What Does Referral Intake and Scheduling for Specialty Medical Groups Look Like?

Together, the referral intake and appointment scheduling for specialty medical groups cover a wide span of the patient access process. That entails everything from the patient’s first visit, including records, authorizations, provider matching, and booking. A dedicated team will run this work for all locations of a multi-site specialty group, while a Director of Operations will own the result.

What happens when a referral arrives?

All referrals from all sources (fax, electronic referral, portal, phone, etc.) should be logged in one central place right when they arrive.

How is a referral checked for completeness?

When they arrive, each referral needs to be checked for a proper diagnosis, as well as clinical notes, imaging results, and insurance details. If there is anything missing, the specialist will need to request it from the referring office as soon as possible.

When is prior authorization needed?

Prior authorization is required for a variety of specialty visits and procedures, including many types of injections, imaging, and surgical consultations. The prior authorization requests will typically begin at the patient intake period, not after booking.

How is the patient matched to the right provider?

Based on the specialty group’s clinical leadership’s rules. Referrals tend to be routed based on urgency, location, subspecialty, and payer.

How is the appointment scheduled?

Scheduling appointments at a specialty medical group requires prompt patient contact after referral, selecting the right visit type, and adequate preparation before the first visit.

How soon is the patient contacted?

Outreach begins on the same day of the referral. If, for whatever reason, the patient can’t be reached, the team will then make a set number of attempts to get in contact and finally close the referral if no contact can be made.

How is the right visit type chosen?

For providers to have an accurate schedule and for each patient to get the right resources and care at a specialty clinic, it’s important to book them with the appropriate type of visit, guaranteeing that the patient has a visit of the correct length, using the right equipment, and attended by the right staff.

New patients will need a longer appointment to review their medical history and records and get the provider up to speed with their needs. A procedure consultation will require the right provider with the right context. And an imaging or testing appointment will require the appropriate tools and a team trained to use them.

Based on the patients needs, a visit type can be chosen that adequately addresses them.

What happens before the first visit?

Before meeting with patients for the first time, specialty medical groups need to verify insurance information, collect patient intake forms, and confirm the appointment with the patient. To learn more about reducing missed patient visits, see our no-show prevention page.

How does the referring provider stay informed?

The office that referred the patient receives a confirmation of the specialist’s receipt of the patient, as well as an appointment date. Any referrals that cannot be scheduled are flagged with the referring office, which is notified that the patient could not be reached.

How is the referral intake and scheduling process measured?

The right metrics allow specialists to track this process and ensure that everything is running smoothly. Some of the most informative data here includes:

• Referral-to-care time: The time span between receiving the referral and the patient’s first visit. This tells you how long the patient is left waiting.
• Contact time: The time between the initial referral and the patient is contacted by the specialist. This shows the speed of outreach.
• Conversion rate: What percentage of referrals become completed first visits?
• Backlog age: How long do unscheduled referrals sit waiting?

How do groups get started?

To get started with outsourced referral intake, a great first move is to map your current referral volume and timelines by location. This provides you with a baseline for your clinic’s metrics and gives later metrics more context.

See where your referred patients are stalling and where ROI CX Solutions can help. Speak with us about your referral workflow to learn more and see what an outsourced referral intake and scheduling team can do for you.

Schedule a conversation with our team.