- Payment Rules in the Referral-Consultation Process<\/a><\/li><\/ol>\n\n\n\n
- Overview of the Referral-Consultation Process<\/a>\u00a0\u00a0<\/li><\/ol>\n\n\n\n
<\/p>\n\n\n\n
1. MSP Billing Definitions for the Referral-Consultation Process <\/h2>\n\n\n\n
Let\u2019s start off with defining the terms of the referral-consultation process as defined by the Ministry. <\/p>\n\n\n\n
Consultation<\/strong> <\/h4>\n\n\n\n
A consultation applies when a medical practitioner or health care practitioner, in light of his\/her professional knowledge of the patient and because of the complexity, obscurity, or seriousness of the case, requests the opinion of a medical practitioner competent to give advice in this field. Essentially, a consultation is the consultant\u2019s response to a referral. <\/p>\n\n\n\n
In this context, the term \u201chealth care practitioner\u201d includes: <\/p>\n\n\n\n
- Chiropractor, for orthopaedic consultations; <\/li>
- Midwife, for obstetric or neonatal consultations; <\/li>
- Nurse practitioner; <\/li>
- Optometrist, for ophthalmology consultations; <\/li>
- Optometrist, for neurology consultations for suspected optic neuritis or <\/li><\/ul>\n\n\n\n
- Amaurosis fugax or anterior ischemic optic neuropathy (AION) or stroke or diplopia; <\/li>
- Oral\/dental surgeon, for diseases of mastication; <\/li>
- Registered nurse or registered psychiatric nurse, for addiction medicine or <\/li>
- Psychiatry consultations for substance use conditions. <\/li><\/ul>\n\n\n\n
Aside from the regular full consultation, there are also limited and special consultations. <\/p>\n\n\n\n
Limited Consultation <\/strong> <\/h4>\n\n\n\n
A limited consultation requires all the components expected of a full consultation for that specialty but is less demanding and normally requires substantially less of the medical practitioner\u2019s time than a full consultation. <\/p>\n\n\n\n
Special Consultation <\/strong> <\/h4>\n\n\n\n
A special consultation applies when an ophthalmologist, neurologist, pediatric neurologist, or neurosurgeon refers a patient to an ophthalmologist for special examination, or when an ophthalmologist refers a patient to another ophthalmologist where a decision regarding medical or surgical treatment is complicated and requires extra consideration, judgment, and implementation of specialized knowledge and experience. <\/p>\n\n\n\n
Referrals <\/strong> <\/h4>\n\n\n\n
A referral is a request from one practitioner to another practitioner to render a service with respect to a specific patient. Such service usually would be a consultation, a laboratory procedure or other diagnostic test, or specific surgical\/medical treatment. <\/p>\n\n\n\n
Transferals<\/strong> <\/h4>\n\n\n\n
A transferal involves the transfer of responsibility for the care of the patient temporarily or permanently. When one medical practitioner is going off call or leaving on holidays and is unable to continue to treat his\/her cases, medical practitioners who are substituting for that medical practitioner should consider that the patients have been temporarily transferred (not referred) to their care. <\/p>\n\n\n\n
2. Payment Rules in the Referral-Consultation Process <\/h2>\n\n\n\n
There are specific payment rules that referring physicians must follow for consultations, referrals, and transferals. <\/p>\n\n\n\n
Payment Rules for Consultations<\/strong> <\/h3>\n\n\n\n
To request the opinion of a medical practitioner for advice, the practitioner must provide the following requirements: <\/p>\n\n\n\n
- A letter of referral that includes: <\/li><\/ul>\n\n\n\n
- The reason for the request <\/li><\/ul>\n\n\n\n
- Relevant background on the patient <\/li><\/ul>\n\n\n\n
- Notify MSP of the referral and include: <\/li><\/ul>\n\n\n\n
- The practitioner number of the specialist who the patient is being referred on their associated FFS claim <\/li>
- Note: If there is no FFS claim, the physician must send a \u201cno charge referral\u201d claim under fee item 03333 to MSP <\/li><\/ul>\n\n\n\n
- Generate the report within 2 weeks of the date-of-service. <\/li><\/ul>\n\n\n\n
The consultation includes the initial services of a consultant necessary to enable him\/her to prepare and render a written report, including his\/her findings, opinions, and recommendations, to the referring practitioner.
