Referral Protocol. Initiated 4/17/14 JL Updated 11/13/14 JL

Transcription

1 Satisfies Element 5B-1 Referral Protocol Initiated 4/17/14 JL Updated 11/13/14 JL Create outgoing referral Complete all pertinent outgoing fields i.e. provider being referred to or facility, reason for referral, patient specific notes (hard of hearing, mobility issues and visual deficiencies). o If a referring physician is not included in the current referring provider list within eclinicalworks, demographics including name, identification numbers, specialty, address, phone, and fax are gathered by the medical office assistant (MOA) and entered into the EMR prior to creating the referral. Complete the memorandum of understanding field in the structured data tab. Attach medical summary, any pertinent progress notes, labs, or radiology testing results. All above information should be sent to the outgoing referral provider/facility by fax or electronically via P2P (provider to provider). Care Coordinator will track all outgoing referrals within the EMR outgoing referral screen to ensure timely appointment completion and follow up documentation received. (see outstanding referral protocol) Colleen Bingham, M.D. Michael G. Brummer, M.D. Amanda Bierman, M.D. Jeffrey K. Brummer, D.O. Jeffrey Crowell, M.D. Thomas Heischmidt, M.D.

2 Satisfies Element 5B- 2 and 3 Outstanding Referral Protocol Initiated 5/13/14 JL Referral orders are generated electronically within eclinicalworks (ECW). When the order is generated, it automatically defaults to the ordering provider s designated Medical Office Assistant (MOA). The order shows up in the individualized electronic in-box, or R-Jelly bean (see end of document for description). When the appointment is scheduled and the patient is notified, the staff member sends the order to the holding queue. This is done by assigning the order to z-pending, Referrals. Once the clinical information is received by the referred to physician via fax or mail, the Health Information Technician attaches the documents (electronically) to the referral order within ECW, marks the referral as received and sends the clinical documents to the ordering provider. If further action is required, an electronic message will be created and sent to the appropriate staff member. If the referral information is not received by the referred to physician within 30 days of the scheduled appointment, the staff member reconciling the holding queue will send the referred to physician a record request. Below is a workflow algorithm indicating how referrals are followed. Staff continuously monitors the holding queue and reconciles outstanding orders Staff contacts the referred to provider to obtain clinical documentation. If the patient failed to follow through with the referral appointment, the staff member will contact the patient for follow up. Referral created electronically in eclinicalworks Referral order sent to holding queue z- Pending, Referrals Clinical information is obtained and sent to the ordering provider Information reviewed and an electronic message is sent to staff member within ECW if any follow up is necessary. Z pending referrals need to be done at the end of every month. There are referral fax sheets that can be faxed to request notes; they are located at the refill/referral desk. Please allow 4 weeks from the scheduled appointment date to request the note. We should request notes every 4 weeks until we receive the note or the providers give a recommendation to address the referral. Colleen Bingham, M.D. Michael G. Brummer, M.D. Amanda Bierman, M.D. Jeffrey K. Brummer, D.O. Jeffrey Crowell, M.D. Thomas Heischmidt, M.D.

3 1. To access the Z-pending referrals, Click on the R jelly bean. Under the Assigned To: drop down click the 3 dots and choose Z-Pending, Orders. 2. Click on referral to and select the first provider of the alphabet. If this provider has a referral under his name, check to see when the appointment is/was scheduled for. If greater than 4 weeks, we can either request note or see if note has been faxed. Before requesting any referral notes, we need to check the pt. documents to see if there are already notes faxed to us regarding this referral. It is most likely that you find the note in the referral tab, however things can be put under the wrong section, so please check all folders for referral notes. If there are any notes from that provider, the referral can be ADRESSED at that time. 3. If there is not a note in pt. documents, now we need to request a note. Fill out one of the referral fax forms with all patients you need to request notes on. Fax the form to the appropriate facility. Place an S in front of the reason of the referral. (This lets other people know that a request has been sent). Also go into the referral, under notes, timestamp and say that office notes have been requested. 4. Remember, we can only request notes of patients that look like they have been seen by the provider and at least 4 weeks has passed since the scheduled appointment date. If there is no appointment time/date in the referral, you may need to call or fax a request to see if patient was seen. If you put a question mark (?) next to pt. name on the request notes, the person sending back any notes will indicate if a patient has been seen. The most important thing to remember before writing a pt. name down is to check and see if the Referral can be addressed first. 5. Once you have gone through the providers, you will need to go to Z pending referrals and All referrals. There will be several in there to dietary, physical therapy, etc. There will probably not be any notes faxed back on some of these patients. We need to make sure they were compliant with their appt. Colleen Bingham, M.D. Michael G. Brummer, M.D. Amanda Bierman, M.D. Jeffrey K. Brummer, D.O. Jeffrey Crowell, M.D. Thomas Heischmidt, M.D.

