In January 2021, Fulcrum announced their partnership with Preferred One, which meant all in-network chiropractic services would bill thru Fulcrum (previously thru Magellan). This week, they notified providers of a processing issue. They have been mistakenly processing Non-Preferred One Aetna policies that should not bill to them.
At this time Fulcrum is beginning the process of recouping prior incorrect payment. To see which plans this effects and what action is needed, see below.
Whether you own your own practice, are an associate, or you are getting ready to graduate and start your new journey, you have plans. You have dreams. You have desires.
Remembering the old saying of “You need to work on your business not just in it” is easy, but to DO it can prove challenging. Especially with the ever-changing daily distractions we face.
Ever have one of these days? You wake up and the dog peed on your slippers, your coffee maker broke, and your kid missed the bus. Only to walk in the office door and you are hit with emergencies, the toilet is overflowing, staff issues, the phone isn’t working, and you only have enough headrest paper for your first 10 patients, and so on…? Yes, many of us have. These are called “temporary distractions”. These distractions tend to pull us away from our vision and goals of what we want – for our business and our lives. Sometimes we get stuck in the distractions while life passes us by.
Where your coaching comes in is how you learn to work through those temporary distractions and help you stay focused on what is important for you, your business, and your family. You have a plan. Coaching helps you maintain that daily focus so these temporary distractions will no longer be something that pull you away from what is important to you and your business.
This month we are focusing on Distraction #1 – Recruiting & Retaining Your Team
No matter what type of business, there are always staffing issues of some kind. Recently, Action Coach MN, held a webinar on recruiting and retaining your Team. Their message spoke volumes to business owners who want to work “on” their business and get where they want to go.
The graph below shows The Cycle of Business. Your team are the ones working in your business. Your team are the ones who have first and last contact with your patients. Finding the right team will free up your time to work ON your business.
Finding the right team, however, can prove challenging. Here are some questions to ask yourself:
For example, say you need a Front Desk person to greet your patients, take cash payments, answer your phones, and schedule visits. Looking at this chart, you would say you want a People Person “I” and “S”. In your ad you would say something like: “a fun and happy place to work. Friendly environment. Love to laugh and converse with people? We want to talk with you.” These words attract the “I” and “S”. It’s okay to not market to everyone, because you don’t want just anyone.
It is challenging to find and keep good people. Take the time to find the right people and your coach will help you stay on task for your goals and dreams.
Next edition we will discuss how to talk and reach Millennials to help keep you focused “on” your business.
Many times, when you recommend a supplement regimen to your patient, the patient will purchase this item and never refill, or potentially not follow-up in a timely manner. Their supplement care falls through the cracks.
There are also many cases when what the provider is recommending does not necessarily follow the dosage on the bottle, therefore throwing off the refill date. This can be time-consuming and increases the chance for error when checking out at the front desk.
The Vitamin Calculator is a simple tool that will help you calculate dosage, determine time between refills, ensure your patient has enough supplements to last them through their next appointment, and increase your bottom line.
SecureCare has released their current Clinical Review Guidelines for Blue Cross and Blue Shield of Minnesota. If you are an in-network provider, you should have received this notification.
The guidelines are measured bi-annually and are used as benchmarks in helping SecureCare determine your provider status within the Blue Cross Blue Shield of MN network. This status determines your ability to stay in the network.
Depending on the policy type (Commercial, Medicaid and/or Medicare), benchmarks are based on average allowed dollars per patient, average number of services per visit and average number of patient visits annually.
Providers who fail to meet the benchmarks, based on their overall average, are identified as “Outliers”. SecureCare states that “Outliers” will be subject to medical records reviews and corrective action plans in order to maintain in-network status.
Please be sure to watch for your notification!
Update: On May 21, 2021, SecureCare emailed an updated version of the Clinical Review Guidelines for Blue Cross and Blue Shield of Minnesota (BCBSMN) Commercial plans. We believe these revisions simplify our clinical review requirements for clinics. However, questions have arisen regarding the $500 allowed dollars-per-patient clinical benchmark for BCBSMN Commercial claims. We hope the following explanation will offer more clarity.
The $500 per-patient commercial benchmark is an average of all commercial patient seen by a clinic over the course of a 12-month period. It is not a “per-patient” cap. This benchmark allows clinics more flexibility in delivering medically appropriate care based on patient needs. Some patients require a lower number of services but longer plan of care, while other patients require a higher number of services and a shorter plan of care. Only clinics exceeding this $500 per-patient average will be required to undergo medical record reviews. The SecureCare Provider Portal is updated monthly allowing you the opportunity to review not only your clinic data but also your peer averages. Be sure to visit your secure online provider portal at: www.securecarecorp.com.
SecureCare assumed responsibility of BCBSMN chiropractic network management on October 1st, 2016. In the years since, chiropractic clinics received two fee schedule increases, the ability to bill for CPT code 97140, and the removal of prior authorizations. In addition, this past January, a re-tiering of the network occurred affording 50% of network clinics an improvement in their tier position.
SecureCare is proud of its accomplishments and of its relationship with both the provider community and with. SecureCare continues to work for the advancement of chiropractic in Minnesota while creating a unified voice for all conservative care providers across the country. If you have any additional question, contact providerservices@securecarecorp.com.
