DOCSLIB.ORG

Public Health Services Table of Costs Effective from 1 January 2016

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Public Health Services Table of Costs Effective from 1 January 2016 Public health services table of costs Effective from 1 January 2016 Contents Introduction ............................................................................................................................ 2 Working together.................................................................................................................... 2 An insurer’s liability for services ............................................................................................. 2 Reports .................................................................................................................................. 4 Fees....................................................................................................................................... 5 Emergency department services ............................................................................................ 5 Emergency department fees and item numbers ............................................................ 6 Emergency department fees ......................................................................................... 6 Non-listed hospitals providing emergency treatment ..................................................... 7 Emergency department item numbers .......................................................................... 7 Inpatient services ................................................................................................................... 8 Inpatient fee types.................................................................................................................. 8 Small hospitals ....................................................................................................................... 9 Small hospitals - Group X hospital fees......................................................................... 9 Small hospitals - Group X hospital item numbers .......................................................... 9 Sub and non-acute care ......................................................................................................... 9 Sub and non-acute care fees – Hospital groups A, B, P, T............................................ 9 Sub and non-acute care item numbers – Hospital groups A, B, P, T ........................... 10 Acute care............................................................................................................................ 10 Acute care fees - Hospital groups A, B, P, T ............................................................... 10 Base Rates ............................................................................................................................. 10 Long stay per day rates ........................................................................................................... 11 Extra long stay per day rates ................................................................................................... 11 Trim points .............................................................................................................................. 11 Formulas 12 Acute care fee verification - Hospital groups A, B, P, T ............................................... 13 Acute care item numbers - Hospital groups A, B, P, T ................................................ 13 Hospital in the Home (HITH) ................................................................................................ 14 Hospital in the Home item numbers – Hospital groups A, B, P,T & X ................................... 14 Interfacility transfer costs and escort fee item number.......................................................... 14 Outpatients .......................................................................................................................... 15 The Queensland Hospital & Health Services invoice ............................................................ 16 Hospital groups .................................................................................................................... 17 WorkCover DRG item number code ............................................................................ 19 The information provided in this publication is distributed by WorkCover Queensland as an information source only. The information is provided solely on the basis that readers will be responsible for making their own assessment of the matters discussed herein and are advised to verify all relevant representations, statements and information. Page 1 of 22 Public health services table of costs Effective from 1 January 2016 Introduction This table of costs commences 1 January 2016. This table of costs sets out the costs applicable for the treatment of workers under the workers’ compensation statutory scheme as public patients in Queensland public hospitals. This table of costs is a comprehensive table of costs for all public health services and includes the Public hospitalisation table of costs published in the Industrial Gazette. This table of costs applies only to the costs of the services provided to: • A worker who is discharged from a public hospital (an inpatient) on or after 1 January 2016; or • A worker who receives treatment at a public hospital emergency department on or after 1 January 2016 or • A worker who receives treatment at a public hospital out-patient facility on or after 1 January 2016; and • Where the service is not covered under the Memorandum of Understanding between Queensland Health and WorkCover Queensland from 1 July 2015 until 31 December 2015. From 1 January 2016, the Hospital & Health Services will be responsible for invoicing WorkCover Queensland directly for services. This table of costs