Richard Hosking wrote:
Most of my indefinite referrals are not accepted - the patient is asked
to get a new one - does it have something to do with the higher rebate
for a new referral?
The Medicare rules for this seems to be a bit complex:
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=6&qt=NoteID
"6.7 Definition of a Single Course of Treatment
6.7.1 A single course of treatment involves an initial attendance
by a specialist or consultant physician and the continuing
management/treatment up to the stage where the patient is referred back
to the care of the referring practitioner. It also includes any
subsequent review of the patient's condition by the specialist or the
consultant physician that may be necessary. Such a review may be
initiated by either the referring practitioner or the
specialist/consultant physician.
6.7.2 The presentation of an unrelated illness, requiring the
referral of the patient to the specialist's or the consultant
physician's care would initiate a new course of treatment in which case
a new referral would be required.
6.7.3 The receipt by a specialist or consultant physician of a new
referral following the expiration of a previous referral for the same
condition(s) does not necessarily indicate the commencement of a new
course of treatment involving the itemisation of an initial
consultation. In the continuing management/treatment situation the new
referral is to facilitate the payment of benefits at the specialist or
the consultant physician referred rates rather than the unreferred rates.
6.7.4 However, where the referring practitioner:-
(a) deems it necessary for the patient's condition to be
reviewed; and
(b) the patient is seen by the specialist or the consultant
physician outside the currency of the last referral; and
(c) the patient was last seen by the specialist or the
consultant physician more than 9 months earlier
the attendance following the new referral initiates a new course of
treatment for which Medicare benefit would be payable at the initial
consultation rates."
I think that this is saying that the higher initial consultation
benefits are payable for seeing a referred patient with a new problem or
for the same problem if the previous referral has expired and it is at
least nine months since the specialist last saw the patient.
Do you suspect that specialists who insist on new referrals for
continuing to see a patient for the same problem are fraudulently using
the initial consultation item number for the first visit after each of
these new referrals, even though the service does not quality for this?
--
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683
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