Patient Referral Management in healthcare plays a vital role in treating patients. The physician identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A patient referral goes through the following steps,
Referral Initiation – The referring physician identifies the need for a referral and initiates medical referrals.
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.
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.
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.
Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. The physician should get things sorted and continue with the referral. The provider should schedule appointments with the patient and follow-up with the same. The specialist should give the referring physician timely updates on its progress.
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.
Ten Advantages a Referral Management Software should Offer
The current process of referral is very time-consuming and tedious. It has no tracking system or cannot give periodic updates to the referring physician, patient, and the receiving provider. An updated electronic referral management system is required to streamline the referrals. It would enhance the overall experience of the PCP and patients, curb referral leakage and patient no-show rate. A Referral Management Software reduces manual intervention and makes the process simpler. It should offer benefits that will improve the physician-specialist equation, improve hospitals’ operational efficiency and increased revenue. The hospital must consider the following benefits before choosing a Referral Tracking Software,
Multichannel Referral Consolidation – The receiving provider gets multi-channel referrals through sources like FAX, online forms, direct messaging, email, virtual print, direct walk-ins, etc. An Inbound Referral setup must have a Referral Management software that consolidates all referrals into a single queue. After the first step of multi-channel referral consolidation, it is easier to process the referrals.
Reduced Referral Leakage – Referral Leakage is the single huge problem faced by high referral inbound setups. Referral leakage for any health system is between an average 55% to 65%. This, in turn, leads to high revenue loss. A Referral Management Software should ease the processing of several referrals on time. The Referral Tracking Software must help in finding the right specialist and also make sure that no tests are repeated. The Referral Management Software must make the patient documents available to both the referring and receiving physicians. Scheduling patient appointments and following up to see if the patient completed a referral visit will reduce the referral leakage.
Increased Operational Efficiency – It is the efficiency of hospital staff to manage referrals and check the progress of the treatment. A Referral Tracking Software must make the process simple by reducing the time spent on referral initiation.The software must make referral information available to both the referring and receiving physicians. Multi-channel referral consolidation, specialist smart search and increased referral tracking will improve operational efficiency.
Automated Scheduling – The Referral Management Software must support an inbuilt scheduler. It schedules automated appointments with the patients and gives prompt reminders to the patient and the physician. This will never let a patient or physician miss their appointments thus reducing patient no-show rates. It helps the physician manage all their appointments on time. It thus leads to reduced patient referral leakage.
Improved Referral Tracking – Manual referral tracking is a tedious job for hospitals. The referring physicians are least informed about the progress of the referral. This affects referral completion and referral loop closure. The Referral Management Software must always keep the referring physicians informed about the referral’s progress.
Referral Completion – 25 to 50% of referring physicians do not know if their patients actually visit the specialist.Referral loop closure is very important for the referring physicians. Referral completion cannot happen when the referring physician is not informed about the progress of the referral. The Referral Management Software must aid in referral completion by providing a secure platform for the receiving and referring physicians to communicate. Referral tracking and feedback for the referral from the receiving physician aid referral loop closure.
Streamline the Flow of Referral – A Referral Management Software must streamline the flow of referral. It should consume less time for each step with minimal efforts of the patient, receiving and referring physicians.
Enhanced communication between PCPs and specialists – The primary care physicians and the specialist find it difficult to communicate about referrals. The physicians may need to communicate for missing referral information, referral tracking or referral completion. The referral tracking software must have inbuilt messaging, audio and video calling features to enhance the communication between the primary care physicians and specialists.
Improved Patient Satisfaction – The patient faces difficulties in acting as a bridge between the referring and the receiving medical care physicians. This leads to patient dissatisfaction and patient referral leakage. Timely response to referrals, minimal diagnosis, and full insurance coverage improve patient’s experience with the referral. A Referral Tracking Software must cut down patient waiting time, improve the relationship between PCPs and specialists and the overall patient satisfaction. Improved patient experience directly results in increased revenue.
