Specialty Clinic Referrals

1. Specialty Clinic Referrals AKA: “The Blue Sheets”

2. How many referrals do we do? • 650-700 referrals/ month

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

4. Clinics where patients must call to schedule their own appointment:

5. 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

6. 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 Top 3 reasons why appointment referral request are not scheduled:

7. Priority tracking Internal Medicine Clinic Referral Form Patient: ____________________________________ MR# ____________________________________ Date: ____________________________________ Referring MD: ____________________________________ Attending MD: ____________________________________ Referring MD Signature: ________________________________________ 1Referring 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: ___________________

8. 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

9. Comments? Suggestions? • There is no universal referral form for UNC • No current electronic referral system

10. Ancillary Scheduling • Universal order form

11. 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

12. 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

13. 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

14. 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

15. Daily Protocol

16. Daily Protocol (continued)

17. Ancillary Scheduling Data

18. Ancillary Test Data (West Wing)

19. 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.

20. 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