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

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to a SCP (Specialty Care Physician) for consultation • Completes an IPA Referral which should provide the following information to the specialist: • Specific reason the consultation is being requested • Information and/or results regarding any tests and/or procedures which may have already been performed • Forwards the IPA Referral to the SCP with any pertinent results of previous testing • Provides a copy of the Referral to the patient Specialist (SCP) Responsibilities • Ensures the patient is referred appropriately • Orders diagnostic tests necessary to complete the requested consultation • Complies with CMO requirements for notification and authorization • Determines if additional treatment is necessary and communicates the treatment plan to PCP • If the PCP is in agreement with the plan, the SCP coordinates the treatment, including arranging surgery and/or inpatient hospitalization • If SCP determines that referral to another SCP for cognitive consult may be appropriate, the SCP must inform the PCP and the PCP coordinates as above • Provides a follow-up written report to the PCP which outlines: • Evaluation • Findings • Recommended treatment • For extended course of treatment, the SCP provides a progress report to the PCP at intervals agreed upon Contract Management (CMO) Responsibilities • Verifies network status of the provider • Verifies member eligibility and coverage • If the referral requires authorization, the UM Coordinator performs review • If criteria are met, the CMO generates an authorization number • Will provide the PCP or SCP office with the authorization number as appropriate • If criteria are not met, the UM Coordinator refers the case to the CMO Physician Advisor for review • If the Physician Advisor denies the request for referral authorization, the provider is notified of his/her right to appeal the decision through the Appeals Process Exceptions to the Referral Guidelines • OB/GYN: Self-referral by patients to OB/GYN providers within the IPA/HMO network is permitted under state law for: • Two well women visits per year • All maternity care • Follow-up for any abnormal findings detected during a well woman visit • Acute gynecological conditions • Follow – Up to Care Received in the Emergency Department 24
• Referral by the ED physician is permitted to arrange appropriate and timely follow-up to care provided in the ED for conditions involving trauma. • Mental Health/Chemical Dependency For Specific Health Plans • Mental health/Chemical dependency services for IPA patients is coordinated by University Behavioral Associates (UBA). The PCP or patient should contact UBA directly to arrange for referral to an appropriate provider. A paper referral is not required. • UBA: (800)401-4822 • Diagnostic testing performed in IPA participating facilities • Lab, Optometry, Routine Podiatry (for members with benefit coverage), Influenza and Pneumococal vaccine visits do not require referrals Denials The CMO tracks, monitors and responds to denials associated with inpatient hospitalizations. Notification of denial may be received prior to, during or following a hospitalization. In the event a denial is received prior to or during a hospitalization that you are managing, you may be contacted with a request to contact a <strong>Medical</strong> Director at the health plan issuing the denial to provide additional clinical information in an effort to reverse the denial. In the event a denial is received following the hospitalization, you may be contacted to provide additional clinical information necessary to complete an appeal. If you should receive verbal notification from a health plan of a denial, please contact the Director of Denial Management at (914) 377-4678 with information regarding the patient and health plan involved. If you receive written notification of a denial, please fax to (914) 377-4677. CONTRACT MANAGEMENT ORGANIZATION (CMO) IMPORTANT TELEPHONE NUMBERS CMO Customer Service Line 888- MONTE CMO or 914-377-4400 Monday – Friday: 8:00 am – 6:00 PM • Confirm a member’s enrollment status, benefits and co-payment information • Confirm authorization status including all medical management inquiries • Confirm claim status • Resolve inquiries regarding complaints, grievances and administrative appeals • Address any questions or needs related to the CMO Fax: 914-375-2174 Credentialing Phone: 914-377-4690 Fax : 914-377-4691 <strong>Medical</strong> Management Fax 914-377-4798 25
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 and 22: MEDICAL STAFF CREDENTIALING OFFICE
Page 23: MONTEFIORE INTEGRATED PROVIDER ASSO
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
Page 73 and 74: No procedure can be performed until
Page 75 and 76:
Bronx, New York 10461 Administrativ
Page 77 and 78:
Director, Education Programs Rasim
Page 79 and 80:
North Central Bronx Hospital 718-51
Page 81 and 82:
Arlene Saunders 718-741-2492 Admini
Page 83 and 84:
printed name of the referring physi
Page 85 and 86:
The radiology department at Jack D.
Page 87 and 88:
Pediatric Surgery 718-920-7200 Burt
Page 89 and 90:
SECTION V • POLICIES AND PROCEDUR
Page 91 and 92:
Note: This summary contains key poi
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WHERE: • Advance directives are a
Page 95 and 96:
• 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
Page 103 and 104:
VERIFICATION OF OPERATIVE PROCEDURE
Page 105 and 106:
INFECTION CONTROL PROGRAM Moses Nur
Page 107 and 108:
person who feels that he/she may be
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CONTROLLED SUBSTANCES IN THE MEDICA
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• Practitioners will immediately
Page 113 and 114:
One Quality Improvement Plan exists
Page 115 and 116:
SECTION VI • SERVICE DEPARTMENTS
Page 117 and 118:
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
Page 135 and 136:
The mission of the Occupational Hea
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• Families and caregivers need as
Page 139 and 140:
The Patient Safety Officer and the
Page 141 and 142:
Unified Director of Pharmacy Frank
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successful, expanded to other areas
Page 145 and 146:
• Professional Misconduct • Pho
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Outpatient testing, evaluation and
Page 149 and 150:
Office Coordinator Lillian Zambardi
Page 151 and 152:
E Educational Administration 28 Eme
Page 153 and 154:
Paychecks, House Staff 40 Pediatric
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