For many health systems, referral leakage may equate to millions of dollars in foregone revenue. Every patient who seeks care elsewhere is a lost revenue opportunity now and potentially into the future. For many health systems, referral leakage may equate to millions of dollars in foregone revenue. Every patient who seeks care elsewhere is a lost revenue opportunity now and potentially into the future. Thus it is important for health systems to increasingly focus on minimizing referral leakage while managing referrals.

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1
How To Identify An
Underperforming Referral System
And Make Improvements For The Same?
www.healthviewx.com
Learn how a patient referral software can help

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For many health systems, referral leakage may equate to millions of dollars in
foregone revenue. Every patient who seeks care elsewhere is a lost revenue
opportunity now and potentially into the future.
Symptoms of an underperforming referral
management system
Thus it is important for health systems to increasingly focus on minimizing
referral leakage while managing referrals.
The following are the symptoms of an underperforming referral management
system which have a negative impact on referral leakage,

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Inability to identify in-network or aligned providers
Underperforming Referral Management
System
Insufficient or unclear information on what patient types or conditions a provider treats
Ineffective prioritization and workload management
Limited/no ability to measure the referral management team performance/financial
outcomes
Increased authorization-related denials and write-offs
Increased reliance on paper-based or manual communication and tracking systems
Increased patient referral leakage due to complicated, cumbersome, or unclear referral
processes.

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The ability to make significant improvements in referral processing efficiency and patient
retention depends on the following factors,
1. Degree of process standardization
2. Organization’s accountability
3. Underlying infrastructure
4. Organization of staff
5. Technological capabilities
Analyzing your organizations' opportunity for
improvement

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There is a huge communication gap between the referring provider and receiving provider
offices which makes the process inconsistent. Organizations often fail to standardize the
process by defining who is responsible for
1. Obtaining prior authorizations
2. Locating a specialist with good access who will treat the patient’s condition
3. Gathering relevant medical records
4. Contacting the patient to schedule the appointment
Accountability and standardization of the process

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Organizations with strong referral management programs have developed a
consistent and standardized workflow that clearly delineates responsibilities by
role. Achieving this level of efficiency requires that operational and clinical
leadership collaborate to design and develop policies, procedures, standards, and
workflows to support strong referral management practices.
Accountability and standardization of the process

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Even when standardized workflows have been designed and implemented, it is common for a
variation to be introduced over time. It particularly happens in decentralized environments where
managers have competing priorities and training can be highly varied.
Further, the clinic-based staff is rarely dedicated to the referral management function, so the
work is often deprioritized as other, patient-facing tasks take precedence. To address these
challenges, many health systems are adopting a centralized approach to referral management.
Centralization of Referral Management

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In this case, staff resources are specialized and specifically dedicated to the
function of referral management.
While the implementation effort can be high, it is a relatively low-cost option that
can produce tremendous financial and patient-experience benefits.
Centralization of Referral Management

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Technology Systems and Capabilities
Despite having a thoughtful and disciplined approach to monitoring and
managing referrals, technology systems are often unable to facilitate best
practice workflows or deliver the performance data necessary to
effectively manage the end-to-end process. Therefore, manual processes
have become commonplace to
Track authorization status
Monitor scheduled appointments
Calculate referral conversion rates, staff productivity, and downstream
revenue

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Furthermore, the inability to share information electronically among providers
necessitates increased use of paper-based and faxing processes. Without
the proper supporting technologies, there is increased processing effort and
workload, risk of lost or inaccurate data, and, most importantly, the potential
to delay patient care.

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The following are the technological capabilities needed to support the best
practice referral, management team,
● Identifies providers in the referral network
● Matches patients with the ideal scheduling providers
● Prompts follow-up when appointments are not scheduled or care is not
received
● Facilitates the transfer of post-visit documentation between providers
● Supports detailed reporting to manage performance

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The Primary Care Provider (PCP) identifies the need for a referral and initiates
the same through the EHR system.
Close your referral loops with the HealthViewX
Patient Referral System
The referral coordination team then validates the referral and does the insurance
pre-authorization with the help of HealthViewX solution.
The referral coordination team then sends the referral with the necessary
documents to the relevant specialist or imaging center through the HealthViewX
platform.
The Intelligent Provider Smart Search feature of HealthViewX Patient Referral
Management System helps in finding the right specialist or imaging center easily.
Information Technology enables patient referral workflow automation. HealthViewX
Patient Referral Management System simplifies the process and closes the referral loop
on time.

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The patient and the receiving provider get reminders of the appointments thus
reducing no-show rates.
Close your referral loops with the HealthViewX
Patient Referral System
The referring provider is also notified about the status of the referral and how it is
progressing. HealthViewX timeline view makes tracking and managing the referral
lifecycle easier.
HealthViewX makes it easy for the referring provider by automatically updating this
information back to the EHR system.
HealthViewX tracks and sends reminders to the receiving provider to update the
diagnosis, treatment recommendations, care plans in the referral.
The receiving provider gets notified about the referral and can schedule appointments
with the patient.

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Patient coordination framework achieved through the patient application that helps in
managing appointments and log data for the care plans prescribed by the provider.
Features and Functionalities
Automated insurance pre-authorization reduces the work of the referral coordination team
and makes the process simple
Referral timeline view and communication enables an easy flow of information between the
referring and the receiving ends.
The Intelligent Provider Search feature helps in finding the right specialist or imaging
center in no time.
Referral workflow automation reduces the time and manual effort spent on a referral.
Thus HealthViewX solution improves the efficiency of the process

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Referral insights and analytics gives the PCPs concrete data of how many referrals
were converted to an appointment by a specialty care or an imaging center. It will help
in analyzing who responds quickly and to whom the PCP can direct future referrals.
Features and Functionalities
Scheduler integration gives timely reminders and notifications to the patients and
providers about appointments, lab tests, etc.

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Streamline referral management - With HealthViewX Patient Referral System in place,
the referral workflow is automated and streamlined.
Benefits of closing the patient referral loop in the
healthcare industry
Increased Medicare reimbursements - Medicare considers closing medical referral
loop as a benchmark for giving reimbursements. Closed medical referral loops
increase the opportunities for Medicare reimbursements for referral marketing
Improved patient care - Reduced waiting time gives patient satisfaction thereby
improving the care quality.
Increased productivity - Reduced operational time improves the efficiency of the
patient referral system.

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HealthViewX Patient Referral Management
Solution helps in closing the referral loop and
increases the revenue for the practice
Schedule a demo with us and our patient referral
management experts will guide you through our
HIPAA compliant solution.

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