Context
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?
