INFORMATION PACKAGE
FOR
PRIVATE HOSPITAL
MENTAL HEALTH SERVICES
November 2015
Table of Contents
1.
OVERVIEW ............................................................................................................... 1
2.
PATIENT ELIGIBILITY ............................................................................................. 2
2.1
2.2
2.3
3.
PRIOR FINANCIAL AUTHORISATION REQUIREMENTS ..................................................... 3
SEEKING PRIOR FINANCIAL AUTHORISATION ............................................................... 3
DEPARTMENT OF DEFENCE ARRANGEMENTS .............................................................. 3
CONTRACT MANAGERS ........................................................................................ 4
3.1
4.
ADDITIONAL INFORMATION ......................................................................................... 4
ADMISSION, TRANSFER AND DISCHARGE ......................................................... 5
4.1
HOSPITAL ADMISSION VOUCHER - D652B .................................................................. 5
5.
QUALITY STANDARDS ........................................................................................... 7
6.
INFORMATION MANAGEMENT – SUBMITTING HCP DATA ................................ 8
7.
IN HOSPITAL CLAIMS (IHC) RELEASE 6 .............................................................. 9
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
7.10
7.11
7.12
7.13
7.14
8.
WHAT ARE THE ADVANTAGES FOR FACILITIES THAT MOVE TO DVA IHC? ....................... 9
WHAT TYPES OF SERVICES ARE ABLE TO BE CLAIMED VIA IHC FOR DVA? ...................... 9
WHAT TYPES OF SERVICES CANNOT BE CLAIMED VIA IHC FOR DVA? .......................... 10
IS EFT MANDATORY FOR CLAIMS LODGED THROUGH IHC? ......................................... 10
ARE REMITTANCE ADVICES AVAILABLE ELECTRONICALLY THROUGH IHC? .................... 10
WHAT HAPPENS TO PAPERWORK WHEN CLAIMING VIA IHC?........................................ 10
CAN A CLAIM BE SUBMITTED IF IHC IS UNABLE TO IDENTIFY A VETERAN? ...................... 10
WILL A CLAIM BE PAID IF IHC IDENTIFIES A VETERAN PATIENT? ................................... 11
DO FACILITIES NEED TO CHECK A VETERAN’S ACCEPTED CONDITIONS? ........................ 11
ARE DVA PRIOR APPROVALS REQUIRED FOR IHC? ................................................ 11
HOW DO FACILITIES GET ACCESS TO IHC? ............................................................. 11
HOW DO FACILITIES USING IN-HOUSE SOFTWARE GET ACCESS TO IHC?.................... 11
WHO DOES MY SOFTWARE VENDOR CONTACT FOR INFORMATION ON IHC? ............... 11
WHO SHOULD I CONTACT FOR MORE INFORMATION? ............................................... 11
BILLING ARRANGEMENTS .................................................................................. 13
8.1 WHERE TO SEND CLAIMS ......................................................................................... 13
8.2 PROMPT PAYMENT ................................................................................................. 13
8.3 ACCOUNT ENQUIRIES .............................................................................................. 13
8.4 DISCHARGE ADVICE AND HOSPITAL CLAIM FORM (D653A)......................................... 13
8.5 COMPLETING THE FORM .......................................................................................... 16
8.6 HOW TO CLAIM ....................................................................................................... 18
8.6.1 How to claim a complete episode................................................................... 18
8.6.2 How to claim a Continuation claim ................................................................. 18
8.6.3 How to claim a Leave Day ............................................................................. 19
8.6.4 How to claim an ECT as part of an Inpatient Stay .......................................... 19
8.6.5 How to claim an ECT as a Day Patient .......................................................... 19
8.6.6 Calculating day count ..................................................................................... 20
8.6.7 Acute Care Certificates .................................................................................. 20
8.6.8 Critical Care Certificate .................................................................................. 20
9.
CLAIM STATIONERY ............................................................................................. 21
10.
ADVERTISING........................................................................................................ 22
ATTACHMENT 1 – CONTACT DETAILS FOR THE DEPARTMENT OF DEFENCE
JOINT HEALTH COMMAND ........................................................................................... 23
ATTACHMENT 2 - DVA QUICK CONTACT LIST........................................................... 24
1.
Overview
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 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 Hospital Services Agreement between DVA and your organisation defines how the
arrangements will work. You should familiarise yourself with the aspects of the Agreement
relevant to your position.
In addition to its arrangements with private hospitals providing mental health services, DVA
has arrangements in place with other private hospitals, 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 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 provision of Mental Health Hospital Services under your Agreement is to be in
accordance with the following legislative frameworks:
a) 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
b) the Safety, Rehabilitation and Compensation Act 1988
DVA advises Entitled Persons to present their Repatriation Health Cards or their written
authorisation for treatment, 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. 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.
Gold Cardholders are entitled to treatment of most conditions, however, prior financial
authorisation must be sought for some services and treatment, see “Prior Financial
Authorisation Requirements” below.
White Cardholders continue to be eligible for treatment only for those conditions for which
DVA has specifically accepted financial responsibility.
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.
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 Person with eligibility for the
treatment provided.
2.1
Prior Financial Authorisation Requirements
Prior financial authorisation must be sought for some services and treatment for all Entitled
Persons. These are:



