Any specialty, inpatient, outpatient, or laboratory services that are ordered or arranged but not furnished directly. Certain situations may exist that should be considered referral services for purposes of determining if a physician/group is at substantial financial risk (see Box R-1 ).Box R-1REFERRAL SERVICESExample 1: A managed care organization (MCO) may require a physician group/physician to authorize retroactive referral for emergency care received outside the MCO’s network. If the physician group/physician’s payment from the MCO can be affected by the use of emergency care such as a bonus if emergency referrals are low, then these emergency services are considered services and must be included in the calculation of substantial financial risk.Example 2: If a physician group contracts with an individual physician or another group to provide services that the initial group cannot provide itself, any services referred to the contracted physician group/physician should be considered referral services.