Complete Referral Analytics – The Referral Management software should give complete data of the referrals flowing in and out of the network. Visualized data in the form of graphs, tables, charts, etc help in tracking the referrals in the pipeline. It helps in scheduling patient appointments with available documents. It gives a comprehensive data of the number of patients with various referral status and follow-up reminders for a day. The physician can customize the dashboard to show the preferred receiving physicians, the average revenue generated per patient referral, etc.
HealthViewX Patient Referral Management solution features
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.
Data Analytics – A comprehensive dashboard helps to track the number of referrals in the queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.
With HealthViewX Patient Referral Management solution in hand managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.
Health providers in a health system need patients to run their practice profitably. Be it a hospital, health network or private practice, healthcare providers rely on incoming referrals from other health providers and entities. Referrals generate revenue and improve patient retention rate. Providers tend to refer patients to specialists within the same hospital or health network. This is to retain them in the same hospital. A provider should consider factors such as personal relationships, quality outcomes, proximity, insurance coverage and patient preference before referring a patient. When a provider fails to consider these, patient referral leakage is bound to happen.
Patient Referral Leakage
Patient Referral Leakage happens when healthcare providers refer patients out-of-network. Accordingly, patient leakage is sometimes known as network leakage or referral leakage. The following definitions will help in better understanding of patient leakage,
In-Network – In-network refers to medical care within a network of doctors, hospitals, and other health providers who have a contract with a health insurance company. Inside the network, patients seek medical care only from those providers who are under the terms of the health insurance. In-network care is cheaper due to discounted rates that a health insurance company has negotiated ahead of time with the various health networks.
Out-of-Network – Out-of-network refers to patients looking to get medical care outside their current health network. This means that the patients seek care from out-of-network providers who cover their health insurance. Health providers refer patients seeking advanced treatment out-of-network. This is the main reason for patient leakage.
Why does patient referral leakage happen?
Sometimes patient referral leakage is unavoidable. When patients need medical care that is unavailable in their network, the health provider must understand the patient’s needs. The health provider must refer the patient to a specialist or an imaging center depending on the need.
However, there are occasions where in-network providers may refer patients to out-of-network providers on purpose.
Provider’s Repute – Sometimes, a health provider may refer their patients out-of-network to another provider who is more reputable in that specialty. This could be because the current health network has not employed a reputable specialist. The provider must make sure that a patient gets the best treatment possible.
Unaware of Providers in their network – Health providers who have just joined a health network or are a part joint ventures, acquisitions do not know all their specialists. This causes confusion and the health providers refer the patient out-of-network. When a health system fails to make it easy for health providers to refer within the network, patient leakage is inevitable.
Patient’s Choice – When certain treatment or care is not available within a network then it is up to the provider to refer the patient out-of-network. The health provider may recommend a next best course of treatment and the provider to consult for advanced treatment. Patients do tend to take the provider’s advice but it is up to the patient. This is why certain amounts of patient leakage will always exist. If the patient decides to move out of the practice due to unavoidable reasons then referral leakage becomes inevitable.
Why should it be curbed?
Patient’s Benefit – The patient may need immediate care and attention. So processing and closing it at the earliest will be the best for the patient. Patient leakage leads to open patient referral loop which will affect the patient’s health.
Patient’s Experience – A patient moves out-of-network due to many reasons. Primarily it is because the patient is not satisfied with the medical care provided in the current health system. Patient’s bad experience has a direct effect on hospital’s revenue, the number of incoming referrals, patient crowd, etc. In order to give efficient care to the patients, a health system must prevent patient leakage.
Missed Revenue and Reimbursement opportunities – The main problem with patient leakage is the missed revenue opportunities for health systems. These organizations miss out on reimbursement for medical services that they had provided earlier when patient leakage occurs. This applies to healthcare systems that adopt value-based care or payment models such as accountable care organizations (ACOs).
Failed relationships with healthcare providers and patients – Patient leakage results in failed relationships with healthcare providers and patients. Many health systems have spent resources on building clinical alignment with their referral network. Unfortunately, when patients go out of the system providers lose their trusted receiving providers.
How to tackle Patient Referral Leakage?