is based on the Independent Hospital Pricing Authority cost data and published price increase. This table of costs outlines the procedures, conditions and fees for the delivery of public hospital services in Queensland public hospital facilities, for medical and allied health services to workers’ compensation claimants. This table of costs applies only to workers’ compensation claimants receiving treatment in the public hospital sector as a public patient under the care of a public hospital doctor. This table of costs excludes claimants under the statutory workers’ compensation system electing to be treated as private patients and all workers’ compensation common law claimants. Private patient fees for statutory claimants are documented in the Queensland Health Fees and Charges Register and can be found at: http://www.health.qld.gov.au/directives/html/a.asp#f The common law only patients are charged under compensable third party fees when treated in the public hospital sector. The table of costs is structured to promote the provision of quality, timely and relevant treatment in the management of injured workers. In the majority of cases, the rehabilitation goal is for the worker to return to work. In situations where the injury prevents the worker returning to work, rehabilitation must focus on maximising functional independence. Working together Insurers are committed to working with the Hospital & Health Services. If there is an issue in dispute, a Hospital & Health Service should contact the insurer to discuss an appropriate resolution. WorkCover Queensland offers each Hospital & Health Service a dedicated relationship manager for resolution of any issues. An insurer’s liability for services The payment for services outlined in this document is subject to the following condition that the worker’s compensation claim for the injury or condition being treated must be allowed by the Queensland workers’ compensation insurer; i.e. WorkCover Queensland or the self-insurer, in Page 2 of 22 Public health services table of costs Effective from 1 January 2016 accordance with the legislation. A list of insurers is available at https://www.worksafe.qld.gov.au/insurance/find-a-self-insurer. The insurer’s liability is subject to the Workers’ Compensation and Rehabilitation Act 2003. In all instances, the insurer requires the worker to have a current workers’ compensation medical certificate to cover the period of the services provided. If there is no workers’ compensation medical certificate, the insurer has no liability for the costs of treatment. If the worker does not have a certificate upon presentation to a public facility, a certificate may be issued by an emergency department or public hospital during the course of the treatment, or upon discharge. Due to the diversity of medical services and rehabilitation program content, there may be other expenses which are not covered in this document. These expenses are to be negotiated with the Insurer prior to the delivery of such services. The following definitions apply - “public hospital” means a hospital to which a worker is admitted as a public patient. “public patient” means a patient who is not a private patient. “private hospital” means a hospital to which a worker is admitted as a private patient. “private patient” means a worker who is a patient of a private doctor at a hospital that is not a contracted hospital. The worker has elected to be treated as a private patient by a doctor of their choice. An “inpatient in a public hospital” is a public patient admitted at a public hospital and includes admission as a public patient to a Mater Misericordiae Public Hospital or transfer to contracted hospital. An “out-patient in a public hospital” is a public patient who is not admitted to a public hospital and receives treatment as an outpatient. The patient may have been an inpatient
Load more

Recommended publications
  • 7.10 Emergency Department Care
    Australia’s health 2018 7.10 Emergency department care Emergency departments are a critical part of Australia’s health care system, providing care for patients who require urgent medical attention. Most larger public hospitals have purpose-built emergency departments. Some smaller public hospitals can also provide emergency services though informal arrangements. Accident and emergency services can also be provided by private hospitals. In 2015–16, there were 36 private hospitals in Australia providing these services. The information presented in this snapshot relates to the 287 Australian public hospitals with purpose-built formal emergency departments that are staffed 24 hours a day. These hospitals report to the AIHW’s National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD). The latest available estimate (2014–15) indicated that around 88% of all public hospital emergency services were provided in formal emergency departments covered by the NNAPEDCD. Emergency department presentations In 2016–17, there were about 7.8 million presentations to public hospital emergency departments. This was an average of more than 21,000 each day across Australia. Between 2012–13 and 2016–17, after adjusting for hospital coverage changes, the number Chapter 7 of emergency department presentations increased by an average of 2.6% each year. In 2016–17: 7 • emergency department presentations were evenly split for males (50%) and females (50%) • the most common 10-year age groups presenting at emergency departments were people aged 25–34 (14%) and 15–24 (13%). Some population groups were over-represented in emergency department presentations compared with their representation in the population as a whole: 21% were aged 65 and over (15% of the population) 11% were aged under 5 (7% of the population) 6.5% were Aboriginal and Torres Strait Islander people (3.3% of the population) Australian Institute of Health and Welfare 2018.
