Tag Archives: patient specific

How Can Federally Qualified Health Centers Improve Patient Engagement With HealthViewX Patient Referral Management Software?

Patient Referral Program in Federally Qualified Health Centers

FQHCs are high outbound referral setups, meaning they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the need for specialist examination or additional diagnosis, the PCP might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

Most of the FQHCs have a team of referral coordinators or RN’s, LPA’s, MA’s operating across various locations handling the referrals today. This team sends out referrals and ensures effective referral coordination. With the help of the patient demographics and diagnosis details available from the referral order, the referral coordinator does the insurance preauthorization and finds the right imaging center or specialty practice for the patient. Following that, the coordinator creates a referral that includes the details of patient demographics and the required diagnosis. Then the referral is sent to the relevant imaging center or specialty practice.

What factors plague the traditional referral process?

The traditional patient referral process in FQHCs are riddled with flaws. The primary shortcomings of the process are improper communication and the far-reaching consequences of follow-ups. Let us consider the following stats,

  • According to the Archives of Internal Medicine, only half of the referrals result in a completed appointment.
  • An Archives of Internal Medicine study shows that PCPs do not receive consult reports from the receiving providers about 40% of the time.
  • The Journal of General Internal Medicine found that 68% of specialists receive no information from the PCP prior to referral visits.
  • The Journal of General Internal Medicine found that 63% of PCPs and 35% of specialists were dissatisfied with the current referral process
  • An MGMA study found that 53% of Appointments with more than three weeks of lead time resulted in a no-show

Given these statistics, it is fair to conclude that PCPs are not satisfied with the existing referral program in Federally Qualified Health Centers.

Challenges in the existing referral workflow

The following are the most common problems faced by Federally Qualified Health Centers. Let us consider the challenges with a typical referral scenario to understand it better.

  1. Finding the right specialist/imaging center – Due to the increasing amount of imaging centers and specialists, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one. It is also less likely for an FQHC to have the updated list of imaging centers and specialty practices.
  2. Insurance pre-authorization – The referral coordinator must check the pre-authorization requirements, health plans, etc. They must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. They must then send it to the insurance company to validate these records. This exhaustive process increases the burden for the referral coordination team.
  3. Time Spent – As referrals are handled manually, a referring coordinator spends approximately half-an-hour to one-hour for creating a referral and even more time in following up.
  4. Tracking the referral – Specialists are usually busy and do not have the time to inform physicians about the progress of referrals. This causes physicians to lose track of referrals. They get no information about appointments, referral loop closure, or feedback from specialists or patients.

Improve Patient Referral Workflow with HealthViewX Patient Referral Management

As per the report from the Journal of General Internal Medicine, referrals managed electronically are twice as likely to result in better referral adherence. This proves that web-based referral management optimizes patient satisfaction and care. HealthViewX has thoroughly analyzed the workflow of FQHCs. We have implemented the following features for many of our FQHC clients thus positively impacting their workflow.

  • EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real-time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
  • Insurance pre-authorization automation –  There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the API-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the Form Automation method. Through this, we get all payer-specific forms, fill in the necessary information and send it to the insurance company via e-fax.
  • Intelligent Provider Match – The system has a smart search feature that enables PCPs to filter receiving providers according to their preferences. The list is always up to date with the newly added specialty and imaging centers which makes it easy for the PCP.
  • To and fro Communication – The PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications at any time of the referral process. This allows physicians to get referral updates easily.
  • Referral Analytics Customizable dashboards and reports provide information about the number of referrals sent, referrals in various statuses, referrals that were missed, processed and pending. It gives a clear picture for the FQHC and helps them in making informed decisions.

Web-Based Referrals Encourage Patients to Engage With Your FQHC

Patients can use electronic resources within HealthViewX Patient Referral Management System to contact providers regarding questions or concerns. This feature

  • minimizes unnecessary visits and re-referrals
  • improves provider availability for other patients who need an in-person appointment.

Electronic referrals also enable PCPs to spend less time on administrative tasks, giving them more time to engage with their patients. Web-based referral management improves accountability and patient satisfaction while reducing costs, allowing providers to effectively close gaps in healthcare.

