Direct Referrals Fact Sheet
Purpose of the Direct Referral Policy
The purpose of the direct referral policy is to ensure that appropriate testing is performed on patients who are referred only for a sleep study. The referring physician, who is not a sleep center staff physician, orders the sleep study to be performed in the sleep center, then treats and provides longitudinal care for the patient in his/her own office.
- Patients who are never seen in consultation by a sleep center facility medical staff physician member.
- Patients referred from any physician not related to the sleep facility.
- Patients seen for testing only, returned to referring physician for treatment and care.
- Must be counted in the cumulative database.
A Direct Referral is not:
- A patient who is sent by a referring clinician for a sleep study and is seen in consultation by a medical staff member prior to or within 3 months of the sleep study.
The Sleep Center’s Direct Referral Policy Must Provide the Following:
- Detailed descriptions of the information needed from the referring physician prior to testing;
- Instructions indicating that the information for directly referred patients is reviewed and signed by the facility director or medical staff member prior to performance of the sleep study on the directly referred patient; and
- A description of what information is maintained in the directly referred patient’s medical record.
The Difference Between Referring Physicians and Consultants
- A referring physician is typically a primary-care physician who refers patients to the sleep center for testing. Physicians listed among a facility’s professional staff are not considered referring physicians.
- A consultant is a clinician who sees patients from the sleep center for specialized evaluation or treatment, e.g. cognitive behavioral therapy for insomnia.
Applicable Accreditation Standards
For patients directly referred, the facility director or appropriately licensed medical staff member must review the information provided for each patient and determine if the proposed evaluation conforms to established AASM Practice Parameters, or, if not, whether the evaluation is indicated for other reasons. Evidence of compliance with this standard must be included in the medical chart record.
The sleep facility must maintain a cumulative database of the final diagnosis, using the most recent diagnostic and coding manual of the AASM, and procedures performed for each patient evaluated. This database must include cases seen by the facility’s medical staff that did not require polysomnography.
Key Things to Keep In Mind
- Physicians listed among a facility’s professional staff are not considered referring physicians.
- Direct referrals must be counted in the sleep facility’s cumulative database.
- A direct referral must be reviewed to ensure the proposed testing is in adherence to the AASM Practice Parameters for the test.
- Procedure for review must be described in the direct referral policy.
- Evidence of communication with the referring clinician is to be recorded in the medical record and a copy of the study report sent back to the referring clinician.