<\/p>\n\n\n\nOther Requirements for Consultations <\/strong> <\/h4>\n\n\n\n
- Consultation cannot be claimed unless it has been specifically requested, and the written report is rendered. <\/li>
- Consultation for the same diagnosis is not normally payable as a full consultation unless an interval of at least six months has passed since the consultant has last billed a visit or service for the patient. <\/li>
- For consultations and\/or other specialty limited services to be paid by MSP, the medical practitioner rendering the service must be certified by or be a Fellow of the Royal College of Physicians and Surgeons of Canada and be so recognized by the College of Physicians and Surgeons of British Columbia. <\/li><\/ul>\n\n\n\n
Limited Consultation<\/strong> <\/h4>\n\n\n\n
It is expected that the limited consultation, when medically necessary and specifically requested, will be billed as part of continuing care, and that a full consultation is not billed simply because of the passage of time. <\/p>\n\n\n\n
A new and unrelated diagnosis can be billed as a full consultation without regard to the passage of time since the consultant has last billed any visit or service for the patient. <\/p>\n\n\n\n
A limited consultation may be payable within the six-month interval, if medically necessary and a consultation has been specifically requested. <\/p>\n\n\n\n
Special consultation<\/strong> <\/h4>\n\n\n\n
Specific additional conditions may apply to specific types of consultation, as designated in the Preamble to the pertinent section of the MSC Payment Schedule and\/or the notes to the specific listings. <\/p>\n\n\n\n
Payment Rules for Referrals<\/strong> <\/h3>\n\n\n\n
A referral is required to bill any consultation. The referring practitioner must provide the following requirements: <\/p>\n\n\n\n
- There can be only one consultation for any one referral. Another consultation will require a second referral. <\/li><\/ul>\n\n\n\n
- When the medical practitioner to whom a patient has been referred makes further referrals to other medical practitioners, it is the usual practice that the original referring medical practitioner be informed of these further referrals. <\/li><\/ul>\n\n\n\n
Note: Referrals, once accepted, do not expire. Once a referral is accepted it remains valid until the consultation is performed. <\/p>\n\n\n\n
Payment Rules for Transferals<\/strong> <\/h3>\n\n\n\n
For transferals, the practitioner must provide the following requirements: <\/p>\n\n\n\n
- The medical practitioner to whom a patient has been transferred normally should not bill a consultation for that patient. However, when the complexity or severity of the illness requires that the medical practitioner accepting the transfer reviews the records of the patient and examines the patient, a limited or full consultation may be billed when specifically requested by the transferring medical practitioner. <\/li><\/ul>\n\n\n\n
- A new consultation is not allowed when a group or physicians routinely working together provide call for each other. <\/li><\/ul>\n\n\n\n
3. Overview of the Referral \u2013 Consultation Process <\/h2>\n\n\n\n
To demonstrate how the process works, we have shared a step-by-step illustration of the referral \u2013 consultation process. The first three steps are completed by the referring practitioner and the last 3 steps are completed by the consulting physician. <\/p>\n\n\n\n
![\"\"](\"https:\/\/websites.awesomified.com\/doctorcarewp-content\/uploads\/sites\/4\/2021\/12\/image.png\")
<\/figure>\n\n\n\nReferring Practitioner<\/strong> <\/h3>\n\n\n\n
Step 1: Inform the Patient <\/strong> <\/h4>\n\n\n\n
Prior to requesting a referral, referring physicians should ensure that their patient is fully aware of the purpose of the referral and that the patient provides their consent to the referral, and can ask questions about the referral. <\/p>\n\n\n\n
Step 2: Complete Written Request <\/strong> <\/h4>\n\n\n\n
The referring physician should then make a timely, written request for consultation that includes the following information: <\/p>\n\n\n\n
- patient\u2019s name, personal health number, preferred and current contact details (Note: If patient has consented to email communication with the referring physician, inform the consulting physician of that consent.) <\/li>
- date of referral \u2022 specific purpose of the referral <\/li>
- relevant clinical information (e.g., current medications, allergies, health history, physical examination) and social information (e.g. language barriers, gender identity) <\/li>
- level of urgency of the referral <\/li><\/ul>\n\n\n\n
- expectations about the consultation outcome (e.g., medical opinion only, treatment, transfer of care, other) <\/li>
- copies or summaries of pertinent laboratory investigations, imaging and other consultant reports <\/li><\/ul>\n\n\n\n
Physicians referring a patient after a telemedicine visit must complete a standard primary care history and arrange for any necessary physical assessments prior to referring the patient to a consulting physician. It is not appropriate for the referring physician to send the same referral letter to multiple specialists concurrently hoping that one will accept the referral, as this can result in wasted time, inefficiencies in the process, and annoyance for both patients and colleagues. <\/p>\n\n\n\n
- A new consultation is not allowed when a group or physicians routinely working together provide call for each other. <\/li><\/ul>\n\n\n\n
- The medical practitioner to whom a patient has been transferred normally should not bill a consultation for that patient. However, when the complexity or severity of the illness requires that the medical practitioner accepting the transfer reviews the records of the patient and examines the patient, a limited or full consultation may be billed when specifically requested by the transferring medical practitioner. <\/li><\/ul>\n\n\n\n
- When the medical practitioner to whom a patient has been referred makes further referrals to other medical practitioners, it is the usual practice that the original referring medical practitioner be informed of these further referrals. <\/li><\/ul>\n\n\n\n
- There can be only one consultation for any one referral. Another consultation will require a second referral. <\/li><\/ul>\n\n\n\n
- Generate the report within 2 weeks of the date-of-service. <\/li><\/ul>\n\n\n\n
- Notify MSP of the referral and include: <\/li><\/ul>\n\n\n\n
- Relevant background on the patient <\/li><\/ul>\n\n\n\n
- The reason for the request <\/li><\/ul>\n\n\n\n
- A letter of referral that includes: <\/li><\/ul>\n\n\n\n
- Overview of the Referral-Consultation Process<\/a>\u00a0\u00a0<\/li><\/ol>\n\n\n\n