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Effective management of referrals is a key component of care coordination and is essential to ensure patient continuity of care. As outlined in “Chapter 4 – Required and Additional Health Services” (Chapter 4 – Required and Additional Health Services) and “Chapter 21 – Federal Tort Claims Act” (Chapter 21 – Federal Tort Claims Act) of the Health Center Compliance Manual, health centers must have a solid system in place for tracking referrals.
Ensuring compliance requires a collaborative effort from both health center staff and the referral provider. If done efficiently, referrals provide important patient care recommendations that contribute to a patient centered model of care. Unfortunately, oftentimes the referral process can cause frustration for all involved, including the patient.
The following can help health centers not only ensure compliance, but also alleviate undue burden on the part of both health center staff and patients, as well as ensure the delivery of quality patient care.
Most importantly, the health center must ensure evaluation of the referral tracking process by incorporating referral tracking metrics into the Quality Management Program. Metrics should be reported out a minimum of quarterly to ensure compliance with HRSA Quality Assurance/Improvement requirements, as well as FTCA Risk Management standards.