Author Archives: Vignesh Eswaramoorthy

Chronic Care Management Services In Federally Qualified Health Centers

What are FQHCs?

Federally Qualified Health Centers (FQHCs) in the United States are non-profit entities comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in FQHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. FQHC is a dominant model for providing integrated primary care and public health services to low-income and underserved population. There are two types of FQHCs, one receives federal funding under Section 330 of Public Health Service Act and the other meets all requirements applicable to federally funded health centers and is supported through state and local grants. To receive federal funding, FQHCs must meet the following requirements.

Be located in a federally designated medically underserved area (MUA) or serve medically underserved populations (MUP)
Provide comprehensive primary care
Adjust charges for health services on a sliding fee schedule according to patient income
Be governed by a community board of which a majority of members are patients at the FQHC

What is Chronic Care Management?

The CMS introduced the Chronic Care Management program in 2015. It insisted care coordinators give 20 minutes of monthly non-face-to-face care management services for beneficiaries with two or more chronic conditions. It helps in managing their conditions, risk factors, medication adherence, and coordination of care with other providers. In order to claim CCM reimbursements, the practices must offer

24/7 access to care management services
a platform for direct patient-practitioner communication
ability to manage transitions between providers and settings

Chronic Care Management in FQHCs

It is not mandatory for FQHCs to furnish Chronic Care Management services for their patients. These services can be given in addition to any routine care coordination services already furnished as a part of the patient’s visit to FQHC. Though it is not mandatory for them to give CCM services, they can bill for the same if the CCM requirements are met.

The CCM billing for FQHCs is a little different though. For CCM services furnished between January 1, 2016, and December 31, 2017, FQHC can bill the under the CPT code 99490. Payment is based on the Physician Fee Schedule (PFS) national average non-facility payment rate for CPT code 99490. FQHC claims submitted using CPT code 99490 for services on or after January 1, 2018, will be denied.

For CCM services furnished on or after January 1, 2018, FQHCs can bill CCM services under the general care management HCPCS code, G0511. CMS has set the payment annually at the average of three national non-facility PFS payment rate for CPT codes 99490, 99487 and 99484.

It is important to note that the 2018 payment of HCPCS code G0511 is $62.28. It is high compared to the reimbursement of $42, CMS gives to practices other than FQHCs under the 99490 CPT code.

Why should FQHCs give CCM services to their patients?

Increased reimbursements – FQHCs receive grants for treating their patients. When they provide Chronic Care Management services to their patients, they get more grants from CMS. This increases the revenue for FQHCs.
Improved patient satisfaction – Chronic Care Management services establish a long-term connection with patients. The patients can reach out to the physicians at any time in need. This improves patient experience and the FQHC will see more patients coming into their hospital.

HealthViewX Chronic Care Management Software, the best fit for FQHCs

FQHCs are reluctant in giving CCM services to their patients as it is a laborious task. With increasing CCM requirements from CMS, FQHCs are worried about taking up the Chronic Care Management program. This is when an electronic healthcare product can come to play. HealthViewX Chronic Care Management solution has features that solve most of the problems faced by FQHCs.

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. Our solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution is on par with the current requirements of the CCM program by the CMS. It helps FQHCs to set up a CCM program with the least investment. To know more about our Chronic Care Management solution, schedule a demo with us.

Does A Referral Management Software Really Enhance The Patient Experience?

When patients need advanced treatment or additional diagnosis that cannot be given within the practice, they are referred to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. There are many challenges faced by the patients in the referral process.

Challenges faced by patients

Let us review a typical referral process including the challenges faced by the patients.

Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was experiencing pain in his knee joints. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
PCP initiates the referral – John created a referral in his EMR. He did not have time to do the insurance pre-authorization so he left it to Andrews. He then found an orthopedic and gave him referral information verbally. Now when he met the specialist, Andrews had to again elaborate his condition and problems to him. This increased the efforts he took to meet a specialist. It did no go well with Andrews as he was already in pain.
Patient Disorientation – John had instructed Andrews about the specialist he should visit, tests he should take and how to explain his condition. Andrews found these instructions too complicated to comprehend. He left the clinic with lots of confusions and doubts.
Patient visits the specialist – Andrews then called the specialist a number of times. The first two times, the line was engaged. Finally, when he got through, all appointments were booked for the day. to confirm his appointment. He had to wait for 24 hours in pain to meet the specialist. He spent another two hours in coordinating with the insurance company. At last, He met the orthopedic after long hours of waiting in pain. He got treated but was not happy with the waiting time and negative experience. He did not get back to the PCP to share referral updates and plans to visit some other PCP next time.

