Category 1
Category 2
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Category 4
100

What change does the CM make to research for a RAP member?

note should be placed in the SOE acknowledging the RAP score indicator and CM plan.

100

How frequently should a CM make outreach to the member for the fist 30 days.

At minimum, weekly call should occur 

100

If a member remains out of the hospital for 30 days post discharge what will the CM mark the DGA as?

DGA would be marked as "met"

100

The treating physician should also be notified of any unscheduled readmission by when?

within 1 business day of CM notification

200

When should the CM complete and inpatient confinement call with RAP member?

within 2 days of case assignment

200

Give me 2 things that a member should understand upon discharge?

  1. Member fully understands hospital discharge plan
  2. Member has all new medication, understands how/when to take it, and knows whether they should continue other medications they were taking prior to admission
  3. Member has a follow-up appointment with a provider, knows when it is, recognizes the importance of that appointment, and has transportation to the appointment
  4. Member understands warning signs of a worsening condition and when and where to seek urgent medical care, if needed
  5. Members have supplies and support to thrive in the home environment. (Ex. wound care supplies, assistive devices, caregiver assistance, home care services).
200

When do you close the RAP focus?

at step down

200

Who should be making all provider outreaches for the RAP members?

Due to the risk level, CM should complete

300

When a RAP member is discharged from the hospital, what is considered best practice for when post discharge call should be made?

within 3 calendar days of discharge

300

What are some important items to be sure are documented with our RAP members after PD call?

  • If the member received DC instructions and if they were reviewed together
  • Does the member have all the medications that were ordered
  • Prior to discharge- what instructions did the member receive regarding warning signs or when to call physician
  • Have you experienced worsening or change in symptoms
  • Follow up appointments set and name/ practice of MD (Physician)
300

When does the first MD consult need to be completed for RAP members?

send by the first business day after engagment

300

How long does the RAP DGA stay open?

at least 30 days from day of discharge

400

If member is discharged on a Thursday, what day is the best to make that first PD call?

Friday, to avoid going into the weekend without ensuring member has all needs addressed.

400

How many days should the RAP DGA remain open?

DGA should remain open for 30 days

400

With a non engaged member when should the CM outreach the treating provider?

within 10 business days of RAP

500

To avoid readmittance to hospital within 30 days how long is the CM encouraged to keep the member engaged (at minimum)?

30 days

500

How should the CM complete the DGA if member is readmitted during those 30 days?

Complete as "not met"

500

MD notification is required for all RAP cases that have unscheduled readmissions within 30 days of discharge by when?

  • within 10 business days of RAP identification)
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