Trying to navigate the maze of outpatient orders without a strong technology platform can be a futile effort. Instead of creating clarity and continuity from order placement to scheduling, results and reimbursement, you can end up with disjointed parts that may not always lead you on a direct path to full reimbursement.
An example of a successful path to service excellence and payment certainty is an outpatient orders program that links an entire care community with touch points at every stage in the process. The result is greater physician loyalty, higher patient satisfaction, reduced workloads, maximized use of technical resources and improved reimbursement.
But the fragmentation that occurs without a comprehensive, automated program is evident. The Milbank Quarterly found that 63 percent of primary care providers are dissatisfied with the referral and orders process. Summarizing other studies, the Milbank article points out that 25 to 50 percent of referring physicians did not know whether their patients had actually seen the specialist to which they were referred. Typically, in more than half of the referrals, the referring provider had no communication with the specialist and up to 45 percent of referrals resulted in no communication from the specialist back to the referring provider.
To compound these problems, paper orders can be illegible, lost, forgotten by the patient and not meet regulatory requirements. When the circle is broken, it causes problems that reverberate throughout a healthcare community with a potentially negative impact on patient outcomes, scheduled resources, reimbursement and compliance. But that’s where an efficient, technology-enabled order system can deliver strong results, including:
- Improved communications – An orders system serves as a strong communications channel with automatic acknowledgement of order receipt, notification to the ordering provider when the procedure is being performed and delivery of results. It can even automate patient reminders of scheduled appointments. Automated orders can also include procedure prep instructions as well as information on post procedure care. Disruptive calls to physician offices for additional information, clarity and preauthorization are eliminated, resulting in efficiencies across the continuum.
- Payment certainty – By introducing medical necessity validation and pre-authorization at the beginning of the orders process, service providers are much more likely to obtain full reimbursement.
- Streamlined workflow – Exception-based processing means staff doesn’t have to manually intervene with disruptive calls to physician providers or other with a prior-authorization inquiry or claims submission, unless there is a problem.
- Greater loyalty – Processes that make a providers’ life easier are more likely to gain traction in a busy practice. A hospital or health system that streamlines the order process and closes the communications loop will gain longstanding, happy patients.
- Patient satisfaction – No one likes surprises, so proper management of payer and clinical requirements can provide peace of mind for your patients – and your healthcare organization. Additionally, lost or forgotten orders will never be a problem upon a patient’s point of entry.
As payers continue to increase the complexity of the reimbursement process, providers must find new ways to comply with payer policies to receive full reimbursement for their clinical services. An advanced technology solution that can be customized to meet a system’s specific needs eases the paperwork burden and simultaneously improves the revenue cycle.
Find out how the Experian Health/Passport Orders Suite of solutions can help your healthcare organization streamline the physician order process, improve registration throughput, automate prior authorizations and validate medical necessity and eliminate uncertainty, allowing you to devote more time to patient satisfaction, safety and care.