Referral Management Process in healthcare

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

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

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

How can HealthViewX help in solving such challenges?

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

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

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