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CPRs which indicate an "average cost per patient" outside the ROA result in a participation status of probation. The probation period is 12 months.
Counseling In the first month of the provider's probationary period, the provider is contacted by one of HNS' Chiropractic Medical Directors and offered counseling regarding the HNS CPR program, understanding the CPR reports, and the provider's and network's responsibility to ensure cost-efficient care.
CE Requirements Providers new on probation are required to complete the six hour CE program on the HNS website titled "Improving Outcomes with Excellence in Clinical Documentation". This CE must be completed within 20 days of the date shown on the CPR report in which the probation status was first assigned.
Interim Reports To ensure the provider's performance is measured fairly while on probation with HNS, during the 12 month probationary period, HNS only reviews data from claims submitted since the onset of the probationary period. HNS generates "interim" CPR reports for the provider each month of the probationary period, and each report reflects only data from claims submitted since the onset of the probationary period.
Initial 90 Day Probation Period While the provider's probationary period is 12 months, the provider is given an initial period of approximately 90 days to improve their "average cost per patient" (CPP) to within the ROA. The three month period is intended to allow for the completion of one treatment cycle for many of the provider's active patients. If the provider's average CPP does not improve to within the HNS ROA by the end of the three month initial probationary period, the provider's participation in the network may be terminated.
If during the initial 90 day probationary period, the provider has an insufficient volume of patients to demonstrate improvement, he may be granted an additional period of 90 days.
Remaining Probation Period If the provider's "average cost per patient" improves to within the ROA by the end of the initial 90 day probationary period, but between months 4-12 of the probationary period, is again outside the ROA, for the same health care plan, the provider's participation in the network may be terminated.
Subsequent Performance Providers are expected to ensure the consistent delivery of cost-effective care. Providers who have been on CPR Probation with HNS and again have average per patient costs outside of the HNS ROA, may be terminated from the network.
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