Medicare letters to GPs

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As I toiled over the medicare letters to the GPs last week, a colleague (NOT a pod) stated that she does not write any first or final letters to the GPs for their medicare referrals for her services. Her argument is that we should be paid to do so (as are GPs). I wonder what would happen if she were audited?? Is there a penalty for not complying?? Or is it just that the GP never gets feedback, gets annoyed and refers elsewhere?? Anyone know? or am I the only bunny that dutifully writes after the 1st and final visits?

 

It is my understanding that it is a medicare requirement that a letter be provided to the GP and I guess that if she were ever audited by medicare there is the possibility that she/he could be penalised, including having to relinquish her provider number & therefore ot be able to claim under medicare.

Aside from this though I see the professional issue of not writing back to the GP more of a concern. I would think that writing a letter back to any professional who has referred a patient to you is not only good professional practice but also common courtesy. In the majority of cases a letter doesn't take long to write, especially if you have some templates already in place.

 

I think it has more to do with the GP being audited. I had a GP in my area get audited and they required all correspondance with the EPC's, I guess so they can prove they are not dishing them out to everyone.

 

Dear All

I noticed an earlier quote that says GP's get paid to write a letter. News to me after 39 years in the game.

secondly, if you read the agreement you took on with the EPC you are obliged to write a letter.

Another simple point is that it is common curtesy to do so. If I do not get a reply I do not use that provider again, it is that simple.

Finally, if you are looking for a practice package that will generate a letter using a mouse byt the time they have tied up their shoelaces let me know privately, email address included below.

Regards
Paul Conneely
paul@musmed.com.au

 

- yes I realize that (that is why I DO write the letters) but is there a penalty for not doing so? THAT is what got me thinking. Does one forfeit their provider number or just get a slap on the wrist?

Yes posalafin -couldn't agree more-that is why I do follow up with letters (and keep getting more referrals!!)

 

Hi Jos,

I know of a podiatry clinic in Sydney that was recently audited by Medicare. Not sure if they were penalised but I do know that since the audit the owner took considerable amount of time off clinical work in order to write letters back to GPs. The audit was a very stressful process apparently.

It may also interest some to know that the reason for the audit was they were only claiming under the practice owners provider number rather than individual podiatrists' provider numbers who worked in the clinic. This had resulted in a larger than normal number of claims at least on one occasion that I know of and had prompted the investigation.

 

Hi as Paul has said it is a legal requirement but I agree a courtesy as well. We set up a tick and flick box that has been discussed previously on P Arena.

Mr Weed advised when he spoke at a conference that it is also about branding! This is several decades ago. Do you want your referral base to be reading your letter head a dozen times a week or some one elses? )

PS I hope you are fit and well Paul.

cheers

 

I believe that for the claims you have made that can not be supported by all the correct paperwork (reply to referrer on 1st and last appt, assessment notes and appointment of 20min+) Medicare will require you PAY THEM BACK.
I think there is then a judgement on severity of errors, whether they were fraudulent or false claims etc - then the provided number can be forfeited.

Personally, with so much confusion and poor awareness about what is right and what is expected - Medicare has a lot to answer for in education and communication to providers.

There will be a Medicare representative at the Private Practice conference in July discussing these issues. I look forward to notting some of their policies out!

conference details: www.podiatryevents.com.au

 

I have a funny feeling they wont have nay answers for you on policy either. I had a GP call me this morning stating that one of his patients wants to come and see me and they were requesting an EPC referral - he wanted to know what it was all about....

...and if another GP tells a patient of mine that the EPC referral entitles them to FREE Podiatry I am going to go bonkers.

Seriously, if Medicare cannot successfully educate all of us on the use of this service then the service is doomed.

Then again maybe its our own profession we should be angry at for not taking the rope and running with it?

 

OK doing medicare letters can be a bit of a pain at times, but i have to say i would writte back to a Gp as a matter of courtesy anyway.
so whats the big deal?

getting paid for it or not isnt the issue for me.

 

[
...and if another GP tells a patient of mine that the EPC referral entitles them to FREE Podiatry I am going to go bonkers.


ME TOO!!!:craig:

 

It is a requirement by medicare that you respond to the EPC referal in doing so you are commiting yourself to treating the patient. Alot of GP's in our area require us to sign a reatment agreement. It is also required that you send a letter back at the end of the designated treatments with a brief report on your treatment. As also DVA require a new referal annually and the correspondence between podiatrist and GP to be the same. Yes the GP's get audited and the onus is not on them if we have not forefilled our duty of care. The auditors will then move on to the allied health professional that have not complied. I do not know what ramifications this would have on the podiatrist nor do I wish to find out no matter how irritated I get writting referal letters. Yes I am irritated the GP's get paid good money to write EPC's. Some are great and have a detailed care plan. Others scratch their initials on the paper, often with dates and treatment numbers missing. Others dont understand the system, dont have time to understand the system and dont want to waste their time understanding the system and getting involved. I also am irritated that the GP's get an incentive to process medicare claims in their practices. Details of requirements can be found on the medicare disc that was sent out for allied health professionals from medicare.

 

interesting read. I c an assure you that reports/letters are required for all patients, on the initial and final consults. This is a requirement by Medicare !! It is, as has been stated that professional courtesy and professionalism between GP and Podiatrist necessitates a report.
Medicare are auditing allied health professionals and are demanding refunds, in full, per consultation for reports/letters not done in either instance. I know many colleagues who have not done any letters or not all. Recently a friend got audited and is now not only facing large payments back, but also has had the practice visited by 2 Medicare officials who are pulling hundreds of files. I can assure you that he is pulling his hair out.
As several have mentioned, reply correspondence only further re-inforces your name and practice........which gains more growth in the long run

 

I just finished having an audit this morning. They do go over the requirements with a fine tooth comb but do give some small leeway. They supplied me with 20 patients names and than go over each persons file to check number of visits in a nominated time frame, letters are done (1st and last) referrals are valid, and I was the one providing the service.

I asked about referral periods and the confusion medicare cause by giving ten different answers and they said that they were going to bring that up. Overall if you follow the rules it should be reasonably pain free. Boy I was stressed prior to it but.

 

Thanks Tim.

I have been sending a long winded 2 page letter of about 500 words for each patient. I was thinking of downscaling this to a 'tick the box' type letter similar to my initial notes page within the file.

Is this the most common method most people are using? I am just trying to save some time and am finding tweaking each patient within the long winded letter to be too time consuming!

Thankyou!

 

Normally I do a detailed report after the initial visit but have a standard letter indicating that this is the final visit for such and such of their current EPC plan and intend to follow-up with a detailed letter after the initial consultation of their new EPC (the audit suggested adding that this would be an ongoing basis). I personally don't think a tick the box would be sufficient for an audit purpose but I may be wrong.

 

In that case I think I may keep it as is
My final visit letter is standard to all GP's

and unless there is a major change in the treatment plan, if a plan is renewed I simple write to say thanks and the treatment plan will continue as outlined in the initial consultation

 

Hi Tim,

Thanks for that info.

Did the Medicare Bureaucrat supply you with the 20 patient names well before the actual audit ??? -

Or did he arrive and then randomly select 20 patient files ?

Thanks mate.
S.

 

why doesn't someone simply put up a standard letters for EPC to Doc so everyone can have a template

 

Good idea GBC, I look forward to your template
Would be better if Medicare did though!!