Referrals
Where do you document when you update a referral?
Communication tab within the referral
Is it appropriate/common practice to send encounter to multiple people or pools?
No , most encounter do not get routed to more than one place unless in structed to in the guide
what kind of appointments require notes?
All appts
when placing a refill encounter what is the reason for call, Dot Phrase, who is the encounter routed to, and what is the time frame?
Refill request , CCrefill , last prescriber, 48-72 business hours.
Where would you go to see if there is a HIPPA on file?
Media
If patient asks for an insurance referral, what do they need?
Prior Authorization
What are 2 main reasons we would route and encounter directly to the provider?
Refills and referral generations outside of that something would rarely be sent directly from the provider
Is just putting follow up an appropriate appt note?
No in addition to follow up you should be explaining what patient is following up on example (f/u on lab results, F/u from taking antibodics) point is provide detail for all appts.
When patient calls in to follow up on there refill request, PSR goes into the chart and see there was already a request placed but medication was never approved, and the request has been place 4 days ago, what is the work flow?
addend encounter and re-route it to Call center nursing.
Submitting an encounter for a HIPPA what is the reason for call? What dot phrase we will use? Who would we route the encounter to?
reason for call -Medical records ,Dot phrase Medical Rec, Route to site PSR pool
When submitting a prior authorization request to Call Center PSRs, what 3 pieces of information are most crucial?
Doctor's name, NPI and appointment date
When should PSR/MOA pool be routed to for responses?
For medical medication refills only
where in the guide can the information be found for what should be notated for pre-op clearance?
In the guide/Appointment reminder tab
True or false - a medication request that has already been approved or denied by a provider can be addended and sent again?
False , a New encounter request must be created.
After how many days would you mark an encounter HIGH PRIORITY after the request goes without being seen?
7-10 business days
When a location is requesting an EPIC Care Link for a referral, what is the workflow?
The same as a referral Prior Authorization, except it is routed to the site referral department instead of the Call Center PSRs.
Can you addend a medication request when the medication pending has been approved or denied?
No, a new encounter should be started even if pertaining to same med
what should be notated in annual physical appt notes and why?
Date of last physical so we can know that psr has reviewed the last physical and that they are in fact due and who made appt for pt
Before routing a medication request, what must be done under the routing tab?
Ensure the request is being sent as an "RX request" and Not a patient call.
If a lawyer's office calls to request medical records what is the work flow?
The caller must document in patient chart, Provide Kenya's email, let the caller know the turn around time.
- If a patient has been seen within a year, what referrals can they request without needing an appointment?
Mammogram, Colonoscopy, and Pap Smears
If encounter has been placed pertaining to what it is your caller is calling for, should you start a new encounter?
No, you should addend encounter pertaining to that matter .
What do you do if you reschedule an appointment for a patient but the previous notes were blank?
Add appointment notes
Before placing refill encounter , what are your first steps?
Making sure patient has an up coming apt
Chart review: make sure this is the first request
Make sure patient was recently seen.
ensure no other refills available
Please list 4 institutions that do NOT need a HIPAA release on file to obtain patient information?