Tag Archives: patient specific

Top 6 Reasons Why You Need A Referral Management System Even Though You Have An EMR/EHR

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

  • Appointments
  • 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.

Why Should Federally Qualified Health Centers Give Virtual Communication Services To Their Patients?

Virtual communication services in FQHCs

With effect from January 1, 2019, CMS has released a new reimbursement plan for FQHCs. It says,

“FQHCs can now receive payment for virtual communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an FQHC practitioner to a patient.”

The patient must have had an FQHC billable visit within the previous year, and both of the following requirements are met:

  • The medical discussion or remote evaluation is for a condition not related to an FQHC service provided within the previous 7 days.
  • The medical discussion or remote evaluation does not lead to an FQHC visit within the next 24 hours or at the soonest available appointment.

Virtual Communication in the age of COVID-19

On March 27, 2020, the Federal Government signed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The CARES Act was developed to support the American economy during the COVID-19 Pandemic. Section 3704 of this Act allows FQHCs to utilize telehealth services to access eligible Medicare beneficiaries. The price for such long-distance telehealth services is $92. 

How can FQHCs receive payment for virtual communication services?

To receive payment for Virtual Communication services, FQHCs must submit an FQHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services. Payment for G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes.

What is the payment rate for G0071 and G2012?

HCPCS code G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services). HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes. For 2020, the payment amount for code G0071 will be $13.53 (average of HCPCS codes G2012 and G2010).

What types of practitioners in FQHCs can furnish virtual communication services?

Technology-based communication and remote evaluation services are billable by FQHCs only when the discussion requires the skill level of an FQHC practitioner. FQHC practitioners are physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, and clinical social workers. If the discussion could be conducted by a nurse, health educator, or other clinical personnel, it would not be billable as a virtual communication service.

What types of communication technology can be used?

Virtual communication services should be initiated by the patient contacting the FQHC by

  • Telephone call
  • Integrated audio/video system or
  • Store-and-forward method

The Store and forward method includes sending a picture or video to the FQHC practitioner for evaluation and follow up within 24 hours. The FQHC practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.

How can HealthViewX help FQHCs in giving virtual communication services to their patients?

HealthViewX has the following features that will enable FQHCs in providing communication services to their patients,

  1. Inbuilt audio and video calling apps – HealthViewX supports audio and video calling options that help practitioners in contacting their patients easily.
  2. Secure messaging – HealthViewX has an asynchronous messaging option that enables providers to chat with patients and discuss their health plans.
  3. 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.

With HealthViewX Patient Referral Management solution in hand FQHCs can stay in touch with their patients easily. A 30-minute demo with our team will help you know how effectively our solution can give virtual communication services to your patients. To know more schedule a demo with us.

Pros and Cons of Patient Referral Management Software: All you need to know

Advantages of HealthViewX patient referral management software

  1. Inbound and Outbound Patient Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In the case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – Any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
  3. Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules – who sends it, to whom, what data must be included). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
  5. Data Management – HealthViewX is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – Minimal disruption in the existing referral flow by integrating with any EMR/EHR/RIS or Third Party application.
  7. Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  8. Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  9. Referral Data Analytics – Referral data-centric dashboard gives a complete view of incoming and outgoing referral pipeline, referral volume, referral status, patient follow-ups, etc.
  10. Insurance Pre-authorization – HealthViewX supports automated insurance pre-authorization that reduces the manual work of the referral coordinators and saves 10 minutes of manual work per patient.
  11. Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily based on the diagnosis, relevance, location, distance, patient preference.
  12. Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
  13. HIPAA compliant data security – HealthViewX is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  14. Referral loop closure – Referral updates are hard to miss making it easier for timely referral loop closure.

Disadvantages of patient referral management software and the hindrance to its usage

  1. Capital investment: Depending on the number of referrals processed and the size of the referral network, healthcare organizations are billed quarterly or annually. This is an additional recurring expense.
  2. Misunderstanding that ‘EMRs are enough’. With EMR implementation being widespread across the USA, its acceptability is increasing. Most health care organizations that have gone through the process of evaluating, comparing different EMR/EHR management systems, choosing, implementing and training their staff on its usage are wary of repeating the process. They definitely see benefits from using EHR systems and feel the satisfaction of process improvement more than the urge to improve further.
  3. Mindset – Psychologically organizations are more open to EMR EHR implementation than patient referral software and often compare the two rather than evaluate wholesome benefits.

