A Medicare provider number is required if you bill, prescribe or request services that are eligible for a Medicare benefit.
A refer and request provider number does not let you bill items to Medicare but will allow you to provide services in a private billing setting as well as refer your patients to other practitioners and send requests for diagnostic tests.
This means that your patients will have to pay your entire bill and will not be able to have the appointment subsidised by Medicare.
Generally, doctors who are restricted by 19AA and/or 19AB who are not meeting their restrictions, will apply for a refer and request provider number.
Hospital doctors will also generally hold a refer and request provider number.
If you have a refer and request Medicare provider number, your patients will need to pay the full fee for any services you provide. For this reason, you may have a hard time building a patient base, and so practice may also be unwilling to take on a GP that will be privately billing. So how do you make money?
If you have a refer and request medicare provider number, you will need to focus on the patient demographic that isn’t eligible for Medicare.
Australian Citizens and Permanent Residents, New Zealand Citizens, those applying for Permanent Residency in Australia and some temporary residents are eligible to enrol in Medicare. This means you need to focus on providing care for overseas visitors or by offering something that other GP’s in the area can’t such as speaking another language that is highly used by the community or by providing WorkCover or other privately billing consults.
You will need to go onto the Medicare website and fill out a HW019 Form. When you fill it out, you will need to select the option ‘Refer and request only (such as hospital interns)’ on question 22 of the form.
You can find the link for the form here: https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/hw019
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