The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.
In Australia you don’t need a Referral to see a (sub-) Specialist. So, say you wanted to see a Plastic Surgeon about a skin lesion, you can just find a Plastic Surgeon on the internet or ask a friend and make an appointment and off you go. But be prepared for a bill – sometimes a really big bill. This is because, you won’t be able to access a Medicare rebate for the Plastic Surgeon’s fees. To do so you need to first have a valid referral from your GP. But it is not as simple as just calling your GP and asking for a referral.
Referrals from a GP are valid for 12 months whereas referrals from one sub-specialist to another are only valid for 3 months (for example when the surgeon that fixes your knee refers to the medical specialist to look after your heart). GPs can also do INDEFINITE referrals – for when you are seeing the same sub-specialist for the same problem for a long period of time (for example when a heart specialist is looking after an ongoing heart problem). Remember though, often your GP can manage your ongoing conditions very well together with your sub-specialist – saving you money and making it more convenient for you!
There are, however, rules!
As a Referral is a legal document, Medicare does not permit backdating a Referral.
A Specialist can see a patient without a valid referral only in an emergency. Apparently, if your dog ate your referral, or another good excuse, there is a exemption available for you to claim your rebate if the Specialist notes that the “Referral is lost”. I am sure that Medicare would get suspicious if this happened a lot. Medicare do audit what GP’s and Specialists get up to make sure the rules are being followed. There are fines for not following the rules!
If you need a Referral make sure you see your GP before seeing the Specialist if you wish to get a Medicare rebate for the service. Asking your GP for a backdated Referral is like asking the Specialist to forward date your consultation so you can get a Referral. Both are not permitted under Medicare.
Backdating a referral is stating, in writing, that the doctor saw the patient BEFORE they actually did. Therefore…
Seeing a patient on Friday and writing a referral to a sub-specialist dated Monday for a consult that occurred on Tuesday is FRAUD.
Seeing a patient on Friday and providing a certificate dated Friday stating that the patient says they were unwell Monday and Tuesday is legally OK.
Some more rules and regulations.
So when You need a referral – or it’s time to manage Your health more conveniently – You can see any of our Great GPs right here: