It is a busy afternoon, and a patient phones you asking for a referral for a follow-up specialist appointment she attended a month earlier. You had initially referred her to the specialist and that referral had expired.
The patient is at the Medicare office trying to claim a rebate for the specialist visit, and explains that Medicare would not pay a claim for the specialist consultation because the referral was out of date. GPs often feel caught in the middle this scenario arises. They can feel an obligation to help their patient who will otherwise be left out of pocket without a current referral.
However, there is no leeway in this situation.
It is unlawful to backdate a referral and GPs should not agree to such requests. Under the provisions in the Commonwealth Health Insurance Act, stiff penalties can apply for making false or misleading statements in relation to Medicare.
A valid referral is required before a specialist can itemise the consultation so the patient is eligible for Medicare benefits. Referrals from a GP to a specialist last for 12 months unless otherwise specified. If the specialist on-refers to another specialist, the specialist referral is
Backdating specialist referrals spelling valid for three months.
An indefinite referral to the specialist or consultant physician can be provided where appropriate. However, if a patient on an indefinite referral has a new or unrelated condition, the GP must issue a new referral for that condition, even if for the same specialist. In some situations, provisions are made for Medicare benefits to be paid if a referral has been lost, stolen or destroyed.
In those cases the patient must declare to the specialist that a referral was completed by a referring practitioner, but was not delivered to the specialist because it was lost, stolen or destroyed. The patient must be able to provide to the specialist the name of the referring practitioner and the practice address or the provider number of the referring practitioner.
There are also situations where referrals are not necessary, such as pre-anaesthetic consultations, emergencies and referrals of private patients in hospital. GPs can introduce risk management strategies in a bid to avoid requests for backdated referrals from patients:.
This article was first published in Medical Observer. Read the original article here. We welcome your feedback on this article — email the Editor at: What to do when a patient requests a backdated referral.
Share your view We welcome your feedback on this article — email the Editor at: In other words, patients do not need a referral to see a specialist, but It is against the law for a GP or referring doctor to backdate a referral. I even asked if there was a locum doctor or something I could see but.