This blog post is about in-house referral processes for medical practices emphasizes the importance of establishing workflows and procedures for handling referrals before opening a practice.
The post outlines two main types of referrals: courtesy referrals and insurance-required referrals.
Courtesy referrals are sent from one provider to another to inform them about a patient and their condition. Insurance-required referrals are mandated by the patient's insurance company and are necessary for coverage of specialist visits.
Procedural specialties feel referral rules most acutely, because the referral has to be valid on the date of the procedure, not just the date of the consult. In gastroenterology, a patient referred for a consultation may return weeks later for a colonoscopy, and if the referral has expired or covered only the office visit, both the facility and professional claims deny. Tracking the visit count and expiration date on every inbound referral, and confirming coverage before the procedure is scheduled, avoids a denial on the most expensive claim of the episode. Practices with high scope volumes usually build this check into scheduling rather than leaving it to the biller, which is one of the first workflows a gastroenterology billing service reviews.
The author recommends that medical practices designate staff members to be responsible for handling different aspects of the referral process, such as collecting patient information, sending referrals, and following up with referring offices. She also suggests using an electronic health record (EHR) system to track referrals and automate certain tasks.
Here are some key takeaways from the blog post:
Establish workflows and procedures for handling referrals before opening your practice.
There are two main types of referrals: courtesy referrals and insurance-required referrals.
Designate staff members to be responsible for different aspects of the referral process.
Use an EHR system to track referrals and automate certain tasks.
