You have legal obligations when you bill a referred or requested service to Medicare.
There are rules you need to meet when referring a patient to a specialist or consultant physician for treatment.
Read more about referrals for specialist treatment on the MBS online website.
You can refer patients for allied health services under the following initiatives:
- Chronic Disease Management Plan
- Better Access to psychiatrists, psychologists and general practitioners
- Eating disorder treatment and management
- Complex neurodevelopmental disorders and eligible disabilities
- follow-up services after Aboriginal and Torres Strait Islander health assessments.
Requests for diagnostic imaging services must include:
- the requesting health professional’s full name, provider number or practice address
- the date of the request
- a description of the services requested.
Requests for diagnostic imaging services do not expire and are valid until the service has been performed. There is no requirement for the requesting health professional to sign a request.
A single request may be used to order multiple diagnostic imaging services. For Medicare benefits to be payable, all services must be rendered within seven days of the first service.
Patients choose their own diagnostic imaging practice and don’t need to give a request to a specific practice.
Read more about requests for R-type diagnostic imaging services on the MBS Online website.
The terms ‘request’ and ‘referral’ are often used interchangeably. Requests apply specifically to diagnostic imaging and pathology services. Referrals apply to specialist and consultant physician consultation items.
Read more about Requests for diagnostic imaging services versus referrals for other services under Medicare on MBS Online website.
Requests for pathology services must include:
- the patient’s name and address
- the patient’s hospital status
- the requesting health professional’s full name, provider number and practice address
- a description of the services requested
- the date of the request.
Patients can choose their own Approved Collection Centre if there’s no clinical need for a specific pathologist or Accredited Pathology Laboratory to do the service.
Read more about Responsibilities of Treating and Requesting Practitioners on the MBS Online website.
When sending or accepting electronic referrals and requests between parties, you have legal obligations as stipulated in the Electronic Transactions Act 1999. Section 10 has information about electronic signatures..
You can use electronic means when you’re required or permitted under Australian Government law to:
- provide information in writing
- provide a signature
- produce a document in material form
- retain information.
You must save, store and retain access to electronic referrals or requests so you can retrieve them unaltered. Your records may need to be checked in the event of an audit.
Read more about electronic transactions on the Attorney-General’s Department website.
Your legal obligations when you bill a referred or requested service to Medicare are outlined in the following legislation:
- Health Insurance Act 1973.
- Health Insurance Regulations 2018.
- Health Insurance (Pathology Services Table) Regulations 2020.
- Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.
- Health Insurance (General Medical Services Table) Regulations 2021.
- Health Insurance (Allied Health Services) Determination 2014.
- Electronic Transactions Act 1999, refer to Section 10.