ABC Medical Clinic Policies & Procedures
Document ID
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Revision
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Effective Date:
mm/dd/yyyy
SAMPLE Policy
Title: Referral Tracking and Follow-Up
Print Date
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Prepared By
Date Prepared
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Reviewed By
Date Reviewed
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Approved By
Date Approved
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Applicable Standard: PCMH Standard 5: Care Coordination and Care Transitions;
Element B: Referral Tracking and Follow-Up.
Description: The Practice coordinates referrals for patients including referrals to all medical
specialists, mental health and substance abuse specialists and all other services.
Policy:
It is the policy of the Practice to document and monitor all referrals using an electronic system. The patient’s
provider is notified of all unfilled referrals in a timely manner.
It is the policy of the Practice to document results and monitor all results or other communication from
providers to whom the patient is referred. All referrals are monitored for the successful completion of the
referral.
Scope:
This procedure applies to all office personnel.
Procedure:
The Practice tracks referrals to specialists, including medical, mental health, and substance abuse specialists,
using an electronic reporting system. Referrals tracked are those determined by the patient’s provider to be
important for a patient’s treatment or as indicated by evidence-based guidelines.
The Practice uses available data from Physician Compare Website, health plans and Iowa Medical Society
on the performance of the clinicians and the practice before initiating a referral with the specialist. The
Practice establishes an informal agreement with a subset of specialist based on this criterion.
The Practice has an agreement with two behavioral health specialists:
Dr.XXXXX and Dr. YYYYYYY (locations)
The Practice tracks the following factors for referrals:
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Date of initiation of referral
Originating provider
Reason for the referral
Timing of the expected receipt of the communication from the referral, or relative urgency
of the referral based on the clinical circumstance. Per current protocol, the urgency is
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ABC Medical Clinic Policies & Procedures
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SAMPLE Policy
defined by: Emergent — within 24 hours; Urgent — 24 to 72 hours; Routine — 72 hours to
2 weeks.
Relevant demographic and clinical information as it pertains to the referral
Whether a consultation/referral report is received from specialist
General purpose of the referral
Required communication or information following the referral
The Practice strives to electronically communicate with specialists. The communication includes both
ordering consultations and receiving reports. The Practice establishes any alternative mechanisms of timely
communication with each specialist or consultant for whom it does not have electronic communications.
These alternative or supplemental lines of communication include telephone, fax, secure email, or written
correspondence.
When referring a patient, the Practice provides an electronic summary-of-care record to the specialist.
(Exceptions may be made to the electronic transmission, including the request of the patient for a paper
copy to bring with him or her.)
The following actions are taken regarding referrals:
1. An encounter with the patient is completed. The decision of the provider to refer the
patient to another provider is documented in the patient’s record in a manner that is
consistent with medical and legal prudence.
2. The provider or authorized Practice clinical staff enters the order for consultation or
referral into the progress notes in the patient’s medical record.
3. A staff member of the Practice schedules the appointment with the designated specialist at
a date and time convenient for the patient, but within the time frame as dictated by the
clinical circumstances.
4. A staff member of the Practice completes any insurance referral information and records it
for entry in the patient’s progress notes.
5. Referral requests are entered into the electronic health record (EHR) system or, if
applicable, a tracking system, as items in “pending status.”
6. A communication to the referral provider, facility, etc., is produced using an appropriate
standard form or template. The communication is automatically transmitted to the
referring provider following the encounter.
7. The patient is notified of the specialist’s name, address and the date and time of the
appointment.
8. The patient’s specialty referral appointment — time, date, and location — is recorded in
the appropriate data field in the progress notes of the patient’s EHR or referral tracking
system, as is the time, date, and method by which the patient was notified of the
appointment (e.g., written notification, telephone call).
9. Referral requests are either linked to a referral tracking system through the EHR or entered
into an electronic tracking system to ensure that the referral request is not lost.
All details of the appointment with the referral specialist are documented in a manner that is consistent
with medical and legal prudence.
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ABC Medical Clinic Policies & Procedures
SAMPLE Policy
The Practice tracks the orders of all consultations, regardless of the location (e.g., internal or external) of the
specialist. All orders are tracked through completion (e.g., receipt of consultative report) in a manner that is
consistent with medical and legal prudence. The Practice flags all outstanding orders based on a designated
period of expected turnaround time for the consultation as determined by the provider (see above for
current protocol).
Immediately upon receipt, communications from specialists (e.g., consultation reports, letters of treatment)
are scanned into the patient’s medical record by a staff member of the Practice.
The patient’s provider is alerted when new communications arrive.
The patient’s provider electronically acknowledges or manually initials the report or letter after reviewing it,
with notation made in the patient’s medical record in a manner that is consistent with medical and legal
prudence.
The “open” encounter is closed in the EHR or the Practice’s referral tracking system.
On a daily basis, the health coach downloads a report for all “open” encounters that are outstanding for
a week or more to ensure that no referrals have been lost or delayed. The health coach contacts the
specialists’ office to determine the status of the referral. For example, a patient is scheduled for an
appointment with a cardiologist on March 1. The report is expected by March 8. If the report is not
received by March 9, the health coach contacts the cardiologist’s office to determine the status of the
report. If the patient did not keep the appointment, the patient’s record is updated accordingly, and an
electronic alert is sent to the patient’s provider. If necessary, the patient is contacted. All specialists’
encounters are expected to be “closed,” as defined by a communication received or an acknowledgment
of a missed appointment, in the EHR no later than 14 days after the scheduled appointment.
When consultative reports are received, they are documented in a manner that is consistent with medical
and legal prudence. The Practice strives to receive reports electronically from specialists.
For patients who are regularly treated by a specific specialist, the patient’s provider and the specialist enter
into an agreement that enables co-management of the patient’s care and includes timely sharing of changes
in patient status and treatment plan. For co-managed patients, the patient’s provider gives information to
the specialist and receives information from the specialist within a period agreed to by both parties. All
communications, including the agreement(s), are documented in the patient’s record in a manner that is
consistent with medical and legal prudence.
When they establish with the Practice, patients are informed that they should communicate with the
Practice when they choose to seek care with another healthcare provider. They are encouraged to
communicate this information in order to maintain a complete record of their care so that their chosen
primary provider can coordinate their care. This encouragement is also made available through the Practice
brochure and, when applicable, in other Practice promotional efforts. Providers routinely ask patients if they
have seen a specialist or are receiving care from a specialist. If the patient has been treated by a specialist,
the report is requested for inclusion in the patient’s medical record.
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ABC Medical Clinic Policies & Procedures
SAMPLE Policy
Quality Control:
The Practice monitors the policy and procedure in the following manner:
1. Annual monitoring of consultative reports, to include turnaround time and outstanding
referrals. If one type of referral is deemed to be untimely in notification, the CMO reviews
the situation to determine if an intervention with the specialist is in order or if an alternate
specialist will be used.
2. Annual monitoring of the provision of summary-of-care records. The numerator is the
number of referrals in the denominator where a summary-of-care record was provided.
The denominator is the number of referrals during the reporting period.
Revision History:
Revision
Date
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mm/dd/yy
Description of changes
Requested By
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