Smooth Transition: Making Referrals Work for Physicians and Patients

Christina M. Sorenson, OD


June 07, 2019

Referring your patient to another physician used to be simple. You called the physician, informed him or her about the patient's condition, and obtained an appointment slot in the needed time frame.

Now, when your patient needs a referral to a specialist, it requires working within the electronic record, interfacing with the insurance company, and contacting the specialty practice to ensure the patient can be seen within the time frame indicated for the problem.

The support of the front office is invaluable in each step of a specialty referral. A proficient front office worker will obtain the insurance information and often the coverage it will afford your patient. Additionally, the front office staff will reach out to the specialty practice, confirm insurance acceptance, and make the appointment for the patient. This step is crucial for patients' confidence in the care they receive and ongoing patient management.

The physician or a scribe directed by the physician typically completes the work within the electronic health record. The documentation usually includes specific information: the type of specialist, the clinical indication and correct ICD-10 code, the time frame, and if you are the primary physician, sometimes the number of visits approved.

The accompanying encounter notes are invaluable to a specialty physician. Offering your clinical information and the results of ancillary testing can be instrumental to expedite your patient’s evaluation and management.

Outlining your concerns is important, but knowing your referral colleagues' preferences is also extremely helpful. There may be referral physicians who prefer to obtain all of their own testing. In this case, any testing completed prior to the referral only duplicates cost and may delay care. Conversely, you may find that having laboratory test results available for the uveitis specialist, fundus photos for the cardiologist, serial visual field studies for the glaucoma specialist, or optical coherence tomography imaging for the retinal specialist may make the difference in having your patient seen sooner rather than later.

Getting a follow-up confirmatory note from the referral physician is good practice. If you have not received one, consult with the physician. This allows for a two-way conversation regarding the care of a patient. It can also be an opportunity to develop a long-lasting professional relationship and enhance the likelihood of timely specialty care for your patients.

Referrals may not be as simple as they once were, but they are the basis of a broad-based approach to ongoing patient care.

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