PRIVATE HOSPITAL MENTAL HEALTH SERVICES INFORMATION PACKAGE

Transcription

1 PRIVATE HOSPITAL MENTAL HEALTH SERVICES INFORMATION PACKAGE July 2014

2 Table of Contents 1. OVERVIEW PATIENT ELIGIBILITY SEEKING PRIOR FINANCIAL AUTHORISATION DEPARTMENT OF DEFENCE ARRANGEMENTS THE PRIVATE HOSPITAL MENTAL HEALTH SERVICES AGREEMENT ADMISSION, TRANSFER AND DISCHARGE HOSPITAL ADMISSION VOUCHER... 4 D652B Hospital Admission Voucher CONTRACT MANAGERS QUALITY STANDARDS INFORMATION MANAGEMENT SUBMITTING HCP DATA IN HOSPITAL CLAIMS (IHC) RELEASE BILLING ARRANGEMENTS WHERE TO SEND CLAIMS PROMPT PAYMENT ACCOUNT ENQUIRIES D653A DISCHARGE ADVICE AND HOSPITAL CLAIM FORM COMPLETING THE FORM HOW TO CLAIM How to claim a complete episode How to claim an ECT as part of an inpatient stay How to claim an ECT as a day patient How to claim a leave day Calculating day count Acute care certificates Day only procedure certification and overnight stay certification CLAIM STATIONERY ADVERTISING...17 ATTACHMENT 1 - DVA QUICK CONTACT LIST...18

3 1. Overview The Repatriation Commission and the Military Rehabilitation and Compensation Commission (the Commissions) have entered into a Hospital Services Agreement with your organisation for the provision of mental health services to Entitled Persons. The Department of Veterans Affairs (DVA), on behalf of the Commissions, will work with you during the life of this Agreement to ensure the best outcomes for Entitled Persons, with minimal administrative impediments. The Repatriation Private Patient Principles (RPPPs) provide the legislative framework for hospital services to be provided to Entitled Persons. In addition to its arrangements with Hospitals providing mental health services, DVA has arrangements in place with Tier 1 hospitals, Day Procedure Centres and Tier 2 private hospitals. These arrangements ensure that Entitled Persons have access to hospital services when they are needed. While the Agreement defines the term Entitled Persons, throughout this document the terms veteran, veteran community or patient are used, but the same broader meaning is intended. 2. Patient eligibility The RPPPs applies to all Entitled Persons eligible to receive health care under DVA arrangements. DVA advises Entitled Persons to present their Repatriation Health Cards to hospital admission staff in order to access treatment under DVA arrangements. Veterans who are Repatriation Card holders also have the option of being treated as a private patient outside DVA arrangements. In those circumstances DVA is unable to accept financial responsibility for any part of the admission. Entitled Persons are to be accommodated in shared ward accommodation, or a single room, if that is deemed clinically necessary. Entitled Persons requesting a private room as a matter of preference will be personally responsible for paying the agreed private room surcharge and should be notified of, and agree to accept in writing, the applicable charges prior to admission. All Entitled Persons at the time of admission are to be provided with a copy of DVA s fact sheet HSV74 Hospital Admission and Discharge which can be obtained at the following website: Gold Cardholders are entitled to treatment of most conditions, however, prior financial authorisation must be sought for some services and treatment. These are: respite care or convalescent care; surgical/medical procedures not listed on the MBS; or specific treatments nominated in writing by DVA (e.g. non approved DVA Programs). Private Hospital - Mental Health Services Information Guide Page 1

4 White Cardholders are eligible for treatment only for those conditions for which DVA has specifically accepted financial responsibility. DVA will not be responsible for payment for the treatment of any person admitted to the Hospital who, at the time of admission, was not an entitled veteran with eligibility for the treatment provided. If a veteran presents with a White Card and eligibility for treatment is uncertain, you should confirm eligibility with DVA to ensure treatment costs will be met by DVA. For emergency treatment outside business hours, financial authorisation should be sought from DVA on the first business day after the treatment. 2.1 Seeking prior financial authorisation To seek prior financial authorisation you should: provide a written request from a doctor, and fax it to DVA on (08) ; or contact DVA during business hours by telephoning (metro) or (non metro). 2.2 Department of Defence arrangements All ADF Personnel admissions require prior financial authorisation from the Department of Defence local Joint Health Command. The contact details are listed in the Agreement. Claims for payment should be sent to the relevant Joint Health Command. They should not be sent to Medicare Australia. Private Hospital - Mental Health Services Information Guide Page 2

