The Australian Institute of Medical Administration and Compliance
If you work in multiple outpatient locations, and first see the patient in Location A for an initial consult and bill a 110, can you provide a follow up consult from Location B (which has a different provider number) and bill a 116 under the same Medicare referral? Or do you need a separate referral to bill from a different location/provider number?
read more >This question relates to medical specialists exercising rights of private practice in public hospital outpatient departments. The questioner wanted to know if both Dr ABC and XYZ can use the referral in this context, given they are both named on it. In addition, the questioner had received advice that a “named referral” under the National Health Reform Agreement can only have one name on it, not two. The advice was that the referral had to have “a” name on it, and this was therefore an invalid referral.
read more >I have a question regarding the validity of referrals sent via fax without a GP signature. All too frequently the GP gives the client the only signed hard copy and they either lose it or turn up without it. This leaves us chasing a referral. If the receptionist at the GP practice sends us a copy of the referral, they can only do so via fax without a GP signature. Current debate in the professional circles is underway again about whether a referral received via fax without a GP signature is indeed legal under Medicare.
read more >In the last 12 months or so, I’ve had repeated problems with referrals marked “indefinite” by the GP. These will be accepted by Medicare for some time, then randomly start getting rejected. Repeated phone calls to Medicare cannot provide an explanation. As a result, I am tempted to reject indefinite referrals – but GPs just see that as a self-serving request assuming I’m just doing it to increase my billings. An issue mostly for patients as they get very disgruntled when Medicare refuses their rebate, and since the event has occurred, they can’t get a new referral from their GP, since it would have to be backdated. An example was given: An inpatient ECLIPSE claim contained both a 116 and a 13918 on the same date of service, with a valid indefinite referral. Claims for this patient had previously been accepted without issue under the same referral. The 116 claim was rejected by Medicare, but the 13918 was paid. This makes me question whether 13918 and 13706 are item numbers that require a referral at all… Nothing in the item wording says they are a referred item number. Can you advise?
read more >Obstetrician A is going overseas. Obstetrician A’s patients due for delivery while she is away will be looked after by Obstetrician B for antenatal visits billing 16500. Obstetrician B usually works in the same practice as Obstetrician A and sometimes sees Obstetrician A’s antenatal patients billing item 16500. Can Obstetrician B bill for a pregnancy management fee for those patients who are due while she is away using item 16591? Does this scenario qualify as shared caring?
read more >I am a rehabilitation specialist working in a private hospital doing Day Rehab (patients are inpatients as they are admitted for the day). Usually, I see patients on the day they attend therapy (inpatient) however sometimes it is necessary to see them on another day (outpatient). I have access to their inpatient notes, but often there is not a formal referral (e.g., discharge summary states ‘For Day Rehab’). I have read a source that seems to suggest I don’t need a formal referral if I am billing them privately. However, I have read elsewhere that I need a valid referral for every patient (signed, dated, by a specialist or GP etc.). Which is correct?
read more >I am working in a day rehabilitation setting at a private hospital (patients are admitted for the day for allied health interventions mostly after joint replacements and are inpatients when I see them). For patients who have come from an inpatient admission under another rehabilitation specialist, can I charge 110 when I first assess them, or would it be a 116?
read more >No additional context was provided.
read more >If I see patients referred to me in the public clinic, and they are unwell and require admission to hospital at presentation to the clinic as patients with chronic disease sometimes are, do I need a separate referral from the referring GP or other senior doctor to admit them to the private hospital?
read more >This FACEM was planning to open a walk-in emergency clinic similar to a GP urgent care centre. Importantly, this would not be an approved private emergency department (ED). The following scenarios were posed as part of the question. Scenario 1: A 68-year-old female presents to the treatment centre (FACEM lead) post fall and sustains a right wrist fracture & a laceration to her forehead. The patient is assessed by the FACEM which includes history, examination and organising investigations – some blood tests, ECG and X ray. As a part of treatment, the patient requires interpretation of an ECG, reduction of the fracture and application of plaster under a local block, and suturing of forehead laceration under local. Which code applies for the consult, is it 104 or 107? Which code applies for the fracture reduction and plaster application? Which code applies for the local block? Scenario 2: A patient presents with abdominal pain on a Sunday. The patient requires assessment by a FACEM, which includes, history, examination and organising investigations followed by treatment. Is seeing this patient on a Sunday considered an afterhours presentation? If yes, which code applies for the consult?
read more >When a podiatrist has received a referral from a GP to be involved in a coordinated care plan, can their receptionist sign the acceptance of the referral?
read more >The question posed was: “Cardiologist, Dr Z, performs a procedure (permanent pacemaker implant) at hospital A (provider number 1), but would like to see the patient for ongoing care/follow up at practice B (provider number 2). Can Dr Z self-refer for the follow up visit?”
read more >A hospital billing manager asked: If we have a public inpatient that is discharged from the brain injury unit to the outpatient clinic for follow up (at this point no previous Medicare billing would have taken place as they were a public patient) and the GP writes a specific referral for the patient to see a specialist post inpatient discharge (different specialist from their inpatient stay). The patient is seen in the outpatient clinic for > 1 hr. Can we bill a 132, given that no previous billing has occurred? The factors here are that the patient is referred to a new service by a GP; no previous 132 has been raised.
read more >Doctor A was a rehabilitation physician working in a public hospital day rehabilitation unit. Prior to patients commencing the day rehab program (where they are admitted inpatients on each day they attend), they have an initial outpatient visit to determine their eligibility for the program. The referrals from the GPs always name one of the rehabilitation specialists. Doctor A wanted to know whether Doctor B could see the patient for the initial outpatient assessment even though the referral was to Doctor A.
read more >This is a common question. Who should the referrer be in these circumstances?
read more >Dr A was unsure about correct referral pathways for patients transferred to a private hospital after an episode of care in a public hospital, and how such patients should be billed.
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