    [Show full text]
  • The Evolution of Hospitals from Antiquity to the Renaissance
    Acta Theologica Supplementum 7 2005 THE EVOLUTION OF HOSPITALS FROM ANTIQUITY TO THE RENAISSANCE ABSTRACT There is some evidence that a kind of hospital already existed towards the end of the 2nd millennium BC in ancient Mesopotamia. In India the monastic system created by the Buddhist religion led to institutionalised health care facilities as early as the 5th century BC, and with the spread of Buddhism to the east, nursing facilities, the nature and function of which are not known to us, also appeared in Sri Lanka, China and South East Asia. One would expect to find the origin of the hospital in the modern sense of the word in Greece, the birthplace of rational medicine in the 4th century BC, but the Hippocratic doctors paid house-calls, and the temples of Asclepius were vi- sited for incubation sleep and magico-religious treatment. In Roman times the military and slave hospitals were built for a specialised group and not for the public, and were therefore not precursors of the modern hospital. It is to the Christians that one must turn for the origin of the modern hospital. Hospices, originally called xenodochia, ini- tially built to shelter pilgrims and messengers between various bishops, were under Christian control developed into hospitals in the modern sense of the word. In Rome itself, the first hospital was built in the 4th century AD by a wealthy penitent widow, Fabiola. In the early Middle Ages (6th to 10th century), under the influence of the Be- nedictine Order, an infirmary became an established part of every monastery.
    [Show full text]
  • Determinants of Patient Satisfaction with Public Hospital Services
    Determinants Of Patient Satisfaction With Public Hospital Services Which Rubin accoutres so vicariously that Emmet renamed her lungies? Subtracted Deane garland or refurnish some molars anatomically, however niffy Gustavus desolates throatily or fin. Philoprogenitive Lambert studs, his custodies invigorates attends amuck. Hospital or longer waiting on wom and other factors related factors with patient of determinants satisfaction public hospital services are. Medicaid health sciences in french, and of determinants patient satisfaction public hospital services with services could also support. The manuscript with patient satisfaction public hospital of services? The patient hospital to help further questions brief the views of the utility for. Validity are being performed at three norwegian acute psychiatric services of determinants patient satisfaction with public hospital had exclusive breastfeeding also acknowledge the exercise. Cook county health leads worked hard to manage with the effectiveness or hospital of patient satisfaction with public services. Nicu patient satisfaction at p, eugene moustaferi and health care practice registrars: associations of that with patient opinion makes a negative and. Client satisfaction was obtained low correlation with services of determinants patient satisfaction public hospital of care services have higher reimbursement payments can help? And not be used for by referring to our study is compulsory health hospital of much as the phrase match the survey, please patients into a frequent checking of. Bayer institute ethical journalism for public hospital of determinants patient satisfaction services with general medical condition and private hospitals were counted as more meaningful information from pakistan. Researcher unless they do this thematic analysis was measured using analysitcs to evaluate patient satisfaction in this study of age and the help highlight those services unlike products are kindly asked if duty towards patient with.
    [Show full text]
  • Threats to Urban Public Hospitals and How To
    THREATS TO URBAN PUBLIC HOSPITALS AND HOW TO RESPOND TO THEM Alan Sager, Ph.D. Professor of Health Services and Co-Director, Health Reform Program Health Services Department Boston University School of Public Health 715 Albany Street Boston, Massachusetts 02118 phone (617) 638-4664 fax (617) 638-5374 [email protected] Health Reform Program Doctors Day Address Medical and Dental Staff District of Columbia General Hospital Washington, D.C. Friday 30 March 2001 As always, I write and speak only for myself, not for the Boston University School of Public Health, or for organizations that provide financial support. Thank you for inviting me to speak with you this afternoon. I. INTRODUCTION Since the 1930s, decade after decade, urban hospitals that serve lower-income patients and minority patients (African-Americans or Hispanic-Americans) have been substantially more likely to close, even after controlling for number of beds, whether the hospital is a teaching hospital, efficiency of the hospital, and other factors. I’ve examined all hospitals (some 1,200) open at any time since 1936 in 52 U.S. cities—all of the large cities and most of the mid-sized ones. Fully 54 percent of hospitals have remained open in census tracts with 1990 minority population shares under 20 percent, but only 33 percent of hospitals have remained open in hospitals with minority shares over 80 percent. If we map hospitals and their closings in several cities, we can see how this works out for people. These maps of St. Louis, Washington, Detroit, and Brooklyn succinctly summarize hospital survival over time in relation to demography.
