Development Of Arrangement A Billing Procedures
This operational directive is in relation to Arrangement A billing procedures.
Area health services are required to develop procedures and/or guidelines on Arrangement A billing for implementation in their respective area health services.
It is mandatory that public health organisations comply with this operational directive.
This operational directive applies to area health services and includes:
- Child and Adolescent Health Service
- North Metropolitan Health Service
- South Metropolitan Health Service
- WA Country Health Service
The Office of the Auditor General (OAG) issued a qualification on the accounts and financial statements of metropolitan health services in relation to Arrangement A billing in 2010, 2011 and 2012.
While metropolitan health services have commenced some action it appears that there have been different approaches adopted at the site level. It is important to standardise the Arrangement A billing practices across sites in the respective area health service.
Arrangement A billing is in accordance with the Australian Medical Association award Clause (29) where medical practitioners may elect, under Arrangement ‘A’ to relinquish all private practice rights for payment of the Private Practice Income Allowance. The Award (29:2 & 3) states:
A Practitioner who assigns to the Employer private practice income generated from all work, whether publicly or privately funded, carried out on behalf of the employer shall:
- Be paid the applicable Private Practice Income Allowance
- Authorise the employer to render accounts in the Practitioner’s name
- On each occasion the opportunity to exercise private practice rights arises, assess the fee to be charged and advise the Employer so that an account can be rendered by the Employer
The following patient categories are subject to Arrangement A billing:
- Australian Defence Force - Defence personnel employed by the Australian Army, Navy and Air force who are admitted as an inpatient or attend an outpatient clinic.
- Compensable Claim - A patient pursuing legal compensation for injury or illness sustained against a company who are admitted as an inpatient or attend an outpatient clinic.
- Eastern States Motor Vehicle - A patient has been involved in a motor vehicle accident where the car is registered interstate and the charges are billed to the Eastern States Motor Vehicle Insurance Company e.g. Tac Victoria.
- Foreign Defence Force - Foreign Defence personnel employed by the overseas Army, Navy and Air force from overseas who are admitted as an inpatient or attend an outpatient clinic.
- Motor Vehicle - The patient is admitted as an inpatient as they were involved in a motor vehicle accident where the car is registered in Western Australia.
- Overseas Patient - All overseas visitors who are not covered under the Reciprocal Health Care Agreement are charged for inpatient and outpatient services.
- Overseas Students - Students from overseas studying in Australia and they must have health insurance membership.
- Private Insured - A patient elects to be treated as a private inpatient.
- Private Uninsured - A patient elects to cover costs of own medical bills when admitted as an inpatient. A patient is referred to the health site for a consultation or procedure but are not admitted.
- Shipping - A patient who is a master, seaman, apprentice or other member of a ship who has been hurt or injured or contracted a disease in the service of the ship who is admitted as an inpatient and can attend outpatient clinics.
- Veteran Affairs - Patients who are ex Australian service personnel or war widows receiving a service pension.
- Workers Compensation - A patient covered for injuries sustained at work
The following documents are related to this issue:
OD 0181/09 – Compensable Patient Admission – 2009 Update
OD 0099/08 – Billing Arrangements for Selected Services Provided to DVA Entitled Persons
OP 1820/04 – Implementation of a Privately Referred Non-Inpatient Billing System
DEPARTMENT OF HEALTH WA