Specialty Clinic Referrals

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Specialty Clinic Referrals

• AKA The Blue Sheets

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How many referrals do we do?

• 650-700 referrals/ month

3
Three different pathways

1. Patients must call for own appointment
2. Internal Medicine can schedule appointment for
   patient
3. Appointment goes under review by the specialty
   department physician who decides if appointment
   can be scheduled

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Clinics where patients must call to schedule
their own appointment
SPECIALTY CLINIC PHONE FAX
Dental Clinic 966-2115
Dental School 966-2805
Psychiatry 966-5217
Orthopedics / Spine 962-6637 966-7956
General Neurology / Sleep 966-4401 966-6501
Dermatology 966-2485 843-6357
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Clinics that require referrals to go under
physician review

• General Surgery
• GI/ Hepatology
• Plastic Surgery
• Podiatry
• Rheumatology
• Urology
• Specialty Neurology Clinics
• Scheduling process can take up to 2 weeks

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Top 3 reasons why appointment referral request
are not scheduled

• Self Pay Patient
• No notes posted in WebCis regarding referral
  reason.
• Internal Medicine physician is not listed as the
  PCP on the patients insurance card.

• Patient must set up payment arrangements with
  Financial Counselor.
• Clinic will deny referral request during
  physician review process.
• Authorization will be denied by patients
  insurance company.
• - Aetna
• - Cigna
• - Partners Medicare
• - Tricare Prime
• - Mamsi
• - Carolina Access

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Priority tracking

• Internal Medicine Clinic
• Referral Form
• Patient ____________________________________
• MR ____________________________________
• Date ____________________________________
• Referring MD ___________________________________
  _
• Attending MD ___________________________________
  _
• Referring MD Signature __________________________
  ______________
• 1 Referring to Clinic_________________ Doctor
  _________________ New to referred clinic
• When Routine within ______________________
  ___ Return to referred
  clinic
• Dx/Symptoms __________________________________
  ________________ Date of Onset _____________
• Reason for Referral ________________________
  __________________________________________________
  ____
• _______________________________________________
  __________________________________________________
  _
• Priority referral needs tracking
  See WebCIS Note.
  Note Date ___________________

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Priority Referrals

• Designed to indicate if provider wants to track
  the referral process for a particular appointment
• If you mark the priority referral box on blue
  sheet, then a WebCIS message will be sent to you
  when appointment has been scheduled
• Keep in mind, the following can happen at various
  stages
• Patient given number and told to call
• Specialty physician is reviewing the case
• Financial arrangements need to be made

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Comments? Suggestions?

• There is no universal referral form for UNC
• No current electronic referral system

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Ancillary Scheduling

• Universal order form

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The Process

• Physician fills out the order form and gives it
  to the patient
• Patient carries form to front desk
• CBA calls for appt with patient waiting

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Scheduling Protocol

• Call and schedule with patient present
• Effective 95 of the time takes 5-7 min
• Exceptions
• CBA at lunch
• No answer
• These appts made later in the day or the
  following morning
• Patients called for near appts
• Others mailed

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Scheduling Protocol (continued)

• Fax requisition
• File
• Copy of requisition kept for 3 months
• Confirmation of fax receipt (separate file)
• Radiology may deny receipt of fax
• Original goes to Med Records

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Pending GI procedures

• Requires patient confirmation to schedule
• Other services allow scheduling with subsequent
  patient notification
• Procedure
• Fax requisition to GI
• GI calls patient
• GI faxes confirmation of appt to IM Clinic
• File kept until circle closed
• 2 currently in file
• Failures
• GI tries 3 calls over 30 days and then gives up
• Patient declines
• Changes mind may happen at any time
• Financial intimidation
• Doctor notified with webcis message

