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INSURANCE AND BILLING REQUEST TRACKER

Effective Date: 
Mon, 06/20/2016
Policy: 

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.

Procedure: 

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.

EMAILS

All emails sent to insure@ucsc.edu 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.

 

 

 

 

STUDENT OF CONCERN ALERTS

Effective Date: 
Mon, 04/18/2016
Policy: 

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.

Harvest

  1. Open the patient
  2. Click “…” under alerts
  3. Add in text from PNC IM
  4. Save patient

Propharm

  1. Open the patient
  2. Click on the note icon (paper with a thumbtack)
  3. Select New
  4. Title with the IM title from PNC
  5. Add in body of note
  6. Set Priority = High
  7. Save

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.

OPTOMETRY CONSULTATIONS

Effective Date: 
Wed, 04/06/2016
Revised: 
Thu, 09/08/2016
Policy: 

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.

Procedure: 

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.

 

Key Points: 
  • The optometrist may be available to consult with SHS clinicians on ophthalmologic illnesses or injuries when time permits
  • The clinician will complete the care and notes

LATE PATIENT/END OF DAY RESPONSIBILITIES

Effective Date: 
Wed, 01/06/2016
Reviewed: 
Wed, 01/06/2016
Revised: 
Wed, 01/27/2016
Policy: 

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.  

Procedure: 

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.

 

DIVERSION STATUS

Effective Date: 
Wed, 01/06/2016
Reviewed: 
Wed, 01/06/2016
Policy: 

The Student Health Center will begin to divert students if all of the case management and appointment slots are filled for the day.   

Procedure: 

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.

 

INTERCOLLEGIATE ATHLETIC VISITS

Effective Date: 
Wed, 11/25/2015
Revised: 
Wed, 12/02/2015
Policy: 

Any registered student is eligible for services at the SHC and can consult with the Triage Nurse at no charge.  

  • Intercollegiate athletes
  • (aka NCAA or Varsity) are required to purchase an "insurance rider" for the health care costs of injuries due to their sport/s, such as advanced imaging and surgery. This does not preclude students with CruzCare or UC SHIP from having an evaluation at the UCSC Student Health Center.   If a student athlete has UC SHIP or CruzCare, we can see them for the initial evaluation at NO charge.  If the student athlete need referrals for specialty care or imaging, then they need to be informed that UC SHIP explicitly excludes coverage for injuries from intercollegiate athletics  whether in a game, practice  or training.

NOTE: There are also sports clubs, both competitive and non-competive (cycling, ultimate frisbee, rugby, lacrosse, judo, dance etc.).  Sports Club students have access to their own "Sports Club" Athletic Trainer

  • The athletes may allow the athletic trainers to communicate with our clinicians or allow the clincian to communicate with the athletic trainers.  In that case, use HC 560 (attached) for the transfer of that information.  The student athlete is responsible for transporting the form back and forth.  
Procedure: 
  • Student intercollegiate athletes with UC SHIP or CruzCare can be seen in the Same Day Clinic for an  initial evaluation by SHC providers, with X-­rays ordered if indicated for no additional charge. 
  • Students without UC SHIP or CruzCare who elect to see an SHC clinician will be charged for visits and X-­rays  beyond  the Triage Nurse visit
  • Referrals can be made by UCSC SHS clinicians; however, UC SHIP excludes coverage for injuries sustained during  intercollegiate athletics including training.  Therefore, the student athletes must use their other insurance for care  for athletic injuries  
  • UC SHIP referrals do not guarantee authorization for coverage by the health insurance carrier 
  • Students with or without UC SHIP who need follow up, need to see providers in their respective primary insurance  plan; a referral from the SHC can be given, as can a compact disk (CD) of digital X-­rays performed here, if helpful    
  • A referral from the SHC for a student to a specialist does not meet the requirements of their private  insurance plan and does not imply that their private insurance will cover the cost of the visit or  procedure with the specialist.  Final determination of insurance coverage for specialty care is made  by the insurance carrier and cannot be guaranteed