5 3. The Private Hospital Mental Health Services Agreement The Services Agreement between DVA and your organisation defines how the arrangements work. You should familiarise yourself with the aspects of the Agreement relevant to your position. Your DVA Contract Manager is available to discuss any of the conditions of the Agreement, including: treatment of Entitled Persons; provision of services; admission, transfer and discharge procedures; charges; and quality and performance management. 4. Admission, transfer and discharge The Services Agreement also outlines admission, transfer and discharge requirements that apply to Entitled Persons. Detailed information is available in your Agreement on: admission procedures and notification; prior financial authorisation requirements; transfer requirements; discharge planning protocols; pre-discharge assessments; discharge medications; discharge advice to Local Medical Officers; and arranging post-discharge services. To assist with admission and discharge, DVA has a Discharge Planners Resource Kit available at: and Fact Sheets HIP40 Providers Discharge Planning and HSV74 Hospital Admission and Discharge at: Private Hospital - Mental Health Services Information Guide Page 3

6 4.1 Hospital Admission Voucher Completion of an Hospital Admission Voucher (form D652B) for each veteran patient is a requirement of the Hospital Services Agreement. These should be kept with the patient s medical records to facilitate audit. Where facilities are using electronic patient software for their records, then the data elements of this form are required to be retained in the patient record. Do not include the Hospital Admission Voucher with the claim sent to Medicare Australia. D652B Hospital Admission Voucher Private Hospital - Mental Health Services Information Guide Page 4

7 5. Contract managers Your organisation and DVA have both appointed Contract Managers (see Agreement) to ensure that services provided are consistent with the spirit of the Agreement. The respective Contract Managers will work together to establish and maintain a productive working relationship. They will have the management authority to communicate binding decisions on behalf of the party that they represent, and will jointly: set objectives, goals and criteria against which DVA will measure the effectiveness of the delivery of care by the hospital; arrange for the timely provision of data that measures the hospital s performance; and plan, effect and manage changes required to achieve continuously high quality services to veterans. In terms of quality reporting, the Contract Managers shall be responsible for: measuring performance in service delivery against DVA requirements; ascertaining DVA s level of satisfaction with such performance; and assuring, through measurement, assessment, planning and execution that there is consistent attention to DVA requirements. General information is available on the DVA Hospitals Webpage to assist Contract Managers, such as the Quality Reporting Template. The website is: spx Other useful contact information is at Attachment 1. Private Hospital - Mental Health Services Information Guide Page 5

8 6. Quality standards Quality management under arrangements for the provision of mental health services is aimed at continuously improving the effectiveness of hospital and health care for Entitled Persons in terms of accessibility, appropriateness and efficiency, continuity and satisfaction. DVA acknowledges the significant developments in accreditation (e.g. The Australian Council on Healthcare Standards and the International Organization for Standardization) over recent years. With such robust accreditation requirements now in place, DVA has refined its Quality Reporting requirements to make the reporting process less onerous and repetitive. DVA will focus its interest in areas that particularly affect our demographic of clients (e.g. falls, discharge management, veteran complaints, etc). DVA will still maintain an interest in accessing ACHS reporting feedback, but would not expect hospitals to duplicate this reporting to satisfy DVA formats. Veteran satisfaction In addition to your organisation establishing a complaints handling mechanism and reporting Entitled Person comments to DVA, the Department will from time to time appoint an independent agency to undertake random surveys of veterans, their carers, relatives and referring doctors. These surveys will establish the level of satisfaction with respect to quality, dignity, privacy, efficacy and communication associated with the treatment provided. Private Hospital - Mental Health Services Information Guide Page 6

9 7. Information management submitting HCP data Each month you must provide to DVA s Contract Manager, in electronic medium and without charge, information in respect of each Entitled Person separation during the preceding month. The data must be supplied using the Hospital Casemix Protocol (HCP) format, as specified by the Department of Health and Ageing (DoHA), and split into monthly periods. The HCP data provided will be based on the current version of ICD-10 as specified by DoHA. It will be supplied using DVA s Secure File Transfer facility. It is critical that the HCP data specification complies with the DoHA HCP header and episode record, hospital-to-insurer layout. The current specification conforms to the current HCP version data specific specification. From time to time the specification of HCP data is altered and these changes will be advised by the APHA and made available via the APHA website: If you are not already submitting HCP data electronically, a nominated staff member within your hospital needs to contact DVA to obtain a copy of the Secure File Transfer Registration Form and Confidentiality Deed, complete and return them by post to your DVA Contract Manager for registration. Once a secure file transfer logon and passphrase are issued, your staff member will be contacted with the details and assisted in accessing the HCP data transfer website. If you have any queries regarding the electronic submission of HCP data, please contact your DVA Contract Manager. 8. In Hospital Claims (IHC) release 6 The In Hospital Claims (IHC) system has been developed by Medicare Australia (MA) in collaboration with DVA, the health care industry and the medical software industry. It has been available to software vendors since May 2007 and provides for patient verifications and the electronic lodgement of claims through the IHC claiming channel. Further information about how your hospital can implement IHC Release 6 claiming can be obtained by contacting DVA on (03) or via at onlineclaiming@dva.gov.au. Private Hospital - Mental Health Services Information Guide Page 7