Automating referrals and related processes enables practices to eliminate 70% of tedious administrative duties so they can focus on improving care delivery. Patients are more likely to schedule and keep appointments when physicians are consistently available and receive accurate patient information to provide optimal care.

Reference

https://www.mgma.com/getattachment/Products/Products/Maximizing-Patient-Access-and-Scheduling/PatientAccessSchedulingResearchReport-INTER_FINAL.PDF.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553012/

How Can Large Enterprise Hospitals Overcome The Challenges In Patient Referral Workflow?

Did you know? There are about 8000+ large enterprise hospitals in U.S. Recently, Becker’s Hospital Review released the list of top 50 large health systems. 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 broader needs of the community. 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.

Considering the huge number of patients in such hospitals, the referral numbers are also high. So such large health systems face challenges such as operational inefficiency, patient dissatisfaction, care discoordination and missed referral updates in their referral process. Let us go through the patient referral workflow in detail to understand their challenges better.

Patient Referral Workflow in Large Enterprise Hospitals

In order to understand how a patient referral works in a large enterprise hospital, let us consider a scenario,

XYZ hospital is a large enterprise hospital with 10,000 plus PCPs and specialists. It is a busy hospital that sends and receives 1000 plus referrals in a day. In the workflow explained below, Mark is the patient who visits his PCP, Dr.James.

  1. Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
  2. Dr.James does the insurance pre-authorization – The PCP does the insurance prior authorization manually. He places a request with the insurance company and waits for their response. The process takes time and forces Mark to wait. After about four hours, Dr.James gets the consent of the insurance company for the diagnosis.
  3. Dr.James has difficulty finding the right specialist – The hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. So he misses the famous diabetologist within the network and looks for someone outside the network. After considering many factors like the patient’s comfort, specialist’s availability, distance from the patient’s residence, specialist’s experience etc, he finally chooses a receiving provider.
  4. Dr.James sends the referral – Dr.James finally sends the referral to Dr.Hales after trying to reach the specialist office via phone. The line seems to be engaged. He looks for many other ways which will be easy to send referrals but to his disappointment, Dr.Hales accepts only referrals through phone or website.
  5. Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark was not notified clearly about the appointment. So he fails to show up. It results in revenue loss for the specialist and patient dissatisfaction with the PCP. Mark who is still suffering from pain and waiting for the specialist to examine him. After two missed appointments, Mark finally visits the specialist.
  6. Referral progress updates and loop closure – Throughout the referral process, Dr.James is in the dark. Dr.Hales is busy and fails to give referral updates to Dr.James. He is anxious to know if Mark was taken care of. Without referral updates, Dr.James cannot close the referral loop.

Challenges of 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. EMR interoperability is their greatest challenge.
  2. Finding the right specialist – A Large Enterprise Hospital has huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
  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 any 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. There could be many factors such as reputation of a 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 and to close referral loops.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

  • 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.
  • Intelligent Provider Match – The HealthViewX “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. This saves a lot of time for the referring provider.
  • 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.

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.

 

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

Seven Ways In Which Artificial Intelligence Is Impacting The Healthcare Industry

Artificial Intelligence or AI has accelerated the growth in various industries. The growth has been pretty quick and sometimes, totally unpredictable. So, what is AI?

AI is a combination of various technologies that imitate human intelligence. It is an essential part of the technology industry. The core concepts of AI include programming computers for certain human traits like:

  • Knowledge
  • Reasoning
  • Problem solving
  • Perception
  • Learning
  • Planning
  • Ability to manipulate and move objects

Artificial Intelligence in healthcare

Artificial Intelligence has impacted modern healthcare industry to a great extent. With the application of AI, there has been tremendous changes in the way patients are treated by doctors.

AI can be applied to both ordinate and inordinate data, with techniques including machine learning and natural language processing. Nurses and doctors are adopting technology to

  • Reduce manual work
  • Provide more accurate service
  • Give impact interventions to patients

AI helps reduce the repetitive manual work and human intervention in data analysis. A good example of this is predictive diagnosis through which medical condition possibilities can be diagnosed by monitoring the vital stats and other necessary parameters. This helps providers prepare and provide necessary proactive care as foreseen by AI systems. The predictive possibilities of AI transcends to patient experience as well. Using chatbots and AI for responses to patients reduces the burden on manual intervention for scheduling appointments, responding to common queries on the website/chatbot/sms/apps, analyzing x-ray and basic scans and much more. This can help enhance patient experience with quick response times and avoid unnecessary hospital visits.

