Patient Referrals

The Authorization and Referral Management component of Medical and Practice Management provides health care organizations with a streamlined approach for managing authorizations and referrals. Comprehensive referrals and authorizations are easily entered and accessible during the scheduling, registration and billing processes.

Medical and Practice Management
MEDITECH has incorporated authorization and referral management into Medical and Practice Management (MPM), which serves clinicians and administrative staff in practices, clinics and other ambulatory locations. This includes scheduling, registration, electronic patient records, open-item billing and authorization and referral management to fully automate these facilities. The software also:

• Enables organizations to proactively manage referrals and approve/delete authorizations
• Facilitates billing by expediting and ensuring reimbursement through entering and processing authorizations.
• Allows clinical staff to properly enter/track referrals from the enterprise

Integration with other MEDITECH Applications
Integration of authorizations and referrals with registration, scheduling, billing and the recording of the patient’s medical account are crucial. This integration provides users with the following capabilities:

• Patient and subscriber data entered in Community-Wide Scheduling, Registration and Billing/Accounts Receivable is transferred automatically to Authorization and Referral Management for any patient with referral and authorization activity
• Patient data in Authorization and Referral Management is linked to and updated by Medical Records
• The most recent insurance verification data and authorization status flows from Admissions (and from the Admissions worklist) to the Authorization/Referral Management database
• Authorizations and referrals are linked to scheduled appointments, both individual and series, in Community Wide Scheduling and automatically depleted when the appointment is attended
• Authorization information is automatically updated throughout applications when a patient no-shows or cancels an appointment
• In Community-Wide Scheduling, schedulers are flagged when patients are booked for appointments beyond the authorization’s expiration date or when the last remaining visit allowed by the authorization has been used or exceeded.

Authorization and Referral Data
Authorizations and referrals for follow-up care are quickly retrieved during scheduling and registration so staff have the necessary details when needed. Authorizations and referrals, also available for viewing through the Enterprise Medical Record, ensure the latest, most comprehensive data is available. The following data is captured:

• Multiple unique authorization identifiers, including the authorization number, pre-certification number and internal tracking number
• Status of each authorization (Pending, Approved, Denied) and Referral Type (Physical Therapy, Cardiology, etc.)
• Diagnosis and CPT Codes
• Requesting provider and/or specialist that the patient has requested
• Requested provider searched for, based upon the following provider selection criteria: specialty, physician practice, gender, language, facility and insurance
• Effective and expiration date of the authorization and referral
• Special instructions captured in queries or notes section
• Custom Referral Forms generated to meet the requirements of your organization

Referral Processing, Worklists and Reminders
Users can expedite referral management functions by creating online worklists and reminders. With these features, users can:

• Prioritize requests and expedite referral management functions, instantly seeing which referrals must be reviewed immediately
• Highlight particular issues or events for later review and processing
• Process referral worklists on-line with user-defined sort criteria
• Track multiple, concurrent authorizations

Additional Features/Reporting Capabilities
Users can download existing data from across departments and facilities to organize into useable formats via standard report writer capabilities. Specific functions include:

• Cumulative Reporting by number of referrals, specialty, requesting/requested provider, and referral type
• Production of standard reports via Compiled Report Capabilities, including standard authorization and referral and patient reports, or custom report writer routines via integration with other MEDITECH applications
• Letters created in either Rich Text or Microsoft® Word® format