By DigiMed Australia
There are 20 million + GP referrals to specialists issued every year in Australia.
Here’s a quick update on everything doctors, practice managers and patients need to know about specialist referrals.
1 In Australia referrals from GPs to any medical specialist last for 12 months.
2 Any referral from a GP to a specialist is valid from the first service date of the specialist visit, NOT the date the GP wrote it.
3 Referrals from specialist to specialist are only valid for three months.
4 However if the patient cannot get to see the specialist for up to 12 months it should still technically be valid for three months after the first specialist appointment.
5 Patients do not need a referral to see a medical specialist but they do need one if they wish to claim a medical rebate.
6 The initial referral:
· Covers a single course of treatment for a patient, including the initial attendance by the specialist and continuing management and treatment until the patient is referred back to the referring GP
· Any subsequent reviews of patients within 9 months of the period of validity of the last referral.
7 Initial charges are higher for first specialist appointment, and the initial fee should not be charged with subsequent appointments. However, an initial attendance item can be billed if:
- The referring practitioner decides the patient’s condition needs to be reviewed, and
- The patient is seen by the specialist or consultant physician after the expiry of the last referral
- The patient was last seen by the specialist or consultant physician more than 9 months earlier
- If the patient has a new or unrelated condition
8 In some circumstances, where patients have a “chronic” condition such as arthritis or depression, GPs can write an indefinite referral “eg please see patient indefinitely for ongoing treatment of arthritis.”
Where an indefinite referral exists, a specialist or consultant shouldn’t request (and a GP shouldn’t issue) a new referral which attracts a higher initial fee charge - unless a new condition has developed.
9 If a patient’s referral is lost destroyed or stolen, it is valid for only one attendance on the patient.
A valid referral must be received before any subsequent services are billed. According to the Department of Human Services the account receipt or assignment must include the referring medical provider’s name, address and provider number and the words “lost referral”.
10 It is unlawful for GPs to backdate medical referrals (despite pressure from patients whose initial referral may have expired).
Further Reading
AMA Medical Requirements or referrals to Specialists
The Medical Republic – Everything You Need to Know About Referrals 16 referrals per 100 GP consults Practice In Australia
145 million episodes of care in Australia by GPs in 2016
