Monthly Archives: August 2018

HIPAA Compliance Checklist

The HIPAA compliance checklist is divided into segments for each of the applicable rules. One important point is that there is no hierarchy in HIPAA regulations, and even though privacy and security measures are referred to as “addressable”. It does not imply that they are optional. Any organization must adhere to each of the criteria in the HIPAA compliance checklist to achieve full HIPAA compliance.

It is necessary for organizations having electronic Protected Health Information (ePHI) to read through this HIPAA compliance checklist. The primary motive of this HIPAA compliance checklist is to help organizations comply with HIPAA regulations. Failing to this breaches the security and privacy of confidential patient data and results in substantial fines and even criminal charges.

Ignorance of HIPAA regulations is not considered to be a justifiable defense by the Office for Civil Rights of the Department of Health and Human Services (OCR). The OCR will issue fines for non-compliance regardless of whether the violation was inadvertent or resulted from willful neglect.

What is HIPAA compliance?

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection. Companies that deal with PHI must have physical, network, and process security measures in place and follow them to ensure HIPAA Compliance. Covered entities (anyone providing treatment, payment, and operations in healthcare) and business associates (anyone who has access to patient information and provides support in treatment, payment, or operations) must meet HIPAA Compliance. Other entities, such as subcontractors and any other related business associates must also be in compliance.

HIPAA Requirements

Every Covered Entity and Business Associate that has access to PHI must ensure that they should

  • Adhere to the technical, physical and administrative safeguards
  • Comply with the HIPAA Privacy Rule to protect the integrity of PHI
  • follow the procedure in the HIPAA Breach Notification Rule in the event of PHI breach

All risk assessments, HIPAA-related policies and reasons why addressable safeguards are not implemented must be chronicled in case of PHI breach. An investigation will take place to establish how the breach happened. Each of the other HIPAA requirements is explained in detail below.

HIPAA Security Rule

The HIPAA Security Rule sets the standards for safeguarding and protecting ePHI when it is at rest and in transit. The rules apply to anybody or any system that has access to confidential patient data. By “access” it means necessary to read, write, modify or communicate ePHI or personal identifiers which reveal the identity of an individual.

There are three parts to the HIPAA Security Rule

  • Technical safeguards
  • Physical safeguards
  • Administrative safeguards

Let us address these in order, in our HIPAA compliance checklist.

Technical Safeguards

The Technical Safeguards is about the technology used to protect the ePHI. The important requirement is that ePHI must be encrypted to NIST standards once it is beyond an organization’s internal firewalled servers. This is to ensure that any breach of confidential patient data renders it unreadable, indecipherable and unusable.

Physical Safeguards

The Physical Safeguards focus on physical access to ePHI irrespective of its location. ePHI can be stored in a remote data center, in the cloud, or on servers located within the premises of the HIPAA covered entity.

Administrative Safeguards

The Administrative Safeguards are the policies and procedures which bring the Privacy Rule and the Security Rule together. They are the pivotal elements of a HIPAA compliance checklist. These require a Security Officer and a Privacy Officer to put the measures in place to protect ePHI.

HIPAA Privacy Rule

The HIPAA Privacy Rule governs how ePHI can be used and disclosed. In effect since 2003, the rule applies to all healthcare organizations. It demands that the implementation of appropriate safeguards to protect PHI. It also limits the use and disclosure of PHI without patient authorization. The Rule also gives patients or their nominated representatives,  rights over their PHI; including the right to

  • obtain a copy of their health records or examine them
  • to request corrections if necessary

HIPAA Breach Notification Rule

The HIPAA Breach Notification Rule authorizes the covered entities to notify patients when there is an ePHI breach. It also requires them to promptly notify the Department of Health and Human Services of such the breach of along with issue a notice to the media if it affects more than 500 patients.

There is also a necessity to report smaller breaches those affecting fewer than 500 individuals via the OCR web portal. These smaller breach reports should ideally be made once the initial investigation has been conducted. The OCR only requires these reports annually.