2.2
respite care or convalescent care;
surgical/medical procedures not listed on the MBS; and
specific treatments nominated in writing by DVA from time to time (e.g. noncontracted programs).
Seeking Prior Financial Authorisation
Where prior financial authorisation is required, you should:

complete a hospital admission request or provide a written request from a doctor,
and fax it to DVA on (08) 8290 0422; or
 contact DVA during business hours by telephoning 1300 550 457 (metro) or
1800 550 457 (non metro).
2.3
Department of Defence Arrangements
All ADF Personnel admissions require prior financial authorisation from the Department of
Defence local Joint Health Command. The contact details for the Joint Health Command are
shown at Attachment 1.
3.
Contract Managers
Your organisation and DVA have both appointed Contract Managers (see Clause 13.1 of the
Agreement) to ensure that services provided are consistent with the spirit of the
arrangements.
Your DVA Contract Manager (see Clause 13.5 of your Hospital Services Agreement) 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.
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;
implement the partnering arrangements detailed in the Agreement; and
plan, effect and manage changes required to achieve continuously high quality
services to veterans.
In terms of quality and performance management and reporting, the Contract Managers
shall be responsible for:



3.1
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.
Additional Information
General information is available on the DVA Hospitals Webpage to assist Contract
Managers. The website is: http://www.dva.gov.au/providers/hospitals-day-procedurecentres-and-mental-health-private-hospitals#private_hospitals
Other useful contact information is at Attachment 2.
4.
Admission, Transfer and Discharge
The Hospital Services Agreement 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 General Practitioners; and
arranging post-discharge services.
You must ensure that each Entitled Person has a documented Discharge Plan which is to
be commenced on or prior to admission. A copy of the confirmed Discharge Plan must be
given to the Entitled Person on discharge.
You must ensure that subject to clauses 5.1.2 and 16.5.1 of the Hospital Services
Agreement, as part of a mental health admission process, a comprehensive Intake
Assessment by a psychiatrist or psychiatry registrar including a treatment plan undertaken
required for each Entitled Person.
Entitled Persons who are enrolled as participants in the Coordinated Veterans’ Care (CVC)
Program should be identified and a copy of their CVC Care Plan should be made available.
The Entitled Person’s General Practitioner or Nurse Coordinator should also be made aware
of the admission and is to be involved in the implementation of the Discharge Plan where
appropriate.
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 downloaded from the DVA
website: http://factsheets.dva.gov.au/factsheets/
4.1
Hospital Admission Voucher - D652B
Completion of a Hospital Admission Voucher (D652B) for each veteran patient is a
requirement of the Agreement. These must be kept with the patient’s clinical record to
confirm patient identity and eligibility when required for audit and investigation of claims, and
to document the Entitled Person’s authorisation for disclosure of Clinical Information as
shown by their signature.
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 the Department of
Human Services (DHS) for processing and payment.
5.
Quality Standards
Quality management under the arrangements is aimed at continuously improving the
effectiveness of veterans’ hospital care and health care in terms of accessibility,
appropriateness and efficiency, continuity and veteran satisfaction.
Hospitals must comply with the accreditation requirements specified in the Australian Health
Services Safety and Quality Accreditation (AHSSQA) Scheme, which commenced in
January 2013. Hospitals will be required to be assessed against the National Safety and
Quality Health Service (NSQHS) Standards and the National Standards for Mental Health
Services (NSMHS) at their next accreditation assessment. In the interim, the Hospital must
have and maintain accreditation by an appropriate body acceptable to DVA.
DVA acknowledges the significant developments in accreditation (e.g. ACHS and ISO) 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.
The Private Hospitals (Mental Health) Annual Quality Report template is available at:
http://www.dva.gov.au/sites/default/files/files/providers/hospitals/MentalHealthQualityReport.pdf
Where hospitals provide Trauma Recovery Programmes – PTSD, these programmes must
be accredited against the 2015 National Standards (available at www.at-ease.gov.au) within
12 months of approval.
5.1
Veteran Satisfaction
In addition to establishing a complaints handling mechanism and reporting veteran
comments to DVA, the Department will undertake surveys of veterans, their carers, relatives
and referring doctors, including the DVA Patient Satisfaction Survey (see Clause 11.6).
The Agreement requires Hospitals to participate in the DVA Patient Satisfaction Survey by
distributing the DVA questionnaire to Entitled Person Inpatients.
These surveys will establish the level of satisfaction with respect to quality, dignity, privacy,
efficacy and communication associated with the treatment provided.
Information Management – Submitting HCP data
6.
Each month you must provide to DVA’s Contract Manager, in electronic medium and without
charge, information in respect of each veteran separation during the preceding month. The
data must be supplied using the Hospital Casemix Protocol (HCP) format, as specified by
the Department of Health (DoH), and split into monthly periods. The HCP data provided will
be based on the current HCP version, or any future revisions as specified by DoH. It will be
supplied using DVA’s Secure File Transfer facility.
It is critical that the HCP data specification complies with the DoH header and episode
record, hospital-to-fund layout.
From time to time the specification of HCP data is altered and these changes will be advised
by DoH and made available via the DoH website:
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-datacollections-about-HCP
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. For this and further information please contact the DVA Secure Services
Desk on 1300 301 575 or email:

For Qld and NSW/ACT facilities – HCPDataNth@dva.gov.au or

For Vic, SA/NT, WA and Tas facilities – HCPDataSth@dva.gov.au
7.
In Hospital Claims (IHC) Release 6
Your organisation has agreed to implement and/or maintain effective electronic billing and
payment arrangements during the period of the Agreement.
The In Hospital Claims (IHC) system is an electronic billing system available to Private
Hospitals and Day Procedure Centres (DPCs). It was developed by the Department of
Human Services (DHS) in collaboration with DVA, the health care industry and the medical
software industry.
This product is an extension of the DHS online claiming solutions which:
1) enables Private Hospitals and DPCs to submit electronic claims for processing without
the requirement to send additional paperwork to DHS;
2) offers a secure connection between private hospitals, DHS and DVA and health funds;
and
3) incorporates direct communication for providers with DHS and health funds, all in the
one transaction.
7.1
What are the advantages for facilities that move to DVA IHC?

Facilities are able to submit DVA claims electronically for processing and payment. This
may reduce administration and management costs.

DVA’s IHC component is consistent with the system used for health funds.

IHC contains an inbuilt automated veteran verification system that confirms whether a
veteran’s patient details are correct.

Electronic remittance advice statements detailing DVA’s payment of claims allow
automated account reconciliation on request.

Facilities can check the status of their hospital claim assessments and request
processing and payment reports relating to claims through their claiming software.

Certificate information (such as Acute Care Certificate) can be submitted electronically.
7.2
What types of services are able to be claimed via IHC for DVA?
The following private hospital and DPC DVA claim types can be claimed electronically using
IHC:
Accommodation
Acute Care*
Critical care
In patient
Interim claims
Miscellaneous charges
Overnight
Prosthesis
Psychiatry
Rehabilitation
Same day
Theatre
*Including certificates
7.3
What types of services cannot be claimed via IHC for DVA?