10 9. Billing arrangements 9.1 Where to send claims Medicare Australia is an agent for DVA and claims will be processed in accordance with DVA s policies and procedures. Amounts are paid in accordance with contracted or negotiated rates. Accounts for hospital accommodation, theatre fees, day only accommodation, fixed price items, case payments and prostheses supplies should be mailed to: Medicare Australia GPO Box 9917 In your Capital City 9.2 Prompt payment Claims submitted to Medicare Australia must be on the DVA Discharge Advice and Hospital Claim Form (D653A). Incomplete, inaccurate or illegible information can cause delays in payment. Please include sufficient information with your claim to ensure prompt and accurate processing. Claims must be itemised using the item numbers that apply at the date of service. Claims which are incorrectly completed, e.g. without item numbers, admission date or principal diagnosis code, will be rejected and returned to hospitals. 9.3 Account enquiries Hospital account enquires should be directed to Medicare Australia on: (local call cost) Where hospitals have issues with the timeliness of payment of correctly rendered invoices, this should be raised with their DVA Contract Manager. 9.4 D653A Discharge Advice and Hospital Claim form The DVA Discharge Advice and Hospital Claim (form D653A) should be used for all hospital and prostheses claims. It is comprised of two copies: 1. Departmental Claim Copy; and 2. Hospital Copy. Please forward the Departmental Claim Copy to Medicare Australia for claiming purposes, and retain the Hospital Copy for your records. Private Hospital - Mental Health Services Information Guide Page 8

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12 9.5 Completing the form The D653A has a number of elements: Hospital Details: Patient Details: Dates of Service: This section should contain the hospital name, address and provider number. The details required for each patient are: DVA File Number Patient Surname Given Names Date of Birth Insert the date of service FROM (ie. the admission date or continuation claim date) and the date of service TO (ie. the day prior to discharge or continuation claim date TO). Dates of service must not overlap. In cases where there is more than one accommodation line (eg. because of a change in rate or patient classification) the FROM date will be the first day of the new classification or rate. An example of these can be shown below. Correct claim Date of Service No of Days Item No From To 29 /01/08 30/01/08 $ 31 /01/08 04//02/08 $ Incorrect claim Date of Service No of Days Item No From To 29 /01/08 30/01/08 $ 30 /01/08 04/02/08 $ Total Claimed Total Claimed Number of days: Item Numbers: Total Claimed: Theatre Date: Total Claimed: Insert the number of occupied bed days being claimed. The first and last day of an inpatient stay are counted as one day in total. Insert the item numbers from your Agreement. Item numbers not within your Agreement cannot be claimed. Insert the accommodation amount claimed in accordance with contracted or negotiated rates. Insert the date the operation or procedure was performed. Insert the theatre amount claimed for each MBS item. Payment will be made in accordance with contracted or negotiated rates. Procedure Item No: Insert the appropriate MBS procedure item number and procedure fee item that are relevant to the service provided. Private Hospital - Mental Health Services Information Guide Page 10