HIPAA Omnibus Rule

The HIPAA Omnibus Rule was introduced to address the areas that had been omitted by previous updates to HIPAA. It amended definitions, clarified procedures and policies, and expanded the HIPAA compliance checklist to cover Business Associates and their subcontractors.

HIPAA Enforcement Rule

The HIPAA Enforcement Rule governs the investigations that follow a breach of ePHI. It enforces penalties for covered entities responsible for an avoidable breach of ePHI and conducts the procedures for hearings.

What Should a HIPAA Risk Assessment Consist Of?

OCR provides guidance on the objectives of a HIPAA risk assessment:

  • Identify the PHI that your organization creates, receives, stores and transmits – including PHI shared with consultants, vendors, and Business Associates.
  • Identify the human, natural and environmental threats to the integrity of PHI – human threats including those which are both intentional and unintentional.
  • Assess what measures are in place to protect against threats to the integrity of PHI, and the likelihood of a “reasonably anticipated” breach occurring.
  • Determine the potential impact of a PHI breach and assign each potential occurrence a risk level based on the average of the assigned likelihood and impact levels.
  • Document the findings and implement measures, procedures and policies were necessary to tick the boxes on the HIPAA compliance checklist and ensure HIPAA compliance.

HealthViewX, a HIPAA compliant platform for Chronic Care Management and Patient Referral Management

How nice would it be if a solution like HealthViewX can protect all patient-related data securely? The practice need not worry as HealthViewX is a HIPAA compliant solution. We are passionate about making things easy for the healthcare industry. We offer three important solutions.

In this period, when the healthcare industry is experiencing its most drastic change, HealthViewX focuses on helping healthcare providers adapt and evolve to meet the changing needs of the industry and provide the best quality care for its patients.

Know more about our Care Orchestration Solutions to Improve Care, Performance, and Compliance! Partner with us for sustained healthcare outcomes, data insights and informed decision making!

Referral Management Software For Referral Inbound-Heavy Practices

In a year, practices receive 15 billion fax referrals in the USA. Practices receive referrals through fax, online forms, direct messaging, email, virtual print, direct walk-ins, and other channels. An imaging center or specialty practice or a dental center is a high inbound referral setup. Thousands of referrals flow in every day. So they need an effective referral management solution to manage the increasing inbound referral rates.

Traditional referral process in a dental center

In a dental center, a referral coordinator has to receive, accept and process the referral requests. The referral coordinator has to manually key in and create a referral, include all the patient information into the EMR/EHR/RIS. The referral coordinator takes around half an hour to process a referral request. The rate of processing is very slow. The referral coordinator finds it difficult to process even 20 referral faxes in a day. It results in piling up requests that are not yet processed. The referral coordinator is at loss trying to contact the referring provider for missing information. Patient referral leakage also becomes imminent.

Consequences of a slow referral network

  • The dental center loses its revenue they do not process referrals on time.
  • Providers stop referring the center thereby harming its reputation.
  • Patients may have severe illness and may need immediate attention. The waiting time may affect their health.

Problems faced

  • Handling many referrals manually in a short period.
  • Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in.
  • Limited referral information makes it difficult for the referral coordinator to proceed with the diagnosis.
  • It takes a lot of time for the dental center to contact the referring provider for clarifications.

HealthViewX Patient Referral Management solution at your aid

Patient Referral Management is complicated not only by the different sources but also by trying to manage all the referrals manually. The current referral management is no way close to the increasing demands of the referral process. Its inability to communicate between the referring and the receiving ends makes it slow and non-feasible. Relying on EHR/EMR/RIS for managing referrals makes it a costly affair and does not fulfill the current requirements.

Electronic Referral Management has been creating buzz for some time. Many applications are looking to solve the referral process issues. Before choosing one, a practice must consider the following aspects.

