Monthly Archives: September 2017

11 Questions To Validate Before Choosing Referral Management System

A medical Referral Management System is essential for a health system or clinic which sends and receives patient referrals to other care providers. Using a referral management system helps to track and grow referral sources. Before deciding on a referral management system for your practice, there are various factors you should consider.

Following are 11 questions to address before choosing your referral management system

1. Is the system easy to adopt?

By choosing a referral management system that your staff and you can adapt easily, you can avoid wasting time on installation and implementation. Cloud-based referral software is recommended as it does not need any installation and a single sign up can get you started.

2. Is the system easy to navigate?

However comprehensive a referral management system may be, it must be easy to navigate through.  For non-technical clinicians, nurses, administrative staff at a hospital the system must be easy to comprehend and use even from the first instance. A simple workflow of the system helps save time not wondering what is the next required action.

3. Is the system expensive?

Various budgets suit various practices depending on the conditions treated, size of the referral network, number of referrals received and sent each month, number of employees who need to use the system etc. It is recommended that you pick a system within your budget with the necessary features so it can add value by optimizing the referral process and not be a financial burden on your practice.

4. Is the system scalable?

As your practice grows by volume of patients, a number of locations, referral network or a number of conditions treated, a referral management system should allow you to scale up or down based on the requirement. If your staff is overlooking 100 referrals per month now, you should be able to upsize ( increase by 10%, 50 %, double, triple or more!) your referral pipeline based on the requirement or downsize based on seasonality.

5. Does the system allow user hierarchy and access control?

A referral system can store different types of data like patient medical records, patient schedules, billing, insurance details, list of specialists referred to, dashboard overview, referral pipeline, referral status etc. Not all this information needs to be accessed by every employee of the practice. The admin team would need to view the patient pipeline, clinicians would need access to patient medical records and referral status, finance team would need access to billing and insurance details, management would need admin access to the dashboards to monitor overall performance and reports. Having a system with user hierarchy allows for boundaries to be maintained between data modules to ensure patient privacy and data security.

6. Can the system process multi-channel referrals?

A clinical practice with a good referral network receives referrals from multiple channels like phone, email, fax, chat, SMS etc. A missed referral is a missed opportunity for potential revenue of hundreds of dollars.  An efficient referral management system must be able to collate all the referrals automatically with minimal manual intervention.  A referral pipeline that shows a comprehensive list including all referral sources will help the practice track and grow referrals. A dashboard view of referral network indicating the performance of each referral source allows for analytics on revenue split based on referral source, a number of referrals from each source etc.

7. Does the system allow you to view detailed patient profile?

While diagnosing a patient, all medical history of that patient must be visible for accurate diagnosis and treatment. A comprehensive view of the patient profile helps consider details of other related ailments diagnosed earlier, prevent repeat tests from being prescribed, prevent unnecessary costs to the patient, suggest a more accurate specific specialist for referral based on patient’s current condition and medical history. Each action by a specialist against a referral should be recorded in a chronological order for documentation and future reference. A complete patient profile allows for faster and more accurate diagnosis.

8. Does the system allow easy secure access to patient records?

An effective referral system must store patient demographic and medical information securely for immediate access on any internet-enabled device. HIPAA compliance and data security must be maintained. Relevant information can be targeted to the treating clinician.  

9. Can medical records be shared among relevant clinicians?

Lack of proper communication channels create problems in the referral process. This leads to specialists not having access to required records and test results on time. The physical transfer of files put the patient protected information at risk of being misplaced, lost or compromised. The system should have the flexibility to restrict sensitive information. A good referral management system must allow PCPs to share patient documents securely and quickly.

10. Can you track what happened to your referral after you sent it?

Referring providers mostly do not know what happened to a referral they sent. After the referral is sent the PCP is out of touch with the rest of the process and this can have serious repercussions like inappropriate re-referrals, inefficient care or lack of time-bound care, patient dissatisfaction, and even malpractice lawsuits.

