Coordination of care is a significant factor in today?s health care environment. With the increasing use of hospitals, urgent care centers, and retail health clinics, as well as multiple specialty services, it can be difficult to ensure that patients receive the best individual care. While electronic record systems may improve coordination of care, communication between specialists and primary care providers can still be challenging. AmeriHealth has established medical records standards to facilitate communication, coordination, and continuity of care and to promote efficient and effective treatment. One of these standards refers to coordination between providers of primary care and consultants.

Primary care

Primary care offices are generally the central point for care. Points to remember include:

• For HMO members, ask about referrals the patient requested or that your office provided. Referrals are part of the electronic record or patient chart and can be checked when the patient signs in at the front desk. If the patient was seen and no consultation is present, the staff can contact the office while the patient is still in the office.
• For radiology studies or testing ordered by a consulting practice that need to be coordinated by your office, check for a consultation note or call the requesting office for information. Document the request in the patient record, including the ordering consultant. Ask for a report to be sent to your office as part of the consultation note.
• Document all recommendations or referrals for consultation and rationale in the patient record. If a patient requested a referral, document the patient request.
• Don?t forget about behavioral health. Discuss behavioral health concerns with your patients or patient representatives and request permission to discuss care with the behavioral health provider. Some behavioral health concerns or treatments may affect or influence the patient?s response to medical care. Document all discussions in the medical records.
• Make sure to review all consultation notes and initial or sign the documents to indicate your review. AmeriHealth Medical Record Keeping Standards require the ordering practitioner to initial the review. Note: Review and signature by other professional staff in the office do not meet this requirement.

Specialty care

Specialists may coordinate care and/or act as a primary care provider. Points to remember include:

• For HMO members, send consultation notes/updates to the primary care provider after each patient encounter.
• Document all recommendations or referrals for consultation and rationale in the patient record. If a patient requested a referral, document the patient request.
• Don?t forget about behavioral health. Discuss behavioral health concerns with your patients or patient representatives and request permission to discuss care with the behavioral health provider. Some behavioral health concerns or treatments may affect or influence the patient?s response to medical care. Document all discussions in the medical records.
• Make sure to review all notes received by the primary care provider or other consultants. Initial or sign the documents to indicate your review. Note: Review and signature by other professional staff in the office do not meet this requirement.

Collaboration of care and medical record keeping standards are two requirements for accreditation by the National Committee for Quality Assurance (NCQA). NCQA views these standards as significant in providing quality and comprehensive care to patients.

Standards for maintaining appropriate medical records can be found in the Provider Manual for Participating Professional Providers (Provider Manual), available in the Current Publications section of AmeriHealth NaviNet^® Plan Central. A paper copy of the Provider Manual can be ordered by submitting an online request or by calling the Provider Supply Line at 1-800-858-4728.

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