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Daily Protocol
Ancillary Test Location Phone Fax Protocol
Nuclear Medicine / Cardiology Basement / Womens Hospital 966-1884 843-0924 To schedule, call then fax Two copies are required for the following tests. The first copy goes in the file cabinet the printer sits on the next copy is stapled to the faxed confirmation (once faxed) and placed in the box in front of filing cabinet.
Barium Enema / Barium Swallow Basement / Womens Hospital 966-1884 843-0927 To schedule, call then fax Two copies are required for the following tests. The first copy goes in the file cabinet the printer sits on the next copy is stapled to the faxed confirmation (once faxed) and placed in the box in front of filing cabinet.
Bone Density Basement / Womens Hospital 1st floor / ACC 966-1884 843-0924 To schedule, call then fax Two copies are required for the following tests. The first copy goes in the file cabinet the printer sits on the next copy is stapled to the faxed confirmation (once faxed) and placed in the box in front of filing cabinet.
Ultrasound Basement / Womens Hospital 966-1884 843-0924 To schedule, call then fax Two copies are required for the following tests. The first copy goes in the file cabinet the printer sits on the next copy is stapled to the faxed confirmation (once faxed) and placed in the box in front of filing cabinet.
CT Scan Basement / Womens Hospital 966-1884 843-0924 To schedule, call then fax Two copies are required for the following tests. The first copy goes in the file cabinet the printer sits on the next copy is stapled to the faxed confirmation (once faxed) and placed in the box in front of filing cabinet.
MRI / MRA Childrens Hospital 966-6775 843-8046 To schedule, call then fax Two copies are required for the following tests. The first copy goes in the file cabinet the printer sits on the next copy is stapled to the faxed confirmation (once faxed) and placed in the box in front of filing cabinet.
Echo Cardiac Graphics / hospital 966-5214 Beverly / Helene 966-7401 Requires ICD-9 code and type of insurance written on the requisition then fax to the appropriate department and call for scheduling.
Echo Meadowmont 966-7245 Tracey Evans 966-7322 Requires ICD-9 code and type of insurance written on the requisition then fax to the appropriate department and call for scheduling.
ETT / 24 48 Hour Holter Monitors 2nd floor / Main Hospital 966-5121 Erik, Philmer, Bobbie 966-5308 Call to schedule. Make a copy and file in the appropriate file. Same day testing possible if moniors available.
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Daily Protocol (continued)
Ancillary Test Location Phone Fax Protocol
Fees Test ENT, 1st floor / Neurosciencess 843-4479 or 843-0017 843-3280 Fax first, then call to schedule test.
GI Procedures GI / main hospital 966-2310, opt 0 Nia / Kate 966-8764 If scheduled real time, make a copy of the requisition and file. If not, fax to GI for scheduling and then be sure to stand the requisition up in the folder as not complete. GI will fax the requisition back with the appointment time date listed. Replace the incomplete requisition with the completed form and file as complete.
GI Procedures Meadowmont 966-9707 Karen / Patty 843-7136 If scheduled real time, make a copy of the requisition and file. If not, fax to GI for scheduling and then be sure to stand the requisition up in the folder as not complete. GI will fax the requisition back with the appointment time date listed. Replace the incomplete requisition with the completed form and file as complete.
GI Clinic Dr. Nick Shaheen 966-2513 Patty 843-2508 If scheduled real time, make a copy of the requisition and file. If not, fax to GI for scheduling and then be sure to stand the requisition up in the folder as not complete. GI will fax the requisition back with the appointment time date listed. Replace the incomplete requisition with the completed form and file as complete.
Mammogram Gravely, Womens, or ACC 966-8477 or 966-1081 966-9278 Make a copy and file in file cabinet
Pet scan Basement / Womens Hospital 966-6522 Heather / Stacey 843-0591 Fax, then call to schedule. Make 2 copies file one and keep confirmation with the other.
Physical Therapy ACC Main Hospital Mesdowmont 966-6481 or 966-1494 Kaye 966-8500 Make 2 copies. File one and Johnnie Satterfield gets the other copy for her records. Fax, then call to schedule.
Pulmonary Function Test 6th floor Main Hospital 966-4531 966-0292 Call to schedule then make a copy and file.
Peripheral Vascular 2nd floor Neurosciences 966-4582 Quincy / Thomas 966-7784 Call to schedule then make a copy and file.
Neurophysiology EEG, NC Study, EMG 1st floor Anderson Pavillion 966-1686 966-4278 Call and schedule then copy and file.
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Ancillary Scheduling Data
TEST STANDARD WAIT EXCEPTIONS
CARDIAC GRAPHICS Hospital Meadowmont January January Patients can call daily to see if there are any cancellations to get an earlier appointment
MRI / MRA ACC January Night appointments plenty of availability Weekend appointments plenty of availability
MAMMOGRAMS ACC Womens Diagnostics February January 2 weeks out For diagnostics, patients can be schedule same day per doctors request
CT SCANS January Night appointments plenty of availability Weekend appointments plenty of availability (hours 10 11 am Can do add-ons if there are any openings (emergencies only)
ULTRASOUNDS Several days Can do add-ons if there are any openings (emergencies only)
GI PROCEDURES Screenings 2-3 months out Diabetics 4 months out Can do add-ons if there are any openings (emergencies only) Diabetics must be done in mornings
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Ancillary Test Data (West Wing)
Ancillary Test RTS (Real Time Schedule) June July Aug Sept Oct Nov TOTALS PER TEST
1 Barium Enema / Swallow 0 0 2 2 3 3 2 12
2 Bone Density 6 30 31 41 28 39 43 212
3 Cardiac Graphics / Echo 5 21 35 27 37 28 24 182
4 CT Scan 2 26 28 15 21 31 21 142
5 ETT 1 2 0 3 0 2 1 8
6 Event Monitor 0 4 0 2 2 0 5 13
7 Fees 0 0 0 0 0 0 0 0
8 GI Procedures 21 71 69 82 82 92 76 472
9 Holter Monitor 3 7 1 3 1 5 5 22
10 Mammogram 42 114 114 99 106 139 141 714
11 MRI / MRA 6 24 30 30 22 25 20 151
12 Neurophysiology / NC, EEG, EMG 0 1 5 3 0 1 2 12
13 Nuclear Cardiology 2 13 6 19 19 11 18 86
14 Peripheral Vascular Lab 6 31 16 21 26 36 20 150
15 Pet Scan 0 2 1 1 0 0 0 4
16 Pulmonary Function Tests 3 9 16 12 19 13 17 86
17 Physical Therapy 5 35 32 30 28 45 27 197
18 Ultrasound 2 22 17 26 18 30 20 133
TOTALS PER MONTH TOTALS PER MONTH TOTALS PER MONTH 413 403 416 412 500 442 2586
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Tracking

• Files are maintained at each of the front desk
  areas for ancillary requests. Each of the
  folders are divided into headings GI, CT, MR,
  Echo, etc.
• Complete. These include ancillary appointments
  scheduled in real time as well as those completed
  later.
• Pending. This folder contains all request forms
  that are delayed for any reason. (Primarily GI
  procedures)
• A master file is maintained by date of service
  for all completed ancillaries for at least a 3
  month period.
• These are filed at the West Wing front desk by
  Kelly Gillison East Wing by Yvette McCollum.

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Scheduling problems

• Incomplete and illegible forms
• No physician code
• No signature may require wait until next clinic
• No diagnosis page or interrupt doctor
• No ICD code for echo page or interrupt doctor,
  or try coding
• Patient changes mind
• Meeting with financial counselor required