Intercollegiate Athletes

  • Always have outside insurance that is checked by the athletic training department to assure primary coverage for intercollegiate athletic injuries and coverage of up to at  least $90,000.  
  • Always have additional coverage through OPERS, provided by the University as a secondary insurance
  • Kaiser coverage often qualifies as the primary
  • Students may choose to have UC SHIP or CruzCare
  • The athletic trainers recommend waiving UC SHIP ­but SHS recommends that student athletes add on CruzCare for non-sports medical needs 
  • Both UC SHIP and CruzCare may be included in financial aid  
  • Typically, the trainers do NOT send students to the SHC, however, if they do, it is often for X-­rays when the student  athlete cannot get to an Urgent Care Clinic.  Use the attachment if students want the clinician and the trainer to communicate - HC 560 - make a copy to be scanned into the EMR and give the original to the student athlete to bring to the trainer
  • For more information on UCSC Athletics, link to: http://www.goslugs.com/landing/index  
  • Current Intercollegiate Teams o Men’s Basketball o Men’s Cross Country o Men’s Soccer o Men’s Swimming and Diving o Men’s Tennis o Men’s Volleyball o Women’s Basketball o Women’s Cross Country o Women’s Golf o Women’s Soccer o Women’s Swimming and Diving o Women’s Tennis o Women’s Track o Women’s Volleyball 

EXIT CHECKLIST

Form Type: 
HC
Form Number: 
753

EMPLOYEE EXIT POLICY

Effective Date: 
Mon, 11/16/2015
Revised: 
Fri, 04/01/2016
Policy: 

The attached Employee Exit Checklist must be completed for any employee terminating employment with UCSC Student Health Services.  This will be completed by multiple stakeholders and will ensure follow through for all UCSC and UCSC SHS requirements for IT, SHS Administration and SHR actions.

Supervisor Responsibilities:

1.  Upon receipt of notice to terminate/resignation, accept resignation in writing and forward to Student Health Center Staff HR liaison who in turn will notify central Staff HR to initiate process

2.  Initiate and complete HC 753 Employee Exit Checklist

Notify Staff

PERIPHERAL DEVICES

Effective Date: 
Mon, 06/29/2015
Policy: 

The University of California Santa Cruz Student Health Services (SHS) is committed to conducting business in compliance with all applicable laws, regulations and University of California policies. UCSC SHS has adopted this policy to outline the security measures required to protect electronic information systems and related equipment from unauthorized use.

Our objective is to provide an organized approach for handling potential exposure of information from peripheral devices.

Procedure: 

At the University of California Santa Cruz Student Health Services, peripheral devices that store or process confidential or protected information are prohibited except under the approval and direction of the Business and Information Systems Coordinator.

Violations of this policy may lead to disciplinary action up to and including termination under either the Human Resources corrective action process or the HIPAA Sanction policy.

CLINICAL CASE REVIEW

Effective Date: 
Wed, 06/10/2015
Revised: 
Fri, 02/03/2017
Policy: 

Policy: 

In cases where there are questions or concerns about clinical management the Medical Director or appropriate supervisor shall convene a Clinical Case Review committee composed of appropriate licensed professionals who will review the case and make evaluations and/or recommendations concerning the case.  The Clinical Case Review committee is an "ad hoc" committee composed of the Medical Director and/or Executive Director and additional professionals capable of appropriate review the case. 

Case Review Committee responsibilities include: 
1. Providing additional review of cases identified in the peer review process as having possible quality of care problems
2. Reviewing clinical incident reports
3. Participating, as appropriate, in resolution of quality of care issues involving clinician staff.

Depending on the outcome of the review, results may be summarized as an Incident Report and reported to the QM committee.  Some clinical case reviews may result in verbal or written feedback to the individual clinician and others may not warrant any feedback if the care and documentation meet community standards.

 

 

 

 

 

 

Procedure: 

Procedure: 

1. When questions about specific clinical care are identified and an analysis of the situation indicated a Case Review Committee shall be convened.

2. The committee is under the direction of the Executive Director or the Medical Director and includes professional staff appropriate to evaluate the clinical situation.

3.  Case Review committee evaluations and recommendations are summarized as Incident Reports and shared with the appropriate staff and the QM committee as appropriate. 

Key Points: 

Key Points: 

The SHS has in place a process for the objective evaluation of clinical situations. 

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