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Each year approximately 14,000 children are born in North Carolina who have or will develop special health care needs. The supply of sub-specialists needed to support these children’s local primary care providers is limited and concentrated in the six major medical centers across the state. To encourage and facilitate consultation between primary care providers (PCP) and these physician sub-specialists (PS), a program for paying for distant "electronic" consults was initiated in 2006 with support from the North Carolina Foundation for Advanced Health Programs, Inc.
The program was piloted in the Infectious Disease clinics at most facilities (GI at NC Children’s Hospital). PS were paid to provide distant consult services. To receive compensation, they provided minimal data identifying the patient, the PCP requesting the consult and the presenting problem in need of PS input (see attached Reimbursement Request Form). They also checked a CPT code describing the method of electronic response (email or phone with 3 codes distinguishing between lengths of phone consults). Finally, the PS described whether the consult resulted in the avoidance of a specialist visit, ER visit, hospitalization, transfer to another hospital or some other type of service specified by the physician. Analyses of the resulting data showed that each dollar spent resulted in ~ $39 saved through voidance of additional medical services. A paper describing the success of the program will be published in Pediatrics shortly. A set of PowerPoint slides describing the program and its results is available here.
FAX completed Reimbursement Request Forms to AccessCare at 919-468-8573 (Attn: Courtney Sanderson). Consults will be processed on a monthly basis with checks sent to participating PS % his or her tertiary care facility unless otherwise requested. Please submit forms as promptly as possible.
Specialists submitting properly completed requests will be reimbursed $40 per form for consultations regarding care of Medicaid patients < 22 years old. Please note that we cannot approve reimbursement for incomplete forms because we have to provide documentation on expenditures as part of the evaluation of our programs by our funding agencies. Required items are starred (*) on the Request Form.
Contact Charles Humble or Courtney Sanderson.
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