Public hospital claims - existing payment arrangements for public hospital services will
continue.

Australian Defence Force personnel claims - claims should continue to be sent to the
relevant Defence Area Health Service for payment.

Adjustments to previous claims – these claims should be manually submitted to DHS for
payment.

Some claims where Letters of Authority indicate other specific billing arrangements.
7.4
Is EFT mandatory for claims lodged through IHC?
Yes, Electronic Funds Transfer (EFT) is a mandatory part of the IHC registration process.
Facilities are required to provide their EFT details as part of the IHC registration process.
For further information on EFT, contact DHS on 1800 700 199.
7.5
Are remittance advices available electronically through IHC?
Yes, a facility can retrieve a remittance advice through their software for up to six months
from the date of payment. After six months have lapsed the facility will need to contact DHS
on 1300 550 017 to request duplicate statements.
7.6
What happens to paperwork when claiming via IHC?
Facilities are required to retain auditable records, these may be in paper form or electronic.
DHS does not require paperwork to process the claims. You no longer need to complete
the Discharge Advice and Hospital Claim Form (D653A) when claiming via IHC. However,
you must retain all the data elements required by this form, and any accompanying
certification, with the Entitled Person’s Clinical Record.
You must complete a Hospital Admission Voucher (D652B) and retain a copy with the
Entitled Person’s Clinical Record.
Paperwork that would normally be submitted with a claim for payment, such as Critical Care
Certificates, no longer need to be submitted. An electronic/paper record should be kept by
you with the Entitled Person’s Clinical Record for audit purposes.
7.7
Can a claim be submitted if IHC is unable to identify a veteran?
No, if a veteran verification request does not identify the veteran, the facility should either:



