The Medicare requirements for referrals to specialists and consultant physicians has been released by the Australian Medical Association which has been compiled to explain, in the simplest terms, the Medicare benefits rules for referrals and the implications of not adhering to them.
1. Referrals must be made in accordance with the regulations – Relevant Provision
2. Referrals must be in writing, signed by the referring practitioner and dated – Relevant Provision
3. A referral covers a single course of treatment for a patient, being
– the initial attendance by the specialist or consultant physician;
– the continuing management/treatment until the patient is referred back to the care of the referring
practioner; and
– any subsequent review of the patient’s condition that occurs within 9 months after the period
of validity of the last referral – Relevant Provision
4. The period of validity of referrals is clear and can be managed by the practice without exposing the referring practitioner, specialist or consultant physician to penalties – Relevant Provision
5. Accounts for medical fees must contain particular information for a Medicare benefit to be paid – Relevant Provision
6. Accounts for referred services must contain the date on which the service was given and the date on which the patient was referred – Relevant Provision
7. Provision is made for situations when referrals are lost, stolen or destroyed – Relevant Provision
8. Because the referral must be received before the service is provided, any back dating by the referring practitioner would be a false statement capable of being used to claim a benefit – Relevant Provision
9. There are 3 penalty provisions for making false or misleading statements capable of being used to claim a Medicare benefit. Knowingly making a false or misleading statement carries a much higher penalty than accidentally making a false or misleading statement – Relevant Provision
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