MD Consult TATs
When does the MD consult need to be completed for Engaged RAP members?
Within 1 business day of engagement
A MD consult can never be deferred? T or F
False
CM's are not allowed to initiate a P2P? T or F
CMs are to initiate a P2P when any significant gaps in care are noted.
A subsequent MD consult should only be submitted according to TAT given by MD in previous MD consult? T or F
FALSE - MD consult can also be completed based upon CM judgement BUT no later than TAT provided by MD at time of last consult
When does the MD consult need to be completed for non-engaged RAP members
within the 30 day period and after attempts for provider engagement
Any deferral of the MD consult must include a CM-centered reason and a deferral note must be entered in 60 days.
False - Any Deferral of the MD Consult must include a member-centered reason, and deferral note must be entered by the TAT.
When a case is over 500K what should the CM plan to do in regards to MD involvement
When 500K is identified CM is to bring to the next scheduled MD Open Office Hours or Care Rounds.
IF the MD does not provide a TAT for subsequent MD consult when should the CM send consult again?
MD Consult is due at least every 3 months, if engagement continues, case remains complex, and additional outreach is scheduled.
When does the MD consult need to be completed for complex or post acute members?
No later than 30 calendar days of engagement if member remains engaged and additional outreach is needed. OR per CM judgement if needed sooner
CM may elect to defer MD consult for inpatient cases that have MD review documented?
True -
MD referrals can be done electronically or discussed in rounds. When the MD consult is submitted electronically (through ATV) what DGA does the CM add and task to MD?
Medical Director Consult in ATV DGA:
Deficit Collaboration needed with Medical Director Goal Complete collaboration with Medical Director Activity A1A Collaborate with Medical Director
In regards to MD consults and subsequent MD consult, is PRN considered a frequency?
YES, so CM would only send back MD consult as needed.
When does the MD Consult need to be completed for HICO members?
when case hits 250K plus
CM may elect to defer MD consult for re-identified, or RAP / HICO identified, where the MD has recently (30 days) completed the review and is aware of the situation. CM must document deferral reasons.
True
When submitting the MD consult electronically, the CM will task DGA to the medical director. Once the medical director reviews the case he will send back the same DGA to the CM with a note in SOE providing feedback. The CM only needs to review the note and move DGA to next recommended date for MD Consult? T or F
FALSE - Once the MD reviews the case he will send DGA back to CM and add note in the SOE providing feedback. The CM is to document the notes as reviewed and make note of any follow up items based on MD feedback. The CM then completes the DGA as met and sets a NEW DGA for the next requested MD consult.
If you have engaged member that has went to UTR status but you are continuing to follow for HCC, would you send MD disengagement consult?
NO - Disengagement is complete finalization of all CM activities. Do not send the disengagement update until all CM interventions have ceased. This includes any "behind the scenes" activities.
When does the MD consult need to be completed for non complex opportunity?
No later than 60 calendar days of engagement if member remains engaged and additional outreach is needed
CM may defer MD consult due to CM caseload for that week?
FALSE
When the medical director consult occurs during a discussion in rounds or open office hours the CM would manually add what DGA and complete as MET?
Present Member in Case Rounds or Office Hours DGA
Deficit Referral needed to Medical Director Goal Complete Medical Director referral Activity A1A Medical Director Consult