February 14, 2019

Question:
Would you mind giving your two cents?  I saw a patient from urgent care yesterday with no formal referral order put in.  But the patient says they sent her over and the Urgent Care nurse practitioner note says “follow up” with our service in the plan. My billers are telling me that referral language is too vague because it doesn’t say “follow up with” our specific practice’s name or my name specifically.  You mentioned at the course we attended that documentation of the request for consultation in the referring providers note was needed, but I didn’t think there really was a need for the note to specifically say our practice or me by name.

Answer:
You are correct.  Be sure you have the specific name of the provider who asked the patient to you so that name can be put on the claim as the requesting provider.  The requesting provider saying “follow up with” or “refer to” your practice is just fine – their note doesn’t have specifically state your practice’s name or your name.  The key is having the requesting provider’s note saying they want someone of your specialty to see the patient AND having that specific requesting provider’s name for the claim.

*This response is based on the best information available as of 2/14/19.