Tag Archives: referral management

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

Virtual communication services in FQHCs

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

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

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

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

Virtual Communication in the age of COVID-19

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

How can FQHCs receive payment for virtual communication services?

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

What is the payment rate for G0071 and G2012?

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

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

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

What types of communication technology can be used?

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

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

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

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

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

Inbuilt audio and video calling apps – HealthViewX supports audio and video calling options that help practitioners in contacting their patients easily.
Secure messaging – HealthViewX has an asynchronous messaging option that enables providers to chat with patients and discuss their health plans.
HIPAA compliant data security – The solution is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.

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

Relevance and use of patient referral management software to FQHCs and large enterprise hospitals

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. Importance of revenue is no different for Federally Qualified Health Centers, Community Clinics, Large Enterprise, and Specialty Hospitals. One way to ensure constant revenue is by retaining patients within the hospital network and providing optimal patient care. To do this efficiently, hospitals use patient referral management software.

Role of FQHCs:

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

Operate with maximum operational efficiency
Preserve financial security
Maintain staffing levels to continue operations

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

Maximizing their business and staff efficiency
Minimizing financial risks

The relevance of patient referral management software to FQHCs

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. Using referral management software, providers can access patient health records, schedule appointments and choose providers based on diagnosis and preferences. FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

FQHCs traditionally prefer working with EMR/EHR systems because they are comfortable with it. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

The relevance of patient referral management software to Enterprise Hospitals

The following challenges in the patient referral workflow are common in enterprise hospitals across the USA.

Limited provider information – Physicians do not have information about the providers within their network. This is to blame for unnecessary out of network referrals. Providers who refer out of network could avoid at least one-third of these if they had access to more robust information about providers in their networks. Even when physicians have access to their health system’s provider directories, they are not using the directories because they don’t have the level of information that is needed.
Inadequate referral information – Even when physicians refer their patients out-of-network, the chances of a successful referral are less. This is because many providers who receive referrals rate referral information as poor. Without referral information, receiving providers cannot treat their patients effectively.
Inefficient patient appointment scheduling – For providers who schedule an appointment for the patient, they prefer doing it through the phone to shared electronic health records system. When heavy use of the phone occurs, it is difficult for providers to see capacity in their network to book the next available appointment. So they bypass the network and book the appointment before the patient leaves the office.

For FQHCs and Enterprise Hospitals, additional investment in a patient referral solution is recommended for the following reasons:

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

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.

Patient Referral Management Simplified using Referral Management Software

Following features of HealthViewX simplify patient referral workflow for FQHCs and Enterprise Hospitals:

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

HealthViewX Patient Referral Management solution smoothens 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.

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

Advantages of HealthViewX patient referral management software

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

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

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

Common challenges of manual patient referral management in 2019

Documentation – During the referral process, referring physicians tend to miss out valuable patient information. Many times vital symptoms and findings from initial tests are often not sent with the referral order, leading to health complications that could have otherwise been avoided.
Leadership disconnects – The leadership team should know which doctors are referring patients to specialists. Well-connected team structure enables educational conversation between leadership and care providers regarding overutilization, referrals to high-cost specialists, or the importance of sending all necessary documentation with every referral.
Lack of coordination among caregivers – Did you know? Lack of coordination among caregivers are endemic and contribute to an estimated 44,000 to 98,000 deaths from medical errors each year.
Follow-ups – Many primary care practices do not follow-up after they’ve referred a patient to a specialist. They vest the responsibility of scheduling a specialist visit with the patient. According to the Archives of Internal Medicine, this process does not happen in 50-60% of referrals that are made, putting patients at risk.
Delays – The patient faces extended delays between the time the referral is sent and the time at which the actual appointment is made. As mentioned previously, delays and frustrations with the scheduling process can cause patients to avoid making an appointment, or they may ultimately cancel an existing appointment if the wait is too long.
High-cost referrals – Primary care practices that refer patients to high-cost providers are harming their own practice and their patients. Exorbitant price tags affect reimbursement for PCPs and scare patients away from the idea of seeing a specialist, despite their medical conditions.

Challenges Specific to Patient Referral Workflow in Large Enterprise Hospitals

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.
Finding the right specialist – A Large Enterprise Hospital has a 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.
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, a better specialist within the locality, reputation of the receiving provider, etc.
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 the reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
Patient dissatisfaction – Large enterprise hospitals should keep 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.
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.