check the details with the Veteran, or
contact their local DVA Office on 1300 550 457 to confirm the veteran’s details, and
correct the details before submitting the claim.
Where the process does not verify a veteran’s details the claim will be rejected.
7.8
Will a claim be paid if IHC identifies a veteran patient?
In most cases yes, however the claim must meet all DVA’s business rules. The process
does not check a veteran’s accepted conditions, a claim could still be rejected for reasons
relating to the accepted condition.
7.9
Do facilities need to check a veteran’s accepted conditions?
Yes, under DVA contracting arrangements it is the facility’s responsibility to ensure that a
veteran has eligibility for the requested treatment before admitting a patient at the expense
of DVA. If a facility is unsure of a veteran’s eligibility, they should contact their local DVA
Office on 1300 550 457 for confirmation.
7.10
Are DVA prior approvals required for IHC?
Prior approval requirements are specified within contractual agreements for certain items.
IHC has not changed any of DVA’s prior approval requirements. Please check your contract
for these requirements.
7.11
How do facilities get access to IHC?
The facility should contact the software vendor that currently supplies the billing software.
The software vendor should call DHS Online Technical Support on 1300 550 115 for advice
and assistance.
Each private hospital and DPC must be registered to use IHC.
DHS eBusiness Service Centre can assist your facility with registering for IHC and can be
contacted on 1800 700 199.
All sites submitting claims electronically through IHC require a digital certificate that ensures
the security of claims lodged online. DHS eBusiness Service Centre will also assist with
registering for digital certificates.
7.12
How do facilities using in-house software get access to IHC?
Private Hospitals or DPCs using in-house software or facilities who do not have a software
vendor should contact DHS Online Technical Support on 1300 550 115 for advice and
assistance on the steps required to incorporate IHC functions into their software.
7.13
Who does my software vendor contact for information on IHC?
If your software vendor is unaware of IHC and requires further information they should
contact DHS Online Technical Support on 1300 550 115 for advice and assistance on the
steps needed to incorporate IHC functions into their existing software products.
7.14
Who should I contact for more information?
Hospitals and DPCs
Enquiries from hospitals or DPCs seeking more about the products available or to register for
IHC, should be directed to the DHS eBusiness Service Centre on 1800 700 199.
Software Vendors
Enquiries from software vendors should be directed to DHS Online Technical Support
on telephone: 1300 550 115. Enquiries can also be directed to DVA by email:
onlineclaiming@dva.gov.au or by telephone: 03 6221 6725.
8.
8.1
Billing Arrangements
Where to send claims
Department of Human Services (DHS) - is an agent for DVA and process all Gold and White
card DVA admissions in accordance with DVA’s policies and procedures. Amounts are paid
in accordance with contracted or negotiated rates.
Electronic billing is preferred, however where this is not available accounts for hospital
accommodation, theatre fees, day only accommodation, fixed price items, case payments
and prostheses supplies should be mailed to:
Hospitals in SA - NT - WA - NSW - ACT send claims to:
Veterans’ Affairs Processing
Hospital Provider Claims
DHS-Medicare Programs
PO Box 9917
PERTH WA 6848
Hospitals in VIC - TAS - QLD send claims to:
Veterans’ Affairs Processing
DHS-Medicare Programs
PO Box 9917
MELBOURNE VIC 3001
Invoices for non-DVA Card holders should be submitted to DVA and must include the
reference number appearing on the written authorisation. Claims for payment for ADF
Personnel should be sent to the relevant Joint Health Command (see Attachment 1).
8.2
Prompt Payment
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.
8.3
Account Enquiries
Hospital account enquires should be directed to DHS on: 1300 550 017 (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.
8.4
Discharge Advice and Hospital Claim form (D653A)
