Managing Referrals

September 1, 2008

As a primary-care physician, my office is responsible for specialist referrals for the vast majority of payer types. It takes an extraordinary amount of time to verify the information and communicate with the patient. It is an expensive process for me and I get no return other than avoiding liability for not doing so.Another part of the problem is being in a community which sometimes requires additional assistance in making the appointment: language barriers, literacy issues, and behavioral issues. Can my staff bill for a “nursing visit” if the patient is brought back in for “coordination of care” to help in arranging specialist visits?

Question: As a primary-care physician, my office is responsible for specialist referrals for the vast majority of payer types. It takes an extraordinary amount of time to verify the information and communicate with the patient. It is an expensive process for me and I get no return other than avoiding liability for not doing so.

Another part of the problem is being in a community which sometimes requires additional assistance in making the appointment: language barriers, literacy issues, and behavioral issues. Can my staff bill for a “nursing visit” if the patient is brought back in for “coordination of care” to help in arranging specialist visits?

Answer: You can’t bill a 99211 without actually doing evaluation and management of some sort.

I think your better bet is to try to streamline things: Can the key practices to which you refer help out? You need to do the referral, but maybe they can help track down information. It seems to me that many specialist practices do this leg work with payers. If they never turn down a referral, do they really need you to do all this paperwork/preauthorization?

Finally can you capture better data from patients at the front end of the process to ease referrals later on?