Meet
the Board: Dr. Zach Kimble
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A founding
member of ChiroCare, Zach Kimble, DC, became interested in chiropractic care
after a friend's father, a chiropractor, suggested that he consider it as a
possible career path. After attending the University of Minnesota, Dr. Kimble
attended Northwestern College of Chiropractic, graduating in 1978. Following
graduation, he practiced in Minneapolis for a short time before relocating to
St. Paul where he has practiced since 1980.
In the early
1980s, Dr. Kimble, along with a small group of other chiropractors, helped
establish ChiroCare when managed care first arrived in the Twin Cities. The
group's initial goal was to help the chiropractic profession gain a presence
within the HMO product, which had quickly become popular in this region. Today,
he serves as the ChiroCare board's Secretary and also chairs the Provider
Services Committee. "From the
very beginning, my involvement with ChiroCare has been to focus on making sure
chiropractic is available to all," says Dr. Kimble. "I believe we, as an
organization, have helped to make that a reality in Minnesota."
In addition to
his board service with ChiroCare, Dr. Kimble has also served on the Minnesota
Chiropractic Association board, was the chiropractic representative on the
Carrier Advisory Committee for Minnesota's Medicare administrator (WPS), and
has been involved in national ACA programs. In 1992 he was named Chiropractor
of the Year by the Minnesota Chiropractic Association.
In his free time, he enjoys
spending time in Northern Minnesota and playing with his grandson.
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Ingenix
Remits Update
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As of late January, claims files have
been successfully exchanged with Ingenix. Providers
who use Ingenix, must register with the clearinghouse if they wish to receive
electronic remits from them.
Upon receipt of registration information from Ingenix, Landmark will
adjust the claims file sent to the clearinghouse to include claims for newly
registered providers. Please note that this data sharing and record update
process may take up to two weeks.
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Annual
Meeting Reminder
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ChiroCare recently distributed invitations
to its 2010 Annual Meeting at the Ramada Plaza Minneapolis Hotel from 6 p.m.-8
p.m. on Thursday, February 25, 2010. If you did not receive a copy, or have
misplaced it, click here to
view it, or log on to www.chirocaremn.org
and select "2010 Business Meeting Invitation" from the Provider Communications/Provider
Alerts section. The meeting is open to all ChiroCare contracted providers and
will include distribution of our annual report. All providers who plan to
attend are strongly encouraged to RSVP.
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Greetings!
In this month's ChiroCare Provider Newsletter you will find the following articles:
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Advanced Imaging Referrals
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While
ChiroCare understands it is within a chiropractor's scope of practice to refer a
patient for advanced imaging services, e.g., CT scans and MRIs, most health
plans have implemented cost control measures that do not allow chiropractors to
provide a referral without fear of the service being denied. To support its
provider network in the delivery of comprehensive chiropractic care, ChiroCare
has been working to collect and provide the health plans with data to demonstrate
the high percentage of significant clinical findings that result from direct
chiropractic referrals. Progress with the plans has, however, been slow.
Until further data can
prompt policy change, ChiroCare recommends that providers help their patients who
require advanced imaging services obtain the best possible coverage by directing
them to a medical doctor for a referral. With current health plan policies,
direct chiropractic referrals may result in costly claim denials, jeopardizing
your valued patient relationship.
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Changing
Perceptions: ChiroCare's Oswestry Initiative
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Increasingly, the focus of the health
care industry, as well as recently passed and pending legislation, is
collecting and measuring outcomes data to identify and/or validate appropriate
levels of patient care. The result
is that, more than ever before, any care that has not been proven to be
clinically and/or cost effective, will no longer be covered by insurance
policies and/or self insured employer groups. In addition, the growing
availability of information will likely cause some potential patients to
gravitate to care options that are able to provide sound outcomes data.
As demonstrated by the Dr. Kane literature
search ChiroCare funded in 2009 (click here to see details in August 21, 2009 bulletin), the
collection of outcomes data associated with the chiropractic profession has
lagged behind other providers, putting chiropractic at risk for further
alienation from the general medical and insurance communities. To help address
this growing gap and support the future of its network providers, ChiroCare
will launch a data-gathering pilot next week.
The pilot will roll out with ChiroCare's
Advisory Committee members and we will begin collecting outcomes data for
chiropractic patients. Because we know that chiropractors offer effective and
efficient care, we are confident that the data collected will show a very high
level of clinical effectiveness and help to change some lingering negative
perceptions about chiropractic providers.
The pilot will involve loading very basic
patient, provider and treatment data, including Oswestry scores. Data will be
collected through a secure ChiroCare Web site at various intervals of patient
care. Once the pilot has been completed, we expect to roll this program out to
the full ChiroCare network, likely in the second quarter of 2010. All data
collected will be shared with our health plan customers and other independent
organizations in a position to support chiropractic through sound data analysis
and comparison.
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Lunch
with the President Meetings Resume
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Following a break for the holiday season,
ChiroCare has resumed its "Lunch with the President" schedule. Earlier this
week, ChiroCare visited with providers in the Rochester, Minnesota area. The next
meeting is scheduled for March 18, 2010, in the Woodbury area. If you are
invited to attend a ChiroCare lunch with the president, we hope you will choose
to participate in these personal and direct discussions, which are held to help
ChiroCare do the best possible job in meeting your needs.
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Effective
Case Manager Outreach
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The role of ChiroCare's case management
team is multi-faceted. While it is charged with reviewing cases to determine
medical necessity, an equally important responsibility is to be a resource for
ChiroCare providers. Perhaps you have a question about why a particular service
was not approved, or maybe you have a particularly difficult case that you
would like to discuss with a chiropractic peer. When clinical questions arise,
know that you are welcome to contact a ChiroCare Case Manager for assistance.
When reaching out to a case manager,
please note the following:
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Case
managers are available for phone assistance from 7:30 a.m. to 7 p.m. Central
Time.
- There
are two ways to contact a case manager:
- Call the Clinical Hotline directly at
(916) 569-3345; if all case managers are busy helping other providers, you will
be invited to leave a voice mail message
- Call (800) 638-4557, tell the provider services
representative that you have a clinical issue and would like to be transferred
to a case manager
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Voice
mail messages on the Clinical Hotline are returned as soon as the next Case
Manager is available, or the next business day, if you call after hours.
If you have any concerns
about the ChiroCare case management team, please feel free to reach out to the
corporate office via email ( info@chirocaremn.org)
or phone (651) 389-2007. Upon receipt, a ChiroCare Executive will contact you
to discuss your concerns in further detail.
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