Harnessing the Power of NextGen Referral Management


Darren Mathis

Manage financial risks & ensure regulatory compliance

Successful Operators know that making rapid decisions on hospital referrals is a key factor in converting admissions.  An inherent challenge in making snap decisions is increasing financial & regulatory risks.  Having a system that provides the right information with built-in safeguards can mean the difference between a successful admission and a financial or regulatory nightmare.

Today’s vastly improved Referral Management System (RMS) can be a valuable tool for SNF Operators to enhance their financial management and regulatory compliance efforts. Here are some ways a NextGen RMS can help:

Streamlined Referral Process

A robust RMS can automate and streamline the referral process, ensuring that all necessary information is collected accurately and efficiently. This helps avoid delays and potential financial losses due to missing or incorrect data.

Real-Time Bed Availability

An RMS can provide real-time information about bed availability and occupancy rates, enabling operators to optimize their facility's capacity. This helps in avoiding potential revenue loss from unoccupied beds and ensures efficient resource utilization.

Improved Communication with Referral Sources

An RMS can facilitate seamless communication with referral sources, such as hospitals and physician offices. This improves coordination and helps build strong relationships, leading to a steady stream of referrals and reduced financial risks related to low occupancy.

Enhanced Patient Eligibility Verification

By integrating with various data sources and payor systems, an RMS can assist in verifying patient eligibility and insurance coverage. This minimizes the risk of admitting patients with inadequate or non-reimbursable insurance, reducing potential financial losses.

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Better Care Coordination

An RMS can support care coordination between SNF staff and referring institutions. This helps ensure that patients' care needs are accurately assessed, leading to appropriate reimbursement levels and avoiding potential penalties for inadequate care.

Automated Billing and Coding Compliance

A comprehensive RMS can assist in automating billing processes, reducing the chances of billing errors and improving coding compliance. This ensures that the SNF receives appropriate reimbursements for the care provided and mitigates financial risks associated with billing irregularities.

Regulatory Compliance Tracking

An RMS can maintain records of regulatory requirements and assist in tracking compliance efforts. It can help SNF operators stay updated with changing regulations and avoid penalties and fines related to non-compliance.

Data Analytics and Performance Monitoring

An RMS can generate valuable data and reports, enabling SNF operators to analyze trends, identify areas for improvement, and make informed decisions. By monitoring key performance indicators, operators can proactively address potential financial risks and optimize their operations.

Reduction of Readmission Rates

A well-implemented RMS can contribute to a more effective care transition process, leading to reduced hospital readmissions. This not only improves patient outcomes but also reduces financial risks associated with penalties for excessive readmissions.

Compliance Documentation

An RMS can assist in maintaining comprehensive and accurate documentation of all aspects related to referrals and patient care, which is vital for regulatory audits and risk mitigation.

Well-designed and integrated Referral Management System can empower SNF operators with valuable tools and insights to better manage their financial risks, optimize operational efficiency, and maintain regulatory compliance in an ever-evolving healthcare landscape.

LincWare’s Referral Management System (RMS), known simply as Referral+ is a solution that offers a unique seamlessly integrated platform that sews multiple systems together (including PCC, Matrix, and others) to allow SNFs to process and respond to referrals at lightning speeds while capturing the clinical and financial information necessary for a quick, confident, and safe decision.

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