13 Prostheses: Use the Item Numbers issued by DoHA in the Surgically Implanted Prosthesis Schedule. Prostheses should be charged at the DoHA list price. The DoHA Surgically Implanted Prosthesis List can be found at the following website: Handling charges for prosthesis items need to be billed individually and not included in a total prosthesis charge. The handling charge item number to claim is QA00 which is set at 5% and capped at $ An example of how to claim the handling charge is shown below: Prosthesis Item No. Total claimed JJ014 (*10) $89.00 QA00 $4.45 JJ015 (*2) $200 QA00 $10.00 Miscellaneous: Principal ICD-10 Code: This section is used for DVA miscellaneous items e.g. all M items. Do not include items of a personal nature such as newspapers, haircuts, personal laundry, phone calls and television charges. These are not paid by DVA. The Principal Diagnosis code describes non-surgical treatment and is always required where the Medical patient classification applies. This information is required to validate the group accommodation claimed within the Medical patient classification. This section should contain ICD-10 codes only (not DRGs). Interim accounts: Separation code: Tick Interim if this is part of a continuation claim. Tick Final if this is the only claim for that patient s admission. Include the relevant code from the following list: A Discharge by hospital B Discharge own risk C Transferred to nursing home D Transfer to psychiatric hospital E Transfer to other hospital F Death with autopsy G Death without autopsy H Transferred to other accommodation I Type change separation R Deceased S Still an in-patient W Nursing home X Other hospital Z Home Admitted for treatment of: Insert the condition treated. Where additional space is required, please put details in miscellaneous box. Private Hospital - Mental Health Services Information Guide Page 11

14 Name of treating doctor: Place to which discharged: Admission date: Discharge date: Your reference/ invoice no: Patient Declaration: Claimant Declaration: Insert the name of the doctor providing treatment. Indicate the place to which the person was discharged, e.g. home, aged care facility, family care. Insert the date the person was admitted. This information is also required for interim accounts. Insert the date of discharge. If this is an interim account, leave the section blank. This information is optional, but will appear on the cheque statement if provided. The patient must sign to certify services claimed have been received. If the patient is unable to sign, the patient s agent or Authorised Officer must sign. The form must be signed by an Authorised Officer. Private Hospital - Mental Health Services Information Guide Page 12

15 9.6 How to claim Disclaimer - The scenarios and rates included in the examples below are fictitious and have been developed for the purposes of claiming examples. How to claim a complete episode In the example below, a veteran was admitted on 1 March 2008 for an acute Mental Health episode of care. The veteran was discharged on the 28th day. Date of Service No of Item Total From To Days No Claimed 01/03/08 21/03/08 21 H300 $9, /03/08 28/03/08 6 H300 $1, Theatre Date Total Claimed Procedure Item No For this example item number H300 is an acute psychiatric accommodation item which has a step-downs on days 22, 43 and 66. Consequently, the primary rate would be billed for the first 21 days (row 1 01/03/08 to 21/03/08), the first step-down rate would be billed for the next 6 days (days 22-27, row 2 22/03/08 to 28/03/08). The day of discharge is not payable. How to claim an ECT as part of an inpatient stay Example In the example below, a veteran was admitted on 1 March 2008 for an acute episode of care. The veteran was discharged on the 28th day. Date of Service No of Item Total From To Days No Claimed 01/03/08 21/03/08 21 H300 $9, /03/08 28/03/08 6 H300 $1, Theatre Date Total Claimed Procedure Item No 05//03/08 $ M009 09/03/08 $ M009 For this example item number H300 is an acute psychiatric accommodation item which has a step-downs on days 22, 43 and 66. Consequently, the primary rate would be billed for the first 21 days (row 1 01/03/08 to 21/03/08), the first step-down rate would be billed for the next 6 days (days 22-27, row 2 22/03/08 to 28/03/08). ECT would be billed under the Theatre for each service provided. The day of discharge is not payable. How to claim an ECT as a day patient Example In the example below, a veteran was admitted on 1 March 2008 as a Day Patient for ECT Date of Service No of Item Total From To Days No Claimed 01/03/08 01/03/08 1 H468 $ Theatre Date Total Claimed Procedure Item No For this example item number H468 is Day patient ECT item. No Theatre is claimed as the H468 item includes Accommodation and Theatre. Private Hospital - Mental Health Services Information Guide Page 13