    [Show full text]
  • Summary of Findings: Privatization of Public Hospitals
    JANUARY 1999 Summary of Findings: Privatization of Public Hospitals To obtain a copy of the Full Report: Privatization of Public Hospitals (document #1450) call The Henry J. Kaiser Family Foundation publications request line at 1-800-656-4533 or down load the report from our website at www.kff.org. Prepared for The Henry J. Kaiser Family Foundation by: The Economic and Social Research Institute Summary of Findings: Privatization of Public Hospitals Prepared for The Henry J. Kaiser Family Foundation Prepared by Economic and Social Research Institute Mark W. Legnini Stephanie E. Anthony Elliot K. Wicks Jack A. Meyer Lise S. Rybowski Larry S. Stepnick January 1999 Summary of Findings Public hospitals (other than those run by the federal government) account for almost one- quarter of the community hospitals in the United States, yet their numbers have been decreasing for more than a decade, through both conversions and closures. The Henry J. Kaiser Family Foundation commissioned the Economic and Social Research Institute (ESRI) to conduct a study to better understand the causes and effects of the conversions of public hospitals to private ownership or management. ESRI explored conversions that occur via lease, sale, management contract, merger, consolidation, and the establishment of an independent hospital authority. Recent studies of hospital conversions have focused primarily on hospitals that have converted to for-profit status, examining the impact on a community when a former not-for-profit hospital (whether public or private) becomes part of an investor-owned hospital organization. Very few studies, however, have explored the effect on communities and hospital operations of the privatization of public hospital care, broadly defined to encompass conversions from public to private (often non-profit) status.
    [Show full text]
  • Victoria's Public Hospital Patient Charter - Department of Human Services Victoria Australia
    Victoria's Public Hospital Patient Charter - Department of Human Services Victoria Australia Patient Charter Home << Putting Patients First (1995) Public Hospitals: What Do They Offer You? ACCESS A Wide Range of Public Hospital Services ● As an Australian resident you have access to a wide range of public hospital services. If you are away from home, any public hospital in Australia will provide quality care for you. ● Public hospitals provide different types of care depending on their size and role. Some common services such as general surgery and obstetrics will be available in nearly all hospitals. More complex services such as heart surgery and burns units are usually only available in teaching and/or specialist hospitals. ● Patients requiring specialised inpatient care that is not available locally will be transferred or referred appropriately to another hospital. ● In an emergency patients will usually be taken to the nearest public hospital with the necessary services. Some private hospitals in the city can also treat emergency patients. ● Doctors have admitting rights at certain hospitals. Patients who want to receive care at a particular public hospital should speak with their doctor about whether they can be treated in that hospital. Treatment Regardless of Ability To Pay or Health Insurance Status ● Public hospitals treat both public and private patients Admission to public hospitals and treatment in emergency departments is based on health needs of patients. ● Where urgent treatment is required to prevent loss of life in an emergency, immediate treatment will be provided in a public hospital. Non-emergency health needs will be treated in a reasonable time, according to the condition.