11. Does the system ease communication?

A referral system must keep the PCP always in the loop by providing information on the status of referral sent and a secure channel to share notes and documents. A referral system must enable convenient communication between the primary care provider, specialist and other clinicians involved in the patient diagnosis. With effective communication, quick resolutions of queries are possible enabling optimal care orchestration.

If you are looking for an effective medical referral management system, consider a 30-minute walkthrough with the HealthViewX team. Our specialists will guide you through the HIPAA compliant industry-leading features with user-centric modern design.

CPT Codes 99490, 99487 & 99489- All you need to know

Chronic care management executed remotely is a win-win for both patients and care providers. The Medicare CPT codes for chronic care management encourage care providers to offer remote healthcare to chronic patients. Across America care providers are growing their practice through the additional revenue channel of CCM Medicare CPT codes reimbursement. In all cases, documentation of consent should be maintained

How do patients benefit from Chronic Care Management?

Patients with two or more chronic medical conditions can benefit from the CCM services. Chronic diseases are defined as those conditions expected to last a minimum of 12 months after diagnosis and put the patient at a risk of death or functional decline.  

Such patients above the age of 65 can stay connected through telephone, web or mobile applications with their care providers for regular monitoring and in case of emergencies. Such coordinated care improves their wellbeing and reduces the cost incurred in face-face treatment if it is substituted by remote care.

How can medical professionals benefit from Chronic Care Management CPT Codes 99490 and 99487 and 99489?

Physicians and Non-Physicians can benefit from Medicare’s reimbursement for chronic care services.

Non Physicians include Certified Nurse-Midwife, Physician Assistant, Nurse Practitioner and Clinical Nurse Specialists. The flexibility of remote medical monitoring offers patients and professionals convenience to reach out as per their schedule.

CPT Code CPT Amount(approx) per consultation Description
CPT99490 $42 Min 20min nonface to face time monitoring the care plan
CPT99487 $60 Min 60min nonface to face consultation time establishing or monitoring a care plan
CPT99489 $47 To be billed with CPT 99487 for every additional 30 min of nonface to face consultation

CPT 99490:

By using this code, care providers can bill approximately $42 per consultation. This includes at least 20 minutes of nonface to face consultation that can be used to monitor the vitals, check the compliance to care plan and effectiveness of the ongoing care treatment. This time can also be used to establish a new care plan based on the patient’s condition. Care providers must keep in mind that only one medical professional can bill using this code per month per patient. To claim the reimbursement for care provided to the patient, the claim must be submitted once a month by the professional who provided care in that month. Medical practitioners should also use a recognized Electronic Medical Record System to securely access the patient records remotely.

CPT 99487:

Using this code, medical professionals may bill approximately $94 per consultation. This code may be used by medical professionals who offer chronic care management for at least 60 minutes per consultation. This refers to nonface to face consultation. In cases where 20 minutes of care may not be sufficient and additional detailed monitoring is required, CPT 99487 code may be used. Treatment, in this case, includes advanced medical care planning and monitoring. A recognized electronic record system ensures smooth care transition between primary care providers and specialists. The 60 minutes scheduled should cover ongoing oversight, direction, and management of care plans. Decision making of moderate-high complexity may be needed. This code can be used by only one medical professional per patient per billing cycle. The claim for CPT reimbursement can be submitted once a month.

CPT 99489:

This code has to be used along with CPT 99487. With this code, medical care providers can bill up to $47 for every additional 30 minutes of consultation provided to the chronic patient. This additional time may be used to establish a care plan or substantially revise an existing plan. A care plan should include a complete assessment of patient needs taking into account the physical, functional, psychological and environmental conditions of the patient.

Challenges in implementing chronic care management for Medicare reimbursement:

Care providers have always had put in a lot of workloads doing back-end nonface-to-face tasks to manage patients. This includes time to schedule appointments, follow-ups to ensure that the patient is complying with the care plan prescribed, calls to collect vital patient information at regular intervals etc.