  • Simplify data sources – Capable of handling numerous referrals from various sources and bringing it to a platform from where it can be processed.
  • Data security – Sensitive patient data must be secured and protected.
  • Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc.
  • Timeline View – To know the history of the referral and to what status it is attached to.
  • Integration with scheduler – To schedule appointments for the patients.
  • HIPAA Compliant – Secure data exchange of patient sensitive documents.

Any dental center receives a number of referral requests in a day. The referrals usually have an attachment in pdf form which will be not editable. They will have a form that has to be filled out with the details given in the referral. HealthViewX Patient  Referral Management comes to play here. Using Optical Character Recognition(OCR) the information from the referral will be read and the form is prefilled with the required details. Now the referral coordinator can just validate the details and create a referral and assign it for further action. The referral information can also be channelized based on the request of the user for eg: Two referrals forms can be filled in if it concerns people in different locations. The solution can be integrated with EMR/EHR/RIS and can write the updated information back the system used by them.

Problems Addressed

  • Single Referral Workflow Queue Consolidation – It collects Fax, Phone, Email, Website form referrals and manages them in a single interface. This helps in managing the referrals better.
  • Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. The referring and receiving providers can attach documents and notes at any time for one another’s reference.
  • To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications.
  • Referral Data Consolidation – It has options for printing the consolidated data about the referrals and the referral history of any patient as a hard copy at any time in pdf/excel.
  • Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution helps dental centers in managing their referral network and increasing their revenue. Are you a dental center looking to track your inbound referrals very effectively? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

Ten Ways In Which HealthViewX Solution Can Fix Your Referral Management

Referral Management Process in healthcare

Patient Referral Management in healthcare plays a vital role in treating patients. The physician or the PCP identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A typical patient referral process goes through the following steps,

  1. Referral Initiation – The referring physician usually a PCP identifies the need for a referral and initiates medical referrals. A need for a referral arises when the patient needs advanced treatment or diagnosis that cannot be provided by a PCP.
  2. Insurance Pre-authorization – If the patient has an insurance coverage, the referring physician has to validate the same. The physician must do this to find the imaging center/specialist care practice comes under the patient’s insurance coverage. Most of the PCPs do this manually. It is a time-consuming process wherein the PCP has to wait for the insurance company to respond.
  3. Finding the right provider – Depending on the treatment required, insurance coverage and patient’s convenience, the physician will narrow down the search and find the right receiving provider for the referral. Dr.Miller is a primary care physician. A patient visits his clinic complaining of chest pain. After the initial diagnosis, the physician refers him to a specialist for better treatment. The referring physician looks for the best cardiologist in the city. Considering the patient’s and specialist’s comfort, the referring physician initiates the referral. This the more complicated than the insurance pre-authorization step as it takes more time and effort of the PCP.
  4. Sending out the referral – After finding the right provider, the referring physician shares the patient information and the diagnosis details with the receiving provider. The referral is sent via phone, fax, email, etc depending on the source, the receiving provider is comfortable in getting the referrals from. Most referrals are sent via fax. The PCP has to fill out a form and fax it to the receiving provider. This process takes a lot of manual effort as faxes and forms are tedious to work with.
  5. Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. Most of the time, the PCP may not be available to the specialist for queries. This slows down the referral process as the specialist cannot proceed with the referral. The specialist who is also a busy doctor may not have the time to update the referring physician regarding the referral. This affects the referring provider as he cannot close the referral loop or get a feedback from the patient or receiving provider.

The referral process is quite demanding for the physicians. Communicating and giving timely updates is not easy with the current workflow. Considering the complexity of referral networks, an effective Referral Management Software is the need of the hour.

How can HealthViewX help in solving such challenges?

To sum up, these challenges cause a bad experience for the patients and providers. These challenges can be addressed by the unique features of HealthViewX.

  1. Simple referral forms – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three-step form.
  2. Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. This reduces the manual effort of the referral coordinators.
  3. Intelligent Provider Match – Our “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements.
  4. Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort.
  5. Timeline ViewWith the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
  6. HIPAA compliance The solution is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  7. Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
  8. Referral loop closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
  9. Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.
  10. New Referral Channels – HealthViewX supports two channels of referrals, Desktop Direct and Type-enabled pdf for sending referrals. This reduces the time and effort the physician spends in filling in forms and sending faxes. The best part is that it does not require the referring provider to use our system.

