Medical Staff House Staff Orientation Manual - Montefiore Medical ...

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• list all continuing medical education credits; minimum of 150 CME credits per three (3) years are required • indicate hospital affiliations and any actions regarding licensure, registration and privileges or sanctions • complete a malpractice history questionnaire • complete departmental delineation of clinical privileges and self evaluation forms • submit documentation of an annual health assessment • complete authorization to release information • submit current certificates • complete other forms and provide other supplemental information as required Change of Status All Medical Staff members and/or clinical departments are required to submit status changes (e.g. change from Full Time to Voluntary) prior to the effective date of the change in writing. Information may be faxed to (914)709-0386. Change of Address/Location Change of address or practice information must be submitted in writing to Justina Marrone using the “Provider Change of Address” form. Forms may be faxed to (914)709-0386. PROVIDER RELATIONS OFFICE Bill Scesney Director, Provider Relations Office 914-377-4701 Fax 914-377-4794 Provider Relations is the communication link between Montefiore Medical Center, IPA providers, and contracted health plans. Provider Relations Liaisons offer a variety of services including orientation and educational sessions for IPA providers and office staff on CMO and health plan policies and procedures. Along with Network Development, Provider Relations works closely with the health plans to strengthen the IPA position in the market and grow provider membership in the network. 22
MONTEFIORE INTEGRATED PROVIDER ASSOCIATION (MIPA) AND THE CONTRACT MANAGEMENT ORGANIZATION (CMO) What is Managed Care Managed care is a broad term that is used to describe the delivery and financing of health care services to a specific group of people (i.e., those covered under the payer's insurance plan) across all levels of services. The services may range from a routine physician office visit to hospital intensive care needs to healthcare provided in a home setting. The goal is to manage all the levels of care in a way that provides quality care in a cost effective manner. There are a variety of types of managed care benefits plans such as: Health Maintenance Organizations (HMOs), Preferred Provider organizations (PPOs), and Point of Service (POS). Each of these benefit plans pays the provider in a different way – usually a capitated rate or a discounted fee for service. The patient is responsible for co-payments based on their benefit plan requirements. MIPA and CMO Overview The Montefiore Independent Provider Associations (MIPA) were formed to provide a coordinated, integrated health services network (including physicians and hospital services) that will render comprehensive quality health care in the Bronx and the surrounding communities. The Contract Management Organization (CMO) employs staff to handle contracting with payers, medical management activities, credentialing and processing and payment of claims. The physicians accept the negotiated rates and may only bill patients for copayments or non-covered services with a signed waiver. Providers send claims to a central location at the CMO for claims review and processing. The MIPA is governed by a Board of Directors comprised of physician and hospital representatives. The board members are charged with broad policy decisions for the MIPA and approval of recommendations made by specific MIPA committees. Each committee has a specific area for which they make recommendations to the Board of Directors. In addition, the specific committees may serve as a monitoring arm of the CMO for its particular area of focus. The standing committees are Credentialing, Medical Management and Finance. MONTEFIORE IPA REFERRAL MANAGEMENT PROCESS CareLink Care Link is an Internet based system that allows providers and office staff direct access to verify member eligibility, submit referrals and authorizations, and check status of a referral/authorization in real-time. The features of this application include: • Verify eligibility for IPA Members • Submit referrals and authorizations on-line • View status of referrals and authorizations • View reports of referrals and authorization activity for a particular office Primary Care Physician (PCP) Responsibilities • Initially determines when appropriate for a patient to be referred 23
Page 1 and 2: Medical Staff House Staff Orientati
Page 3 and 4: We would like to take this opportun
Page 5 and 6: Montefiore’s Institute for Reprod
Page 7 and 8: TABLE OF CONTENTS SECTION 1- Genera
Page 9 and 10: Plastic and Reconstructive Surgery
Page 11 and 12: SECTION 1 • GENERAL INFORMATION 1
Page 13 and 14: Contract Management Organization (C
Page 15 and 16: Neurology M 4656 3351 Steuben A 316
Page 17 and 18: MOSES NURSING STATIONS C 741-2377 P
Page 19 and 20: M 5584 Lupus Clinic M 5584 Neurolog
Page 21: MEDICAL STAFF CREDENTIALING OFFICE
Page 25 and 26: • Referral by the ED physician is
Page 27 and 28: HOUSE STAFF OFFICE 150 East 210th S
Page 29 and 30: • Institutions must have a GME Co
Page 31 and 32: accreditation, then the institution
Page 33 and 34: and the conditions under which livi
Page 35 and 36: • Patient support services, such
Page 37 and 38: following: counseling, appointment
Page 39 and 40: Physician Impairment and Drug Abuse
Page 41 and 42: participants the opportunity to com
Page 43 and 44: WALDO AVENUE SHUTTLE Those resident
Page 45 and 46: First Year Residents: Assignments o
Page 47 and 48: SECTION III • MONTEFIORE MEDICAL
Page 49 and 50: Administrator: Jennifer Ortiz Medic
Page 51 and 52: Medical Director: Marta Rico, MD, A
Page 53 and 54: 2532 Grand Concourse Bronx, New Yor
Page 55 and 56: Briggs Avenue Academy 3010 Briggs A
Page 57 and 58: Nurse: Maria Campos, LPN Sheila Mon
Page 59 and 60: Gloria Feliciano - Director FRANKLI
Page 61 and 62: ANESTHESIOLOGY Chairman 718-920-280
Page 63 and 64: Director John Fisher, MD 718-920-42
Page 65 and 66: Christine Clarke 718-920-5996 PROGR
Page 67 and 68: SOCIAL PEDIATRICS 3544 Jerome Ave.
Page 69 and 70: Vladimir Kvetan, MD 718-920-5440 De
Page 71 and 72: Residency Program Director Eugene S
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No procedure can be performed until
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Bronx, New York 10461 Administrativ
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Director, Education Programs Rasim
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North Central Bronx Hospital 718-51
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Arlene Saunders 718-741-2492 Admini
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printed name of the referring physi
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The radiology department at Jack D.
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Pediatric Surgery 718-920-7200 Burt
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SECTION V • POLICIES AND PROCEDUR
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Note: This summary contains key poi
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WHERE: • Advance directives are a
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• family has moral or religious o
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• OD1091-4 Affidavit of Close Fri
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Bioethics (Moses) 718- 920-6226 (We
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HOW: • Capacitated patients may r
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VERIFICATION OF OPERATIVE PROCEDURE
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INFECTION CONTROL PROGRAM Moses Nur
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person who feels that he/she may be
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CONTROLLED SUBSTANCES IN THE MEDICA
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• Practitioners will immediately
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One Quality Improvement Plan exists
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SECTION VI • SERVICE DEPARTMENTS
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Legal Certificates 718-904-3456 Fin
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CHILD PROTECTION CENTER The Childre
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CME REQUIREMENTS: Attending physici
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Hours: Monday - Friday 8:00AM - 5:0
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delivery system. Medical record inf
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All physician orders whether writte
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additional information is uncovered
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THE TISHMAN LEARNING CENTER HEALTH
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MAILROOM MOSES Brown Zone, Moses Ba
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The mission of the Occupational Hea
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• Families and caregivers need as
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The Patient Safety Officer and the
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Unified Director of Pharmacy Frank
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successful, expanded to other areas
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• Professional Misconduct • Pho
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Outpatient testing, evaluation and
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Office Coordinator Lillian Zambardi
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E Educational Administration 28 Eme
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Paychecks, House Staff 40 Pediatric
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