Department of Health

Processing of accounts by WorkSafe insurers

Account enquiries can be addressed to the relevant WorkSafe agent or claimants employer. Agent details are available on the WorkSafe website.

Fees

Worksafe and the Department of Health (DH) apply a common set of principles to set fees. The principles are simplicity and transparency, methodological consistency with the DH Policy and Funding Guidelines (where possible), activity based (where possible), equitable, efficient and effective, full cost recovery and budget predictability.

On 1 July 2021, Victoria transitioned to the National Weighted Activity Unit (NWAU) funding model. The WorkSafe has also transitioned to NWAU based payments for admitted activities. The classifications on which these payments are made are: for acute admitted activity, the Australian Refined Diagnosis Related Group and for admitted emergency activity, the Australian Emergency Care Classification. The WorkSafe NWAU is the same NWAU calculated for public hospital funding. NWAU calculators are produced by the Independent Hospital Pricing Authority and are available on their website.

Admission criteria

Acute admitted patients

WorkSafe compensable patients should only be admitted to hospital in accordance with the VAED Criteria for reporting which establishes the criteria for admission. The policy is available at VAED Criteria for reporting 2021-22.

Admitted emergency patients

WorkSafe compensable patients that have met the criteria for admission may have transitioned through the emergency department. These patients must be reported to the VEMD and meet the reporting requirements outlined in the Victorian emergency minimmum dataset. To be eligible for admitted emergency NWAU payment, the WorkSafe compensable patient record must be coded with an admitted departure status, specifically, VEMD departure status in (‘03’, ‘14’, ‘15’, ‘18’, ‘22’, ‘25’, ‘26’, ‘27’, ‘28’ or ‘31’).

Rehabilitation patients

Fees may be raised for WorkSafe compensable patients admitted for same-day rehabilitation for provision of same day treatment. Criteria for admission as a same day admitted patient are that the patient:

  • attends a rehabilitation program designated for payment purposes by the DH; and
  • attends for two or more therapy interventions; and
  • receives treatment for a period of four hours or more.

Where these criteria are not met, the fees raised for attendance for rehabilitation would be in accordance with the appropriate non-admitted patient fee rate.

Fees for patients admitted to Designated Rehabilitation Programs will be in accordance with the DH payment schedule as set out below. The Department’s most current VAED Manual, lists Designated Rehabilitation Programs for the purpose of Care Type P or 6 . Also refer to specification changes to the manual at Victorian Admitted Episodes Dataset.

Description of fees

The Department has agreed admitted patient rates for Worksafe patients.

Admitted acute payment rate

WorkSafe Acute Admitted Price  1 July 2021 - 30 June 2022 1 July 2022 - 30 June 2023
Applicable Victorian Cost Weights  NWAU 21 NWAU 22
Base Price $4,878 $5,000

To calculate the acute admitted patient fee, the base fee is multiplied by the appropriate National Weighted Activity Unit (NWAU) value. That approach likewise applies for the NWAU that might arise from the admitted emergency activity associated with that patient. Medical practitioner costs are excluded from the fee.

Emergency department only attendance fee 

Worksafe compensable patients that are not admitted but attended to in public hospital emergency departments attract an attendance fee. This fee can not be claimed if the patient is eligible for an admitted emergency payment (see guidance on eligibility in the Admitted emergency patients section). Specifically, an emergency patient claim can only be made once for a WorkSafe compensable patient as either an ED only rate, or as an admitted emergency NWAU rate.

WorkSafe should continue to be billed separately for diagnostic and medical services provided in Emergency Departments.

ED only attendance rate

WorkSafe item code Emergency Department fee   1 July 2021 - 30 June 2022 1 July 2022 - 30 June 2023 
 PUB100 ED only attendance fee   $292  $299

Rehabilitation 

The following fees apply for patients admitted to rehabilitation programs designated by the Department of Health.

Rehabilitation payment rates

WorkSafe item code Grouping Rehabilitation Care type

1 July 2021 -

30 June 2022 

per bed day

1 July 2022 -

30 June 2023 

per bed day

REH101   Level 1 $917 $940
REH102   Level 2 $757 $776
REH103   Level 3 $757 $776
RESP01 Spinal
Austin only
Level 1 Spinal $1,378 $1,412
RESP02   Level 2 Spinal $1,171 $1,200
REPD01 Paediatric     $1,376 $1,410

Other rates

The following rates apply for other admitted, non-admitted and miscellaneous categories.

Other admitted rates

Grouping Other inpatient rates Metro/Rural 1 July 2021 - 30 June 2022 per bedday 1 July 2022 - 30 June 2023 per bedday
  Geriatric Evaluation and Management   $706 $724
  Nursing Home Type - Patient/Day   $277 $284
  Palliative care - Admitted  Metro $721 $739
 Rural $727 $745
Specialty clinics Pain Management Inpatient   $757 $776
  Rehabilitation in the Home - Inpatient Equivalent   $531 $544

Mental health admitted rates

WorkSafe will pay the public bed day rates for all inpatient mental health services as published annually in the Victoria – Public Hospitals and Mental Health Services Policy and Funding Guidelines.