Solutions for optimal patient referral management in 2019

HealthViewX introduces a collaborative design that connects primary care providers with specialists on a single and uniform network.
Electronically-connected specialists form a network of care collaboration, where both parties are responsible for the timely care of their mutual patients.
Secure electronic notifications provide quick and reliable information between PCP and specialist.
PCPs now have an enhanced ability to track referrals.
Electronic Referral Management has decreased wait times for face-to-face specialty clinic visits.
With Electronic Referral Management system, each step in the workflow prompts easy follow-ups and automatically closes the loop on all referrals
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 can automatically pull referral orders from EMR/EHR in real-time. It also helps in configuring all other referral coordinator workflows and tasks with maximum automation.
Multi-channel referral consolidation that brings all the referrals from multiple sources like email/phone/fax/notes into a single queue.
Detailed referral information through which the Specialist receives all the necessary referral details.
Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication
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

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.

How Can An Effective Electronic Referral Management System Improve Care Coordination?

In a traditional referral management set up, there is a huge communication gap between primary care providers and specialists while giving care to their patients. It leads to,

Clinical operational inefficiency
Poor care coordination
Broken referral loops

The relationships between PCPs and specialty care providers must evolve and improve to enhance care coordination. In order to do that healthcare organizations must adopt the advanced medical technologies. However, in the recent decades, the healthcare industry has been slow in adopting new technologies.

General Care Coordination mistakes made by medical practices

Did you know? According to the News & World report, medical errors are the third leading cause of death in the U.S. 10% of U.S deaths are due to preventable medical mistakes!

The following care coordination mistakes by medical practices affect patient experience and optimal care the most,

Documentation – During the referral process, referring physicians tend to miss out valuable patient information. Many times vital symptoms and findings from initial tests are often not sent with the referral order, leading to health complications that could have otherwise been avoided.
Leadership disconnects – The leadership team should know which doctors are referring patients to specialists. Well connected team structure enables educational conversation between leadership and care providers regarding over utilization, referrals to high cost specialists, or the importance of sending all necessary documentation with every referral.
Lack of coordination among caregivers – Did you know? Lack of coordination among caregivers are endemic and contribute to an estimated 44,000 to 98,000 deaths from medical errors each year.
Follow-ups – Many primary care practices do not follow-up after they’ve referred a patient to a specialist. They vest the responsibility of scheduling a specialist visit with the patient. According to the Archives of Internal Medicine, this process does not happen in 50-60% of referrals that are made, putting patients at risk.
Delays – The patient faces extended delays between the time the referral is sent and the time at which the actual appointment is made. As mentioned previously, delays and frustrations with the scheduling process can cause patients to avoid making an appointment, or they may ultimately cancel an existing appointment if the wait is too long.
High-cost referrals – Primary care practices that refer patients to high-cost providers are harming their own practice and their patients. Exorbitant price tags affect reimbursement for PCPs and scare patients away from the idea of seeing a specialist, despite their medical conditions.

How can an effective Electronic Referral Management System improve care coordination?

Value-based care is taking the center stage in the healthcare industry. It is high time that primary care providers and specialists find ways to eliminate communication deficiencies and create a bridge for communication. It will ensure a more well-rounded and positive patient experience.

This is when an electronic referral management system comes to play. An electronic referral management platform improves care coordination workflows in the following ways,

Introduces a collaborative design that connects primary care providers with specialists on a single and uniform network.
Electronically-connected specialists form network of care collaboration, where both parties are responsible for the timely care of their mutual patients.
Referral management technology allows primary care providers to ensure quality and optimize their practices’ reimbursements by exceeding patients’ expectations
Secure electronic notifications provide quick and reliable information between PCP and specialist.
PCPs now have an enhanced ability to track referrals.
Electronic Referral Management has decreased wait times for face-to-face specialty clinic visits.
With Electronic Referral Management system, each step in the workflow prompts easy follow-ups and automatically closes the loop on all referrals

Technology has made amazing achievements in the healthcare industry. From treatments to artificial organs, recent changes in innovations have performed incredible feats. Care coordination, however, has just arrived at its technological infancy.

Soon, primary care providers and specialists across multiple practices within a region will be integrated under one care coordination system that will seamlessly

connect providers
enhance the patient experience by closing communication gaps
fill in the entire picture of a patient’s journey across the continuum of care

Are you interested in learning more about how automated care coordination work-flows can improve referral management? Schedule a demo with us!

Reference

https://khn.org/news/coordination-of-care/