Referrals

When an obstetrician takes over the care of another obstetrician’s patients while they are on leave and intends to undertake the births is that shared care?

5 October 24

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?

Do specialists need a valid referral to claim referred services for every private patient they bill?

30 September 24

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?

Should I bill an initial consultation or a follow-up the first time I see a patient in day rehab whose admission was under one of my rehab colleagues?

30 September 24

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?

Do I need a specific referral to admit the patient privately for every episode requiring admission?

27 September 24

No additional context was provided.

If a patient presents at a public hospital outpatient clinic with a named referral from their GP and needs admission but wants to go to a private hospital, is a new referral required?

27 September 24

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?

Can a fellow of the Australasian College for Emergency Medicine (FACEM) bill MBS codes outside of a private emergency department?

24 September 24

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?

Can a podiatrist’s receptionist sign the acceptance of a GP referral?

24 September 24

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?

Can a cardiologist self-refer to follow up a patient post discharge from hospital?

24 February 21

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?”

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

28 January 21

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.

Can I take over a named referral in a public hospital outpatient setting if I am of the same specialty?

22 January 21

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.

What constitutes a referral from the Emergency Department to an inpatient medical unit?

20 January 21

This is a common question. Who should the referrer be in these circumstances?

Can I bill a private patient in a private hospital who was transferred from a public hospital, and who should the referral be from?

20 January 21

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.

How do in-hospital referrals work?

20 January 21

A specialist doctor asked how the various specialists below should claim for their services in this very common scenario. Patient attends the Emergency Department (ED). The ED Dr refers the patient to Dr A and Dr B (of different specialties) for inpatient management of a complex presentation. Dr A performs an initial consultation and is then covered for a few days by Dr C. Dr B performs an initial consultation, which identifies another problem requiring the expertise of Dr D. At the end of the admission, there are outstanding specialist issues that require outpatient follow-up with Drs A and D. 1. Should all four specialists bill using the in-hospital override for all consultations? Can A, B and D all claim a 110 or 132 as reflective of the service they provided? 2. If C identifies a new issue that requires assessment and a change in treatment, can C claim an in-hospital 110 (non locum tenans)? 3. If A and D use an in-hospital override for inpatient claims, and then receive a subsequent Medicare-compliant referral for outpatient review of the issue(s) managed during the admission, does the outpatient review occur “after the end of the period of validity of the last referral to have application” (because the last referral expired at hospital discharge). If so, can they claim a 110?

In a public hospital outpatient clinic does a referral to “Dear Specialist” enable Medicare bulk billing?

21 September 20

Question: If a clinic receives a referral to “Dear specialist” can this be used by anyone in that practice? Or if it comes to a named specialist, can that validly be used by another provider in the same practice? These are privately referred non-inpatient in a public oncology setting that is bulk billed.

Are inpatient and outpatient episodes considered as separate for billing purposes, so that when a patient is discharged a new episode of care automatically commences?

26 August 20

Question: If the same treating rehab physician sees a patient following discharge in their outpatient rooms, can this be billed as a 132 (obviously with a relevant referral), or is it a 133/116 depending on other factors? I’m just not clear if the inpatient and outpatient episodes are to be considered in isolation of each other.

Is a written handover sheet a valid inpatient referral between specialists covering each other on weekends, or does it have to be a formal letter?

4 August 20

Doctor A was a respiratory and sleep physician who had been trying to obtain clarity around this question. The question specifically related to weekend cover when doctors are rostered to cover each other’s admitted patients on a rotating basis. Doctor A said that some groups and individuals seem to apply and interpret the requirements differently, which was of concern to them.

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Topics

Specialities

Referrals

When an obstetrician takes over the care of another obstetrician’s patients while they are on leave and intends to undertake the births is that shared care?

Do specialists need a valid referral to claim referred services for every private patient they bill?

Should I bill an initial consultation or a follow-up the first time I see a patient in day rehab whose admission was under one of my rehab colleagues?

Do I need a specific referral to admit the patient privately for every episode requiring admission?

If a patient presents at a public hospital outpatient clinic with a named referral from their GP and needs admission but wants to go to a private hospital, is a new referral required?

Can a fellow of the Australasian College for Emergency Medicine (FACEM) bill MBS codes outside of a private emergency department?

Can a podiatrist’s receptionist sign the acceptance of a GP referral?

Can a cardiologist self-refer to follow up a patient post discharge from hospital?

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

Can I take over a named referral in a public hospital outpatient setting if I am of the same specialty?

What constitutes a referral from the Emergency Department to an inpatient medical unit?

Can I bill a private patient in a private hospital who was transferred from a public hospital, and who should the referral be from?

How do in-hospital referrals work?

In a public hospital outpatient clinic does a referral to “Dear Specialist” enable Medicare bulk billing?

Are inpatient and outpatient episodes considered as separate for billing purposes, so that when a patient is discharged a new episode of care automatically commences?

Is a written handover sheet a valid inpatient referral between specialists covering each other on weekends, or does it have to be a formal letter?

Topics

Specialities

Referrals

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