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

 

Three Best Practices For Large Hospitals To Improve Patient Experience Through Optimal Referral Management

It is crucial for large hospitals to build a high performing referral network as they serve a huge community by providing them services in primary care and a variety of specializations. Large organizations spend months or even years building a referral management solution for their network which appears to have the right components on paper, but the patient referral volume continues to decline.

Usually, the problem with such Large Hospitals is that they overlook small but impact operational issues that are necessary to retain patients within their network. Making just a few changes to the existing referral strategy can have a huge impact on

  • Retaining more number of patients within the network
  • The quality of care given to their patients

Here are the 3 best practice solutions that can create a high impact in improving the existing referral management process in Large Hospitals.

1. Putting the patient first to build loyalty

The primary step to retain patients within the network is to accommodate their preferences. It is important for the health system to consider patient’s preferences before initiating a referral. Most patients prefer to choose the receiving provider based on a number of convenience factors like insurance, language, availability and distance. When a patient is paired with the receiving provider who best matches his/her preferences, it is more likely for the patient to visit the provider. Also, when the patient’s experience with the referral is good, it is more likely for the patient to stay within the network.

HealthViewX Patient Referral Management Software takes care of updating your provider database with details of specialists newly added to the network. The “Intelligent Provider Match” feature allows physicians to filter and search providers based on patient’s convenience factors like operating hours, location, language, insurance, distance etc.

2. Supporting EMR/EHR Interoperability to improve care coordination

A patient may need to see a specialist in a different facility within the same hospital. In most cases, the EMRs will be different. EMR Interoperability will allow facilities to share the patient’s records in real time without compromising patient security or privacy. Providers, patients and insurers all benefit from increased access to the patient’s medical information.

Also, interoperability is an essential part of the Government’s Meaningful Use Stage 2 requirements. Meaningful Use Stage 2 will affect Medicare payouts for health care providers in stages, eventually leading to reduced payouts to all providers that take Medicare and do not follow the guidelines.

Seamless functioning between EMRs like Epic, Cerner, Athena Health, Greenway Health, Allscripts, Nextgen, etc is important. HealthViewX Patient Referral Management Software acts as a bridge and enables seamless communication of data between the referring and receiving ends.

3. Tracking referral data to know where to make changes in the referral network

Tracking referral data is often the most underestimated and impactful component of a high-performing network. By having real-time visibility of the complete referral ecosystem, health systems can gain actionable insights on how to take meaningful decisions on referral process, provider relationships, etc. Large Hospitals should be able to track referrals in various status, referral loop closures, percentage of referrals flowing in and out of network, referrals sent to different specialities, insurance provider, etc.

HealthViewX Patient Referral Management has a customizable referral-centric dashboard that helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc. It can also be customized for different locations based on the priority of the large hospital.

HealthViewX Patient Referral Management solution smooths the referral process and solves most operational challenges for Large Health Systems. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management solution? Schedule a demo with us.

HealthViewX Blogs rated in Top 100 Healthcare Blogs

How Can Large Enterprise Hospitals Tackle Operational Problems Effectively?

Did you know? There are about 8000+ large enterprise hospitals in U.S. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the whole population in the community by offering them wide range of services related to primary care and specialties. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Operational challenges faced by  Large Enterprise Hospitals

Considering the huge number of patients in such hospitals, the patient referral volume is also high. In order to improve patient satisfaction and retain patients within their network, a large enterprise hospital must have a seamless referral process. Below are the most common operational challenges that affect the patient referral workflow in large enterprise hospitals.

  1. Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. They  spend millions of dollars having to migrate from one EMR/EHR to another. It is also possible that if one EHR faces a down time, the entire patient referral workflow is affected. Data security in communication between multiple platforms is crucial to protect patient interests. In a merger or acquisition, patient experience must never be compromised despite the backend operational challenges that may occur. Seamless functioning between EMRs like Cerner, Athena Health, Greenway Health, Allscripts, Nextgen, etc is important.
  2. Training their staff – Staff in each division in the hospital might be comfortable with using a different EMR system. The user interface and familiarity affects speed of operations. The health system has to train and migrate all staff to a single EMR which costs millions of dollars and time to get the staff up-to-speed.
  3. Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, better specialist within the locality, reputation of the receiving provider, etc.
  4. Referral leakage – Did you know? Referral leakage for large health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. Enterprise hospitals use different systems to track out-of-network and in-network referrals. There could be many factors like reputation of provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep in track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
  6. Referral Analytics –  As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status, referral loop closures, percentage of referrals flowing in and out of network, referrals sent to different specialities, insurance provider, etc.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

In order to solve the operational challenges faced by large enterprise hospital, the process has to be improvised. This can be done with web-based referral management which will optimize patient satisfaction and care.

