If a consultant treats a patient based on a referral that has the intern/resident/registrar listed as referring doctor, and then submits a claim to Medicare for services provided, the claim will not be paid.This is most commonly due to the fact that the referring provider number is not valid.
Where an indefinite referral exists, a specialist shouldn’t request, and a GP shouldn’t issue, a new referral unless a new condition has developed.It is anticipated the some of the rules may be clarified as part of the current MBS review, the final report of which is expected by the end of 2016. A referral is necessary to make sure Medicare Benefits are paid at specialist or consultant referred rates, rather than at unreferred rates.In other words, patients do not need a referral to see a specialist, but they do need one to attract the relevant Medicare rebate. The Health Insurance Regulations state that a practitioner must ‘consider the need for the referral’, and then must provide the specialist any information about the patient’s condition that the referring practitioner considers necessary.Note the referral period begins on the date of the first specialist visit, not on the date the referral was written.This is frequently misunderstood, including by specialists and their receptionists. According to medical defence organisation Avant, the issuance of a new referral due to a previous referral expiring does not entitle the specialist to bill for another initial consultation service (but rather a “consequent” consultation, which attracts a lesser sum), unless it is at least nine months since the patient was last seen for that condition and the referring practitioner deems further review necessary.