Upon reciept of a completed reappointment application, the organization will "primary source verify" items listed in Standards 2.II.B.3.c-f. At the time of reappointment consideration by the governing body, the entire reappointment application and the peer review activities and results, completed in accordance with Chapter 2.III, will be considered.
Completion of a formal reappointment application which includes, at a minumum:
1. Updated personal information
2. Completed attestation questions found in 2.II.B.3.g.
3. A formal statement releasing the organization from any liability in connection with credentiallng decisions
4. A formal statement confirming that the information submitted is accurate and complete
5. Applicant signature and date
Ortho slips are checked to ensure billing is complete.
The University of California Santa Cruz Student Health Services complies with the OIG Medical Billing and Coding Compliance Requirements. Staff are trained and updated regularly (note: ICD-10). These include the seven components for a voluntary compliance program:
• Conducting internal monitoring and auditing;
• Implementing compliance and practice standards;
• Designating a compliance officer or contact;
• Conducting appropriate training and education;
• Responding appropriately to detected offenses and developing corrective action;
• Developing open lines of communication; and
• Enforcing disciplinary standards through well-publicized guidelines
The compliance guidelines are available via the attached link.
All inquiries for the Insurance and Billing Departments at UCSC Student Health Services will be funneled through the UCSC Request Tracker (RT) for Insurance and Billing. The Request Tracker is not a secure system and any content that contains PHI must be removed and responded to securely and if necessary documented in the EMR under Admin Notes.
This customer service documentation and resolution system provides auto-replies and standardized answers to common questions. It is also a continuous documentation system that allows for follow up or allows return to a topic or request since that information and data are retrievable, and all communications that are received are addressed in an orderly and timely fashion. The goal is to have as much resolved as possible at the first contact.
Any communications from outside providers or which contain referral requests or PHI will be prioritized.
Staff will complete the shared daily tasks to make sure that all duties are complete.
Utilization and productivity data will be collected monthly via built in reports.
Insurance and Billing advocates will manage all inquiries through the UCSC Request Tracker. The advocates will follow specific procedures listed in the RT Binder and other communication methods.
Insurance and Billing advocates will monitor the RT queue and each will "take" or transfer ownership of the oldest ticket and respond to the ticket as appropriate with articles that provide standardized text on common questions or specific answers as necessary. Tickets that are tagged as needing referral assistance are prioritized due to possible timely need of information and/or content that contains PHI, which must be removed, and addressed securely.
Once a ticket is "taken" then it is "open". Once the inquiry is addressed, then the ticket can be changed to "resolved". If necessary, the ticket can be designated as "stalled" which means it is pending due to the need for additional information prior to resolution.
An advocate can tag a ticket with another staff member's name if that staff member has already been working with the case.
All emails sent to firstname.lastname@example.org automatically go into the RT.
PHONE CALLS AND WALK-INS
Phone calls and walk-in inquiries that can be answered with a quick response do not need to be entered into the Request Tracker. All other requests will be entered into the Request Tracker and responded to according to established procedures.
Referrals or other inquiries containing PHI will be managed securely through the EMR.
At times SHS Management may be alerted to a student of concern via various sources such as campus police, Academic Advising, and Student Conduct. SHS staff may also become aware of a student of concern, in which case they should alert their manager to this situation ASAP. If the SHS Management determines that this is information all SHS staff should be alerted to, the following process is to be following:
A “Third Party" note is created by SHS Management in the student’s medical record with details of the concern. The entry “Student of Concern – alert your supervisor” with managers initials and date will be made in 3 places in the EMR:
1. Scheduler Comments (OpenRegistration > Registration > Scheduler Comments)
2. Clinical Comments (OpenChart > Clinical Comments > All Divisions)
3. Admin Alert (OpenRegistration > Admin Alert)
A Broadcast Instant Message will be sent via the EMR to the “Alert Group” comprised of management and IT staff. Laboratory management or IT will add an alert in the “Harvest” lab interface program. Pharmacy management or IT will add the alert in the “Propharm” prescription interface program.
This system of alert notification will help assure all SHS staff have immediate access to any student of concern alerts relevant to staff and/or student safety. In the event a student with this alert system in place presents or contacts the SHS, all staff should immediately alert their supervisor for further instructions.
The optometrists at UCSC will endeavor to assist primary care providers with consults for eye problems.
The optometrists may be busy with patients so will come to primary care when convenient - between patients or when waiting for dilation.
When a clinician needs a consultation from the optometrist for same day ophthalmic medical needs, the clinician can call Optometry or more often, notify the charge nurse with the request.
The charge nurse or designee (most often Floor 2 Reception staff) will take action by putting an identified bright laminated sign, in the optometry box inside the door alerting the optometrist that a consult with primary care is requested.
When the optometrist can leave the department they will call the charge nurse to find out details of the consult request and determine if they can facilitate a consult. If a consult can be provided, the optometrist and charge nurse will determine where and how this will occur. The charge nurse will alert the patient and primary care clinician of the details of the consult.
The optometrist will help examine the patient and communicate any findings to the clinician for the clinician to document in the medical record.
Occasionally, the optometrist may be too busy to consult, or the situation may need more acute treatment i.e. ER. The optometrist will let the charge nurse know of that fact.
There will be no extra charges for the consultation.
In the event that any patients will still be in the building after 5:30pm, the DOC and Charge Nurse will confer to determine the best plan of care for these patients.
1. The DOC will confer with the Charge Nurse at the end of each day to ensure all patients have been discharged from the building prior to leaving work.
2. In the event that patients are still in the building, the DOC or charge nurse will confirm with the treating provider that no assistance is needed from the DOC prior to the DOC departing. The DOC assignment is rotated among career clinicians and has the primary responsibility to stay after 5:30 if needed for patient care. It is the responsibility of the DOC to arrange physician coverage for this back up responsibility if the DOC departs prior to the last patient leaving.
3. Each day, on a rotating basis one member of the Nursing staff is assigned to stay after 5:30 if needed for patient care.
4. Anytime patients are still on-site, at a minimum, two members of staff (1 clinician and 1 nurse) will remain until patient discharge.
5. The Charge Nurse is responsible for notifying Ancillary Services (Lab, Radiology, Pharmacy) at end of day when all students have been discharged and their services are no longer needed.
The Student Health Center will begin to divert students if all of the case management and appointment slots are filled for the day.
1. The charge nurse will make the decision to divert in consultation with the medical director or available manager.
2. When it has been decided to go on “diversion status” a Broadcast IM to all of the SHS community. SHOP will be notified by phone.
3. The Nurse Advice Line will be diverted to the after-hours advice line and the service will be notified of Health Center diversion status by Charge Nurse or Manager.
4. A sandwich board will be posted at the Health Center main entrance which says:
“The Student Health Center is experiencing higher than normal demand for care. Please consider returning tomorrow. If you need to be seen today, our office may assist you to be seen at an off campus site if necessary.”
5. When the Health Center is on diversion, students will still be evaluated by the triage nurse who will determine the appropriate plan of care in collaboration with the student. All available staff will assist with triage as able.