4 6. After the 2 nd attempt via fax with no response, we will need to contact the office and verbally ask for notes. 7. Once you get the notes, the notes will go to the in house provider for review and the referral can be addressed. If you receive the request back from the facility and they say a patient didn t show up for their appointment, timestamp the notes and state patient did not show up. Send this back to the provider s MOA. 8. The MOA should notify the provider that the patient did not show up for the appointment verbally, document this in the referral tab or create a TE with this information and send to the provider. Please include in the documentation in the referral the provider s recommendations. 9. If a patient has an appointment with psychologist, psychiatrist, counselor, etc. (example: Melissa Semple ) we cannot request notes but we do need to make sure they showed up for their appt. Once you have this established, you can address referral. Colleen Bingham, M.D. Michael G. Brummer, M.D. Amanda Bierman, M.D. Jeffrey K. Brummer, D.O. Jeffrey Crowell, M.D. Thomas Heischmidt, M.D.

5 Family Care Associates Satisfies Element 5B-1,2, and 3 Referrals are tracked in the Outgoing Referrals screen and filtered by those assigned to Z-Pending. From here, we can see the referral reason, referred to provider, start/end/appointment date, and status (check-mark indicates an electronic referral via ecw Provider-to-Provider or P2P. NA indicates the referral was faxed). If the appointment date was greater than 4 weeks ago, we contact the specialist office for visit notes or updates via fax or phone call per the Referral Protocol and the Outstanding Referral Protocol.

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7 5B-1, Completed outgoing referral screen Priority can be Routine, Urgent, or STAT Three attachments have been added to this referral. Attachments generally include pertinent progress notes, clinical summaries, and/or relevant diagnostic/lab results

8 Satisfies Element 5B-3- Example of Outstanding Referral follow up to specialist office. Family Care Associates of Effingham, S. C 1106 N. Merchant, P.O. Box 665 Effingham, IL Fax FACSIMILE MESSAGE COVER SHEET ATTN: Medical Records/ Dr. Crowell s Office- FAX#: COMMENTS: Please review the following list of patient(s) and fax our office back with consult notes of the referral visits done at your facility initiated by our office Thanks!!! FROM: Family Care Associates of Effingham. S.C. Colleen Bingham, M.D. Michael Brummer, M.D. Jeffrey G. Crowell, M.D. Thomas Heischmidt, M.D. Jeffrey Brummer, D.O, Amanda Bierman, M.D. Dot Behrns, F.N.P. Lenora Drees, F.N.P. Richelle Dillon, F.N.P Candi LeDuc, F.N.P. Jamie Niemerg, F.N.P. CONTACT: Referral Department/ Jenifer FAX#: DATE: TIME: _ NUMBER OF PAGES INCLUDING THIS COVER SHEET-=:;) _ This fax is intended only for the individual or entity to which it is addressed, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby informed that any use, disclosure, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via United States Postal Service. You are hereby notified that any dissemination or copying of this communication is strictly prohibited. THANK YOU!

9 Family Care Associate of Effingham, S.C. I106 N.Merchant.P.O.Box 665 Effingham, IL Phone (217) Fax (217) TO WHOM It MAY CONCERN: Family Care Associates S.C. referral tracking method is further expression of our commitment to improving healthcare quality. In an effort to provide coordinated, effective, and efficient care as well as excellent communication, we are requesting clinical notes and/or any clinical support information on the following patient(s): I Patient Name, DOB, Visit Date details entered here ***********t*********************************************************** Please fax documentation to our office at Thank you, Care Coordinator- Jenifer Colleen Bingham, M.D. Jeffrey K. BrummerD.O. Lenora Drees, F.N.P. Jamie Niemerg,.P.N.P. Michael G. Brummer, M.D. Jeffrey Crowell, M.D. Dot Behrns, F.N.P. Candi LeDuc F.N.P. Amanda Bierman, M.D. Thomas Heischmidt, M.D. Richelle Dillon, F.N.P.