Employing right providers – Organizations can cut down patient leakage by employing respected, experienced, and well-regarded providers that they. This will cut down the number of patients who voluntarily go out-of-network. This is because they will find the right provider in their network.
Clear communication between physicians and patients – Clear communication between providers and patients is key to creating a positive patient experience and engagement. A health system can decide to give patients control of their own health by implementing an e-consult software. It should allow patients to schedule their own appointments, talk to providers online, order prescriptions, etc.
Being transparent in all aspects – The health system must be transparent about prices and pricing structure with the patients. Healthcare providers should give upfront estimates of costs and detailed end-of-care financial statements. Quality metrics is the other part that health networks must make readily available to the patients. It includes patient outcomes, patient satisfaction scores, physician reviews, etc. Ease of use and timely access to best care are crucial aspects of the patient experience. In a health system, it is important for a patient to receive medical care easily and in a timely manner.
How can HealthViewX Referral Management solution help?
Information Technology is transforming healthcare to a great extent. Patient referral leakage never happens with the help of a software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,
Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three-step form which includes health insurance pre-authorization, finding the right receiving provider with the help of “smart search”, etc. 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.
Referral status and timeline view – With 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.
Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
Referral 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.
HealthViewX Patient Referral Management solution smooths the referral process and reduces the burden of the referring and the receiving ends. Referral Management software cuts down patient referral leakage to a considerable number. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.
Healthcare industry of the US has introduced many technologies to give the best care to all irrespective of their place, accessibility, etc.Remote Care to patients is the latest healthcare technology. It enables monitoring of patients’ health outside conventional clinical settings. This may increase access to care and cut down the healthcare delivery costs. Hospitals offer Telehealth services as a part of Remote Care. This includes,
Virtual Consultation – It is a virtual visit that takes place between the patient and the physician. It takes place through audio or video calls. It is effective for common problems like flu, acne, fever, etc. It reduces the patient’s traveling cost and provides better access to quality care.
Remote Health Monitoring – Patient Health Monitoring is the latest technology in the healthcare industry. Patient physiological data like blood pressure, blood sugar, heart rate, etc can be measured by external devices. It can be a Fitbit, apple watch, etc that can communicate with the system in the hospital. It will help the physician to always keep an eye on their patients’ vitals and prescribe telemedicine and preventive care plans.
Chronic Care Management – Chronic Care Management is non-face-to-face care provided to patients with multiple chronic conditions. Medicare reimburses a certain amount for the Chronic Care Management services given by the hospital. Chronic Care Management is most administered through audio calls.
As Chronic Care Management services have reimbursements, physicians must consider administering CCM to the eligible patients. Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions
Expected to last at least 12 months or until the death of the patient.
Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.
CCM Service Summary
The following are steps through which a Chronic Care Management service is furnished,
Initiating Visit – Initiation during an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE) or face-to-face E/M visit for new patients or patients not seen within one year prior to the commencement of Chronic Care Management services.
Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of demographics, problems, medications, and medication allergies using certified EHR technology.
24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified healthcare professionals or clinical staff and continuity of care with a designated member of the care team.
Comprehensive Care Plan – Creation, revision, and/or monitoring of an electronic person-centered care plan.
Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.
Eligibility Criteria for Physicians
Physicians and the following non-physician practitioners may bill CCM services:
Certified Nurse Midwives
Clinical Nurse Specialists
HealthViewX Chronic Care Management solution features
HealthViewX Chronic Care Management solution has the following features that make the process simpler,
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 from 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 reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. All patient-related documents are managed securely.
HealthViewX Chronic Care Management solution is on par with the current requirements. Remote care is the easiest and the cheapest way to treat your patients. Medicare provides reimbursements for Chronic Care Management which makes it the best way to give care to patients from the remote. To know more about our Chronic Care Management solution, schedule a demo with us.
