When patients have been referred to see a specialist, it is essential that they have access to quality healthcare and can be seen in a timely manner due to most referrals being needed for a change in diagnosis or second opinion. Like anything in healthcare, there are a lot of moving parts that can impact the lines of communication and can make essential administrative tasks harder to complete correctly. Referral management is no different. With referrals, within the private and public sector, being such an important aspect of the financial well-being of those healthcare systems, streamlining the process and making it a collaborative effort for all involved is essential.
Having a secure referral management program in place can alleviate common disruptions in the process, such as network issues, patients not meeting certain criteria or medical claims not being billed correctly or even paid. Inefficient scheduling, patient tracking, and billing can quickly cause a massive loss in revenue for providers if not corrected since referrals for care happen regularly for both private and public healthcare sectors. Those who are seeking medical care also suffer because the inefficient process can cause stress and a poor healthcare experience.
COVID-19 Impacted the Referral Process
When COVID-19 emerged in early 2020, it forced the healthcare industry into uncharted territory in almost every respect. Despite the virus being responsible for a vast amount of innovation as healthcare systems navigate new regulations and patient outcomes, the referral process saw a noticeable decrease in completion rates in the spring. The combination of social distancing, stress of the unknown, and self-isolation to reduce the spread of the virus are a few reasons why many patients did not complete or put their specialized care on hold. However, with the expanding coverage for Telehealth appointments and the easing of certain restrictions, the referral process has picked back up and patients are once again seeking specialized medical treatment.
Signs of a Inefficient Referral Management Program
When a customized referral workflow is implemented, it not only streamlines critical administrative processes for those providing, receiving and billing for the medical care, but patients and their families can feel more engaged and have a better overall healthcare experience during their treatment. When there is not an efficient referral management process established, it can result in a massive gap in a patient’s treatment and revenue loss for those providing treatment.
Here are a few signs that a customized, referral management program needs to be implemented:
- Poor communication or exchange of patient information between either Primary Care Physicians (PCP), VA, DHA and Specialists.
- Appointment scheduling errors
- Inefficient patient referral tracking
- Low referral utilization rates
Referral Management in the Private Healthcare Sector
In the private sector, referral management encompasses not only ensuring that veterans and beneficiaries have access to high-quality healthcare, but that their appointments can be scheduled efficiently and excessive wait times can be avoided. Recently, VA implemented its new community care program (VCCP) as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner.
By streamlining the demanding tasks that are associated with the administration aspects of referral management, more time can be spent ensuring that the veteran or their beneficiary has access to the care they require.
Signature Establishes and Maintains All Referral and Claim Activities
Our successful outcomes with the MTFs we serve is a direct reflection of our implementation of the best, industry-based practices, and workflow designs. By streamlining the referral management process and removing common administrative obstacles, those who are in need of care will receive more attention and will have an overall improved experience within their healthcare journey.
With our industry expertise, we are able to construct unique standard operating procedures (SOPs) for the individual needs of each MTF we work with. By ensuring that the referral and claims process is not only timely, but accurate, veterans and their beneficiaries can receive the high-quality care and information they deserve. It is our goal to provide veterans and beneficiaries with a type of customer service that the healthcare industry has never seen before.
We understand that our clients are coming to us because they need assistance. Our team has 16 years of experience and historical data to help clients navigate their industry challenges while showing them that excellence is relevant in the healthcare administrative service industry. To learn more about how Signature Performance can help you or to request a revenue cycle assessment, contact our team today!
Dawn Wierzbicki is the Senior Vice President of Partner Engagement at Signature Performance Inc., in Omaha NE. Signature Performance is an industry leader in reducing healthcare administration costs for private and public healthcare sectors. Our unmatched experience in serving both the payer and provider side of healthcare financial management allows us to implement innovative solutions for every administrative demand.