The DVA Discharge Advice and Hospital Claim (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 DHS for claiming purposes, and retain the
“Hospital Copy” for your records. For electronic claims, all data elements required by this
form must accompany the invoice.
8.5
Completing the form
The D653A has a number of elements:
Hospital Details:
This section should contain the hospital name, address and provider
number.
Patient Details:
The details required for each patient are:
 DVA File Number
 Patient Surname
 Given Names
 Date of Birth
Dates of Service:
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
From
29/01/14
31/01/14
To
30/01/14
04//02/14
No of
Days
Item
No
Total
Claimed
$
$
 Incorrect claim
Date of Service
From
29/01/14
30/01/14
To
30/01/14
04/02/14
No of
Days
Item
No
Total
Claimed
$
$
Number of days:
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.
Item Numbers:
Insert the item numbers from your Agreement. Item numbers not within
your Agreement cannot be claimed.
Total Claimed:
Insert the accommodation amount claimed in accordance with
contracted or negotiated rates.
Theatre Date:
Insert the date the operation or procedure was performed.
Total Claimed:
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.
Pharmaceuticals:
Pharmaceuticals are not to be claimed on the Discharge Advice and
Hospital Claim form (D653A).
As detailed in your Agreement, Imprest pharmaceuticals, the patient copayment, the brand price premium and therapeutic group premium for
all pharmaceuticals (including those for discharge) are included in the
bed fee. This includes medications for conditions unrelated to the acute
episode. Prescription pharmaceuticals should be claimed under the
Repatriation Pharmaceutical Benefits Scheme and, where necessary,
the appropriate authority obtained.
Dressings:
Dressings are included in the bed fee and are not to be claimed on the
Discharge Advice and Hospital Claim form (D653A). High cost items are
to be claimed separately.
Miscellaneous:
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.
Principal ICD-10
Code:
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:
Tick “Interim” if this is part of a continuation claim (see below). Tick
“Final” if this is the only claim for that patient’s admission.
Separation code:
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.
Name of treating doctor:
Insert the name of the doctor providing treatment.
Place to which discharged:
Indicate the place to which the person was discharged, e.g.
home, aged care facility, family care.
Admission date:
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.
Discharge date:
Your reference/ invoice no:
This information is optional, but will appear on the cheque
statement if provided.
Patient Declaration:
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.
Claimant Declaration:
The form must be signed by an Authorised Officer.
8.6
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.
8.6.1 How to claim a complete episode
In the example below, a veteran was admitted on 1 March 2014 for an acute Mental Health
episode of care. The veteran was discharged on the 28th day.
Date of Service
From
01/03/14
22/03/14
To
21/03/14
28/03/14
No of
Days
Item
No
Total
Claimed
21
6
H300
H300
$9,000.00
$1,800.00
Theatre
Date
Total
Claimed
Procedure
Item No
For this example item number H300 is an acute psychiatric accommodation item which has
step-downs on days 22, 43 and 66. Consequently, the primary rate would be billed for the
first 21 days (row 1 – 01/03/14 to 21/03/14), the first step-down rate would be billed for the
next 6 days (days 22-27, row 2 – 22/03/14 to 28/03/14). The day of discharge is not
payable.
8.6.2 How to claim a Continuation claim
In the example below, a veteran was admitted on 1 March 2014 for an acute Mental Health
episode of care.
Date of Service
From
01/03/14
To
14/03/14
No of Days
14
Item No
H300
Total Claimed
$6.000.00
In this example, the person has not been discharged on the 14th day. Therefore, the FROM
date in the subsequent claim would be 15/03/14. In this instance the box on the form (see
below) should be ticked to indicate an interim account and “S” placed in the separation code
box.