Challenges faced by the physicians

What factors stop Dr.John from giving the best patient experience to Andrews?

Insurance Pre-authorization – John runs a practice where he treats many patients in a day. He has not adopted a referral management software. So he has to do the insurance pre-authorization for his patients. It is time-consuming and tedious.
Finding the right specialist/imaging center – The clinic has no effective approach for finding the right specialist/imaging center. The chances of missing out on a good specialist/imaging center are high as it is done manually as they are not updated regularly.
No referral updates – John is not up-to-date with the progress of the referrals which makes referral loop closure impossible.

The lack of a systematic referral workflow increased the manual effort and makes it tedious to follow-up with patients and receive referral updates.

HealthViewX Patient Referral Management System

Considering the challenges faced by the patients, an automated Healthcare Patient Referral Management System is the need of the hour. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

Let us review the same instance with HealthViewX Referral Management solution in place,

Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was having pain in his leg. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
PCP initiates the referral – John created a referral in HealthViewX system. HealthViewX does the insurance pre-authorization automatically in the background. With the help of the “Intelligent Smart Search” feature, he found an orthopedic. After giving the necessary information, John created the referral. The specialist got notified of the referral and all referral information were easily accessible by him.
Patient Disorientation – Andrews left the clinic with clear information about the specialist and appointment details. There was no need for him to call up the specialist for appointment as everything is automated. The patient will be notified about the appointment and tests to be taken.
Patient visits the specialist – Andrews met the orthopedic soon after the appointment was fixed. He got the best treatment and was satisfied with the referral process.

If you were Dr.John, would you not want Andrews to have a better experience? By using referral management software, you can ensure that Andrews’ knee pain heals while he also develops a positive opinion about your practice. Using a referral management software, you as a PCP can retain patients like Andrews in your network.

HealthViewX Patient Referral Management Solution features

Insurance Pre-authorization – HealthViewX solution supports automated insurance pre-authorization that reduces the manual work of the referral coordinators.
Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily.
Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
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.
Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
Referral loop closure – Referral updates are hard to miss that makes it easier to close the referral loops on time.

HealthViewX Patient Referral Management application solves most of the challenges faced by the patients and PCPs. This increases patient satisfaction and revenue. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.

What Are The Requirements To Start Chronic Care Management Program For Your Practice?

Medicare Chronic Care Management program

More than 45% of the American population is suffering from at least one chronic condition. CMS had an insurance policy to reimburse the hospital expenses of chronic patients. Due to inefficient care, the patients were readmitted to the hospital. This, in turn, increased the Medicare reimbursements. Medicare identified the need for continued care to patients with chronic conditions. In order to cut down on insurance expenses and provide continuous care to patients, Medicare introduced the Chronic Care Management (CCM) program.

In 2015, Medicare introduced the Chronic Care Management (CCM) program. It is defined as non-face-to-face services provided to its beneficiaries. In addition to office visits and other face-to-face encounters (billed separately), these services include

Communication with the patient
Health professionals being available both electronically and by phone for care coordination, medication management, and being accessible to patients.

Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions

Expected to last at least 12 months or until the death of the patient.
Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.

CCM Service Summary

The following are steps through which a Chronic Care Management service is furnished,

Initiating Visit – Initiation during an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE) or face-to-face E/M visit for new patients or patients not seen within one year prior to the commencement of Chronic Care Management services.
Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of demographics, problems, medications, and medication allergies using certified EHR technology.
24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified healthcare professionals or clinical staff and continuity of care with a designated member of the care team.
Comprehensive Care Plan – Creation, revision, and/or monitoring of an electronic person-centered care plan.
Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.

Why Chronic Care Management?

Most practices have a large population of patients with two or more chronic conditions. In fact, 68% of Medicare patients fit this description. The goal of a practice is to help their patients get healthier and improve their overall standard of living. This can be tough in case of chronic patients who require significant additional support. The practice may not have the resources to provide care. Without the proper systems in place, treating patients with chronic conditions is difficult to manage. That’s when the Chronic Care Management (CCM) program comes to play.