HealthViewX Patient Referral Management solution smooths the referral process and fixes most of the challenges in a referral management system. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

How Can Physicians Benefit From HealthViewX Chronic Care Management Solution

More than half of the U.S population is suffering from various chronic conditions. Such patients need continued care and support from their physicians. Considering the physicians’ busy schedule, they cannot extend special support to every other patient with chronic conditions. This directly affects chronic patients. Both physicians and patients face a lot of challenges in the process of giving care to chronic patients.

Care Management Workflow for Chronic Patients

Let us consider a scenario to explain the care management workflow for chronic patients.

  1. The chronic patient gets sick – Lily is a diabetic patient who also had blood pressure. She fell down and hurt her head so severely that she started bleeding. As she was diabetic, the wound did not heal. She wants to visit Dr. Matthews who is her PCP.
  2. PCP examines the patient – Dr. Matthews is a busy physician who runs a clinic. Lily waits for two hours to get his appointment. The doctor examines Lily along long hours of her waiting. He advises her to stay in the hospital for two days. The nurses there take good care of her by giving her medications on time, attending to her whenever in need, etc.
  3. The patient gets discharged – After two days, Lily feels that she is all right. She is discharged from the hospital. Dr.Matthews prescribes her medications to be followed strictly to get completely well.
  4. Patient falls ill again – Though Lily takes care of herself, the wound starts bleeding again. She tries reaching the doctor but to no avail. It was only after a day did she get his appointment again.
  5. The patient is readmitted – Dr. Matthews examines her again. He finds that she did not take the medications appropriately. He advises her to stay in the hospital for another day.

Challenges faced by physicians

Though Dr.Matthews took good care of Lily, it could not avoid her get readmission. If only he had been more available to Lily virtually, this would not have happened. So what factors stop Matthews from being available to Lily?

  1. Outdated technology – Dr.Matthews’ clinic has a manual appointment scheduling method. Hundreds of patients call the clinic every day and the possibility of one getting an appointment is only 10%. This prevents him from catering to patients who need immediate diagnosis and attention.
  2. Limited resources – The availability of staff is less in number. Even if Dr.Matthews recruited new people, it would increase his operating costs significantly. The use of a new technology to manage the patient traffic is also not a great idea as it is costly.
  3. No remote patient monitoring tool – Patient readmissions can be avoided only when Dr.Matthews gives continuous care to his patients. He does not have a remote patient monitoring tool or the staff availability to handle it. Because of this, he is finding it difficult to be available to his patients.

Chronic Care Management Program

CMS was spending a lot of money on patient’s insurance who were suffering from chronic conditions. In order to cut down the expenses on hospital admissions, the CMS introduced the Chronic Care Management (CCM) program. Through Chronic Care Management program, the physician can give more attention and care to the patient.

What is Chronic Care Management?

Medicare defines Chronic Care Management (CCM) as non-face-to-face services provided to its beneficiaries with multiple (two or more) significant chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include

  • Communication with the patient
  • Health professionals being available both electronically and by phone for care coordination, medication management, and being accessible to patients.

HealthViewX Chronic Care Management solution to simplify the process

Chronic Care Management program is indeed a good idea to track your patients regularly. But when done manually, it becomes another burden for the physician. This is when a Chronic Care Management software comes to play. It reduces the time and manual effort spent in giving the CCM services. Let us consider the same scenario to explain the Chronic Care Management workflow,