HealthViewX has completely analyzed the workflow of large enterprise hospitals. We have implemented the following features for many of our enterprise hospital clients thus improving their operational efficiency

  • Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
  • Insurance pre-authorization process HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
  • 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. This will cut down patient no-show rates.
  • Timeline View to track referralsWith 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.
  • 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.
  • 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. It can also be customized for different locations based on the priority of the enterprise hospital.

HealthViewX Patient Referral Management solution smooths the referral process and solves most operational challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management solution? Schedule a demo with us.

 

Reference

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf

https://www.beckershospitalreview.com/lists/52-great-health-systems-to-know-2018.html

 

Improve Your FQHC’s Operational Efficiency And Increase Your Revenue

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. It is no different for Federally Qualified Health Centers.

What are FQHCs and how do they operate?

FQHCs are community-based primary care medical practices. They provide comprehensive health care services for people of all ages, regardless of their ability to pay or health insurance status. They form a critical component of the health care safety-net as they provide

  • Primary care
  • Preventive care (oral health and mental health/substance abuse) services

FQHCs are also called Community Health Centers, Migrant or Homeless Health Centers, and 330-Funded Clinics.

The mission of FQHCs is to enhance primary care services to the underserved in both urban and rural communities.  They operate as nonprofit entities under the guidance of a board of directors selected from the community where they operate.  In return for providing care to the underserved and uninsured, FQHCs receive Federal government cash grants, cost-based reimbursements for their Medicaid patients, and malpractice coverage. These practices not only maximize the effect of the federal investment going to local patient care but also expands the impact of the Medicaid and Medicare programs.

Why should FQHCs concentrate on improving operational efficiency and increasing revenue?

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

  • operate with maximum operational efficiency
  • preserve financial security
  • maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

  • Maximizing their business and staff efficiency
  • Minimizing financial risks

How can FQHCs improve operational efficiency and increase revenue?

FQHCs can improve business effectiveness and operational efficiency by making sure they follow these essentials steps.

1. Web portal for patients

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. In order to prevent these, FQHCs should implement a web portal for their patients. Using the web portal, patients can access their health records, appointment schedules and choose providers based on their interests and preferences. When patients have the liberty to choose providers whom they can be referred to and also the appointment slot, they will show up for the appointments. Through this way, FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

2. Using technology

FQHCs prefer working with EMR/EHR systems because they are comfortable with it. So they do not wish to move out their EHR/EMR system. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

How great it would be if a Patient Referral Management software could integrate seamlessly with an EMR/EHR system? It can help in ensuring end-to-end Patient Referral Management without disturbing the existing system.

HealthViewX Patient Referral Management solution provides easy steps to integrate with a practice’s EMR/EHR system. The patient demographics, diagnostic reports, test results or any sensitive information can be transferred safely. The solution is HIPAA-compliant with complete data security.

3. Improving staff behaviour

FQHCs must make sure that the people operating their front desk are friendly enough to deal with customers irrespective of their class status or bank balance. The more welcoming they are, the more the patients will feel comfortable and at ease.

Moreover, operational efficiency is the key to success. The more efficient the front desk operations team is at an FQHC, the more practice revenue the FQHC can generate. It can also help them facilitate additional patient visits; which mean that if more patients are adjusted and facilitated, the FQHC has the potential to make more money.

HealthViewX Referral Management Solution to aid FQHCs

HealthViewX Patient Referral Management Solution has the following features that aid FQHCs in improving their operational efficiency and referral workflow.

  1. Outbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – In HealthViewX Referral Management System, any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
  3. Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
  5. Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  8. Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  9. Referral Data Analytics – Referral data-centric dashboard gives complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

Having Trouble Maximizing And Managing Revenue?

Are you an FQHC facing difficulties in managing your business operations and workflow? Then you may have a revenue cycle problem. HealthViewX Patient Referral Management Software is custom-made to solve the challenges faced by FQHCs. Schedule a demo to know more about our solution!