Outreach
What is the timeframe to complete newly tasked Outreach?
What is:30 Days from ASSIGNED date.
What are the tiers?
High, Moderate, and low.
What E&M code (G code) is utilized when billing for CMP clinical?
G9008IP(County)
Who is considered "Rendering Provider"?
What is Enabling Services
What is qualifying criteria to receive ECM services?
- Individuals experiencing Homelessness w/ a chronic condition.
- High Utilization (5 ER /3 IP)
In what instance would you bill an Outreach encounter? (4 responses)
- Patient has consented to ECM services.
- Patient declined services.
- Inactive insurance
- All 6 Outreach attempts have been completed.
What are the required documents for an ECM initial enrollment?
Consent Form
Release of Information (ROI)
Code of Conduct
HIPAA
Auth. to Disclose (Optional)
Where would you create a NEW patient profile?
EHR System (Globe)
What system would you upload signed documents?
Document management system
What is the role of an LCM vs CHW?
LCM:
- Coordinating overall healthcare
- Connecting member to SDOH services as needed
- Advocate for patient
CHW:
- Engage eligible ECM members (outreach)
- Assist LCM with linkages to resources for patient
- Advocate for patient
What is the workflow when excluding an Outreach patient?
- Case & Consent Tab
- Documentation Portion Tab
- Add codes and process
- Upload Insurance
- Update the Caseload with reason for DE.
When attending a Specialist visit with enrollee, where will it be documented in EHR?
Documentation Tab:
- Face-to-Face (Brief)
- Care Coordination (Depth)
Anthem vs. Health-Net:
Identify the difference when Billing for an enrollee encounter per month?
What is the proper address formatting to be inputted when creating a chart?
a. 224 West D St, APT 22 Lemoore, CA 93245
b. 225 West D St, APT #22 Lemoore, CA 93245
c. 225 West D St, #22 Lemoore, CA 93245
A. 224 West D St, APT 22 Lemoore, CA 93245
- Be sure to capitalize "APT" and not add additional Special characters including (!@#$%^&*?)
What is the timeline for an enrollee to be rescreened?
6 months from last CMP date.
What is the next step for "Home Visit" if patient is considered homeless or no address is found?
Locate nearest shelters in Patients designated County.
Patient has threatened self-harm, what are the next steps:
- Contact 911 for wellness check. (If in person, remain with patient until help arrives)
- Contact assigned Program Coordinator
- Document.
What are the next steps after the CMP clinicals besides charting?
- Schedule Follow-Up appointment to review goals with patient.
- Have patient sign care plan print out.
What is the general workflow for all Documentation from start to finish on?
Check Availity -> EPM (Check-In) -> EHR -> Document Manager -> EMP -> Process Charges (Gold Ticket) -> Check Patient Out -> Update caseload accordingly
True/False: It is okay to leave a pharmacy medication list with a patients family member/friend.
FALSE. Patient needs to authorize by signing ROI for that individual.
*HIPAA COMPLIANCE*
What are the Safety protocols for Outreach? (4 responses)
- Sign-out on Whiteboard
- Update calendar with locations
- Scan the area before exiting vehicle
- In-Person outreach ALWAYS conducted in pair
Where/When is the completed initial screener uploaded?
- NextGen (Document Manager)
- P:Drive (Word & PDF form)
- Within 3 business Days of initial Enrollment.
True/False: If 2 outreach attempts have been made on the same day; only 1 encounter will be created.
False, 2 separate encounters will be made to account for billing purposes and ensure all 6 attempts have been conducted.
Which necessary documentation tabs need to be completed for an initial enrollment?
Case & Consent
Documentation
Comp Assessment
Functional Status
Plan/Intervention
When are updates required for CMP's (medications/goals section/problems, etc.)?
Always!
CMP's should be modified as long as patient is providing continuous updates.