How to track physician referrals

Manage physician referrals with a CRM, spreadsheet or EzHCRM (fax based). Make sure you understand the stages a referral goes through.

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Almost every EMR comes with some form of referral management. If you get referrals from EMR to EMR, you can track referrals there.

However, I have found that it doesn’t allow you to track referrals as in a CRM. Tasks, followups, reminders etc are not easy to do in EMR referral modules.

There are several ways you can tackle this (in a HIPAA secure manner)

  1. You can use 3rd party referral management tools. However, they don’t talk to each other and not everyone uses them.
  2. You can use a spreadsheet to manage your referrals
  3. My favorite – You can track, manage, stay on top of referrals by attaching EzHCRM to your referral fax number. This way, you can be using your own EMR’s referral module, use third party referral software, get referrals via faxes etc.

However you are managing referrals, especially if you are using a spreadsheet, understand the following and you will be well on your way.

What are the stages of a physician referral?

When a referring provider refers a patient to a specialist doctor using fax or referral software, the referral goes through the following referral stages.

Pending/Not Scheduled referral

When an appointment request (referral) is received, the referral is in “Not Scheduled” or “Pending” status.

This is called the “Request backlog” for the referral managers and referral coordinators of the referred to doctor’s office.

It is their job to call and convert these patients into appointments.

Sometimes this is outsourced to a call center.


Unless someone is using a referral software to track all these referrals, or using a spreadsheet to track these (like a CRM), it is nearly impossible to manage how many referrals came in, how many are in pending status etc.

On top of this, the referring provider also wants to know “what’s the status of my referral”.

So they have to be called/emailed/faxed for updates (patient didn’t pick up the phone or patient declined to make an appointment or patient phone number is wrong or patient line was busy etc).

Scheduled Referral

The specialist/ Referred to doctor’s office calls patient to try and set an appointment. 

If the patient picks up the phone, the specialist office makes an appointment for the patient.

This is when the referral gets to the Scheduled status.


Only 20-30% patients actually pick up the phone. So, if in 1 day, you get 100 referrals, only 30 patients pick up the phone.

So, the next day, you have to call 100 patients of next day + 70 patients that didn’t pick up the phone the last day.

On top of this, the referring provider also wants to know “what’s the status of my referral”.

So they have to be called/emailed/faxed for updates (scheduled).

Referral No Show

After a patient makes an appointment, the patient needs to be reminded to keep the appointment.

If they don’t show up, the referred to doctor would lose that time slot and won’t make money for those 15 mins (each appointment is usually 15 mins).

To make sure patients show up, the doctor’s office staff (sometimes a call center) send SMS appointment reminder to the patient 1 week before, 2-3 days before etc.

This can typically be done via the EMR or PMS as well.

One challenge is that not all patient phone numbers are mobile numbers. So, appointment reminder text messages are not always delivered. Choose a software that allows you to leave voicemails automatically.

Some practices, call the patient the day before the appointment and if they cannot reach the patient, they call the patient on the day of the appointment as well.

If the patient does not show up for their appointment, this appointment/referral gets to a No Show status. 

Problem –

Every day about 10-35% of the patients do not show up. These patients are now in the “Request backlog” for the staff to call again and try to set up another appointment with them.

So, now, every day, you have to call much more than 100 patients.

Every day the patients have to be called and reminded to come in for their appointment.

This also adds to the patient call/request backlog. On top of this, the referring provider also wants to know “what’s the status of my referral”.

So they have to be called/emailed/faxed for updates (no-show).

“Patient seen” Referral status

When the patient actually shows up for the appointment, the patient referral is marked as Patient Seen.

At the end of the day or asap, the doctor that saw the patient will write up the encounter / visit / consult notes in their electronic medical record software (e.g. EPIC, eclinicalworks, Modernizing Medicine, CareCloud, Cerner, AthenaHealth, Allscripts, CureMD, GE Healthcare, Practice Fusion).

This note needs to be sent back to the referring doctor.

Problem –

Every day, if you are seeing 100 patients, you will have to send 80+ visit notes back to referring doctors (not all patients are from referrals).

Someone needs to keep track of who is sending these visit notes back to the referring providers or not.

Some people send faxes and some people mail these visit notes (postal mail) and some email them (not HIPAA secure).

Someone needs to keep track of whether mailing these visit notes or faxes is actually happening or not. This is an arduous task to keep up with using paper or spreadsheets.

Hopefully this helps you get a better handle on managing physician referrals.