# referral for Consults



## baldi18 (Oct 7, 2008)

When a patient has insurance such as essence that requires a referral from the primary doctor can we use that as a referral for consult? 

Rachel


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## pamley11 (Oct 7, 2008)

The insurance referral is only to insure that the visit is authorized and you will get paid.

The consult requirements still must be met in that the referring physician is requesting the opinion of the physician being referred to, and that the request is not a transfer of care.


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## RebeccaWoodward* (Oct 7, 2008)

In addition to Pam's response...

*What are the specific requirements for reporting consultations? (The "Three R's")*
The *Request* for consultation, whether verbal or written, must be documented in the medical record. The documentation must include thename of the requesting physician or appropriate sourceas well as the reason or need for the request. 

The consultant must *Render* an opinion/recommendation and any services performed must be documented. 

A written *Report* back to the requesting physician or other appropriate source must be included in the medical record. This can be in the form of a letter, completed hospital pre-operative form, or a copy of the progress note. 

http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm4215.pdf


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