Document ID: chunk:federal_register_of_legislation:F2024C00800:front:0:p40
Version: federal_register_of_legislation:F2024C00800
Segment Type: other
Provision Reference: 
Character Range: 106964–109815

that bill shall be for full settlement of the account for the service provided to the entitled person.

4.3.3 Any billing method described in paragraph 4.3.2 may be used on each occasion of service.

4.3.4 Subject to paragraph 4.7.3, the Commission will accept financial responsibility for any of the services described in paragraph 4.4.1, irrespective of the billing arrangement chosen under paragraph 4.3.2 by the referring general practitioner or specialist.

4.3A  Disqualified Medical Practitioners

4.3A.1 The Commission is not to accept financial responsibility for the cost of a medical service provided to an entitled person by, or on behalf of, a general practitioner or a medical specialist if, at the time the service was provided, a medicare benefit would not have been payable in respect of the service under section 19B or section 19C of the Health Insurance Act 1973 (in force from time to time) if the general practitioner or medical specialist had provided the service as a practitioner under that Act.

4.4 Referrals
4.4.1 A general practitioner may refer an entitled person for:

(a) treatment from a medical specialist, subject to paragraph 4.7.1, and principles 4.5 to 4.8; or

(b) treatment from a general practitioner who has expertise or recognition in a particular field but is not a qualified medical specialist, subject to principles 4.5 to 4.8; or

(c) treatment in a hospital or other institution as indicated in these Principles; or

(d) other health‑care services not requiring prior approval, as indicated in principles 7.3, 7.5 and 7.6.

4.5 Referrals by medical specialists
4.5.1 In providing treatment, a medical specialist, to whom an entitled person is referred under these Principles, may:

(a) arrange diagnostic tests; or

(b) refer the entitled person to another specialist in the same way as may a general practitioner; or

(c) arrange treatment in a hospital or other institution as indicated in these Principles; or

(d) refer the entitled person to a health‑care provider in accordance with principles 7.3, 7.5 or 7.6, in the same way as may a general practitioner.

4.7 Referrals: prior approval
4.7.1 In all instances other than those described in paragraph 4.7.3 and the MRCA Private Patient Principles 2004, prior approval is required for the referral of entitled persons to medical specialists.

4.7.2 Prior approval is required for:

(a) the provision of psychotherapy treatment to entitled persons; or

(b) the provision of services under paragraph 4.2.3.

4.7.3 Prior approval is not required when a general practitioner or medical specialist refers an entitled person to a medical specialist for diagnostic imaging or pathology services not requiring admission and the medical specialist direct bills the Human Services Department at 100 per cent or less of the fee set out in the Medicare