CPT codes for CCM

99490	$42	CCM services for at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month
99487	$60	CCM services for at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month
99489	$47	Each additional 30 minutes of clinical staff time directed by a physician or qualified healthcare professional per calendar month.

Chronic Care Program Requirements

One of the biggest obstacles that prevent medical practices from engaging in these programs are the inherent requirements for Medicare reimbursement. Some of these requirements include:

An established care team
A thorough care plan
24/7 access to clinical staff
Coordination with clinical providers
20+ monthly minutes of non-face-to-face care coordination

Partnering with CCM

With the available finite resources, the practice can partner with CCM services. Chronic Care Management services have the following advantages,

Good Medicare reimbursements depending on the service given
Ability to provide care and support to the patients for managing their conditions better
No additional cost if billing is managed within the network.

HealthViewX Chronic Care Management solution features

As the requirements of Chronic Care Management program are more, practices face difficulty in meeting the requirements. HealthViewX Chronic Care Management solution supports the following features that simplify the process,

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. All patient-related documents are managed securely.

HealthViewX Chronic Care Management solution is on par with the current requirements. It helps the practice to set up a CCM program with the least investment. To know more about our Chronic Care Management solution, schedule a demo with us.

References

www.fightchronicdisease.org/sites/default/files/docs/Almanac_FINAL.ppt

Physicians Complete Guide to Chronic Care Management

Senior citizens with one or more chronic conditions have a hard time managing their health. CMS was spending a lot of money on patient’s insurance who were suffering from chronic conditions. In order to cut down the expenses on hospital admissions, the CMS introduced the Chronic Care Management program. Patients usually visit their physicians for chronic care once or twice a year. With a Chronic Care Management program, a patient’s health improves due to increased attention and care. They can also spend less time on health issues and more on what they like to do.

What is Chronic Care Management?

Medicare defines Chronic Care Management program as non-face-to-face service provided to its beneficiaries with multiple (two or more) significant chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include

Communication with the patient
Health professionals being available both electronically and by phone for care coordination, medication management, and being accessible to patients.

Time-consuming process

Despite the increased Medicare reimbursement rates, patients do not get CCM services due to the physician’s time constraints. Chronic Care Management program requires a lot of time and effort from the physician. Unfortunately, providers must meet a number of requirements to qualify for a CCM Medicare reimbursement. These include:

Twenty minutes of non-face-to-face conversation per month with the patient
Use of a certified EHR
Create a patient care plan based on the assessments and available resources
Provide the patient with a copy of the monthly updated care plan and document the same in the EHR
Ensure that the care plan is available electronically to anyone within the practice providing CCM services
Share the care plan electronically outside the practice as appropriate
Ensure 24/7 access to care management services
Ensure continuity of care with a designated practitioner or member of the care team who will take care of successive routine appointments

The list goes on at considerable length defining the care practice must give. The fact sheet offered by the CMS goes up to eleven pages with multiple requirements to bill for CPT code 99490. This can become quite cumbersome for any practice, considering that the Medicare reimbursements are only $42.60/patient/month.

Steps to improve the Chronic Care Management program

1.Building a strong team

If a practice chooses to offer CCM services, it will be an investment. The demands include

Additional staffing with additional salaries,
Benefits and increased workload for management.
Additional office space depending on your current facility
It is important for the practice to set up a plan of action to calculate the required additional staff members required and the exact cost of this service. The practice must,
Start by assessing how many patients in the practice will be eligible to receive CCM services.
Identify how many people are needed to give quality CCM services to their patients and also additional salaries and benefits, added office space, etc.
It is important to analyze the merits and demerits from a financial perspective. Even if a practice is not profiting from CCM in the first stages, it is always possible to derive profit later.

2.Outsourcing Chronic Care Management services

Many private practices and hospitals who want to offer CCM services but cannot the implementation process can opt for outsourcing their CCM. There are vendors who provide this service and understand the new requirements better for reimbursement eligibility. In essence, they become an extension of the practice and require minimal financial investment from the provider. By this, the practice can manage the risk factors, patient experience, and profit better. A study on outsourcing chronic care management for diabetes patients found that those who participated in the outsourced care,

Rated the experience more positively
Demonstrated better clinical outcomes than those who received clinic-based care

3.Using a Chronic Care Management software

Chronic Care Management software can reduce the time and the manual effort spent in giving the CCM services. HealthViewX Chronic Care Management solution has the following features that make the process simpler,

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

A healthcare practice following the above steps will find significant improvement in their Chronic Care Management program. HealthViewX Chronic Care Management software has features that suit practices as well as CCM vendors. To know more about our Chronic Care Management solution, schedule a demo with us.

