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

Acute admitted rates for WorkSafe compensable separations are based on AR-DRGs with Victorian modifications (VICDRG) and the DHHS cost weights. The formula for calculating weighted inlier equivalent separations is the same as the general hospital case-mix funding formula as set out in the DHHS Policy and Funding Guidelines as amended from time to time. Those Guidelines are available at policy and funding guidelines.

Admission criteria

Acute admitted patients

WorkSafe compensable patients should only be admitted to hospital in accordance with the Criteria for Admission as specified in the Victorian Admitted Episodes Dataset: Criteria for Reporting as amended from time to time. The document is available at policy and funding guidelines.

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 DHHS; 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 DHHS payment schedule as set out in section 6.3 below, Description of Fees. The Department’s most current VAED Manual as may be amended from time to time, lists Designated Rehabilitation Programs for the purpose of Care Type P, 2 or 6 - see also specification changes to the manual at Victorian Admitted Episodes Dataset (VAED).

Description of fees

The Department has agreed new admitted patient rates for Worksafe patients applicable from 1 July 2020 to 30 June 2021.

WIES payment rate

 WorkSafe WIES Price  1 July 2019 - 30 June 2020 1 July 2020 - 30 June 2021 
 Applicable Victorian Cost Weights  WIES 26 WIES 27
 Base WIES Price $5,155 $5,516

To calculate the acute admitted patient fee, the base fee is multiplied by the appropriate Weighted Inlier Equivalent Separation (WIES) value. Medical practitioner costs are excluded from the fee.

Emergency department only attendance fee 

Worksafe patients attended to in public hospital emergency departments attract an attendance fee.

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

Inpatient admissions will not be permitted within the Emergency Department.

ED only attendance rate

 Worksafe item code Emergency Department fee   1 July 2019 - 30 June 2020 1 July 2020 - 30 June 2021 
 PUB100 ED only attendance fee   $277  $284

Rehabilitation 

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

Rehabilitation payment rates

 Worksafe item code Grouping  Rehabilitation  Care type  1 July 2019 - 30 June 2020 per bed day  1 July 2020 - 30 June 2021per bed day 
 REH101   Level 1  $871 $893 
 REH102   Level 2  $719 $737 
 REH103   Level 3  $719 $737
 RESP01 Spinal Austin only Level 1  Spinal  $1,309 $1,342
 RESP02 Level 2  Spinal  $1,112 $1,140
 REPD01 Paediatric      $1,307 $1,340

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 2019 - 30 June 2020 per bedday  1 July 2020 - 30 June 2021 per bedday 
   Geriatric Evaluation and Management    $670 $687
   Nursing Home Type - Patient/Day    $263  $270
   Palliative care - Admitted  Metro  $685  $702
 Rural  $691  $708
Specialty clinics  Pain Management Inpatient    $719  $737

 Rehabilitation in the Home - Inpatient Equivalent
$504  $517

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

 Worksafe item code  Grouping  Non-admitted patients  Specifics  1 July 2019 - 30 June 2020  1 July 2020 - 30 June 2021
 N/A Specialty clinics Pain management    Compensable non-admitted patient fees for outpatients as per DHHS   Funding and Policy Guidelines
 PMEP01
Pain education program

Price per program 

# Refer policy

 $1,085  $1,112
 N/A    Continence    $115  $118
 N/A    Gait analysis  RCH  $2,133  $2,186
 Kingston - 1 Assessment  $1,581  $1,621
 Kingston - 2 Assessment  $2,370  $2,429
 N/A    PAC    $38  $39
 N/A    Rehab in the   home    Compensable non-admitted patient fees for outpatients as per DHHS   Funding and Policy Guidelines
 N/A  Mental   health  Clinical   Community Care  Group per visit  $161  $165
 N/A  Individual per   visit  $276  $283

# 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.

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.  $432  
 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.   $259  
 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 (Regulaitons).

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 VICDRG 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.

 WorkCover Admitted Patient VICDRG Statement

Date:

Treatment Details:

Patient UR No.

Date of birth

Admitted Patient Stay:

Date of admission:

Date discharged:

Length of stay:

Hospital in the Home Length of Stay

Inlier/outlier status:

WIES copayments:

ATSI

Mechanical ventilation

Thalessaemia

AAA Stent

ASD

Colono

Total WIES

VICDRG base fee

VIC-DRG No.

Desc.

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

Separation type code

Description

Acute Admitted Patient Fee

Refer to DHHS Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals

Note:

Descriptions are provided for the primary diagnoses, sequalae diagnoses and operation codes only

This is not an invoice. It must be attached to a hospital invoice before dispatch to VWA


Reviewed 24 February 2016

Health.vic

Contact details

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

Department of Health and Human Services GPO Box 4057, Melbourne, VIC 3000

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