Medicare Referral Validity: A summary for practice staff

Medicare Referral Validity: A summary for practice staff

Do you know how long an indefinite referral lasts? Do you know the rules about if and when you can bill another initial consult item on a new referral? Practice staff are encouraged to learn the Medicare rules regarding Referrals. Responsibility for the accuracy of medical billing ultimately lies with the servicing provider, however a savvy receptionist can be instrumental in identifying potential billing errors before they even occur, simply by knowing the rules and gently advising the practice manager or the doctor if you believe there is reason to bill differently.

Here are the basic essentials:

  • GP referrals last 12 months (unless clearly marked as “indefinite”) from the date of the first appointment using the new referral. An Indefinite referral can often fail via electronic transmission if it is greater than five years old.
  • Specialist referrals last 3 months from the date of the first appointment using the new referral.
  • A new consultation item can only be billed with a new referral if the patient has not been seen for the same condition within the last nine months.
  • Referrals must be signed and dated BEFORE the appointment date, and cannot be back-dated.
  • No referral = no medicare payment

This information is just a general summary. To get everything you need to know for your practice, read these articles:

  1. Medicare Referrals and Requests
  2. Referrals, initial consultations and Medicare compliance by Michael Wade, Avant Special Counsel – Medicare

Be the billing watchdog for your practice –  reduce lost income for the practice, and improve your Medicare compliance.

Here is another great article on Referrals –

Get going with Genie Software!

Get going with Genie Software!

Do you want to learn some Genie tips? Genie practice management software is a popular choice for specialist medical practice in Australia. It is not the cheapest option on the market – but you truly get what you pay for. The Genie software is the flagship product for Genie Solutions. This established Australian company is a forerunner in the medical practice software race with two key products in the arena: Server-Client Genie and the cloud-based Gentu products.

I have heard a few complaints about Genie being “limited”. That couldn’t be further from the truth! I have spent the last ten years working for Genie Solutions as both an installer/trainer and as the coordinator and author of their national group training program. I have an intimate knowledge of Genie and, now that I am an independent consultant, I am excited to have the opportunity to share a series of hints and tips that will help you to utilise the software to better advantage at all levels of your practice. Let me show you some great hidden functions of the software as I explore the gold-standard of practice management processes in Australia.

Subscribe to our blog for exciting new information about the Genie Practice Software functionality delivered straight to your inbox, and discover what Practice Management Plus can do for your practice.