This service IS:

A voluntary service.
Is for a clinical opinion.
Is patient focused.
Is GP support focused.

This service IS NOT:

Obligation based.
A Medico-legal opinion.

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How can I refer for this service?

Referrals can be made by visiting us on-line at www.nextgenss.com.au and accessing the on line referral function OR by calling our offices on (08) 7913 7613 and requesting a Specialist Support appointment.

 

Can I request the Specialist of my choice from the available list?

Yes, you can specify which Specialist you would like your patient to be seen by. If that Specialist is not available within the 14 day time-frame you will be given the option for earlier appointments with a different specialist within the relevant field should you prefer this.

 

Who receives a copy of the Written Summary Report from the Support Specialist?

A copy of the written summary report will automatically be sent you as the treating GP and to your patient . A copy will not be sent to the Claims Specialist / Case Manager. You and/or your patient may elect to release a copy to other parties.

As this service is NOT a medico-legal service, our support specialists will not respond to request for additional information they may receive from third parties such as lawyers, insurers in regards to their assessment of the patient under this service.

 

Can my patient be referred for further tests / investigations by the Support Specialist as part of their assessment?

No, the specialist is not permitted to refer the patient for diagnostic imaging or tests as part of this service. If the specialist believes imaging or medical tests are required they should communicate this to the treating GP who can then consider this further.

 

Can I charge for receiving a phone call from the support specialist to discuss their clinical feedback or to seek further information from them?

Yes, phone calls can be invoiced using the existing WMG24 service item and forwarded to the Claims Agent / Insurer managing the patient’s claim.

 

Arrangements can be made for patients who wish ongoing treatment with the Specialist.

What is the purpose of this service?

This service enables treating GP’s and injured workers to have fast and reliable access to leading SA based medical specialists for the purposes of receiving a support medical opinion regarding medical diagnosis, treatment plan; prognosis and other clinical issues of relevance. The overall focus is on achieving timely medical recommendations to support improved recovery, function and capacity.

 

What is the difference between this service and general GP referrals to a Specialist?

The two key differences are:

1) Under the Second Opinion Specialist Support Service the injured worker will be given an appointment within 14 days of request. Where practical, the GP will receive both a telephone call from the Specialist and a written Clinical Summary Letter.

2) Second Opinion Specialist Support Services provides GP’s and injured workers with access to leading SA based specialists, some of whom would otherwise not see WorkCover patients. As the focus of this service is clinical based rather than medico-legal based all of our Specialists are keen to participate in this service and do what they do best…. pursue recovery and capacity.

 

How are referrals made?

Generally referrals are sent direct from the treating GP to Next Generation Specialist Support Services.

An injured worker can nominate themselves for the service however they must discuss this with their Claims Specialist / Case Manager and the referral must then come from the Claims Specialist / Case Manager.

If a Claims Specialist / Case Manager believes they have clients who would benefit from this service they are encouraged to discuss this with the injured worker’s treating GP and agree on who will action the referral.

 

Who pays for the Service?

In the case of registered employer claims, RTWSA has developed a service framework with dedicated item numbers and set fees Claim Agents and their Claims Specialists have been encouraged by RTWSA to approve the service / cost where appropriate.

In the case of Self-Insured Employers / Case Managers the set fee is payable by the Self- Insurer if approval to proceed with the referral is given.

Upon receipt of a referral Next Generation Specialist Support staff will contact the Claims Specialist / Case Manager to discuss receipt of the referral and confirm approval is given for the service / cost to proceed.

 

How is the service billed?

An invoice will be sent to you by ‘Next Generation Specialist Support’ acting as the administrator of the Second Opinion Support Service. The set fee payable includes the cost of the consult with the Specialist; the phone call from the Specialist to the GP and the written Clinical Summary Letter to the GP and all administrative functions.

 

Will a copy of the Written Clinical Summary Report be sent direct to the Claims Specialist / Case Manager?

No, Next Generation Specialist Support will not distribute a copy of the report to the Claims Specialist / Case Manager. As this service is a medical support service focused on clinical treatment the Clinical Summary Letter is not to be used or distributed for Medico-Legal purposes.

We understand the information in the Clinical Summary Letter may be useful for Claims Management purposes and therefore we would encourage the Claims Specialist / Case Manager to call or write to the treating GP seeking feedback.

We are promoting a service which seeks to respect the GP as the treating medical expert and provide them with consultative and clinical based advice. This approach, as opposed to an adversarial / medico-legal approach is expected to promote best practice medical management and maintain the focus on earlier recovery and increased capacity which translates into earlier and better return to work outcomes.

It is envisaged with access to this fast and unique service, the GP will be more inclined to seek early specialist support and facilitate the medical recommendations. In a traditional approach a referral to a Specialist may be considered later in the life of a claim and subject to significant waiting times all of which impact on recovery and return to work time-frames. Alternatively an Independent Medico-Legal Opinion is obtained and used to confirm or challenge medical treatment / behaviour with often negative consequences. As this service puts the treating GP and the injured worker and the forefront, and is completely voluntary, it is likely to be more effective.

 

Can the Second Opinion Support Specialist refer the injured worker for further medical tests or investigations or act as the treating doctor?

No, under this service the Second Opinion Support Specialist is not permitted to directly refer injured workers for further medical tests / investigation or indeed treat. Their only involvement is to provide an objective medical opinion to support the treating GP with medical treatment and care. The specialist however may make recommendations for further medical tests / investigations in their verbal and written communications to the GP and the GP can elect to facilitate the advice given to them. Arrangements can be made for patients who wish ongoing treatment with the Specialist.

What does this service involve?

This service allows your GP and yourself to have fast and reliable access to leading SA based medical specialists for the purposes of a support medical opinion concerning your medical diagnosis, treatment plan; prognosis and other clinical issues.

 

Who can refer for this service?

Generally referrals are made by your treating GP direct with Next Generation Specialist Support Service (N.G.S.S)

You may also request a referral be made on your behalf via your Claims Specialist / Case Manager if you are unable to access your GP.

 

How does this service differ from a general referral to a specialist?

In many instances if your GP provides you with a standard referral it can take many weeks’, even months, for you to get an appointment to see the Specialist. Under this service you will generally be seen by the Specialist and receive a copy of their written medical summary within 14 working days

A copy of the written summary will also be sent to your GP.

 

Who makes the appointment?

N.G.S.S is responsible for:

  • Making all appointments
  • Sending out appointment letters
  • Re-scheduling appointments
  • Distributing medical summary reports

Any questions or feedback you may have in regards to your appointment, both prior to and after your consult, must be directed to N.G.S.S and not the Specialist Rooms where you attended for the consult.

 

Will my Claims Specialist / Case Manager receive a copy of the report?

No, N.G.S.S. will not distribute a copy of the report to your Claims Specialist / Case Manager. As this service is a medical support service focused on your medical / clinical treatment it is intended for you and your GP only. It is expected your Claims Specialist / Case Manager will contact your GP to discuss the specialist’s report if they so choose.

 

Am I obliged to accept or follow the recommendations of the specialist?

No, this service is a support service for you and your GP. You have the right to choose if you follow any of the recommendations. There is no obligation on you to participate in this service if you elect not to do so.

 

Can the specialist refer me for further medical tests or investigations?

No, under this service the specialist is not permitted to directly refer you for further medical tests / investigation. Their only involvement is to provide a medical opinion to support your GP in your medical treatment and care. The specialist however may make recommendations for further medical tests / investigations in their communications with your GP which can be considered for further action.

 

Who pays for this service?

The cost of this service is invoiced to and payable by your Claims Agent / Insurer.