The Medicare CPT codes CPT 99490, CPT 99489 and CPT 99487 help practitioners monetize these previously unbilled tasks. The chronic care management CPT codes allow for billing up to $42 for 20-minute nonface-to-face care time with the patients. While this may be a good additional stream of revenue to practitioners, it comes with its own implementation challenges.

    1. The technical preparedness of the practice: Medicare CCM codes can only be billed by hospitals which have a certified electronic medical record ( EMR / EHR) system integrated into their practice. Such a financial commitment is not always affordable, especially for smaller practices. In 2017, changes have been proposed to remove the clause which mandates requirement of EHR systems for Medicare billing.
    2. Patient Consent: Before billing for Medicare CPT codes, providers must obtain patient consent. Since there are no readily available templates of the consent form, each practice must spend time in creating templates that can be used based on the patient profiles they treat. The consent forms must also be stored for future reference. Obtaining patient consent before each appointment can be time-consuming. In 2017, it has been recommended to do away with mandatory the consent procedure.
    3. Staffing needs and Billing time: Since the CCM services can be billed only at the end of each month, records such as the discussion details, conversation/email summary, care plans etc. must be maintained of each patient serviced through CCM. Additional staff may be needed to manage the patient consent, bill submission, and accounting procedures. This adds to the overheads of the practice.
    4. Patient payments: Medicare does not bear 100% of the charges for consultation through CCM. Patients have to pay 20% ( about $ 8 per consultation) of the charges. This makes patients reluctant to sign the consent form for CCM. Quick nonface-to-face follow-ups on care compliance were being provided by practitioners as a part of extended patient service and optimal care quality even before the CCM CPT codes came into effect. Some patients expect this to continue and perceive billing for CCM as the provider’s greed for money.

To overcome these challenges, it is important to educate patients on the advantages of CCM and help them see the long-term value of providing consent for CCM services. The proposed changes to the mandatory consent and mandatory EHR requirement will also help more practitioners adopt CCM CPT codes.

Rising popularity of CCM – Common Chronic Diseases In The USA

Chronic illness rates are increasing year by year and are taking a toll on the nation’s population. Serious chronic diseases like stroke, diabetes, cancer, heart disease, etc. are one of the leading cause of increased death rate in the country. More than 75% of healthcare spending is on people with chronic conditions. Beyond any statistics, medication non-adherence is a poor clinical outcome and overcoming this is another great challenge. Thus, doing more to take care of the population health is crucial.

Even today, we witness patients suffering from poor access to healthcare and it is continuing to increase. So improving quality of life for people with chronic disease is vital and is an epidemic in the USA. Simultaneously, the burden of multiple chronic illnesses is also increasing rapidly. In one of the recent release, it is noted that two-thirds of Medicare patients have two or more chronic conditions; another one-third have four or more.  The growing impact of this condition is placing a huge economic demand on the nation. Utmost care has to be taken to address this growing condition, and addressing it will not only reduce cost but also increase the quality of life.  Taking steps towards better health and using care more effectively is a need today.

Chronic Care Management is a boon to both the providers and the patients. The Center for Medicare and Medicaid Services (CMS) has taken a lot of new initiatives to raise awareness of the benefits of Chronic Care Management. This initiative offers family physicians and other healthcare specialists the support they need to implement Chronic Care Management in their practice. It is all about providing care to patients with chronic illness through a framework for embracing healthy life, improving patient health and increasing revenue.

The prime goal of CCM is to improve care quality through remote monitoring and managing patient health conditions better by creating care individual care plans for each of the patients for achieving better health outcomes.

Chronic Care Management promises the below

  • Continuity of care by the provider.
  • Individual care plan for patients.
  • 24/7 access to healthcare.
  • Assessment of patient health records, patient-generated health data.
  • Access patient health information at regular intervals.
  • A secure electronic platform to share patient information and care plans
  • Managing care transitions

