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40
MEDICAL BILLING
clinician taking the load off the consultant,
but it's the consultant who should have been
named as the referring doctor.
Medicare accommodates genuine errors
and states that an invoice can only be
reissued if a genuine error has occurred.
This example can therefore be viewed as
falling within that category and, as such,
the most sensible course of action is to call
the hospital ­ which you will inevitably have
to do anyway ­ negotiate being put through
to the consultant, explain to him or her
what has occurred and seek confirmation
that the referral was issued on the relevant
date by him or her. Then correct your claim
and resubmit.
If your efforts reveal the patient came
to you via the emergency department, the
correct referring doctor will usually be the
director of the department or, in the case of
a larger emergency department, one of the
staff specialists.
Miscellaneous requirements
Onafinalnote,therearespecific
requirements for some items ­ such as the
Geriatrician services covered by items
141-147. These must be GP referred and are
very specific regarding reporting back to the
GP. Always check the MBS if you are unsure.
Referrals can now be electronic,
consistent with the provisions of the
Electronic Transactions Act 1999.
Importantly, referrals for outpatient services
in public hospitals are covered by the
National Healthcare Agreement and, as such,
are not the subject of this article.
As a reader of The Private Practice eZine,
you'll already be switched on to the concept
of building your practice as a business asset.
And now you have been assured that there
is no Medicare requirement to specifically
name the specialist to whom the patient is
being referred, this no longer needs to be
viewed as an impediment to building your
practice for sale.
While referrals are a complex but largely
comprehensible aspect of the Medicare
scheme, their role in state-run, public-
hospital clinics is unimaginably labyrinthine
in comparison. As many of us struggle to
reconcile the federal legislation and the
National Healthcare agreement ­ in the
context of regularly changing national-
partnership agreements, contentious Council
of Australian Governments conferences held
by health ministers and the potential impact
of the National Disability Insurance Scheme
­ perhaps we should be thankful private-
sector referrals are fairly straightforward!
Indefinite referrals are intended to be just
that ­ indefinite ­ but most of you will know
this is simply not the case.