Section A: Fees for Admitted Patients

8. Eligible (including Reciprocal Health Care) and Ineligible Patients

Hospitals may set fees for patients who are not covered by Medicare including overseas patients. Fees for ineligible patients should be set to achieve full cost recovery. In setting fees, hospitals should be aware that some overseas patients are entitled to financial assistance (eg because of reciprocal health care agreements).

The fees will vary between hospitals, and are determined on either a DRG or bed day basis.

Fees raised on a DRG basis are calculated using the DRG cost weight and the private WIES rate. These are published in the Victorian health services policy and funding guidelines. The link is http://www.health.vic.gov.au/pfg/index.htm

The private WIES rate is found in Part 1, Appendix 2; DRG costs weights in Part 2, under technical guidelines.

The following provides a guide to fees raised on a per day basis:
Ineligible Patient Accommodation Charge

The following items will be separately charged to the fee determined on either a DRG or bed day basis:
(i) Theatre fees charged based on TAC Schedule of Fees for Private Hospital Services (Non Arrangement).
http://www.tac.vic.gov.au/upload/Hospital.Private.Non-Arrangement.pdf
(ii) Prostheses in line with the Commonwealth’s schedule rate.
(iii) Diagnostics at 100% of CMBS.
(iv) Drugs at cost (Note: only for bed day fee as DRG fee already includes drug costs).
(v) Allied Health fees charged based on TAC schedule of Non Admitted fees for public patients.
Note: Medical costs are billed separately by the treating medical practitioner and are not included in the above.

To help determine eligibility status, and level (if any) of financial assistance, see:

• the Department's PRS/2 Manual (as may be amended from time to time), which can be accessed though:Internet website: www.health.vic.gov.au/hdss/vaed/ and refer: Part A, Definitions Related to Patients (- see also specification changes at www.health.vic.gov.au/hdss/vaed/ )
• Patient Categories
• Eligible Person
• Australian Resident
• Eligible Overseas Representative
• Reciprocal Health Care Agreements
• Persons Declared Eligible by the Minister
• Ineligible Person
• Types of Ineligible Patient
• Exempt Patient
• Non-Exempt Patient.

• Department Hospital Circulars (as may be amended from time to time), located at Internet website: www.health.vic.gov.au/hospitalcircular/ and refer to: