We get the following questions with regards Referrals a fair bit:
Why is your Referral screen missing the Letter Date/Initial Consult Date/Expiry Date? Please add this second date in!
My claims with indefinite Referrals keep getting rejected and I don't know why? It was on 12 months, but I changed it to indefinite and have resubmitted, but it doesn't work.
With regards to Dates, some even ask for all 3 dates. So, this is an area where we plan on making some changes soon (although I couldn’t give an exact time frame).
That said, the current system of one date is manageable if you understand how the software and Medicare use referrals:
- The Referral Date is the Letter Date.
- Medicare check the validity of the Referrer’s Provider Number as at this Referral Date.
- Medicare do not require the Initial Consult Date – they work that out automatically from the Service Date.
- The Expiry of a Referral is based on the Initial Consult Date + X Months. Again, that’s something that Medicare work out automatically.
The advantage of the one date system is that it’s simple. If you use the Letter Date, it will allow you to claim successfully with Medicare without any issues (i.e. the Referring Provider Number will always be valid as at the Letter Date).
Historically some users have been advised to set the Referral Date in Medilink to be the Initial Consult Date, which is incorrect, but possibly done due to the Expiry problem (see below).
By default, Medilink has always calculated the Expiry as the Referral Date + X Months, which is not how Medicare do it.
This problem can be rectified by turning on File Menu >> General Options >> Calc Referral Expiry On First Serv (4th col, 7th from top).
Note | It’s worth pointing out that some users leave this setting off because the Letter Date + X Months is usually a pretty good estimate of Expiry, and for performance reasons (it is a little slow because it must then check to see when that Referral was first used, which might take a second or two every time you bring up that patient).
The fact that Medicare automatically calculate the Expiry raises another issue you need to be aware of.
For example, if you were to create a Referral for 12 months, but a year later realize it should have been an Indefinite Referral, unless you fax Medicare the Referral Letter and ask them to update the Expiry Date, you will start getting rejections for claims with that Referral. Why? Because Medicare have already calculated the Expiry from the Initial Consult that used that Referral, so you changing the Referral Period for subsequent claims does nothing.
That’s why nowadays we grey out the Period field for existing Referrals, and you must click Edit Period when you want to change the Referral Period (and there’s a little button next to it that explains the situation).