Consult Versus Transfer of Care - Distinguish the Differences

6 steps will increase your referral reimbursement
With physicians using the word "referral" so freely, you can have a hard time telling whether the referring physician is requesting a consultation or a transfer of care from your endocrinologist. For flawless consult coding, follow these six easy steps:
 
1. Know the Three R's: Request, Render and Report. Regardless of what services the physician renders, you can identify a consult every time by checking for these three required components.
  
"There has to be a Request for an opinion [either verbal or written; it must be documented], that opinion needs to be Rendered [it must be performed and documented in the patient's medical record], and there needs to be a written Report sent back to the requesting provider" or other appropriate source, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.
  
2. Remember that specialists can refer, too. Usually the appropriate source is a general practitioner sending a patient to a specialist for consultation. However, Hammer says, the source can also be a specialist practice sending a patient to a general provider for consultation on overall physical condition or for clearance for surgery. In that case, the general provider gets to bill for a consult.
  
3. Keep your eyes on the bottom line. Consults reimburse better than new patient visits - about $30 more for a level-two consult than for a level-two new patient visit - so providers have been known to go to great lengths to justify their service as a consultation. This is why a pattern of billing consults can spark payer audits and why consults remain on the HHS Office of Inspector General's Work Plan for yet another year as a compliance hot spot. 
  
4. Inform your physicians. Improving the communication among providers and among front-desk staff is the best way to nip this problem in the bud, Hammer says. "Tell your providers not to say [or write] 'Thanks for referring so-and-so to me' " in the medical record, Hammer says. That only confuses things. The best way to avoid any confusion between a consult and a transfer of care is to use the word "request," e.g., "The patient is being seen today at the request of Dr. Jones."
  
5. Standardize the referral process. Hammer suggests developing a standard paperwork procedure with your office and the practices you frequently refer patients to or receive referrals from. Create a fax face sheet with boxes to check for "opinion only" or "transfer of care" that front-desk staff can attach when scheduling patients for referrals (be sure to include a disclaimer for HIPAA privacy-rule purposes).
  
In addition, create a similar sheet with check boxes that providers can give to patients to [...]

- Published on 2004-04-16