TATs
Case set up and review case prep tool review needs to be completed within ____ calendar days of assignment. (Day assigned is day 0)
3
follow up calls should be completed on different days and times if 1st call is unsuccessful. How often should f/u calls be scheduled until initial assessments are completed?
at least every 2 weeks or as clinically appropriate until all gaps are closed
Discharge planning outreaches are to be completed within ____ calendar day of PDC/LOS opportunity, manual referral or scheduled inpatient event for cases identified for PAC opp.
1
Reminder: cases identified for PAC opportunity will need discharge planning calls scheduled and PDC completed. Do not step down case until all related calls are completed.
best practice: All dcp calls received on a Friday should be completed that day but no later than following Monday.
If PDC/LOS opp identifies outside of normal business days, call should be completed on Monday or next working business day.
RAP
____ attempts on different days and times within _____calendar days of discharge date.
2 attempts
3 calendar days
Reminder - day of discharge is day 0 and if member is inpatient when RAP identifies you would continue with IPCC and DCP outreach cadence.
If member already reached and engaged for PDC - continue with RAP outreach cadence
Outreach is required within ____ calendar days of engagement or 2nd UTR attempts, if the following opportunities are identified:
· RAP · RAP with readmission (repeat outreach) · HCC per workflow · PDC · Time for Clinical Action (TCA)· Actively receiving cancer treatment
14
If case changes from noncomplex to complex how soon does the research note need to be reentered?
3 calendar days of CM noting the conversion
Second f/u outreach attempt when member is UTR or unable to talk on first attempt must be within _____ calendar days of initial attempt.
14
You should complete discharge planning on Monday, Wednesday and Friday of each week? True or False
False: Attempt two facility DCP calls per week. Make additional follow up based on needs/barriers to discharge presented.
For RAP members, first call should be made within ____ calendar day of discharge date and second outreach within ____ days of discharge date.
1 and 3
Provider outreach is required for all members? True or False?
False - provider outreaches are done per CM discretion for non-complex members
Complex Case Initial outreach needs to be completed within ____ calendar days of case assignment. (day assigned is day 0)
7
Pre-admission outreach is a complex opportunity and cadence for initial outreach is with ____ calendar days and second is within ____ calendar days of case assignment.
7 and 14
Follow complex guidelines for outreach.
Best practice: if you get the case several weeks/months prior to admission, you would want to ensure call is made again closer to time of admission.
_____ attempts will be made for Post discharge calls on different days and times within ____ calendar days of discharge date?
2 attempts
7 calendar days
Best practice: Remember that if a member is readmitted it is usually within 48 hours of discharge. Get 1st call completed ASAP.
If a RAP member is inpatient but CM is unable to confirm inpatient status, how soon should the PDC call be made?
within 1 calendar day
Informed Health Line calls (IHL) ____ call attempt(s) within ___ calendar days of task to CM.
1 call only within 7 calendar days
Reminder: If outreach call already scheduled with engaged member, CM discretion is used whether to call sooner
The initial UTR letter is sent by automation for all cases identified? True or False
FALSE - the initial UTR letter is sent by automation for system generated opportunities only. CM manually sends UTR letter when case is manually identified.
IPCCs need to be completed within ____ calendar day of scheduled inpatient event, PDC/LOS opportunity.
1
If member is in hospital/SNF for extended care, how often should the CM call to do discharge planning?
1 call per week
Provider outreaches for RAP member need to be completed within ____ calendar days of the RAP opportunity date.
If member has an unexpected readmission while the RAP DGA status is open, provider outreach should be completed within _____ calendar days of CM receipt of notification.
14 days
Please note: the RAP opportunity date starts the clock
7 days
Note: CM receipt of notification starts the clock for unexpected admissions
Care Consideration calls:
Level One: Clinically Urgent- _____ attempts on different days and times within ___ calendar days from assign date.
level 1 - 2 attempts within 14 calendar days.
please note - first outreach is within 7 calendar days of assignment. assigned date is day 0
Initial outreaches for Virtual Primary Care referrals need to be completed within ____ calendar days of receiving case.
How many outreaches are made?
7
2 outreaches in 7 calendar days
If member has an extended length of stay, 2 IPCC calls attempts should be made every ____ calendar days of the last attempt.
7
Best Practice: All IPCCs received on Fridays should be completed that day but no later than the following Monday
Discharge planning should be completed how often for NICU cases?
No less than every 14 calendar days; more frequently (weekly +) as discharge approaches, or as requested by UM/MD
MD Consults - May be completed as needed per nursing judgement but no later than _____ calendar days of RAP opportunity identification.
MD Consults for unplanned inpatient readmissions while RAP DGA is open should be completed no later than _____ calendar days.
7
7
Level two Non - clinically urgent care considerations will be called within 14 calendar days? True or False
False - Level Two Non-Clinically Urgent Care Considerations: Address during routinely scheduled follow- up calls