Apart from this Chronic Care Management includes non-face-to-face care management and care coordination. The transition from fee-for-service to value-based payment has a huge impact in the healthcare industry. And the CCM billing model makes it possible by getting paid for the time and effort the care team invests in their patients. It is evident that this is benefitting both the patient and the provider. CCM has gained in traction through the value the physicians bring in by delivering continuous and connected healthcare. For the past many years, physicians have helped patients over the phone but never got paid for it. But now with the introduction of Chronic Care Management (CCM) by Center for Medicare and Medicaid Services (CMS) this has been resolved. Patients can elect one physician to take care of their CCM program. The elected CCM physician or provider must establish, implement, revise, or monitor and manage an electronic care plan that addresses the physical, mental, psychosocial, functional, and environmental needs of the patient as well as maintain an inventory of resources and supports that the patient needs. Thus, the practice must use a certified EHR to bill CCM codes. The CPT CPT codes 99490 and 99487, and the add-on CPT code 99489 is a new source of revenue for the physicians’ and other care providers.

And it is no surprise that CCM is gaining popularity among all the care providers, physicians, and patients. Schedule a demo with us to know more about HealthViewX – Chronic Care Management Solution

5 Benefits of Referral Management Software

The healthcare landscape is changing rapidly. As the industry shifts towards value-based care, it helps healthcare providers to focus on delivering high-quality care and making their care delivery efficient. But the current healthcare system has several other challenges, that include:

  • Protecting patient information from data/ security breaches
  • Ensuring the sending and receiving of care plans through a secured communication channel, maintaining confidentiality
  • Directing patients to the right specialist to ensure better outcomes

All these problems can be addressed with a help of referral management tool.

A referral management system is a unique and powerful tool designed for care providers to keep track of their patient referrals throughout the care continuum. The ultimate mantra of this tool is to refer patients to the right specialist at the right time. This tool helps to improve and streamline communication amongst primary care physicians (PCPs), specialists, and any other members involved in a patient’s care.

So, how does referral work on the ground today?

Some quick statistics on traditional referral processes and adoption draw up a sorry picture:

  • According to the Archives of Internal Medicine, only 50% of referrals result in a scheduled appointment.
  • The Journal of General Internal Medicine says, 70% of specialists are not receiving clinical information before seeing the patient.
  • The Journal of the American College of Physicians says, 30% of missed or delayed diagnoses are due to miscommunication.

An electronic referral management solution can help address some of the problems outlined above and the points below can help you build a case for why you should immediately consider adopting a referral management system for your practice:

#1 Better communication

50% of physicians agree that there is a gap in communication once a referral is made. HealthViewX referral solution has two-way scheduler integration that makes the process simple and efficient.

Our referral software, also allows physicians and specialists to share patient-related information or request for more information when required. The system also allows specialists to share the treatment details and results of diagnosis with other PCPs.

#2 Multi-Channel Integration

Healthcare practices receive referrals via varied media including fax, phone calls, and emails. Tracking and managing these referrals across these various sources proves difficult for providers. Employing a single unified dashboard will help providers to gather information from all sources to one place that helps in achieving better control of the entire process.

Our tool can integrate with any EMR system, so providers can gather information and update their records in seconds.

#3 Manage and Track referrals

An actionable dashboard will help providers identify patterns in referrals and ensure that schedules and appointments are managed better. With a referral management system in place, providers can also track every individual patient’s referral status.

Our referral software will notify all members involved in the referral process about an upcoming appointment. This keeps patients and physicians informed about their meeting and helps providers ensure follow through on their referrals.

#4 Meaningful Engagement

Our referral software allows providers, physicians and patients to access patient records through a secure network from anywhere, anytime. It sends meeting reminders to patient and specialists, allows patients to connect virtually with their physicians, and enables instant communication between patient and specialist on a single tap.

#5 More effective diagnosis and treatment

Quicker referrals mean quicker diagnosis and access to treatment. Our referral solution allows PCPs to choose the specialists from a preloaded list of specialists and helps direct patients to the most suitable specialist. It provides timely updates on patient health status and notifies any breach of preset thresholds that enabling instantaneous or emergency care, where required.

Our Referral Management Solution is HIPAA compliant and can monitor referral progress that helps providers and healthcare institutions to track down all the information involved in a referral process and helps facilities to keep revenue within their system.