Medication management to ensure patients are taking medicine on time and prescribing medicine according to progress is also possible with artificial intelligence and this avoids repetitive human tasks.

The promise of AI in the matters of health, including that of life and death critical issues is highly impressive.

Impacts of Artificial Intelligence in healthcare industry

The following are the top seven impacts in the healthcare industry that are most likely to happen with the advent of artificial intelligence within the next decade.

  • Reducing the burden of EHR usageEHRs are instrumental in the healthcare industry’s journey towards digitization. But the switch brought problems such as cognitive overload, endless documentation, and user burnout. EHR developers are now adopting AI for creating intuitive interfaces and automating some routine processes. Artificial intelligence may also help to process routine requests from the inbox, like medication refills and result notifications. It may also help to prioritize tasks that truly require the clinician’s attention making it easier for users to work through their to-do lists.
  • Operating mind and machine through brain-computer interfaces – AI can create direct interfaces between technology and the human mind without the need for keyboards, mice, and monitors. It is a cutting-edge area of research that has significant applications for some patients. Neurological diseases and nervous system trauma can affect abilities to speak, move, and interact meaningfully with people and their environments.  Brain-computer interfaces (BCIs) backed by AI could restore those fundamental experiences to those who feared them lost forever. Brain-computer interfaces could drastically improve quality of life for patients with ALS, strokes, or locked-in syndrome, as well as the 500,000 people worldwide who experience spinal cord injuries every year.
  • Inventing cutting-edge radiology tools – MRI machines, CT scanners, and x-rays produce radiology images that offer non-invasive visibility into the inner workings of the human body.  But many diagnostic processes still rely on physical tissue samples obtained through biopsies, which carry risks including the potential for infection. AI will enable the next generation of radiology tools that are accurate and detailed enough to replace the need for tissue samples in some cases, experts predict.
  • Improving care accessibility to underserved and developing regions – There is severe shortages of trained healthcare providers like including ultrasound technicians and radiologists. This significantly limits access to life-saving care in developing nations around the world. AI could lessen the impacts of severe deficit of qualified clinical staff by taking over some of the diagnostic duties allocated to humans.
  • Building intelligent medical devices and machines – Smart devices are taking over the consumer environment, ranging from offering real-time video from the inside of a refrigerator to cars that can detect when the driver is distracted. In the medical environment, smart devices are critical for monitoring patients in the ICU and elsewhere.  Using artificial intelligence to enhance the ability to identify deterioration, suggest that sepsis is taking hold, or sense the development of complications can significantly improve outcomes and may reduce costs related to hospital-acquired condition penalties.
  • Monitoring health through wearable and personal devices – Almost all patients now have access to devices with sensors that can collect valuable data about their health.  From smartphones with step trackers to wearable that can track a heartbeat around the clock, a growing proportion of health-related data is generated on the go. Collecting and analyzing such data and supplementing the same with patient-provided information (through apps and other home monitoring devices) can offer a unique perspective into individual and population health. Artificial intelligence will play a significant role in extracting actionable insights from this large trove of data.
  • Robotic assistance – Patients might not be comfortable with robots performing a surgery on them. How about combining the skills of a competent surgeon and the technical brilliance of a robot? That makes for a surgery with impressive levels of precision, steadiness and accuracy. And when we have AI guiding the hand of the surgeon through the help of robots, it opens the doors to extremely high levels of precision, and better patient outcomes. The AI assistant can provide patient’s past and present health details and give suggestions that would help in the diagnosis. Surgical bots use computer vision to perform surgeries after accurately calculating human body measurements. When a surgeon performs a complex surgery, AI can provide real time data that helps in identifying and reducing risk, and improving quality. Highly precise movements are made the robot hands so any tremors in the surgeon’s hands will be neutralized completely, enabling the progress and success of micro surgeries.