Referral Networks of healthcare play a crucial role in determining the hospital’s income, patient stability, and information security. It is essential for a practice to build a strong referral network of health providers from the beginning. It requires a strong provider base to strengthen a patient referral network. Once the practice establishes a patient referral network, they have to maintain it. There are few mistakes that every practice makes and are not aware of how they lose their referrals. The following are few mistakes that can affect patient referral networks,
Ignoring Patient Satisfaction – Patient satisfaction is the determining factor of a hospital’s repute. During the referral process, the patients interact with the receiving physician. So patient experience of the referral has a direct impact on the hospital’s patient referral network. In many cases, the physicians are unaware of how the referral process impacts the patient. When the receiving physician finds the referral information incomplete, the physician will make the patient repeat the diagnosis. This affects the patient’s experience. The patient will also not like to bridge the gap between the referring and the receiving physicians. When the patient is dissatisfied, he/she leaves the practice resulting in patient leakage. A Referral Management software that can easily communicate between the referring and receiving physicians will improve the patient’s experience. Surveys and feedback forms keep the practice informed of the patient’s experience. The physicians must handle patients better and make them feel good during the referral process.
Partnering with bad network physicians – Having health partners with bad repute in a patient referral network is the biggest mistake. If the practice is not selective in choosing the physicians, it is bound to witness worst patient experiences. The practice should not sign any physician just because they have good credentials. Even a good physician may not meet the referral requirements. The hospital must take time to analyze the physician and study the provider’s network before signing them. Choosing good health partners is a strategic decision and should make it considering the future well-being of the practice. If the practice is looking for a long-term partnership then should find a stable health partner. In the age of technology, the practice must choose a physician who complies with the EHR/ Referral Management software used. EHR or Referral Management software compatibility issues greatly influence patient referral networks.
Poor communication – Communication is everything in a referral process. It lays the foundation for patient’s experience. As a part of medical care rules, hospitals should have protocol norms for communicating with patients. The practice should train their staff and should check the same regularly. This will make sure that when the practice refers their patients out, all the essential information moves along with them. This will give the patients better understanding of what to expect and what their responsibilities are. The practice must make sure to spend quality time with the patients for their doubts and queries. Patients expect the physicians to communicate smoothly and flawlessly. Living up to the expectations of the patients make the practice run smoothly.
Neglecting measurements – Staying aware of general patient satisfaction may not be enough. The practice must adopt more formal methods of evaluating the health of the network. The practice can get a high-level view of what’s going on through surveys, feedbacks, software etc. These tools can be used to get patient opinions, evaluate the smoothness and timeliness of transitions. It can also say how well the practice has established patient expectations around referrals and how well they’re being met. Surveys can be anything as simple as a form of feedback options integrated into the patient portal solution. The practice must make sure that the surveys cover topics like coordination, access, and quality of care along with appointment experience. Measurement at this level may require a dedicated staff member, or at the very least, making the required duties a formal part of an employee’s job description. Once the practice has a clear picture of what’s going on, it’s time to improve. The practice can use the information gained to highlight specific areas of improvement. It improves future training and protocol standards.
Neglecting long-term growth – The practice should have a solid business strategy. The American Academy Of Orthopedic Surgeons proposed a ten step process. It helps doctors in having a strategic approach towards the growth of the practice. The process involves market evaluations, budget creation, strategic plans development, marketing plan, new reimbursement model preparation, etc. Business development is the backbone of a strong patient referral network. Once the practice establishes a patient referral network, they must begin adding more doctors and professionals with whom they are comfortable. This will optimize the processes and standards already in place.
Careless about security breaches – One of the few downsides of a well-connected patient referral network is increased exposure to data breaches. Since 2009, 15 million patients’ Personal Health Information has been exposed. A practice should protect their patients’ valuable information. Hiring a professional to audit the practice’s internet breach can help. Audits detect unauthorized access to patient information, curb inappropriate accesses and track misuse of PHI. A practice can consider partnering with other network members. It cuts down the cost of bringing in outside consultants and solutions. The practice must keep all personnel properly trained on HIPAA guidelines.
Using outdated technology – The increase in the number of referrals on a daily basis makes it very tedious and difficult for the existing process and system to manage them. The most commonly used system of referrals being fax and this method of sending / receiving referrals is time-consuming and prone to errors. Communication with the PCP’s and the patients on follow-ups and sharing of the results is a cumbersome process which impacts the overall satisfaction of the both. Considering the complexity of referral system, an effective Referral Management Software is the need of the hour.
