MISSED APPOINTMENTS:
* Missed appointments by the member must be followed-up by the provider.
The CarePlus Member Services Department will assist the Provider in this process if necessary. If the patient does not go to the previously scheduled appointment without prior cancellation, Provider must document within the medical records. A Provider may charge a fee for missed appointments, provided such fees apply uniformly and at the same amount for all Medicare and non-Medicare patients.
APPOINTMENT SCHEDULING CRITERIA:
To ensure accessibility and availability of health services to plan members, the following standards have been set forth by the Centers for Medicare & Medicaid Services (CMS):
* Urgently needed services or Emergency – immediately.
* Non-urgent, but in need of attention – within one (1) week.
* Routine and Preventive Care – within 30 days. Non-emergent complaints that do not restrict a member’s activity or are chronic in nature.
* Provider agrees to maintain hours that do not discriminate against Members’ accessibility to Provider.
In addition, CarePlus recommends the following standards for all physicians:
* Response to urgent calls within 15 minutes; response to routine calls within 24 hours.
* After hours, response to urgent calls within 15 minutes; nonurgent response in 30 minutes.
* The average wait time should not exceed 60 minutes from the scheduled appointment time. This includes time spent both in the waiting and examination room prior to being seen by the physician. In the case of an unexpected emergency, which may cause this standard to be exceeded, the member should be promptly notified and given the option of waiting or rescheduling.
By monitoring compliance with these guidelines over time, CarePlus can take action to improve member service availability and access to medical services when necessary. CarePlus may monitor compliance with the above-mentioned access standards through a variety of ways including site visits, telephone audits, member surveys and complaints.
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