Benefits of Incorporating AI in Healthcare

Healthcare is definitely improving through AI. Patients and medical practitioners experience the following benefits,

  • Predictive medical carePredictive healthcare will lead to an evolving treatment model wherein the patient data is reviewed constantly to check for any anomalies, followed by suggestions of medical intervention.
  • Personalized medicationAI makes it possible for patients to have personalized care based on their body constitution and past medical history.
  • Better diagnosisFast research and cross-referencing of data leads to better diagnosis of diseases
  • Advanced treatment plans New treatment methods are generated and introduced, including robotic surgery, cell biology, stem therapy, genomics and proteomics.
  • Lower liability for hospitalContinuous monitoring of patients would ensure timely care and treatment and even reduced hospital stay.
  • Cost savings for patient and medical care provider AI can make healthcare both efficient and affordable as it helps in
    • Guiding treatment choice
    • Making more efficient diagnosis
    • Helping patients make better decisions regarding their health
    • Taking important decisions in drug development.

The healthcare industry is evolving with Artificial Intelligence. It has a great impact on the role of doctors and patients. There are some challenges like managing and integrating large data sets that need addressing, but the benefits outweigh them, and AI is here to grow and expand. AI will change every medical word – in diagnosis, in treatment, in disease detection, in treatment disciplines and more.

 

Reference

https://www.cabotsolutions.com/revolutionizing-modern-healthcare-with-internet-of-things

https://healthitanalytics.com/features/ehr-users-want-their-time-back-and-artificial-intelligence-can-help

https://healthitanalytics.com/features/what-is-the-role-of-natural-language-processing-in-healthcare

https://healthitanalytics.com/news/ai-for-imaging-analytics-intrigues-healthcare-orgs-yet-starts-slow

https://mhealthintelligence.com/news/mhealth-for-children-4-concepts-that-could-change-the-world

https://mhealthintelligence.com/news/mhealth-wearables-ai-used-to-detect-diabetes-in-ones-heart-rate

How Can A Referral Management Software Compliment An EHR/EMR To Achieve A Highly Performing Referral Network?

Managing patient referrals is a laborious process for large enterprise hospitals. These large multi-specialty set-ups are joint ventures or mergers or acquisitions. The bigger the network, the more complex is their referral process. So these hospitals are relying on computers and customized software to make sure their productivity and patients’ well-being.

In the field of medicine, we need computerization to manage the enormous volume of data that these large enterprise hospitals create and store for each patient. EHR software saves practices time and money, as well as helps them communicate instantly with insurers, hospitals, and referring physicians. Using referral management software with EHR/EMR enables communication between different care providers on patient demographics, diagnostic reports, test results and any sensitive information.

Electronic Health Records

Electronic Health Records (EHR) are digitized forms of patient’s chart data. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. An EHR has the patient’s clinical data including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports over time.

Pros of EHR

  • Financial Incentives – Medical providers who convert patient records into electronic ones get financial incentives from CMS.
  • Speedy process – With an EHR system, doctors can immediately place orders for imaging or laboratory work. This reduces errors because a doctor’s handwriting is difficult to decipher.
  • Unlimited access to medical records – With the help of a patient portal connected to the EHR system, both patient and provider can get access to medical records very easily.

Impacts of EHR on the existing referral workflow

  • Easy management of patient data – As mentioned earlier, Electronic Health Records (EHR) are digitized forms of patient’s chart data. It helps is managing all patient-related information like medications, vitals, diagnostic reports, medical history, etc.
  • e-messaging between providersIn order to attest referral information, telephone tag between providers is common. It is a time-consuming process. With EHR software, physicians can e-message across practices. One situation that benefits in particular from e-messaging is referrals. Rather than playing telephone tag to get an appointment scheduled, the physician electronically sends a message to schedule the appointment.

Why is a Referral Management Software is needed in addition to an EHR/EMR?

Large Enterprise hospitals have implemented an EHR/EMR system because it helps them manage their patient data securely. Providers face difficulties in managing paper-based patient records. So EHR implementation is indeed a boon to them. Yes, indeed EHR/EMRs are doing a great job but are they doing enough for patient referral management? What are the challenges enterprise hospitals face in their referral management even after implementing an EHR/EMR software?

