Referral intake is the process that specialty groups use to process incoming referrals from other providers. This encompasses everything that happens from when the referral arrives to the moment the patient is able to be seen, usually including receiving, logging, reviewing, and taking the appropriate actions.
Also called: referral processing, referral management, referral coordination
What are the steps in referral intake?
While the workflow will vary depending on the specialty and the payer, the usual referral intake process tends to go as follows.
- Receive the referral: Referrals can arrive through various channels, including fax, electronic referrals, patient portals, or over the phone.
- Log it the same day: All referrals should be recorded in the EMR on the day they are received and marked with a “received” date to make it easier to determine the age of each referral.
- Check for completeness: Check for the essential information, such as patient demographics, reason for referral, insurance details, and any required clinical documentation.
- Request missing records: If anything is missing, ask the referring office to provide the missing any necessary materials that were not originally included.
- Start authorization: If the payer requires prior authorization, request this as early as possible to make sure it doesn’t mess up the scheduling.
- Route to the right provider: Match the patient up with the clinician best suited to their care, based on the best location and subspecialty that the patient needs.
- Contact the patient: Get in touch with the patient before the referral goes stale to set up an appointment.
Why does it matter?
Referral intake is often the first interaction patients and other providers have with a specialty practice. How referral intake is handled can affect the experience and working relationship with both the patient and the referring office.
- Patient wait times: When referrals sit in the backlog, unprocessed, it delays the patient’s care. In many conditions, long wait times become hazardous for the patient’s health, instead of just a waste of their time.
- Referral leakage: When a patient can’t get an appointment promptly or never hears from the practice in the first place, it’s only a matter of time before they seek out a different specialist.
- Relationships with referring providers: A referring office wants to make referrals to specialty groups who respond quickly and keep them in the loop. When this doesn’t happen, they usually send referrals elsewhere.
- Revenue: When referrals continuously get lost in the shuffle, don’t get responded to promptly, or get denied entirely, that’s revenue loss for the specialty group.
Where does referral intake break down?
For most clinics, problems in referral intake boil down to a handful of common causes:
- Too many intake channels: It’s tempting to think that having more intake channels would make a clinic far more convenient to reach. However, when there are five different ways a referral can be sent to a clinic, it runs the risk of something falling through the cracks.
- Incomplete records: Referrals without relevant notes, proper insurance information, or other key information halt the process while staff hunt it all down.
- Several teams are in charge of intake: In clinics where various parts of the referral intake process are split between many different teams, the various handoffs in the process make the referrals prone to getting lost or forgotten.
- No tracking of referral age: Knowing clearly how long a referral has been open gives clinics a view of their backlog and the order they need to respond to it at a glance. By processing older referrals first, clinics can make sure that no patient gets forgotten at the end of the list.
Referral intake in outsourced operations
For many specialty groups, it makes more sense to outsource their referral intake to a dedicated team. These outsourced vendors work from within the group’s own EMR under a business associate agreement (BAA). The outsourced team can then consistently work through the referral backlog every day, starting authorizations, chasing down missing records, and interfacing with referring offices. Since these tasks are the team’s main focus, referrals are far less likely to be put to one side when the front desk is occupied by in-office duties.
Referral intake vs. patient intake
Referral intake handles the actual referral, starting from when the referral arrives and ending at authorization, all before the patient is ever scheduled. Patient intake entails preparing the patient for their visit, covering tasks like working through patient forms, gathering medical history, and verifying their insurance.
Related terms
- Referral-to-care time: The period of time from the referral being made to the patient’s first completed visit.
- Referral backlog: The list of referrals that have been received by a clinic but have not been fully answered or scheduled yet.
- Referral leakage: When referrals go unanswered or are not processed, and the patient ends up choosing a different provider.
- Closed-loop referral: Referrals where the specialist contacts the referring provider after providing care for the patient and keeps them in the know about the patient’s care and outcomes.
- Prior authorization: A payer’s approval, which is required before some services and that must be verified before the patient’s visit can happen.
FAQs
How quickly should a new referral be logged and reviewed?
The best practice is for every referral to be logged the day it arrives to ensure that everything gets tracked. If referrals are urgent, they should be flagged immediately and receive priority.
Can referral intake be automated?
Some of the process can be automated, but not all. For instance, some tools can capture incoming faxes and electronic referrals, and then create records directly in the EMR that include the age of the referral and its current status. However, for tasks that require human judgment and cultivating relationships, a human agent is still ideal.
