Referral Policy

PURPOSE: 

The purpose of this policy is to describe the referral policy of Road to Recovery Wellness Center.

POLICY:

It is the Policy of Road to Recovery Wellness Center to refer patients to specialized treatment when it cannot be provided in our center. Each patient will receive services with their insurance provider in mind by the case manager and/nurse.

PROCEDURE/DEFINITIONS:

DEFINITIONS:   Referral Status Open:

1•        The referral has been initiated, but an appointment has not been scheduled.

• The referral appointment has been scheduled, but the patient has not received appointment details yet.

2. Consult Pending

• Information was sent to the receiving provider’s office, but no appointment confirmation has been noted yet.
• Patient was given information to schedule the appointment, but has not confirmed or provided appointment information to our office yet.
• An appointment has been scheduled, but there is no confirmation that the patient arrived or that correspondence has been received.

Addressed:

• Confirmation was received that patient followed through with appointment

(correspondence has been received and is in patient documents).

• Unable to contact patient after 30 days through phone or mail.
• Patient declines referral and notes have been documented
• Patient fails to make appointment within 30 days of referral due to extenuating circumstances such as funds not available

3. I. Creating and sending the referral (See How to do a Referral)
4. Provider initiates an outgoing referral to a specialist. The reason for referral and diagnosis are mandatory fields that must be entered before the referral can be sent. All referrals are routed to a designated person automatically (nurse, case manager, etc).
5. All referrals are marked as routine, urgent or stat.
6. a) Routine referrals do not have an immediate urgency, but should be scheduled within 6 months of referral issue date.
7. b) Urgent referrals need to have an appointment set within two weeks.
8. c) Stat referrals need to be seen immediately or within 48 hours.
9. Sound practice by providers would be to briefly explain in the referral why the status is urgent or stat. Urgent and stat referrals will be processed by the provider’s clinical staff (medical assistant, nurse, etc) to ensure they are handled immediately. Remaining referrals are routed to the designated person/referral center.

1. b) Schedule appointment
2. Call receiving provider’s office to schedule appointment for the patient. Notify patient of necessary information and appointment date and time.
3. Make three phone call attempts on different days to reach the patient, documenting each in the notes section of the referral.