  1. Insurance pre-authorization – The process of waiting for the insurance company to respond and approve the procedures or medication is time-consuming. If this process is automated it would save time and efforts of providers, insurance companies, and patients.
  2. Communication between EHR/EMRs – EHRs can communicate only with EHRs within the same network. Sending patient and referral information to providers who do not use the same EHR is complicated.
  3. Patient Referral Leakage – When a PCP refers the patient out-of-network, it leads to referral leakage. PCP can avoid patient referral leakage if the patient is referred to within the network. When that is difficult, patient referral leakage is inevitable. If the patient is referred out-of-network and is not happy with the care given, the chances of the patient coming back to the PCP is less. Referral leakage causes revenue loss and patient dissatisfaction.
  4. 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 and to close referral loops.
  5. Referral updates and referral loop closure – When PCP refers patients out-of-network, the chances of getting referral updates are minimal. The specialist is usually busy and does not update the referring provider about the referral. Referral updates are crucial in closing referral loops.

How can a Patient Referral Management Referral Management work in cohesion with an EMR/EHR system?

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. It has the following features,

  1. Insurance pre-authorizationHealthViewX solution supports automated insurance pre-authorization that reduces the manual work of the referral coordinators. It will save a lot of time for the hospitals.
  2. Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily. With this feature, it is easy to find a receiving provider within the network. It will reduce the patient referral leakage.
  3. 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. For e.g. – If a patient does not show up for the appointment, the status of the referral can be changed to no-show and a reason can also be given. With the help of a referral timeline, the referring provider can track referrals, share information and seamlessly communicate with the receiving provider.
  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 Data Analytics – Referral data-centric dashboard gives complete data about the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

HealthViewX Referral Management solution helps in building a secure referral network in no time. We can seamlessly integrate with the existing EHR/EMR system and add value to the system by solving major challenges. Our expert team will guide you in changing to a Patient Referral Management Software with minimal effort. Schedule a demo with us to know more about our solution.

 

Reference

https://vittana.org/12-advantages-and-disadvantages-of-electronic-health-records

 

How Is CMS Changing The Face Of Remote Patient Monitoring And Patient Access?

CMS has finally issued its 2019 Physician Fee Schedule Proposed Rule. It has highly anticipated new reimbursement policies for telehealth, remote monitoring, with a stronger focus on patient access to health information.

The new codes for Patient Remote Monitoring

The 2019 Proposed Rule offers three codes through which providers can get reimbursements for integrating remote monitoring data into their practice.

The first two are practice expense codes, which include resources providers spend such as office rent, supplies, and medical equipment. The third code tracks the amount of time a care provider spends managing patient care using the remote monitoring data.

  • 990X0 – Remote monitoring of physiologic parameter(s). Covers the time providers spend on setting up the technology and explaining to patients how it works.
  • 990X1 – Remote monitoring of physiologic parameter(s). Covers device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
  • 994X9 – Remote physiologic monitoring treatment management services. Covers 20 minutes or more of clinical staff, physician, or other qualified healthcare professional time in a calendar month. The code requires interactive communication with the patient and/or the patient’s caregiver during the month.

There are some challenges in the proposed codes. These codes only cover the exchange and interpretation of “physiologic” data; yet many providers today would agree that there is a wealth of patient data that is helpful at the point of care, including patient-reported outcomes or behavioral data, that would fall outside the definition of physiologic.

Further guidance may be helpful to determine exactly which providers on a care team can spend time working with remote monitoring data. While the code definition states “clinical staff, physician, or other qualified healthcare professional,” elsewhere in the PFS proposed rule refers to the term “practitioner,” which “is used to describe both physicians and non-physician practitioners (NPPs) who are permitted to bill Medicare under the PFS for the services they furnish to Medicare beneficiaries.”

New Reimbursement for “Communication Technology-Based Services”

CMS acknowledges the evolution of physician services furnished through communication technology. So Medicare enacted the telehealth services statutory provision for patients with chronic conditions. Recognizing the many statutory restrictions on telehealth in Section 1834 (m) of the Social Security Act, CMS has taken the interpretation that there are physician services that involve interaction with a patient via remote communication technology that are not considered telehealth services and therefore are not covered by these restrictions.

