Medicare Compliance & Reimbursement

When is a request for a consult too much information?

Your consults could slow to a trickle if you're asking for too many details from the practices that refer patients to your specialist. 

But it's still a good idea to have a standardized form that you can fax to doctors who request a consult from your physician. The requesting doctor can fax the form back to your office, and that way you'll have the request in writing. And you can hope that the requesting practice will keep a copy of the fax in its own records.

Keep it simple: The simpler the consult request form, the likelier you'll get it back in a hurry, say experts. Your form can be as simple as: "Dr. X is requesting Dr. Z see Mrs. Pain for a consultation for ______________," says Rena Hall, coder and auditor with Kansas City Neurosurgery in Kansas City, MO.

Other info: You may want to include a space for the patient's date of birth for identification purposes. You may also want to include a space for the date the physician requests the referral and the referring physician's National Provider Identifier (NPI), says Hall. That way, your staff won't have to spend time trying to dig up that NPI info.

If a staff member makes the consult request, your consult form should include a space to specify which provider the staffer requested the consult for, says David Zetter with Health Care Professional Management Services in Mechanicsburg, PA.

Your consult form can also include optional areas such as patient address and phone number, and copies of progress notes, says Zetter.

If the requesting practice finds these areas too cumbersome, you can always leave them out.

Another way: Your consult form could consist of check boxes, suggests Quinten Buechner, president of ProActive Consultants in Cumberland, WI.

Buechner's standard form says patient X is being seen for (check one): advice and treatment, advice and management ideas, advice and management, second opinion, evaluation and treatment, transfer of care for (diagnosis), opinion and recommendation, or recommendation for further care after evaluation. The form also includes a space for the patient's problem.