16 How to claim a leave day Date of Service No of Item Total From To Days No Claimed 01/03/08 05/03/08 5 H300 $2, /03/ /08 1 H999 $0 07/03/08 12/03/08 5 H300 $2, Theatre Date Total Claimed Procedur e Item No In this example, the person has had a leave period during a hospital admission. The hospital is required to show the leave period by entering item H999. (The day count does not restart on return to hospital from leave days). Calculating day count During some admissions there are circumstances where a patient might need to be reclassified, and therefore the day count needs to be restarted. The following table provides common examples: If an Entitled Person in the same hospital is discharged and readmitted within 7 days for a condition that continues to be described by the DRG describing the first condition discharged and readmitted within 7 days for a condition that is not described by the DRG describing the first condition is interrupted with another treatment type (i.e. Advance Surgery, Surgery or Medical) If an Entitled Person in a different hospital is transferred to another hospital for a more complex procedure transferred to another hospital for the same condition Then the day count continues the day count starts again the day count starts again Then the day count starts again at the receiving hospital the day count continues at the receiving hospital (NB: Where an Entitled Person is accommodated in a Psychiatric Intensive Care (H518) unit that accommodation period will count in calculating the relevant step-down period on which daily accommodation charges shall be based). Acute care certificates Acute Care Certificates are required for acute care patients once they have been admitted for 35 days, although no longer compulsory under the Health Insurance Act Leave days and periods between hospitalisation do not count towards the 35 day period. An acute care certificate is available on the DVA website. If claiming an acute rate for a period beyond 35 days, the certificate needs to be forwarded to Medicare Australia with the Discharge Advice and Hospital Claim form. Acute Care certificates are not required to be sent to DVA. Claims for admissions over 35 days which are not accompanied by an Acute care certificate will be rejected. This gives the hospital the opportunity to either resubmit the claim Private Hospital - Mental Health Services Information Guide Page 14

17 accompanied by a certificate, or alter the claim to indicate the appropriate non-acute NHTP rate. Note: DVA will pay the basic daily care fee patient contribution for ex-prisoner of War (ex- POWs) and Victoria Cross recipients who are classified as receiving Nursing Home Type care in hospital. Day only procedure certification and overnight stay certification When a patient undergoes a Type C procedure within an acute facility, Day Only Procedure Certification is required. Certification is not normally required for Theatre Band 1 admissions (eg. chemotherapy, dialysis, etc). On all occasions where a patient is provided with an anaesthetic as a day only patient, the details of the anaesthetic are required. Overnight Stay Certification is also required when a patient undergoing a Type B procedure who then requires an overnight stay in hospital. These certificates should be sent with the Discharge Advice and Hospital Claim form (D653A) to Medicare Australia for claims processing. Private Hospital - Mental Health Services Information Guide Page 15

18 10. Claim Stationery Hospital Admission Voucher and Discharge Advice and Hospital Claim form You can order the D652B Hospital Admission Voucher or D653A Discharge Advice and Hospital Claim form: 1. By mail: DVA Distribution PO Box 251 WODEN ACT 2606 Providers should complete the DVA stationery order form and mail it to the above address when existing stock levels fall to between one to two weeks. 2. On line: There are also online forms able to be completed and printed from this website. 3. Phone: or Fax: Enquiries regarding your stationery order should be directed to (free call). It is essential when completing the order form to include all the necessary information required including hospital name, provider number, full delivery details including street address, department name, building name and contact telephone number. This information ensures your order will be completed accurately and delivered in a timely manner. Please do not quote a Post Office Box number for deliveries. Private Hospital - Mental Health Services Information Guide Page 16

19 11. Advertising Advertising requirements are set out in your Agreement. Advertising to Entitled Persons and others in relation to the awarding and operation of your Agreement is permitted, subject to prior written approval of DVA. This is to ensure that DVA can consider any information issued with reference to the Arrangement which may be interpreted by DVA stakeholders as having reference to or the endorsement of the Department. It includes, but is not limited to, the following: Letters to: Advertising in: Veterans Ex-Service Organisations specialists and medical practitioners allied health providers print and electronic media journals and professional association newsletters Ex-Service Organisation publications pamphlets and brochures You should discuss your advertising needs with your DVA Contract Manager, and provide them with a copy of all material that is published, for DVA records. Private Hospital - Mental Health Services Information Guide Page 17

20 ATTACHMENT 1 - DVA quick contact list Claims for Payment enquiries Medicare Australia Prior Financial Authorisation and Eligibility for Treatment (Admission Approvals) Phone Fax Business hours 8.30 am to 5.00 pm (metro) (non metro) (08) Department of Veterans Affairs Aids & Appliances (Rehabilitation Appliance Program RAP) Community Nursing Allied Health Oxygen Veterans Home Care Aged Care Respite care Reporting a death or Freedom of Information and Privacy Veterans Transport Services Pharmaceuticals Veterans Affairs Pharmaceutical Approvals Centre (VAPAC) Stationery Phone Fax Veterans and Veterans Families Counselling Service (VVCS) Notification of change in organisational details (Please notify both agencies) Department of Health and Ageing Department of Veterans Affairs (metro) (non metro) (metro) (non-metro) (24 hours per day) Ph: (02) or privatehealth@health.gov.au (metro) (non-metro) Private Hospital - Mental Health Services Information Guide Page 18