HealthViewX Referral Management solution features
HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System.
Seamless communication – HealthViewX solution has an audio calling and messaging features. It enables secure and faster communication among the referring physicians, receiving physicians and patients.
HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files that can b sent and received during any time of referral process. It also keeps the patient documents safe.
Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing how far the referral has progressed. It acts as a channel of communication between referring and receiving physicians.
Data Analytics – A comprehensive dashboard helps to track the number of referrals in the queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.
Invariant referral process – HealthViewX Patient Referral Management solution can integrate with EMR/EHR and can write data of referral into any system if required. It is almost zero deviation from the current workflow a practice is using.
With HealthViewX Patient Referral Management solution in place, physicians never make a mistake in the referral process. Managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effective our solution is in tracking and managing the referral process. To know more schedule a demo with us.
The increasing complexity of patient referrals in healthcare
Patient referrals are increasing in number every day. Health Systems and Hospitals which send out numerous medical referrals find it difficult to track and close a patient referral loop on time. What factors prevent the referral coordinators, operations managers, physicians or care providers from closing the patients’ referral loops?
Prior Authorization – The referral coordinator does the insurance pre-authorization for the patient referrals in healthcare. Considering that one out of every three patients is referred to a specialist, it is difficult to do prior authorization. This makes patient referral system time-consuming and affects referral loop closure.
Finding the right specialist/imaging center – The referring provider must choose the right specialist or imaging center that will suit the patient best. He/She should send the referral to a reliable provider who will give the best care and give regular updates. The referring provider must also consider a provider who covers the patient’s insurance before initiating the referral. If the referring provider fails to do this, open patient referral loop becomes imminent.
No updates on the referral progress – The receiving provider fails to update the progress of the referral. 25% to 50% of referring physicians do not know if their patients actually visit the specialist or imaging center. As many patient referrals are initiated on a daily basis, tracking it manually is difficult for the referring provider. This ultimately results in open patient referral loop.
Inadequate referral information – The receiving providers usually have a tough time processing referrals with incomplete information. 70% of the specialists rate the patient referral information from the referring providers as poor. This affects the patient referral lifecycle.
Outdated referral workflow – The current referral workflow is outdated. The providers find it difficult to cope up with the increasing patient referrals in healthcare. On an average, a referring provider spends half an hour to one hour per referral and even more time in following up. Outdated referral technology affects the referral loop closure.
Close a referral loop in healthcare with the HealthViewX Patient Referral System
Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.
The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
The receiving provider gets notified about the referral and can schedule appointments with the patient.
The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.
Features and Functionalities
Referral workflow automation reduces the time and manual effort spent on a referral. Thus HealthViewX solution improves the efficiency of the process.
Patient coordination framework achieved through the patient application that helps in managing appointments and log data for the care plans prescribed by the provider.
Automated insurance pre-authorization reduces the work of the referral coordination team and makes the process simple.
Intelligent Provider Search feature helps in finding the right specialist or imaging center in no time.
Referral timeline view and communication enables easy flow of information between the referring and the receiving ends.
Scheduler integration gives timely reminders and notifications to the patients and the providers about appointments, lab tests, etc.
Referral insights and analytics gives the PCPs concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
Benefits of closing the patient referral loop in the healthcare industry
Increased Medicare reimbursements – Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
Increased productivity – Reduced operational time improves the efficiency of the patient referral system.
HealthViewX Patient Referral Management application helps in closing the referral loop and increases the revenue for the practice. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.
In the year 2011, the Center for Medicare and Medicaid Services (CMS) introduced the Annual Wellness Visit (AWV). An AWV is a yearly appointment of the patient with the physician funded by the American Affordable Care Act. It is very different from an Annual Physical Exam and is more of an educational visit than a diagnostic one. During this visit, the physician formulates a preventive plan for the patient for the coming year. This plan can help in preventing illness based on current health and risk factors.
