Significant changes have been made to the MSC Payment Schedule to improve the re-referral process, effective July 1, 2023. These changes are a result of the work done by the Consultation and Referral Working Group, set up via the 2022 Physician Master Agreement (PMA).
These improvements are a combination of an implicit re-referral and the subsequent consultation.
- All initial referrals include a potential re-referral for the same problem unless a re-referral is specifically excluded.
- The implicit re-referral allows the patient and consultant to schedule and conduct subsequent consultations at intervals of greater than six months for the same problem, on an ongoing basis.
- While an implicit re-referral is automatically included in the initial referral, there are two times when this option will not kick in: when the referring practitioner specifically disallows the implicit re-referral at the time of the initial referral or the referring practitioner disallows the implicit re-referral within two weeks of receiving notification of a scheduled subsequent consultation by the consultant.
The new process guidelines, copied below, have been added as section D.2.3 Subsequent Consultation to the General Preamble. The changes have been implemented by the MSC with an effective date of July 1, 2023.
D. 2. 3. Subsequent Consultation
A subsequent consultation for the same diagnosis may be payable as the applicable full consultation when an interval of at least six months has passed since the consultant has last provided an insured service for the patient. All referrals include a potential implicit re-referral for the same problem unless a re-referral is specifically excluded. A subsequent consultation must comply with MSC Payment Schedule D.2. in all respects with the exception that it does not have to be specifically requested via an explicit (new) re-referral.
The potential implicit re-referral may be activated, if medically appropriate, to allow the patient and consultant to schedule and conduct one or more subsequent consultations for the same problem, unless explicitly excluded by either of the following:
i) The referring practitioner’s referral letter specifically disallows an implicit re-referral by stating: “This referral is for one consultation only and does not include a rereferral” or similar language, OR
ii) The referring practitioner disallows the implicit re-referral via written response to the consultant within 14 days of receiving notification by the consultant of the scheduled date for a subsequent consultation.
Notification by the consultant of the scheduling of any subsequent consultation must be provided to the referring practitioner at least 30 days before the scheduled date and must conform to all other College of Physicians and Surgeons of BC Guidelines and Standards.
Any additional subsequent consultations must follow the same rules. Another implicit re-referral potentially exists following any subsequent consultation unless the referring practitioner has explicitly excluded it as described above. A subsequent consultation may not be billed if the implicit re-referral has been disallowed.
If the referring practitioner is no longer in practice a subsequent consultation may be performed if medically appropriate, but the consultant must document the unavailability of the original referring practitioner and their advice to the patient to obtain a new referring and/or primary care provider.
The clarifications and FAQ’s about consultation-referrals in the Billing Question Library are in the process of being reviewed and updated.
Please contact economics@doctorsofbc.ca with any questions.