Case Referrals

Think of case referrals as a treatment guide that includes procedure, date, and visit restrictions for patient treatment. They are similar to authorizations, but have no reimbursement implied. Rather, they are a physician's or specialist's recommendation as to how to proceed with the patient's treatment. As appointments are scheduled, valid referrals that are defined for the case being scheduled will be available for use in a drop-down on the Edit Appointment screen.

NOTE – Contrast case referrals with the referral source, which is often configured on the Contact and Files tab. The referral source is “how” the patient found out about your organization: It is the “who” or the “what” that referred the patient to you. Though the referral source and case referral can be the same entity, there is no requirement that they are the same.

The Case Referrals tab will list all of the referrals that have been assigned to a given case by Description, Begin Date, End Date and Status. Use the following instructions to navigate the screen an manage your referrals.

Show Deleted Referrals: Check this box to refresh the list to include referrals that have been deleted.

Show Expired Referrals: Check this box to refresh the list to include referrals that have expired.

Add Referral: Click the New button to add a referral to the patient record.

Referral History: Click the View link to output the referral history to the screen. Click the Print link to output the referral history to the selected printer. Note that this applies to individual referral line item only. Click the Print button to output all the referrals the patient has.

Edit Referral: Click this link in the appropriate line item to modify an existing referral. The Edit Referral screen will appear.

Delete Referral: Click this link to remove an unused referral. Referrals that have been associated with an appointment cannot be deleted.

Print: Click the Print button to output a list of the referrals for the selected patient-domain combinations. Don't confuse this with the History: Print link, which will print the history the individual authorization line item.

Adding Referrals

Navigate to the patient demographic screens and select a patient.
Click the Cases tab. Either

Click New as part of a new patient entry
Click Edit in the line item for the case appropriate to your current need

The case demographic screens will appear with Case Information in context.

Click the Referrals tab.
Either

Click the New button to create a referral. The Referral Source search screen will appear. Select the appropriate referral from the list. If the desired referral source does not exist, click New on the Referral Source Search screen to create it.
or click the Edit link in the appropriate referral line item to edit one.

The New Referral for: screen will appear.

Complete the parameters of the referral according to the following definitions:

Referral Source: Verify that the referral source you selected is correct. If not, do one of the following:

Click the field once to display a text field and begin typing the source name. Continue typing until the correct referral is displayed and then select it
Double-click the field to display a drop-down menu and select the appropriate item.
Click Search to open the Referral Search screen and select the appropriate item.

Referral Number: Enter a number up to 20 characters long.
Referral Description: Enter a description up to 50 characters. Referrals appear as referral ID-referral description (begin-end dates) in the scheduling workflow.
Status: Click the drop-down and choose a status from the following options:

Open (the default value)
Pending
Closed
Denied

NOTE – Only open and closed referrals appear on the Edit Appointment screen. Only open referrals can be used to schedule an appointment.

Date Received: Enter the date your office actually received the referral for treatment (mm/dd/yyyy).
Begin Date: Simply enter the date when the referral starts (mm/dd/yyyy). Referrals without a beginning date will simply list “No Begin” in the Edit Appointment screen.
End Date: Simply enter the date when the referral ends (mm/dd/yyyy). Referrals without an end date will simply list “No End” in the Edit Appointment screen.
Initial Visits, Used Visits, and Authorized Visits:

Authorized Visits — Enter the approved number of visits in the Authorized Visits field.
Initial Visits — If the patient is new to the scheduler, but is in the middle of a series of treatment, simply enter the number of visits in the Initial Visits field that he or she has used prior to being scheduled in the program. This number will be used as part of the calculation for Used Visits.
Used Visits: The is the tally of completed authorized visits. It provides a quick reference that a patient’s authorized treatment is nearly finished, which can be used to alert resources so that they can adjust a patient’s treatment plan accordingly. Used visits are calculated using the Initial Visits, if any, and the number of completed appointments: that is, appointments whose status is Arrived or Seen. Used Visits = Initial Visits + (Arrived + Seen) Appointments. For example, If a patient has 15 authorized visits and is entered into the program after he or she has completed 5 visits, do not enter 5 in the Initial Visits field and 10 in the Authorized Visits field. Rather, enter 5 in the Initial Visits and 15 in the Authorized Visits field.

NOTE – Administrators have the option of enabling an alert in Data Maintenance > System and Security > System Settings that will notify users when referral visits falls below a configured threshold. This should be configured to give you enough time in your workflow to evaluate the patient's progress and communicate with the referring provider as needed.

Activate one of the following check boxes in the section titled Apply Referral to Appointments on/after Begin Date to Appointments with.

No Referral - When checked, the referral will be applied to appointments that do not have a referral when the appointment date is on or after the referral Begin Date.
Open Referral - When checked, the referral will be applied to appointments that are linked to an open referral when the appointment date is within the referral date range.
Both of the previous - When checked, the referral will be applied in both of the above scenarios (No Referral and Open Referral).

WellSky Resource Manager will apply the referral to appointments scheduled for the case that fall within the effective dates of the referral. Effective dates are determined as follows:

The referral will be applied to appointments starting with the Begin Date if one was entered. If the Begin Date is left blank, however, today’s date will be used as the starting point.
The referral will be applied to appointments up to the End Date. If no End Date is specified, the referral will be applied to all existing appointments from the starting point forward.

Procedures: Referrals may be issued for a specific procedure or set of procedures. If so, simply click the Add button in the Procedure panel and select the appropriate items.

As appointments are scheduled for this patient case, then, the “procedure” referral will be made available in the Edit Appointment screen. Conflicts will be generated when you attempt to use the referral without selecting the appropriate procedure and you will be able to proceed until you remove the referral or select a procedure that meets the referral parameters.

Notes: Enter anything relevant to the current referral.

Click Accept on the New Referral for: screen to complete the referral. The case demographic screens will refresh on the Referrals tab and the referral will appear in the list panel.
Do either of the following:

Continue entering data in the other case demographic screens, or
Save the Patient: Click the Accept button for new patients. This will temporarily store the changes you have made in case demographics until the patient is saved. Click the Save button for existing patients. Your changes to the case will be recorded, and you will be returned to the Cases tab.

Choose whether to Go to Grid after Save and then click Save on the main demographic screens to commit the changes you have made to the patient record.

Deleting Referrals

To delete a referral:

Locate the appropriate referral on the Referrals tab.
Click Delete in the line item.
Click Save to commit all of your changes in the case demographic screens.
Click Save on the patient demographic screens to commit the changes to the patient record.

Key Considerations

Patient case referral data entry is governed by the Case Operations Security assigned to the user. The security governing the maintenance of referral data is governed by the Global User Right “Edit Referral,” and referral categories by “Edit Referral Categories.”

Referral Sources are maintained in Data Maintenance > Referral Maintenance > Referral Sources.

Referrals use Case rights for scheduling: If the case can be scheduled, then the referral can be used—all other restrictions being met. This is different from authorizations, which are assigned to domains separate from cases. Conflict Operations Security determines whether a user can book beyond date of referral or beyond visit count.
Referrals do not have any implied reimbursement attached to them.
If you edit a referral that has been used and attempt to remove resource types associated with it, a message that the patient has appointments with a resource type no longer associated with the referral will appear, and you will not be able to complete the changes.