Fulcrum expects providers to recommend services that are patient-centered, medically necessary and designed to reach Maximum Therapeutic Benefit (MTB) efficiently.
Treatment recommendations should be patient and condition specific and not solely based on a subluxation philosophy, practice management routine, or technique protocols.
MTB may be determined following a sufficient course of care where no further demonstrable meaningful clinical improvement would be expected in a patient's health status from the current method of treatment. Ongoing treatment may be considered maintenance care.
Maintenance Care: Includes services that seek to prevent disease, promote health, and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
I. Treatment plans and necessity for ongoing care should be determined by:
- An individual’s patient presentation
- Shared goals and decision making
- A providers subluxation philosophy, practice management routine, or technique protocols
- A patients measurable and sustained progress with care measured subjectively, objectively, and with outcome assessment information.
Correct responses 1,2,4
II. Once a patient reaches MTB from your treatment, they may:
- Be discharged from your care
- Be referred to another provider type if additional therapeutic gains are anticipated
- Be transitioned to a self-pay wellness/maintenance care plan, provided the proper financial forms are completed by the patient. Maintenance care is not a covered benefit.
- Continue to schedule visits and bill the health plan.
Correct responses 1,2,3