Improving patient referral management workflow between federally qualified health centers & specialists clinics imaging centers

© 2018 | Payoda - Confidential
1
Improving Patient Referral Management Workflow
Between
Federally Qualified Health Centers
& Specialists Clinics/Imaging Centers
www.healthviewx.com
Learn how a patient referral software can help

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.
What are Federally Qualified Health
Centers (FQHCs) and what they do?
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

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.
Patient Referral Management in Federally
Qualified Health Centers
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.
The gap between the Federally Qualified
Health Center and specialty care
Let us see it from different perspectives to understand why there is a
communication gap.
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.

1
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.

2
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.

3
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.

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.
Guidelines to bridge the gap between Federally
Qualified Health Centers and Specialist Clinics/
Imaging Centers
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.
Imaging Centers
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.
Imaging Centers
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.
Schedule a demo with us and our patient referral
management experts will guide you through our
HIPAA compliant solution.

Email: marketing@healthviewx.com
Phone: +1 (214)-461-0242Contact us anytime.
How can we help?

Improving patient referral management workflow between federally qualified health centers & specialists clinics imaging centers

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Improving patient referral management workflow between federally qualified health centers & specialists clinics imaging centers

Similar to Improving patient referral management workflow between federally qualified health centers & specialists clinics imaging centers (20)

More from GaryRichards30

More from GaryRichards30 (20)

Recently uploaded

Recently uploaded (20)