What is Patient Referral Management?
When patients need advanced treatment or additional diagnosis that is not available within the practice, physicians refer them to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. It is a laborious process for FQHCs who refer patients to other specialists or imaging centers.
Challenges faced by FQHCs
One of our established clients based out of California is an FQHC who faced the following challenges in their patient referral network.
1. No single system for Referral Coordinators
The PCPs can create referrals on their EMRs. However, the referrals coordinators have to extract the referral lists that have been tasked on to their workgroup. They must manually pull down respective documents from patient chart to get the referral packet ready for Insurance pre-authorization. Then the referral coordinators must manually bundle the referrals and send those to the insurance company via fax. Post receipt of pre-auth acceptance, they have to manually track the rest of the activities. They have to communicate and coordinate with the specialist and patient, etc thus driving the referral to closure. In this workflow-intense process, the referral coordinators must hop through multiple systems like EMR, eFax, and spreadsheets etc. There is no system for the Referral coordinators to maintain and track the further status of the referral through the rest of its life cycle.
2. Cumbersome Insurance Pre-Authorization
Our FQHC client sends about 600 plus authorization requests per day to 15 plus different payers. Every authorization or referral packet has 14 plus pages. Some payers have their own physical forms that have to be manually filled in. These forms must be attached to the rest of the patient documents pulled from the EMR manually. Some payers have online portals for the above process. Considering the volume of authorization requests sent every day, it is not advisable to rely on a fully manual function. It makes the process cumbersome and prone to errors.
3. Specialist & Patient Referral Communication
From their EMR, referral order letters go to the patient. But the EMR has issues with its patient referral order template. Hence the referral coordinators have to manually design the template using MS Word and send it out. Specialist cover letters and reminder notifications in the EMR do not meet the requirements of the referral coordinators. They wish to customize and automate it.
4. Referral loop closure
Following up with the Specialists, receiving the reports back from the Specialist, and attaching it back against the patient chart in the EMR are completely manual time-consuming. Relying on only Fax & phone based communication for the same makes it cumbersome to manage as it has no effective means for tracking
5. Meeting Meaningful Use (MU) requirements with the EMR Share feature
Though the EMR SHARE’s main purpose was to help providers meet the MU requirements. In order to meet MU, the FQHC has to get the specialists to enroll on a direct message service so that they can use SHARE to transfer all orders. Though the FQHC already has the technology to meet the MU requirements, the issue is on the specialists’ side. Hence the EMR SHARE is not helping them meet the MU requirements.
HealthViewX is the Next-Generation Patient Referral Management Solution
1. End-to-End referral lifecycle management with bidirectional EMR/EHR Integration HealthViewX platform supports dynamic forms, workflows, task lists, reports, data visualization and has great integration capabilities. It has enabled our FQHC client to automatically pull referral orders from their EMR in real-time. It has also helped them in configuring all other referral coordinator workflows and tasks with maximum automation. Thus our platform has helped them achieve an efficient end-to-end referral management system.
2. Payer-specific prior authorization process automation
HealthViewX platform has a payer management module that maintains and manages
- different payer details
- their modes of prior authorization
- direct authorization procedures
- payer forms
- online portal links
With this information already present, it provides the referral coordinator the capability to automate
- prior authorization submission
- status checks coupled
- fax integration
3. Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication
HealthViewX – Template engine platform along with the communication engine gives the flexibility to the referral coordinators to
- choose the relevant format and mode of delivery for Specialist / Patient communication
- tie it along with the referral workflows by setting trigger rules and reminder rules.
4. Secure Online referral portal for Specialists with easy touch points via Fax /SMS/Email
HealthViewX clearly understands the specialists’ referral preferences by,
- Multi-channel referral consolidation that brings all the referrals from every possible source into a single queue.
- Detailed referral information through which that the Specialist receives all the necessary referral details.
- Ability to communicate back and forth (electronically or via fax) in a simple and secure way.
These are few notable features of HealthViewX that have enabled referral loop closure from the specialist side.
5. Free secure Specialist online accounts with both sides integration capabilities to meet Meaning Use requirements
As mentioned earlier, the problem with MU requirements was not, it was not met by the specialists. HealthViewX solution provides free online accounts for such specialists. It was highly useful to our FQHC client as we supported seamless integration between both ends. It helped the specialists meet the MU requirements.
HealthViewX Patient Referral Management application is the next-generation software for patient referral management. It has provided the best solution to the challenges faced by FQHCs. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.