References

Wolf, M. S., Seligman, H., Davis, T. C., Fleming, D. A., Curtis, L. M., Pandit, A. U., … & DeWalt, D. A. (2014). Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention. Journal of general internal medicine, 29(1), 59-67.

Improving Patient Referral Management Workflow Between Federally Qualified Health Centers & Specialists Clinics/Imaging Centers

Federally Qualified Health Centers and what do they do

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities. a non-profitable, consumer-directed healthcare organization. FQHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms.

FQHCs include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner.

Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities

Patient Referral Management in Federally Qualified Health Centers

Federally Qualified Health Centers comprises of PCPs who offer primary health care services and related services to residents of a defined geographic area that is medically underserved. Many patients visit a PCP in a day. Federally Qualified Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any specialist medical attention, the PCP refers him/her to the most suitable imaging center or specialty practice.

Federally Qualified Health Centers mostly refer their patients out of the network. The referral workflow from the perspective of a referring provider is as follows.

The PCP sends the referral through the EHR/EMR to the referral coordination team.
The referral coördinator will study the patient demographics and understand the required diagnosis.
The team coordinates for insurance preauthorization to cover the medical expenses for the required treatment/services.
Based on these, the referral coordinator will find the right specialist or imaging center for further diagnosis.
After finding the right specialist or imaging center, the patient details are sent out as a referral.
Community Health Systems sends referrals through various sources like phone, fax, email, etc.
The referral coordinator chooses the source depending on the receiving provider’s convenience.

The gap between the Federally Qualified Health Center and specialty care

A referral process may become inefficient and ineffective if the Federally Qualified Health Centers and the specialty clinics/imaging centers fail to communicate. When there is no proper communication from the specialty centers/imaging centers the community healthcare network finds it difficult to understand the progress of the referral. Let us see it from different perspectives to understand why there is a communication gap.

From a referring provider’s perspective, the referral coordinator receives and processes many referrals every day. After sending out a referral, it is very difficult to follow-up with it manually. There are no effective and secure means of communication between the referring and the receiving providers. If the receiving provider or the patient fails to update the progress of a referral to the referring provider, he/she will never get to know what happened with the referral. Closing the referral loop becomes nearly impossible in this case.

From a receiving provider’s perspective, the referral he/she receives may contain incomplete information. Without vital details, processing the referral will be difficult. The source of referral are many but there is no single interface to manage it all. Missing out on referrals is common. There is no way of getting a consolidated data on the number of referrals missed and the number processed. Patient referral leakage becomes imminent if the referrals remain unprocessed for a long time.

From a patient’s perspective, the physician refers him/her to take tests in an imaging center and then meet a specialist to continue with the treatment. If the patient has to communicate back and forth between the referring and the receiving providers for incomplete information, history of illness, etc, it annoys the patient. It is frustrating for the patient to communicate between the two ends.

Referrals become incomplete, inefficient and ineffective when the participants fail to communicate and share timely information.

Guidelines to bridge the gap between Federally Qualified Health Centers and Specialist Clinics/ Imaging Centers

The referring provider must understand the reason for the referral. The referring provider should also make the patient understand why a referral is necessary and what the patient can expect from the referral visit. Give time for questions and encourage the patient to clarify their doubts during the referral appointment.
When the referral coordinator does the insurance pre-authorization, he/she must make sure that the receiving provider covers the insurance policy of the patient. This will keep the patient better informed of how much the service will cost.
It is better for the referral coordinator to contact the specialist directly. He/She can give information about the patient’s current situation, as well as other medical records, test results, and documents to avoid duplication of effort.
Both the sides have to agree on the urgency of the referral and discuss the duration of the process, frequency of referral updates and the mode of communication.
Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
After the referral reports arrive, the provider must check the results and recommendations. If the referring provider cannot understand the specialist’s evaluation, he should contact the specialist to understand the diagnosis better.
Referral is an important part of patient care but the patients are not obligated to follow-up with the specialist. If the referral isn’t completed, the referring provider must talk to the patient during the next visit to find out why. Documenting this can help in directing future referrals to the right specialist or imaging center.