8.6.3 How to claim a Leave Day
Date of Service
From
To
01/03/14 05/03/14
06/03/14 06/03/14
07/03/14 12/03/14
No of
Days
5
1
5
Item
No
H300
H999
H300
Total
Claimed
$2,143.00
$0
$2,143.00
Theatre
Date
Total
Claimed
Procedure
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.
Note: In this instance the day count does not restart on return to hospital from leave days.
8.6.4 How to claim an ECT as part of an Inpatient Stay
Example 1
In the example below, a veteran was admitted on 1 March 2014 for an acute episode of
care. The veteran was discharged on the 28th day.
Date of Service
From
01/03/14
22/03/14
No of
Days
To
21/03/14
28/03/14
21
6
Item No
Total
Claimed
Theatre
Date
Total
Claimed
Procedure
Item No
H300
H300
$9,000.00
$1,800.00
05/03/14
09/03/14
$100.00
$100.00
M009
M009
For this example item number H300 is an acute psychiatric accommodation item which has
step-downs on days 22, 43 and 66. Consequently, the primary rate would be billed for the
first 21 days (row 1 – 01/03/14 to 21/03/14), the first step-down rate would be billed for the
next 6 days (days 22-27, row 2 – 22/03/14 to 28/03/14). ECT would be billed under the
Theatre for each service provided. The day of discharge is not payable.
8.6.5 How to claim an ECT as a Day Patient
Example 2
In the example below, a veteran was admitted on 1 March 2014 as a Day Patient for ECT
Date of Service
From
01/03/14
To
01/03/14
No of
Days
Item
No
Total
Claimed
1
H468
$500.00
Theatre
Date
Total
Claimed
Procedure
Item No
For this example item number H468 is a Day patient ECT item. No Theatre is claimed as
the H468 item includes both Accommodation and Theatre.
8.6.6 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
Then……
the day count continues
discharged and readmitted within 7 days for a
condition that is not described by the DRG
describing the first condition
the day count starts again
interrupted with another treatment type (i.e.
Advance Surgery, Surgery or Medical)
the day count starts again
If an Entitled Person in a different hospital is
Then……
transferred to another hospital for a more complex
procedure
the day count starts again at the
receiving hospital
transferred to another hospital for the same
condition
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).
8.6.7 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 1973. Leave
days and periods between hospitalisation do not count towards the 35 day period.
If claiming an acute rate for a period beyond 35 days, the certificate needs to be forwarded
to DHS with the Discharge Advice and Hospital Claim form. Acute Care certificates are not
required to be sent to DVA.
Where DHS receives a claim for admission longer than 35 days and without an Acute Care
Certificate, the period up to 35 days will be paid at the rate claimed by the hospital and the
period over 35 days will be rejected. This allows the hospital to either resubmit the claim
accompanied by an Acute Care Certificate or alter the claim to indicate the appropriate nonacute NHTP rate.
Note: DVA will pay the basic daily care fee patient contribution for ex-Prisoner of War (exPOWs) and entitled veterans awarded the Victoria Cross who are classified as receiving
Nursing Home Type care in hospital.
8.6.8 Critical Care Certificate
Where a patient requires critical care for 10 days or less, a Critical Care Certificate covering
a period of not more than 10 days is required. Where the length of stay in the Critical Care
Unit exceeds 10 days a subsequent Critical Care Certificate is required.
Please retain Critical Care Certificates on the patient file for audit purposes. You should not
send original Critical Care Certificates to either DHS or DVA.
9.
Claim Stationery
Hospital Admission Voucher and Discharge Advice and Hospital Claim form
From 1 July 2015 DVA will no longer provide manual D652B Hospital Admission Voucher or
D653A Discharge Advice and Hospital Claim forms.
Admission Vouchers, Discharge Advice and Claim forms can be downloaded and filled in
electronically, saved and printed for manual claiming:
http://www.dva.gov.au/providers/forms-service-providers
Acute Care Certificate Forms:
The Acute Care Certificate form can also be downloaded from the DVA website:
http://www.dva.gov.au/providers/hospitals-day-procedure-centres-and-mental-healthprivate-hospitals#d9076
10. Advertising
Advertising requirements are set out in clause 3.4 of your Agreement.
Advertising to Entitled Persons and others in relation to the awarding and operation of this
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 Arrangements 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:




