How to Network Management Service Organization (MSO) Healthcare Facilities with Patient Referral Software

 In Health - HIT, MSO, Patient Referrals, Pre-certification, Revenue Cycle Management

Networking Management Service Organizations can be challenging to say the least.  Why?  Current architecture, internal politics, switching cost, existing policies & procedures, geolocation to name a few barriers but ultimately to see the most benefit in a given MSO, networking physician practices is key.

Its hard to quantify with any level of certainty that an MSO “IS” one thing or another; often times the goals of a group fluctuate in correlation with the dynamic healthcare landscape.  However, at every Management Service Organizations core reside a few principals, one being the desire to leverage a footprint of facilities in an effort to experience savings and gain negotiating power.

Historically MSOs have worked well as an avenue to allow private physicians regardless of concentration an avenue to remain privately held while experience a number of the values larger organizations commonly referred to as (GPO) partake of.

How Stratus Reduces Patient Expense?

Stratus will dramatically decrease the number of no show appointments currently plaguing your facility or network.  We understand receiving a referral as a specialist for a consult is a great first step but in the event the patient never walks in the front door ultimately the referral is worthless.

We believe in patient engagement; patients receive text or email notifications alerting them to upcoming appointments, with a link to save the event within a personal calendar.

In addition, Stratus allows the patient to maintain their Patient Profile from a desktop or mobile device.  Prior to any upcoming appointment patients have the opportunity to update information like phone number, address, or email in file so that networked providers are always working from a current Patient Profile.

Controlling patient expense starts with encouraging providers cross concentration to work together in the pursuit of positive outcomes as it relates to the patient.  Stratus can help, within any patient referral – healthcare providers can message one another in the event for example the patients member number is determined out of date, if MRI contrast was never documented, or maybe they simply want to know if PT/ pain cream has been administered.

As a result, we eliminate the need to participate in phone tag, gone are the days in which a physician needs to ask his or her staff to contact a partner practice only to more than likely have a hard time locating the patient record or physician on file for the patient, only to make a simple inquire, with Stratus simply enter the appropriate note on behalf of your practice, improving real time collaboration with ancillary facilities.

Improve MSO Appeal And Marketability

Many of the MSO currently leveraging Stratus do so to some degree because of the increased visibility and marketing power our tool provides.  To remain relevant MSOs need to grow, simply put if your not growing, a competing MSO is and as they do; so does their ability to negotiate contract terms.

One of the major pain points for any healthcare practice today remains how to efficiently manage patient logistics; share patient referrals, attain patient benefits declaration and or current pre-certification status for a given procedure.  The communication of a medical order to a Specialist can take as much as 45-60 minutes for a PCP to execute – we preform the same workflow in 60 seconds.  

In adopting Stratus MSO managers are able to confirm in real time where patients are headed within a Network and encourage providers to share patient referrals between MSO members.

Imagine the power of being able to go to that local cardio facility you’ve always wanted to join the ranks of your MSO and suggest increased patient volume, real time reporting/ analytical resources, not to mention that every patient referred for a consult or surgery can be received within their current EHR (via Comeleon) accompanied by a benefits work up and preauthorization.

Don’t Settle For “Off The Shelf”

The team at Cguros will take the time to personally get to know your Management Service Organization, the goals of your group and work along side your team in the pursuit of an ideal workflow.  Essentially we allow “Meaningful Use” to exist in a practical use environment rather than just a white board.  But to execute upon that promise takes great patients and fortitude, don’t settle for solutions that don’t stack up, designed by unapproachable teams unwilling to add or remove features or functionality for your individual desires.

Refuse To Be just Another Group!

Decide as a group to passionately care about the patients general wellbeing.  The goals of the MSO shouldn’t simply be to elevate PMPM metric rather to collectively achieve a higher standard of care for the patient.  Stratus allows providers to collaborate in real time around a single patient profile so that as patient John Smith inherently travels from primary care physician to Specialist each member of the healthcare ecosystem that interacts with the patient is able to document all relevant order details.

We work in the background to aggregate medical orders, so that when that patient is referred for surgery we can demonstrate to the payer the patient has received, PT, pain cream, Injections, Imaging etc..

Not only does Stratus share HIPAA compliant medical orders between providers in real time we also work in the background to achieve declaration of benefits for the patient along with current pre-certification status for any procedure codes (CPT) or diagnosis coded (ICD)

Stratus Patient Insurance Full Benefits Declaration Includes Both In Network & Out of Networking Analysis 

  • Eligibility Date
  • Eligibility Expiration
  • Co-Pay ($)     In vs. Out
  • Deductible ($)     In vs. Out
  • Deductible Met ($)     In vs. Out
  • Lifetime Maximum ($)     In vs. Out
  • Coverage Insurance (%)     In vs. Out
  • Coverage Patient (%)     In vs. Out
  • Max OOP ($)     In vs. Out
  • OOP Met ($)     In vs. Out
  • Max Imaging Benefits ($)     In vs. Out
    • Pre-Cert Required?     In vs. Out
  • Max PT Benefits ($)     In vs. Out
    • Pre-Cert Required?     In vs. Out
  • Max DME Benefits ($)     In vs. Out
    • Pre-Cert Required?     In vs. Out

Increase MSO Membership | Cloud Architecture

Stratus leverages organic patient kinetics to grow any MSO’s footprint, as patients move from primary care physicians to specialist their patient profile with all relevant orders travels ahead of them.  Within Stratus cloud based environment a single record exist for each patient, as orders are built and communicated between providers the subsequent records are then nested within the all inclusive patient profile.

Resulting in a perpetual record to reference thus allowing provider “A” and provider “B” an to never have to search for or request supporting details critical to the care of the patient.  69% of PCP claim they sent documentation & patient history while 35% of specialty offices say they receive it, 25% of PCP never receive timely information from specialist post referral.  Stratus cures all!

  • Order Details Are all Fully Documented
  • Procedure Results Communicated Instantly.
  • Current Pre-certification Status
  • Current Payer Benefits Analysis
  • Up to Date Patient Contact Information
  • All Relevant Supporting Files (imaging, sleep study etc ..)
  • Gain Transparency, Know in Real Time Your Patients Scheduled at a Given Specialty Practice
  • Know Which Practices & or Which Doctors that Refer into your Facility Result in Patients your Able to Collect on.
  • Which CPT or ICD Codes Result in the Highest Number of Approvals
  • How Long It Takes For Ancillary Facilities to Process Your Referral
  • Insight As To Which Patient Resulted in Profitable Referral

Imagine the power to promote a Managed Service Organization over a competing MSO, Accountable Care Organization (ACO), Hospital or Payer Network when your able share with a local primary care physician a streamlined patient referral software solution that empowers them to share a legal medical order with full declaration of benefits, current pre-certification status to fellow MSO members in real time.

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