Requests for pathology and diagnostic imaging services

About changes to the Health Insurance Act 1973 that explain how a request should be made for pathology or diagnostic imaging services, including form requirements and prohibited practices

Page last updated: 03 June 2015

Key changes

All changes are stated in the Health Insurance Amendment Inappropriate and Prohibited Practices and Other Measures Act 2007, but collectively they are expected to:
  • increase consumer choice
  • discourage inducement or threat
  • protect patient rights.
The key changes:
  • increase patient choice by removing restrictions on the selection of pathology and diagnostic imaging providers
  • prohibit inappropriate commercial relationships between requesters and providers of pathology and diagnostic imaging services
  • discourage the delivery of pathology or diagnostic imaging services as a result of inducement or threat
  • require that a branded pathology or diagnostic imaging request form is available for use by requesting practitioners and includes a ‘patient advisory statement’.

Key pathology legislation

Subsection 23DNBA(4) of the Health Insurance Act 1973 requires the Minister to determine in writing, the principles that apply to the granting of approvals for eligible pathology specimen collection centres, known as approved collection centres (ACCs).
  1. Health Insurance (Accredited Pathology Laboratories—Approval) Principles
  2. Health Insurance (Eligible Collection Centres) Approval Principles

Key diagnostic imaging legislation

A new range of criminal and civil penalties has also been included in the amendments.

Why is this important?

The changes to the Health Insurance Act 1973 seek to ensure that referrals are made on the basis of patient clinical-need that is in the best interest of the patient and not as a result of commercial arrangements that may be either illegal or unethical and that may jeopardise best patient outcomes or result in over-servicing.

What hasn’t changed?

There remains a legislative requirement that a request for a pathology/diagnostic imaging service be made, but it is no longer a requirement that the request be made to a particular pathology/diagnostic imaging practitioner except if the requester specifies (for clinical reasons) a particular practitioner/authority.

Who is affected?

The amended law affects anyone who can request or provide Medicare-eligible pathology or diagnostic imaging services such as GPs, medical specialists, dental practitioners, podiatrists, physiotherapists, osteopaths and chiropractors.

Amendments details

A branded request form is one that is produced and distributed by or on behalf of a diagnostic imaging or pathology provider and that displays corporate/business details of that or another provider. Since August 2012, it has been a requirement that a branded pathology or diagnostic imaging provider request form must include a patient advisory statement.

Wording options for branded pathology or diagnostic imaging request forms

‘Request forms for diagnostic imaging services must include a statement that informs the patient that they may obtain the services from a provider of their choice and are not restricted to the provider named on the request form’. See section 19 of the Health Insurance Regulations 1975

For example:

Your doctor has recommended that you use (insert name of pathology provider). You are free to choose your own pathology provider. However, if your doctor has specified a particular pathology on clinical grounds, a Medicare rebate will only be payable if that pathologist performs the service. You should discuss this with your doctor.

or

Your treating practitioner has recommended that you use (insert name of pathology provider). You are free to choose your own provider. However, if your treating practitioner has specified a particular provider on clinical grounds, a Medicare rebate will only be payable if that provider performs the service. You should discuss this with your treating practitioner.

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Disclaimer

It is important for individual practices to familiarise themselves with the altered legislation and to review any arrangements that may be affected. Practices may wish to seek independent legal advice to clarify how the legislation might impact their practice.

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