Veterans
Ex-Service Organisations
specialists and medical practitioners
allied health providers
Advertising in:




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.
ATTACHMENT 1 – Contact details for the Department of
Defence Joint Health Command
Joint Health Command
Regional Health Service - Queensland
Gallipoli Barracks
Lloyd Street
ENOGGERA QLD 4051
Phone: (07) 3332 4900
Point of contact for North & South
Queensland
Joint Health Command
Regional Health Service – Central & West
Leeuwin Barracks
EAST FREMANTLE WA 6158
Phone: (08) 9311 2832
Point of contact for WA, SA & NT
Joint Health Command
Regional Health Service – Northern NSW
Defence Plaza
Level 17
270 Pitt St
SYDNEY NSW 2000
Phone: (02) 9393 2518
Point of contact for Sydney metro/regional
areas and northern NSW
Joint Health Command
Regional Health Service – Victoria &
Tasmania
Level 1, M Block
Victoria Barracks
256-310 St Kilda Road
SOUTHBANK VIC 3006
Phone: (03) 9282 7070
Point of Contact for Victoria (including
Albury/Wodonga military area) and
Tasmania
Joint Health Command
Regional Health Service – Southern NSW
Duntroon Garrison
Morshead Drive
CAMPBELL ACT 2612
Phone: (02) 6265 9413
Point of contact for ACT and southern
NSW
ATTACHMENT 2 - DVA Quick Contact List
Claims for Payment enquiries
Department of Human Services
1300 550 017
DHS – Medicare Programs
Prior Financial Authorisation and Eligibility
for Treatment (Admission Approvals)
Business hours 8.30 am to 5.00 pm.
Phone
1300 550 457 (metro)
1800 550 457 (non metro)
Fax
(08) 8290 0422
Department of Veterans’ Affairs
Aids & Appliances (Rehabilitation Appliance
Program RAP)
Community Nursing
Allied Health
Oxygen
Veterans’ Home Care
Aged Care
Respite care
1300 550 457 (metro)
1800 550 457 (non metro)
Reporting a death
or Freedom of Information and Privacy
133 254
Veterans’ Transport Services
1300 550 455 (metro)
1800 550 455 (non-metro)
Pharmaceuticals
Veterans’ Affairs Pharmaceutical Approvals
Centre (VAPAC)
Veterans and Veterans Families Counselling
Service (VVCS)
Notification of change in organisational
details (Please notify both agencies)
Department of Health
Department of Veterans’ Affairs
1800 552 580 (24 hours per day)
1800 011 046
Ph: (02) 6289 9853 or
Email: privatehealth@health.gov.au
1300 550 457 (metro)
1800 550 457 (non-metro)