Medicare oversees doctors’ referral and prescribing patterns and doctors can be prosecuted if they contravene Medicare guidelines for appropriate practice. Most people are completely unaware of this and assume it is a simple matter for doctors to generate repeat scripts and referrals. Not so!
Did you know that doctors can be prosecuted because it is illegal for them to issue backdated referrals? This means that you should never think of seeing a specialist unless you know you have a current and up to date referral. Like everything in our busy lives, this means that you really need to think ahead, and regrettably, often specialist reception staff may not have reminded you. Regardless, since we as doctors can be prosecuted, we cannot help you ‘after the event’.
Many people completely forget to ask for a referral and turn up at their specialist without one and only then think to speak to us. Other times, people ring and can be quite unhappy that reception staff suggest that they may need to see their doctor. Here are some of the points that responsible, ethical outcome focused, health professionals have to think about when writing referrals:
– Who is the specialist you would like to see?
– Does your doctor know anything about it?
– What is your exact medical condition that means you need to see a specialist?
– Is it the same as it was a year ago when your initial referral was issued?
– Has your specialist been in contact with the GP, and do we have up to date information concerning the management of you and your condition?
– Does your specialist know of recent health events or changes in medications that may have occurred since you were last seen?
– Do you still need to see that specialist?
– Is there another approach to your problem that could be better?
– Are we aware that your specialist may no longer be working in the area that they used to?
– Are they the best person to be managing your condition? Or do we have new information that would suggest otherwise?
– Does your referral fall within Medicare guidelines?
For these and many other reasons, you need to make an appointment to discuss referrals.
For your information, GP referrals to specialists last 12 months.
Continuing and ongoing indefinite referrals
People often ask us about these. Medicare will recognise a referral like this if you see a specialist more than twice per year. That means that if you are only going once a year, Medicare will require that you have a new referral issued every 12 months.
Specialist to specialist referrals
Once again, people often ask us about these. This situation arises when you see a specialist and they decide that they are not the right person to solve your problem, and they think you should see a different type of consultant. A good example of when this can occur, is if you are admitted to hospital in an emergency under one type of specialist and once your diagnosis becomes clearer, you are sent to see someone else. The Medicare Legislation only allows those referrals to last 3 months, so if you need to continue to see that second specialist, you will need a new referral from you doctor.
Problems arise when patients know nothing about this and are not told by the specialist’s receptionists when they make their appointment. It becomes even more complicated if we, as your doctors, know nothing about it, and that can easily happen. If we have no information whatsoever in your file, we cannot issue a referral and you will need to come in. This seems to stress people a lot but regrettably, for all of this we must blame Medicare.
It may be of interest to you to know that you can see a specialist at any time without a referral, but if you choose to do this, you will only get back from Medicare the amount that you would if you saw a GP.
As you can see from reading the above information, when you come in to see the doctor it could end up being a complex consultation. If that is the case, you will be billed for a standard consultation.
Very occasionally, if things can be dealt with rapidly, without complexity and the doctor is able to update your records in a brief time, the fee charged may result in an out of pocket cost to you of less than $20.00.