Medicare EPC referral?

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Is this allowed...

Sometimes my boss uses EPC referrals when they r not under his name... i.e. the Pt comes in with a referral to Podiatrist - Sally Foot but he not being (Sally Foot) uses it... (Bad??)
I asked my boss about this and he said it doesnt matter because the patient is meant to make the decision in who they see... This makes sense but it seems a little bad practice...?

 

You'd want to write to the referrer first, to let them know this, plus, don't you have to sign the epc agreement?

 

wow 1 reply...

 

Strictly speaking, the referral should accurately represent the treating podiatrists name; if the patient prefers to see a different podiatrist, then they need a new referral. If the patient wants to see someone specific then they should tell the referring GP before getting the plan done.

 

I think there aren't many answers as it's a bit of a no brainer. Best to stick to the system put in place, rather than plead ignorance when you get caught out. I'm sure the original podiatrist does not want their life complicated by having their name on the epc that someone else is using when they make a clinical error etc.

 

The more I think about it, the more I think all EPC should be blank allowing a Patient to come where ever they wish ... I dont know but yeah... Ill tell the patient

 

Interesting and relevant question OneFoot. I trust the following will assist you:

When the practitioner to whom the referral is addressed is not ultimately the practitioner that the
patient attends, the EPC referral is still valid provided the other referral requirements are met.

There is no legislative requirement for validity of an EPC referral to be subject to the provision of the
professional service by the addressee.

Hoping this information is of assistance.

 

Is this taken from the Medicare website or your own interpretation of the matter?

 

Hi Jdunn,

A good question, thanks.

It is official information that I have received in writing from Medicare, when I sought to formally query this identical matter earlier this year.

If you would also like this information formally from Medicare, please send me a private message and I will supply you with the Provider Eligiblility Section email contact address.

Trusting this is of assistance to you.

 

If you have multiple pods working from the same clinic and you want the referral to be used by any pod working there, the easiest way is to have the GP make out the referral either in the clinic name or the blanket term "podiatrist"...In this case, any of the pods working there can use it.
If you use a referral addressed to some other pod down the road, I would suggest informing the GP that the patient wishes to see you and getting their practice nurse to change it and fax it back to you...It can't hurt to keep that channel open between you and the GP's referring. If you can get the GP to start sending more your way then that's to your benefit. The fact that you have to write your letters to the GP, s/he is going to know they didn't refer to you in the first place...that may annoy them that you haven't contacted them about it....they might have a good referral relationship with the pod on the form and not want to refer to you at all...best to make contact and let them know how wonderful you are and that the patient wants to see you.
If you get audited by Medicare and you're using referrals in other pods names, I think you may have issues that would need explaining. Even if it is actually allowed, as mentioned above, when all other referral aspects are in order...do you really want the hassle of having Medicare on your case?
What if there's also a potential issue if the pod who was originally on the form accuses you of poaching their patients? It's the patient's right to choose where they want to go, but if someone gets their nose out it could create unwanted troubles.
I think it's just best to avoid any potential issues and get them to change it...