  1. The chronic patient gets sick – Lily is a diabetic patient who also had blood pressure. She fell down and hurt her head so severely that she started bleeding. As she was diabetic, the wound did not heal. She wants to visit Dr. Matthews who is her PCP.
  2. PCP examines the patient – Dr. Matthews is a busy physician who runs a clinic. As he is Lily’s PCP, she has HealthViewX application in which she can see the doctor’s availability. She fixes an appointment with the doctor in no time. Dr.Matthews examines her and advises her to stay in the hospital for two days. The nurses there take good care of her by giving her medications on time, attending to her whenever in need, etc.
  3. The patient gets discharged – After two days, Lily feels that she is all right. She is discharged from the hospital. Dr.Matthews prescribes her a care plan with medications and exercises to be followed strictly adhered to.
  4. The patient is continuously monitored – Lily takes care of herself by adhering to the care plan prescribed. She gets monthly calls from the CCM team. If at all she falls sick, the application will help her to reach out to the physician as soon as possible.

HealthViewX Chronic Care Management solution features

HealthViewX Chronic Care Management solution has the following features that make the process simpler for physicians and patients,

  • Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
  • Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
  • Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
  • Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
  • Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
  • HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution has features that suit the physicians best. To know more about our Chronic Care Management solution, schedule a demo with us.

Chronic Care Management Services In Federally Qualified Health Centers

What are FQHCs?

Federally Qualified Health Centers (FQHCs) in the United States are non-profit entities comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in FQHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status.  FQHC is a dominant model for providing integrated primary care and public health services to low-income and underserved population. There are two types of FQHCs, one receives federal funding under Section 330 of Public Health Service Act and the other meets all requirements applicable to federally funded health centers and is supported through state and local grants. To receive federal funding, FQHCs must meet the following requirements.

  • Be located in a federally designated medically underserved area (MUA) or serve medically underserved populations (MUP)
  • Provide comprehensive primary care
  • Adjust charges for health services on a sliding fee schedule according to patient income
  • Be governed by a community board of which a majority of members are patients at the FQHC

What is Chronic Care Management?

The CMS introduced the Chronic Care Management program in 2015. It insisted care coordinators give 20 minutes of monthly non-face-to-face care management services for beneficiaries with two or more chronic conditions. It helps in managing their conditions, risk factors, medication adherence, and coordination of care with other providers. In order to claim CCM reimbursements, the practices must offer

  • 24/7 access to care management services
  • a platform for direct patient-practitioner communication
  • ability to manage transitions between providers and settings

Chronic Care Management in FQHCs

It is not mandatory for FQHCs to furnish Chronic Care Management services for their patients. These services can be given in addition to any routine care coordination services already furnished as a part of the patient’s visit to FQHC. Though it is not mandatory for them to give CCM services, they can bill for the same if the CCM requirements are met.

The CCM billing for FQHCs is a little different though. For CCM services furnished between January 1, 2016,  and December 31, 2017, FQHC can bill the under the CPT code 99490. Payment is based on the Physician Fee Schedule (PFS) national average non-facility payment rate for CPT code 99490. FQHC claims submitted using CPT code 99490 for services on or after January 1, 2018, will be denied.

For CCM services furnished on or after January 1, 2018, FQHCs can bill CCM services under the general care management HCPCS code, G0511. CMS has set the payment annually at the average of three national non-facility PFS payment rate for CPT codes 99490, 99487 and 99484.

It is important to note that the  2018 payment of HCPCS code G0511 is $62.28. It is high compared to the reimbursement of $42, CMS gives to practices other than FQHCs under the 99490 CPT code.

Why should FQHCs give CCM services to their patients?

  1. Increased reimbursements – FQHCs receive grants for treating their patients. When they provide Chronic Care Management services to their patients, they get more grants from CMS. This increases the revenue for FQHCs.
  2. Improved patient satisfaction – Chronic Care Management services establish a long-term connection with patients. The patients can reach out to the physicians at any time in need. This improves patient experience and the FQHC will see more patients coming into their hospital.

HealthViewX Chronic Care Management Software, the best fit for FQHCs

FQHCs are reluctant in giving CCM services to their patients as it is a laborious task. With increasing CCM requirements from CMS, FQHCs are worried about taking up the Chronic Care Management program. This is when an electronic healthcare product can come to play. HealthViewX Chronic Care Management solution has features that solve most of the problems faced by FQHCs.

  • Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
  • Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
  • Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
  • Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
  • Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
  • HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. Our solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution is on par with the current requirements of the CCM program by the CMS. It helps FQHCs to set up a CCM program with the least investment. To know more about our Chronic Care Management solution, schedule a demo with us.

Does A Referral Management Software Really Enhance The Patient Experience?

          When patients need advanced treatment or additional diagnosis that cannot be given within the practice, they are referred to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. There are many challenges faced by the patients in the referral process.

Challenges faced by patients

Let us review a typical referral process including the challenges faced by the patients.

  1. Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was experiencing pain in his knee joints. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
  2. PCP initiates the referral – John created a referral in his EMR. He did not have time to do the insurance pre-authorization so he left it to Andrews. He then found an orthopedic and gave him referral information verbally. Now when he met the specialist, Andrews had to again elaborate his condition and problems to him. This increased the efforts he took to meet a specialist. It did no go well with Andrews as he was already in pain.
  3. Patient Disorientation – John had instructed Andrews about the specialist he should visit, tests he should take and how to explain his condition. Andrews found these instructions too complicated to comprehend. He left the clinic with lots of confusions and doubts.
  4. Patient visits the specialist – Andrews then called the specialist a number of times. The first two times, the line was engaged. Finally, when he got through, all appointments were booked for the day.  to confirm his appointment. He had to wait for 24 hours in pain to meet the specialist. He spent another two hours in coordinating with the insurance company. At last, He met the orthopedic after long hours of waiting in pain. He got treated but was not happy with the waiting time and negative experience. He did not get back to the PCP to share referral updates and plans to visit some other PCP next time.

Challenges faced by the physicians

What factors stop Dr.John from giving the best patient experience to Andrews?

  1. Insurance Pre-authorization – John runs a practice where he treats many patients in a day. He has not adopted a referral management software. So he has to do the insurance pre-authorization for his patients. It is time-consuming and tedious.
  2. Finding the right specialist/imaging center – The clinic has no effective approach for finding the right specialist/imaging center. The chances of missing out on a good specialist/imaging center are high as it is done manually as they are not updated regularly.
  3. No referral updates – John is not up-to-date with the progress of the referrals which makes referral loop closure impossible.

The lack of a systematic referral workflow increased the manual effort and makes it tedious to follow-up with patients and receive referral updates.

HealthViewX Patient Referral Management System

Considering the challenges faced by the patients, an automated Healthcare Patient Referral Management System is the need of the hour. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

Let us review the same instance with HealthViewX Referral Management solution in place,

  1. Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was having pain in his leg. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
  2. PCP initiates the referral – John created a referral in HealthViewX system. HealthViewX does the insurance pre-authorization automatically in the background. With the help of the “Intelligent Smart Search” feature, he found an orthopedic. After giving the necessary information, John created the referral. The specialist got notified of the referral and all referral information were easily accessible by him.
  3. Patient Disorientation – Andrews left the clinic with clear information about the specialist and appointment details. There was no need for him to call up the specialist for appointment as everything is automated. The patient will be notified about the appointment and tests to be taken.
  4. Patient visits the specialist – Andrews met the orthopedic soon after the appointment was fixed. He got the best treatment and was satisfied with the referral process.

If you were Dr.John, would you not want Andrews to have a better experience? By using referral management software, you can ensure that Andrews’ knee pain heals while he also develops a positive opinion about your practice. Using a referral management software, you as a PCP can retain patients like Andrews in your network.

HealthViewX Patient Referral Management Solution features

  • Insurance Pre-authorization – HealthViewX solution supports automated insurance pre-authorization that reduces the manual work of the referral coordinators.
  • Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily.
  • Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
  • HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  • Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
  • Referral loop closure – Referral updates are hard to miss that makes it easier to close the referral loops on time.

HealthViewX Patient Referral Management application solves most of the challenges faced by the patients and PCPs. This increases patient satisfaction and revenue. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.