CMS proposed several new HCPCS codes that are not considered “telehealth” services and as such, not subject to the conditions of Section 1834 (m):

  • HCPCS code GVCI1 – Brief Communication Technology-Based Service, e.g. Virtual Check-in. This would include the kinds of brief non-face-to-face check-in services furnished by a physician or other qualified healthcare professional, using communication technology, to evaluate whether or not an office visit or other service is warranted.
  • HCPCS code GRAS1 – Remote Evaluation of Pre-Recorded Patient Information. This covers physician time spent reviewing patient-submitted video or images to determine if a follow up visit is needed.

CMS acknowledges modern communication technology that allows for “the kinds of brief check-in services furnished using communication technology that are used to evaluate whether or not an office visit or other service is warranted.”

Beginning January 1, 2019, CMS is proposing to pay providers for utilizing these types of preventative technology services, even in cases where the activity means that a follow-up office visit is not scheduled. Where the check-in services precede an office visit or follow a visit within the previous 7 days, they would be bundled into the payment for the visit, but where the service does not lead to an office visit, there could be a separate payment.

CMS is seeking comments on the implications of this approach, as well as more information from industry about the types of technologies in use today to achieve these goals. Additionally, CMS seeks insight from industry as to if,

  • These services are appropriate for new patients
  • They are only for existing patients
  • Patient consent is required

Health Information Technology to simplify the process

Information Technology can greatly simplify the process by making remote patient monitoring easy for the hospitals. HealthViewX is a healthcare product that provides solution for remote patient monitoring, chronic care management and referral management. Our product has many unique features that simplify the workflow and improves patient satisfaction. To know more about our solution, schedule a demo with us.

References

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

How Can Referral Inbound-Heavy Practices Profit From Patient Referrals?

Why are patient referrals important?

Patient referrals are excellent sources of revenue for health systems. Why is it necessary to have referrals flowing into your network? When a practice receives more referrals, it means patients will visit that practice. It has a positive impact on your revenue. When patients regularly visit a practice, the practice always stays active in the healthcare industry. But inbound-heavy referral practices can use technology to take care of their patient referrals.

What are the challenges faced by a referral inbound-heavy practice?

  • Multiple referral channels – For the specialist/imaging center who receive referrals face more difficulties than the referring provider. The receive referrals through various channels like fax, email, direct message, website, user-filled forms, etc. It is difficult to track and manage such a high volume of referrals. Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in. The chances of missing out on a referral are high.
  • Time-consuming process – On an average, referral inbound-heavy practices receive 1000 plus referrals every day. Handling all of them manually is a time-consuming process. The practice is aware of how many were processed and how many need immediate attention.
  • Limited referral information – Many referrals have less or no information required to process them. It makes it difficult for the referral coordinator to proceed with the diagnosis. It takes a lot of time for a practice to contact the referring provider for information or clarifications.
  • Appointment scheduling and patient no-show rates – After receiving the referral, the practice schedules appointments with the patient. In some cases, the patients are not notified clearly about the appointment. When patients do not show up, it is difficult for a practice to track.

How can an Electronic Patient Referral Management help referral-inbound heavy practices?

The current referral management is no way close to the increasing demands of the referral process. It provides no option for communicating between the referring and the receiving ends. 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.

Inbound patient referral management challenges can be resolved to improve operational efficiency, reduce inbound patient referral leakage and close the loop of patient referrals. A patient referral management software must have the following benefits,

  • Consolidating the referral channels – The system must handle referrals from email, fax, phone, referral slips and direct visits. The software must consolidate referrals from all sources into a single queue from where it can be processed.
  • Data security – The software must manage all sensitive patient-related data securely.
  • Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc. Patient referral system should give a clear picture of how efficient the practice is in handling inbound referrals.
  • Referral history – The history must be common to both the referring physician and receiving specialist/imaging center. The progress of the patient referral from the time of referral initiation and subsequent diagnosis should contain patient diagnostic reports, referral status to ensure there is no missing information.
  • Integration with scheduler – This will help in scheduling appointments for the patients. Also, the system should send automated reminders to patients and physicians about the appointments.
  • HIPAA Compliant – This will enable secure data exchange of patient sensitive documents.

HealthViewX Patient Referral Management Solution features

  • Single Referral Workflow Queue Consolidation – It collects Fax, Phone, Email, Website referrals and manages them in a single interface. This helps in managing them 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 provider can attach documents 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.
  • 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.
  • 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. It helps in secure exchange of data.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the number processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

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