Other non-admitted rates

Specialty Clinics

Non-admitted patients Specifics 1 July 2021 - 30 June 2022 1 July 2022 - 30 June 2023
Pain management   Compensable non-admitted patient fees for outpatients as per DH  Funding and Policy Guidelines Compensable non-admitted patient fees for outpatients as per DH  Funding and Policy Guidelines
Pain education program*

Price per program 

# Refer policy

 $1,142  $1,171
Continence    $121  $124
Gait analysis  RCH  $2,245  $2,301
 Kingston - 1 Assessment  $1,665  $1,707
 Kingston - 2 Assessment  $2,495  $2,557
PAC    $40  $41
Rehab in the home   Compensable non-admitted patient fees for outpatients as per DH Funding and Policy Guidelines Compensable non-admitted patient fees for outpatients as per DH  Funding and Policy Guidelines
Clinical  Community Care Group per visit  $169  $173
 Individual per visit  $291  $298

*WorkSafe code PMEP01

# Pain Education Program (Non-admitted) 

Pain education programs are 8-10 hour multi-disciplinary group education programs. To deliver this service, WorkSafe must approve the provider and their pain education program. WorkSafe's current approved providers are Austin Health, Barwon Health and St Vincent's Hospital.

Mental Health - non admitted

Non-admitted patients Specifics 1 July 2021 - 30 June 2022  1 July 2022 - 30 June 2023
Clinical  Community Care Group per visit $169 $173
Individual per visit $291 $298

Diagnostic imaging rates

Report type Amount WorkSafe will reimburse hospital
MRI As listed in the WorkSafe fee schedule Medical Practitioner Services. The rates payable depend on the MBS item billed in relation to the MRI procedure undertaken.
Other diagnostic imagining services

Medical reports rates

WorkSafe item code  Report type Amount WorkSafe will reimburse hospital Conditions/details 
 N/A Standard Discharge Report  $0 Hospitals may not bill for standard discharge reports.
 MEDRPT Medical report- This report is prepared by a public hospital's medical officer as opposed to the treating medical practitioner.  $455  
 HOSRPT Hospital report - The report is prepared by clerical staff on behalf of the public hospital's medical officer and provides a summary of the medical record.   $273  
 PUBFOI FOI request from Worksafe to access medical reports Reasonable costs incurred Public hospital may charge WorkSafe for the reasonable costs incurred in making those arrangements as prescribed in the FOI Act and the Freedom of Information Access Charges Regulations 2004 (RegulaTIons).

Provisional statements

Provisional statements may be issued for high outlier patients whose length of stay exceeds 35 days. A provisional VICDRG statement may be generated by the hospital's own accounts system based on the provisional VICDRG to which a patient would be grouped and according to the program logic for per diem inlier equivalence of high outlier days. A final WorkSafe admitted patient VICDRG Statement for the entire patient episode will be produced during processing of PRS/2 transmissions following separation of the patient. In addition, hospitals may raise progressive invoices for patients admitted to designated rehabilitation programs.

WorkSafe statement and forwarding of invoices

Under the agreement with WorkSafe, hospitals are required to provide details as set out below in the `Admitted Patient VAR-DRG Statement' and 'Emergency Presentation AECC Statement'.

Also, public hospitals will need to obtain the following information for invoicing purposes:

  • worker's name and claim number; and
  • name of the Authorised Insurer.


This information should be available from the worker or the employer. Once the invoice has been raised, it should be sent to the relevant authorised insurer, unless the employer is a registered self-insurer in which case it should be sent direct to the employer.

In addition, public hospitals will need to obtain the following information for invoicing purposes. WorkSafe requires a principal diagnosis from Volume 1 of the International Classification of Diseases, 10th Revision, Australian Modification coded in accordance with the Australian Coding Standards for every admitted patient. Other codes may be provided in addition to this primary requirement.

 WorkSafe Admitted Patient AR-DRG Statement

Campus Code:

Campus name:

Date statement produced:

Patient details:

  • Patient UR Number 
  • Date of Birth (dd-mm-yyyy)

Episode details:

  • Date of Admission  (dd-mm-yyyy)
  • Date of Separation (dd-mm-yyyy)
  • Length of Stay
  • Separation mode code
  • Separation mode description 
  • Inlier/outlier status

NWAU:

  • Base NWAU
  • Dialysis adjustment
  • ICU adjustment
  • Indigenous adjustment
  • Paediatric adjustment
  • Patient residential remoteness adjustment 
  • Patient treatment remoteness adjustment
  • Radiotherapy adjustment
  • Total NWAU

AR -DRG Base fee

Acute admitted patient fee

AR-DRG

Description

 ICD-10-AM Diagnosis Codes Description  
 ICD -10-AM Procedures Codes Description  

 

Refer to DH Fees and Charges for Acute Health Services in Victoria

Note:

Diagnosis codes and descriptions are provided for the primary diagnoses, complication diagnoses and procedure codes only

This is not an invoice. It must be attached to a hospital invoice before being sent to the relevant WorkSafe Victoria Managing agent,

 

 

 WorkSafe Emergency Presentation AECC Statement

Campus Code:

Campus name:

Date statement produced:

Patient details:

  • Patient UR Number 
  • Date of Birth (dd-mm-yyyy)

Episode details:

  • Date of Arrival  (dd-mm-yyyy)
  • Date of Departure (dd-mm-yyyy)
  • Arrival transport mode (code and description)
  • Type of visit (code and description)
  • Triage category (code and description)
  • Departure status (code and description)
  • Base AECC NWAU
  • Indigenous adjustment
  • Patient residential remoteness adjustment 
  • Total NWAU

NWAU Base fee

Emergency presentation fee

AECC

Description

 ICD-10-AM Diagnosis Codes Description  

 

Refer to DH Fees and Charges for Acute Health Services in Victoria

Note:

This is not an invoice. It must be attached to a hospital invoice before being sent to the relevant WorkSafe Victoria Managing agent,

Reviewed 19 July 2022

Health.vic

Contact details

Street address: 50 Lonsdale Street, Melbourne, Victoria, 3000

Department of Health GPO Box 4057, Melbourne, VIC 3000

Was this page helpful?