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The practice:
5.B.1 Considers available performance information on consultants/specialists when making referral recommendations.
According to NCQA, the practice uses available data on the performance of clinicians and practices it refers its patients to. Examples include state physician report cards, health plan directories and the CMS Web site [1].
5.B.2 Maintains formal and informal agreements with a subset of specialists based on established criteria.
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5.B.3 Maintains agreements with behavioral healthcare providers.
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5.B.4 Integrates behavioral healthcare providers within the practice site.
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5.B.5 Gives the consultant or specialist the clinical question, the required timing and the type of referral.
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5.B.6 Gives the consultant or specialist pertinent demographic and clinical data, including test results and the current care plan.
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5.B.7 Has the capacity for electronic exchange of key clinical information+ and provides an electronic summary of care record to another provider for more than 50 percent of referrals.
5.B.8 Tracks referrals until the consultant or specialist’s report is available, flagging and following up on overdue reports. (CRITICAL FACTOR)
5.B.9 Documents co-management arrangements in the patient’s medical record.
5.B.10 Asks patients/families about self-referrals and requesting reports from clinicians.
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