HealthViewX Patient Referral Management solution communicates effectively between the referring and the receiving ends. The timeline view and referral status help in tracking the referral. Prompt reminders will never let you miss an appointment or follow-up. To know our solution better, schedule a demo with us.

Why Is Documenting A Medical Referral Not Easy For A Federally Qualified Health Center?

How does referral works in a Federally Qualified Health Center?

Federally Qualified Health Centers (FQHCs) are private, non-profit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically underserved. Federally Qualified Health Centers are high referral outbound centers, who send out a number of referrals in a day. A Federally Qualified Health Center has many PCPs who attend to numerous patients with different health problems. The PCP initiates referrals when the patient needs an additional diagnosis from an imaging center or a specialist practice. The following are the steps through which a referral flows,

Referral Initiation – The referring provider gives the details of the patient and diagnosis to the central referral coordinating team. A referral coordinator will study the demographics of the patient and the diagnosis required.
Insurance Pre-authorization – If the patient has an insurance coverage, the referral coordinator will validate the same. This step helps in finding out which imaging center or specialist practice will cover the medical expenses.
Finding the right provider – Depending on the treatment required, insurance coverage, patient’s convenience, the referral coordinator will narrow down the search and find the right receiving provider for the referral.
Sending out the referral – After finding the right provider, patient information and the diagnosis details are shared while referring. The physicians can share the information via phone, fax, email, etc depending on the source that suits the receiving provider.

Medical referral history documentation in Federally Qualified Health Centers

Referral history gives details of what has happened with the referral till date. The referral history is equally important to both the referring and receiving providers. Unfortunately, the receiving provider maintains this history through paper-based forms or EHR and it is not easily accessible to the referring provider. Documenting a medical referral is quite a challenge for the provider who initiates the referral. So what factors make it so tedious and challenging?

Physicians get busy – After the referral is initiated, the referring provider gets busy with other appointments and forgets about the referral until the receiving provider gives updates. Not to forget the receiving provider is also a specialist or from an imaging center who will also be busy. The receiving provider or the patient fails to communicate with the referring provider regarding the progress of the referral which makes it difficult to document the referral.
Lack of effective modes of communication – There is no effective platform to share patient’s sensitive data or communicate with the referring or receiving provider. The physicians are not available over calls or messages which makes the situation worse. There is a need for a standard HIPAA compliant application that the referring and receiving providers can use to share information which helps in referral documentation.
Manual effort making the referral process tedious – The referral process has manual intervention at every stage. This frustrates the providers and the referral coordinating team. Giving timely updates to the referring provider regarding a referral is too much of effort for the receiving provider. Documenting the referral manually becomes a challenge.

Why document a medical referral?

Patient’s need – The patient may come to the clinic at any time looking for the medical history of the referral. At that point, the clinic should be able to give the patient the medical referral history. So documenting a referral becomes a necessary process.
Clinic’s records for future reference – It is important for a Federally Qualified Health Center to maintain a history of its patient’s demographics and referral records. If the patient comes back to the clinic with an illness, these records will help in understanding the patient better and giving the best treatment the patient needs.
Direct future referrals – A history of medical referral records will help the physician in figuring out who responds quickly and who does not. The next time the physician sends out a referral, he/she will choose the most responsive and the most suitable receiving provider for the referral.

Information Technology to aid Federally Qualified Health Centers

Information Technology is transforming healthcare to a great extent. Documenting a medical referral is easy for a healthcare based software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,

Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three step form which includes insurance pre-authorization, finding the appropriate receiving provider with the help of “smart search”, etc. The receiving provider is notified of the referral.
Referral status and timeline view – With the status, a referral is tagged to, the referring provider can get to know in what stage the referral is. A timeline view shows a history of stages through which the referral has progressed.
Referral and timeline view reports – The timeline view and the referral analytics data can be generated as a report in any form chosen.
Referral closure and feedback – If the referral is completed, the status can be changed to closed. A feedback form is generated for the patient and the receiving provider. This can help the referring provider in making the referral process better next time.

HealthViewX Patient Referral Management solution smoothes out the referral process and reduces the burden of the referring and the receiving ends of Federally Qualified Health Centers. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.