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Making Physician Referrals and Orders for Outpatient Services Easy – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 6)

  • AVP Health Systems, XIFIN

As the sixth installment of this multi-part blog series, we address the needs of ordering or referring physicians to support them using your health system’s outpatient services. While the patient is always the primary customer, for hospital outpatient services such as ambulatory and outreach laboratory, as your outpatient and outreach programs expand further into the surrounding communities and outside of your health system walls, you have another customer to be focusing on — referring and ordering providers, physicians, and facilities. These entities, also known as clients, play a big role in where their patients have their laboratory and other ancillary services provided to them. Unfortunately, many enterprise level systems or EHRs lack the functionality needed to properly support and maintain a successful client relationship. Specifically, EHRs often have limited fee schedules, inadequate and inflexible client billing capabilities, and a lack of online client support tools and portals.

To compete in the marketplace and gain referrals for outpatient services, the ability to offer flexible pricing is critical. This is often difficult in an EHR, which has limited fee schedules and more narrow pricing structures to accommodate a sale of a service to a specific client or subset of clients. Being constrained to utilizing a list or billed hospital rate often leads clients to look at alternative providers with more competitive pricing.

In addition to the restricted fee schedules, EHRs also have challenges producing a client invoice back to a referring client. EHR systems are geared for patient care and patient billing and may struggle to accumulate charges and line item details in a monthly invoice back to an ordering client outside of the health system’s “walls.” These challenges often lead to outreach labs and other ancillary providers manually accumulating line items details on an Excel spreadsheet outside of the actual EHR. This lack of automation creates a domino effect of issues that leads to both staff and client dissatisfaction as well as financial risk. Staff may be required to work long hours at month end to produce the invoices. In some cases, staff may not be able to schedule PTO during these times. The manual nature of the work leads to delays in invoicing, errors including typos to incorrect prices to more serious PHI compliance concerns with an incorrect patient showing up on the wrong invoice. Clients can quickly become dissatisfied for the same reasons.

If producing a client invoice wasn’t challenge enough, some EHRs may not include robust self service tools and portals specifically designed to support referring and ordering clients. At a minimum, clients need to be able to review their invoices and make payments online. Additionally, many clients want to have 24/7 self-service tools to feel connected to you. Beyond invoice capabilities, clients want to be able to check prices of your services, provide updated insurance and diagnostic information, and upload supporting material such as prior authorizations and medical necessity document to be viewed by you. 

Finally, you need visibility to truly understand your referring clients. This not only includes knowing the number of orders and billable encounters coming into your health system from outside clients, but more importantly, understanding the profitability by ordering entity. Simply having the visibility into your ordering clients and knowing which of your clients are providing the info required for you to get paid is huge.

As you attempt to expand your outreach and outpatient services, these lack of tools in your EHR system are going to make obtaining new clients and maintaining a steady stream of new orders a challenge.

There are purpose-built RCM platforms that are uniquely designed to deal with outpatient claim complexity and interoperate with inpatient enterprise systems so that you can benefit from a best in class infrastructure. Interested in seeing what patients and clients would experience and what kind of process and revenue improvement you could expect? Contact us.

Interested in reading the other blogs in the "Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs" series?

Published by XIFIN
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