Medicare provides Personalized Prevention Plan Services (PPPS) under the wellness plan for beneficiaries who:
Are no longer within 12 months after the effective date of their first Medicare Part B coverage period
Have not received an Initial Preventive Physical Examination (IPPE) or Medicare yearly wellness visitwithin the past 12 months
The following medical practitioners are eligible for providing Medicare yearly wellness visit services to patients:
Physician (a doctor of medicine or osteopathy)
Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioners), or a team of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)
Medicare Wellness checklist
Initial Annual Wellness Visit – This is applicable the first time a beneficiary receives an Annual Wellness Visit. It includes the following components:
Acquire Beneficiary Information:The physician assesses the health risk factors of the patient. It includes analyzing patient self-reported information, demographic data, daily activities, etc. He/She collects data from the list of physicians who regularly treat the patient. The physician reviews the beneficiary’s medical and social history, completely studies the patient’s potential risk factors, mood disorders, functional ability and level of safety.
Begin Assessment:The physician begins the assessment by measuring the patient’s vitals. He/She identifies the patient’s illness through direct observation, medical history, concerns raised by family members, friends, caretakers, etc.
Counsel Beneficiary Action: The physician establishes a written screening schedule for the beneficiary, such as an appropriate checklist for the next 5 to 10 years, etc. He/She furnishes personalized health advice to the beneficiary and generates appropriate referrals to specialist clinics or imaging centers. The physician gives advance care planning at the discretion of the beneficiary.
The subsequent Medicare yearly wellness visits include the above components and will be updated on the later patient visits.
Billing Codes for Medicare Yearly Wellness Visit
Annual wellness visit which includes a personalized prevention plan of service (PPS) and the first visit
Annual wellness visit which includes a personalized prevention plan of service (PPS) and the subsequent visits
Tips for physicians to benefit from Annual Wellness Visit
Managing patients – All Medicare Part B patients are eligible for Wellness Plan services. It is necessary for the practice to find the right patients who would benefit from this service. The physicians must give the patients a clear idea of how Medicare Wellness Program process works, what they can expect from the service, etc. The practice must make the patients aware of the reimbursements and the additional charges they may incur depending on their insurance coverage.
Developing protocols for schedules – A Medicare Wellness Program takes a great deal of both staff and physician resources to give the service. It is better for a practice to take some time to decide how these appointments best fit into their existing schedule. Creating a scheduling protocol will save more time and frustration. For example, how many days in a week, the practice can schedule these appointments, what tool for tracking the Medicare Wellness Program services, patient records, reimbursement rates, etc.
Pre-visit planning – The practice must verify not only the patient’s Medicare Part B effective date but also whether the patient has received a Wellness Plan from any physician in the last 11 months. Otherwise, Medicare may deny the service, leaving the patient with an unexpected bill. The practice must do the same verification for other preventive services that patients receive along with the Medicare Yearly Wellness Visit. It is ideal to have the staff note the last date of these preventive services on a Medicare Yearly Wellness Visit documentation form in advance of the visit. This will help in determining which preventive services are needed and whether the patient is eligible to have these paid for by Medicare. A pre-visit history can also find whether the patient needs any laboratory tests such as the cardiovascular scans, diabetes screening blood tests, etc. These should be completed prior to the Medicare Yearly Wellness Visit to allow discussion of its results at the visit.
Planning for effective follow-up care – The physician should analyze the patient’s risk factors and problems accurately during the Medicare Wellness Program. The physician must generate a care plan for the patient considering these factors. It is necessary to develop a preventive service plan and a general checklist for the next ten years. The physicians should follow-up the same on the patient’s subsequent Medicare Yearly Wellness Visits.
Getting complete reimbursements – The last step in providing the Medicare Yearly Wellness Program is to get paid the service rendered. AWV attracts the physicians’ attention because of the reimbursements offered by Medicare. The practice must keep up a clear documentation to make the process hassle-free.
These practices simplify the Medicare Wellness Program process thereby improving the efficiency of the practice. The HealthViewX solution eases the AWV workflow for the practice. With HealthViewX solution, there is no chance of losing the reimbursements. To know more about HealthViewX solution, schedule a demo with us.
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