Corvette Community Clinic

POLICIES AND PROCEDURES

DEPT/OPS AREA: Clinical
Services (Provision of Care)

POLICY NAME:
REFERRAL MANAGEMENT
COORDINATION OF CARE

EFFECTIVE (ORIGINAL) DATE:

APPROVAL DATE:

POLICY NUMBER: PC XX

REVISED DATE:
DATE REVIEWED:

APPROVED BY:

Board of Directors

POLICY STATEMENT:
It is the policy of Corvette Community Clinic (CCC) to ensure a collaborative approach to care through
the coordination of care, treatment and community-based services based on the patients needs. This
policy applies to all internal and external referrals. This includes but is not limited to specialty care,
ancillary services, dental, mental health and substance abuse, self-management support, health
education, and health promotion.
RESPONSIBILITY:
The CCC Board of Directors (BOD) has the ultimate responsibility for the approval of the Referral
Management Coordination of Care Policy. The BOD delegates policy compliance to the CEO. The
CEO delegates policy review and recommendations to CCCs Quality Improvement Committee (QIC).
The QIC delegates oversight of policy implementation to the Medical Director who delegates day to day
management in compliance with this policy to the Director of Clinical Services or delegate to ensure
implementation of the standards outlined below.
IMPLEMENTATION:
External Referrals:

When the needs of the patient are outside the scope of services provided by CCC, the provider or
appropriate care team member (e.g., care managers, social workers, etc in the case of community
resource referrals) refers the patient to an appropriate healthcare facility / provider.

The provider or appropriate care team member discusses the referral with the patient and
completes the referral, which includes pertinent information about the patients medical
condition, reason for referral, the providers assessment and the request for treatment / services.

The referral is routed to the Referral Coordinator, who is responsible for the coordination of
services and tracking of all referrals

The Referral Coordinator coordinates the requested care, treatment or services within a time

SAMPLE: Referral Mgmt Coordination of Care Policy

Quality First Healthcare Consulting, Inc.
Page 1 of 3

DEPT/OPS AREA: Clinical

Services(Provision of Services)

POLICY NAME: REFERRAL

MANAGEMENT
COORDINATION OF CARE

POLICY NUMBER: PC XX

Corvette Community Clinic

frame that meets the needs of the patient, as well as the recommendations of the provider and
schedules appointments with the referred to provider or community resource when at all
possible.

The Referral Coordinator coordinates and/or notifies the patient of the appointment and tracks the
status of the referral until completed. Completed is defined as the care or service was received or
all communication attempts with the provider and/or patient have been exhausted yet the care or
service was not received. Referrals are tracked according to urgency of the referral.
Immediate: The provider is responsible for managing all immediate healthcare referrals and
coordinates directly with the referred to provider.
Urgent: Within 2 business days from the expected completed date if a consultation report, notes,
or other documentation is not received from the referred to provider or facility.
Routine: Within 10 business days from the expected completed date if a consultation report,
notes, or other documentation is not received from the referred to provider or facility.
Community Resource Referrals: At the next patient visit. These referrals are tracked for
frequency and type of referral only to evaluate whether available community resources is
sufficient and appropriate to meet patient needs.

The patient is given a copy of the referral form, which contains the contact information of the
referral provider, facility or community resource.

In the event the patient is non-compliant with the appointment scheduled for them, CCC initiates
outreach efforts to contact the patient and reschedule the appointment.

A copy of the consultation report, notes, or other documentation about the status or outcome of
the referred service is filed in the medical record / Electronic Health Record (EHR) upon receipt
by CCC.

Internal Referrals:

Internal referrals are made when the provider determines the patient requires assistance from a
specialty provider within CCC, such as Specialty Care, Care Management, Dental, Social Work
or Nutrition, when available

The provider or appropriate care team member discusses the referral with the patient and
completes the referral in accordance with CCCs internal referral protocols, which includes
pertinent information about the patients medical condition, reason for referral, the providers
assessment and the request for treatment / services.

In addition to a written or e- referral, the referring provider communicates with the referred to
provider to discuss the patients needs.

Referral tracking is conducted consistent with external referrals (see External Referrals above)

SAMPLE: Referral Management Coordination of Care Policy

Quality First Healthcare Consulting, Inc.
Page 2 of 3

DEPT/OPS AREA: Clinical

Services(Provision of Services)

POLICY NAME: REFERRAL

MANAGEMENT
COORDINATION OF CARE

POLICY NUMBER: PC XX

Corvette Community Clinic

Self-Referrals:
At each patient visit clinical and/or clinical support staff will inquire with patients and/or families, as
appropriate if they have scheduled or received care or services outside of the health center. If the
patient/family indicates care has been scheduled or received since the previous office visit health center
information is entered in the medical record and the Referral Coordinator is tasked with obtaining
information from the provider in which the patient received care or services, when appropriate.
Patient Co-Management:
In certain clinical situations patients may be referred to providers internal or external to the CCC for regular
treatment of a particular condition. Examples of conditions referred for regular treatment include but are not
limited to, cancer, uncontrolled diabetes, kidney failure, transplantation, etc. In this situations CCC providers
establish co-management agreements with the other provider(s) to ensure care is effectively managed
reducing fragmented or duplicative care or services. This mutually-agreed upon agreement defines timeliness
expectations in exchange of information and the method in which this exchange occurs.
Information provided during the exchange of information is documented in the medical record.
DOCUMENTATION/MONITORING:
All referrals are documented either electronically or using a referral log. A copy of the referral and
consult report is maintained in the patients medical record / EHR. Referrals are monitored and tracked
by the Referral Coordinator. Compliance with the standards outlined above is monitored through
assessment and reporting of compliance with referral follow-up timeliness standards and proportion of
referrals completed
REFERENCES:
Joint Commission Standards for Ambulatory Care: PC.01.03.01, PC.02.01.05, PC.02.02.01, PC.02.03.01,
LD.04.03.01
HRSA FTCA PAL: 2012 -04
2011 NCQA PCMH Standards: 4B and 5B

SAMPLE: Referral Management Coordination of Care Policy

Quality First Healthcare Consulting, Inc.
Page 3 of 3