Medicare Compliance & Reimbursement

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Consult Request Form

It's time to streamline your consult request form. Here's the standard form that consultant Patricia Trites, with Compliance Resources in Augusta, MI, gives her clients:

Dear Dr. ______________,

It is our understanding that you have requested Dr. ________________ to perform a consultation on your patient, _______________________, for the following condition, symptoms or problem: ______________________________.

As you know, the definition of consultation has been changed by CMS and we must now ask your intention regarding this patient.

Would you like us to: (Please Mark the Appropriate Box Below)

--Provide an opinion only regarding the evaluation and/or management of this patient's condition?

--Provide an opinion regarding the evaluation and/or management of this patient's condition as well as treat the patient for this condition?

We have appointed this patient on (date and time) ____________________________. Please fax this completed form back to our office at _______________ as soon as possible. In addition, please forward any necessary medical records to our office that you believe are pertinent for the evaluation of this patient's condition.

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