When an organization considers purchasing a patient Referral Management System (RMS), one of the first points management considers is whether or not its existing EMR/EHR can provide the missing functionality with an add-on, or perhaps already does but is not being used.
In general, use cases that are exclusive to employed healthcare providers working within the provider system will favor using an EMR alone. However, once an organization wants to do complex tiering of its networks and/or work with provider resources outside its organization, a Referral Management System becomes critical.
Below, we provide the top 6 reasons a Referral Management System is a necessary tool for a healthcare system in addition to an EHR/EMR.
6. Referral Management Systems Enable Healthy Provider Network Utilization
A healthy referral network should be able to distribute referrals evenly among comparable resources in a given geography. It is essential to maintain active participation among all the providers in the network. Often a favored specialist at the top of the list keeps getting more and more referrals at the expense of others who might be just as qualified. An effective Referral Management System can provide load-balancing algorithms so that referrals are distributed evenly among comparable providers.
5. Referral Management Systems Provide End-to-End Patient Referral Tracking
Part of the clinical opportunity for referral management stems from the fact that referrals typically occur when there is a change of diagnosis or an escalation in care. As such, a referral is often the first indication that a patient will likely trigger significant downstream consumption. A well-implemented patient referral solution enables an organization to track patients in real-time and better guide patients towards high-quality low-cost care settings. Further, the system needs to encourage specialist staff to report appointment attendance or noncompliance, as well as return clinical notes to primary care offices for better patient care and better patient outcomes.
4. Referral Management Systems Facilitate Real-Time Referral Reporting
The ability to report highly granular referral analytics that illustrates referral patterns is essential for any Referral Management System. Organizations taking on risk as well as organizations optimizing referral patterns need to stay vigilant about network performance and network adequacy. Referral analytics should help organizations identify particular areas of concern as well as provide reporting that impacts referral patterns and facilitates change. Furthermore, robust Referral management software should be able to provide this data within the application itself as well as have the ability to export this data in any suitable format.
3. Referral Management Systems Create Dynamic Referral List Based on Location
Many organizations must be able to manage referrals across large geographic areas. Indeed, the Service Level Agreements (SLAs) that many provider organizations enter into with payers as part of risk-sharing arrangements have network requirements that dictate how far away a specialist referral can be for a patient. A patient referral management solution can store the SLAs from the different payers, and then generate a geo-specific list of referral resources that can be based on the primary care provider’s location or the patient’s home.
2. Referral Management Systems Create Dynamic Referral Lists Based on Payer Selection or Plan Design
Referral networks tend to have networks within the network, where different payers or insurance plans have preferences or rules where patients can go for care. A referral management solution can generate a referral list for each patient based on the plan each patient carries.
1. Referral Management Systems Connect Healthcare Clinics Across Different EMRs
Once an organization wants to manage referrals across networks (e.g. among affiliates), chances are high that many offices will be using different EMRs. An effective referral management solution will be able to provide workflow and integration solutions that can work across multiple different EMR/EHR vendors and networks.
How has HealthViewX added value to referring physicians’ patient referral problems?
1) Automating the insurance pre-authorization process
HealthViewX platform has a payer management module that maintains and manages
- Different payer details
- Modes of prior authorization
- Direct authorization procedures
- Payer forms
- Online portal links
- With this information already present, it provides the referral coordinator with the capability to automate
- Prior authorization submission
- Status checks coupled
- Fax integration
It simplifies the process of insurance pre-authorization. The referral coordinator need not waste time on the process anymore.
2) 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.
3) Establishing best practices
After using our HealthViewX Patient Referral Management System, physicians were automatically alerted to
- Referral status
- Patient diagnostic reports
- Referral completion
As a result, we can cut down on miscommunications and bridge the gaps between the specialist and the physician community. The system also assembles a patient encounter record from the EMR/EHR and pushes it directly to the physician.
4) Forming a close-knit of trusted referral receiving centers
Our system helps in strengthening ties with the medical community. From a history referral experiences the PCPs can from a close-knit of referral receiving providers. Physicians can now refer patients to hospitals they can rely on.
HealthViewX Patient Referral Management solution helps the referring physicians in handling and managing their referrals. Are you an inbound referral heavy practice looking for an end-to-end referral management solution? Schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.