Establish effective care coordination and active referral management that could include one or more of the following:
- Establish care coordination agreements with frequently used consultants that set expectations for documented flow of information and MIPS eligible clinician or MIPS eligible clinician group expectations between settings;
- Provide patients with information that sets their expectations consistently with the care coordination agreements;
- Track patients referred to specialist through the entire process; and/or
- Systematically integrate information from referrals into the plan of care.
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