provider Update tool.

Please contact our Provider Services team at 877-886-4941 with any questions about submission of updates.

We appreciate your continued partnership!

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/

Illustrated Man with Magnifying Glass

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!


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