Table of Contents
b)Patient Eligibility 4
c)2.1 Seeking Prior Financial Authorisation 5
d)Hospital Services Agreement 6
e)Admission, Transfer and Discharge 6
f)Contract Managers 7
g)Quality Standards 8
h)Advice to DVA on existing Accreditation Status: 8
i)Private Hospital Quality Reporting: 9
j)Mental Health Standards 9
k)Mental Health Quality Reporting 10
l)Patient Satisfaction 10
m)Information Management – Submitting HCP data 10
n)8.1 HCP date format requirements 10
o)In Hospital Claims (IHC) Release 6 11
p)9.1 What are the advantages for facilities that move to DVA IHC? 11
q)9.2 What types of services are able to be claimed via IHC for DVA? 12
r)9.3 What types of services cannot be claimed via IHC for DVA? 12
s)9.4 Is EFT mandatory for claims lodged through IHC? 12
t)9.5 Are remittance advices available electronically through IHC? 12
u)9.6 What happens to paperwork when claiming via IHC? 12
v)Billing Arrangements 14
w)Discharge Advice and Hospital Claim D653A Form 15
x)How to Fill in the D653A Form 16
y)How to complete your claim 19
z)Certificates and Certification 23
aa)Claims Stationery and Hospital Forms 25
The Repatriation Commission and the Military Rehabilitation and Compensation Commission (the Commissions) have entered into a Hospital Services Agreement (the Agreement) with your organisation to provide private hospital 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 provision of Hospital Services under your Agreement is to be in accordance with the following legislative frameworks:
the Treatment Principles and Private Patient Principles made under the Veterans’ Entitlements Act 1986, or under the Military Rehabilitation and Compensation Act 2004, or under the Australian Participants in British Nuclear Tests (Treatment) Act 2006; and
the Safety, Rehabilitation and Compensation Act 1988.
In addition to its arrangements with private (including private mental health) hospitals, DVA has arrangements in place with Day Procedure Centres, and all public hospitals in every State and Territory. These arrangements ensure that Entitled Persons have access to hospital services when and where they are needed.
While the Deed of 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.
DVA entered into new contractual arrangements with a range of private hospitals during 2016. This document has been updated to reflect the changes to the Agreement. Hospitals should note that this document is a guide only and that where questions arise, the Hospital Services Agreement has precedence over this document.
DVA advises Entitled Persons to present their Repatriation Health Cards or their written letter of authorisation to hospital admission staff in order to access treatment under DVA arrangements.
Patients who are Repatriation Card holders may also elect to be treated outside DVA arrangements, however, in those circumstances, DVA is unable to accept financial responsibility for any part of the admission.
Charges for inpatient treatment are based on Entitled Persons receiving private room hospital accommodation where available, and doctor of choice, in accordance with the Repatriation Private Patient Principles (See Hospital Services Agreement Section 4.4).
At admission, when determining access to a private room, DVA acknowledges that the hospital will take into account the competing clinical needs of a veteran and non-veteran patient if there are not two private rooms available. In the Hospital Services Agreement, Hospitals agree not to levy additional charges against DVA patients for accommodation in a private room. (See Section 4.12.6 of the Hospital Services Agreement).
All Entitled Persons are, at the time of admission, to be provided with a copy of DVA’s fact sheet HSV74 - Hospital Admission & Discharge available from the DVA website www.dva.gov.au.
Gold Cardholders are entitled to treatment of most conditions, however, prior financial authorisation must be sought for some services and treatment types.
White Cardholders continue to be 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.
Ascertaining the eligibility for White Card Holders:
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.
Holders of Letters of Authorisation may have treatment authorised under either the Veterans’ Entitlements Act 1986, the Military Rehabilitation and Compensation Act 2004, the Australian Participants in British Nuclear Tests (Treatment) Act 2006, or the Safety, Rehabilitation and Compensation Act 1988. As provision of services may vary amongst all four Acts, hospitals should phone the contact officers on the letters to clarify entitlements and billing arrangements.
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