    [Show full text]
  • D/B/A Ocean Beach Hospital) And
    COLLECTIVE BARGAINING AGREEMENT By and Between PUBLIC HOSPITAL DISTRICT #3 OF PACIFIC COUNTY (d/b/a Ocean Beach Hospital) and WASHINGTON STATE NURSES ASSOCIATION April 1, 2019 to March 31, 2022 TABLE OF CONTENTS PREAMBLE ...•...............................•...•....•....•.•.....................................•..•.•.•.•.•............................ 1 ARTICLE 1 - RECOGNITION ...........•.•.•.......................................•.................•.............•.......... I ARTICLE 2 - MANAGEMENT RESPONSIBILITIES .......................................................... 1 2.1 Acknowledgement .............•.•...............................................................•.•.••................ 1 2.2 Managerial responsibilities ............................................•..•..............•....................... 1 ARTICLE 3 - MEMBERSHIP/DUES DEDUCTION .............................................................. 1 3.1 Membership ....•.....•...•.....................................................•.......................................... 1 3.2 Dues Deduction.........................•.........•...................................................................... 1 3.3 Notification of New Hires ..........................•............•...•....•..•..................................... 2 3.4 Hold Harmless .................•.........•..•........................................................•.•.........•...•... 2 ARTICLE 4 - REPRESENTATION ...•...•........................................•....................•....•...•....•...... 2 4.1 Association
    [Show full text]
  • Living the Life That You Want Following a Diagnosis of Bipolar Disorder
    Living the life that you want following a diagnosis of Bipolar Disorder A thesis submitted to The University of Manchester for the degree of Doctor of Clinical Psychology in the Faculty of Biology, Medicine and Health 2018 Helen R Warwick School of Health Sciences Division of Psychology and Mental Health Contents List of Tables ..................................................................................................................... 5 List of Figures .................................................................................................................... 5 Word Count ........................................................................................................................ 4 Abstract ............................................................................................................................. 6 Declaration ......................................................................................................................... 7 Copyright Statement ........................................................................................................... 8 Acknowledgements ............................................................................................................. 9 Paper 1: ‘What People Diagnosed with Bipolar Disorder Experience as Distressing’: A Meta- Synthesis of Qualitative Research ........................................................................................ 11 Abstract .......................................................................................................................
    [Show full text]
  • Key Elements
    Environment of Care: Key Elements Interim LSU Public Hospital Department of Professional Development, Clinical Excellence, and Clinical Affiliation Revised March, 2010 Welcome to Interim LSU Public Hospital • This inservice is an introduction to and overview of our environmental safety policies and practices • It is actually required by the accrediting agencies; therefore it is very important that you participate • Please print out an answer sheet, then read through this presentation. There is a quiz at the end. ILH Core Values • Customer Focused • Healing Environment • Accountability • Respect & Integrity • Innovation • Teamwork • Yes We Can Attitude You are expected to demonstrate these values every day you are here Appearance Standards Policy 8134 • ILH employees, physicians, students, contract workers, and volunteers shall present a neat and clean appearance, and dress in a manner appropriate for a professional healthcare environment • In general, all will wear name badges with name and title, and shall not wear denim, shorts, or revealing clothes Service Excellence Two kinds of customers: • Internal—coworkers, people from other departments, vendors, representatives, students, and instructors • External—patients, and their family and friends Treat all of these people with respect, helpfulness, and willingness to listen Communication Skills • Differences in communication styles can lead to misunderstandings • Nonverbal communication can mean different things to different people • Simplify and explain what you are saying • Check with
    [Show full text]
  • DEPARTMENT of HEALTH CARE SERVICES Public Hospital Project Frequently Asked Questions – January 2013
    1 DEPARTMENT OF HEALTH CARE SERVICES Public Hospital Project Frequently Asked Questions – January 2013 General Questions Why did DHCS decide to go TAR free for certain inpatient hospital days in Public Hospitals? Answer: To increase efficiency and effectiveness while still ensuring hospital inpatient stays are billed appropriately, DHCS is transitioning out of the 100% utilization review to allowing the hospitals to use an evidence-based standardized review criteria, such as InterQual or Milliman Care Guidelines for acute inpatient days and acute administrative days. Do any inpatient services still require a TAR? Answer: Inpatient acute rehabilitation and general acute care inpatient hospice will continue to require a TAR, as will any surgical procedures. Why will some hospitals use diagnosis related groups (DRGs) for payment? Answer: The California Legislature directed DHCS to replace the current reimbursement methodology for private hospital acute care inpatient services (both negotiated contract rates and non-contract cost reimbursement) with payment by DRGs for Medi-Cal beneficiary stays, per Senate Bill 853 which added Section 14105.28 to the California Welfare and Institutions Code. What are the monthly data files/data reviews? Answer: Each month, approximately 60 days after the month of admission, each hospital is required to send DHCS a monthly data file of their fee for service (FFS) admissions. The data will be used to derive a statistically valid sample that will be reviewed by DHCS Nurse Evaluators and Medical Consultants to ensure compliance with Medi-Cal policy and appropriate use of Interqual or Milliman. What additional documentation does DHCS need for the monthly reviews? 2 Answer: Required additional documentation includes: 1.
    [Show full text]
  • Public Hospital Product Guide Effective from 1 April 2015
    Public Hospital Product Guide Effective from 1 April 2015 Public Hospital cover is designed for people living in areas without access to private hospitals. You should be aware What’s covered that public hospital waiting lists will still apply. You are covered for all Medicare-approved treatments but only as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly Favourite features out-of-pocket. Comprehensive ambulance cover 100% of the Department of Health recommended What’s restricted fee for a shared ward in a public hospital including theatre fees, labour ward and intensive care Should you choose to be treated in a private hospital your benefit will be restricted to the equivalent rate for a private Choice of doctor from those associated with the patient in a public hospital shared room. You will experience public hospital you attend significant out-of-pocket expenses. Avoid or minimise Government penalties – such as the Medicare Levy Surcharge and Lifetime Health Cover loadings What’s excluded Services where Medicare pays no benefit (e.g. most Your hospital cover cosmetic surgery) Your hospital cover gives you Choice of doctor from those associated with the public Comprehensive ambulance cover hospital you attend You get 100% cover for ambulance services by state- 100% of the Department of Health recommended fee appointed ambulance providers across Australia. And for a shared ward in a public hospital including theatre there’s no limit on the number of times you can use the fees, labour ward and intensive care ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care Get hospital substitute treatment in your home and air and sea ambulance services.
    [Show full text]
  • Three Rivers Hospital Board of Commissioners Regular Meeting October 28, 2020 Minutes ______
    Three Rivers Hospital Board of Commissioners Regular Meeting October 28, 2020 Minutes _____________________________________________________________________________________ The Three Rivers Hospital Board of Commissioners called a regular meeting to order at 11:19 a.m. Wednesday, October 28, 2020. In order to comply with State Governor’s mandates regarding social distancing, the meeting was held virtually via the Microsoft Teams platform. The presiding officer was Mike Pruett, Board Chairman. A quorum was present, including: Mike Pruett, Board Chairman Cherri Thomas, Vice-Chair Tracy Shrable, Secretary Leslie McNamara, Member David Garcia, Member Others present: J. Scott Graham, Chief Executive Officer Melanie Neddo, Chief Operating Officer Anita Fisk, Director of Human Resources Alan Ulrich, Chief Financial Officer Jennifer Munson, Director of Finance Gretchen Aguilar, Chief Nursing Officer Tina Smith, Assistant Chief Nursing Officer Shauna Field, Administrative Assistant Jennifer Best, Public Relations Chad Schmitt, Chief Information Officer Nancy DeFord, Director of Quality Rosie Poole, Materials Manager Dr. Ty Witt, Chief Medical Officer Jamie Boyer, Clinic Manager Jeremy Vandelac, Ancillary Manager Dr. Jill Jenkins Dr. James Wallace Vision, Mission & Values All took turns reading the vision, mission, and values statements. Agenda Cherri Thomas requested discussion be added to new business regarding Medicare Advantage plans. Anita Fisk requested an action item be added to new business to accept the 2021 medical benefit plan recommendation. A motion was made by L. McNamara to accept the amended agenda as official; seconded by C. Thomas. Motion carried. Minutes from Previous Meeting A motion was made by C. Thomas to approve the September 30, 2020 Regular Meeting minutes; seconded by T. Shrable. Motion carried.
    [Show full text]