Victoria - Public Hospitals Policy and Funding Guidelines 1997-1998
Section B: Standard Conditions of Funding

4. Reporting

4.1 Definitions

4.1.1
The hospital will comply with standard definitions for reporting financial and statistical data as set out in the Notes and Definitions for Use in Completing the 1996/97 Annual Return, the PRS/2 Manual Version 7.0, the Agency Information Management System Public Hospital User Manual Version 5.0, Circular 17/1995 and any other amending documentation prepared by the Department.

4.1.2
The hospital will code patient episodes in accordance with Australian Coding Standards effective 1 July 1996, Victorian additions to the Australian Coding Standards, Departmental Circular 17/1995, and ICD Coding Newsletters Issued by the Department.

4.1.3
During 1997-98, hospitals will be advised of State wide Patient Management Index (PMI) for the linking of multiple admissions. Each hospital is to sign an agreement with the PMI Agency for the provision of patient identifier numbers by a date to be advised by the Department.

4.2 Supply of Statistics and Information
4.2.1
The hospital will provide data to the Department as specified in the Health Service Agreement.

The following categories of reporting are specified:

(a) Agency Level/Aggregated Hospital. The hospital will report on each of the Agency Level forms by the due dates.

(b) Program Specific. The hospital will report on the forms relevant to the hospital's program sources of funding shown in the Health Service Agreement by the due dates.

The data specified in this section will be supplied in hard copy paper returns or computer readable form in accordance with Departmental specifications.

4.2.2

Failure of a hospital to supply accurate and timely statistical and financial data in accordance with the Hospital Conditions of Funding may result in fines or suspension of payments by the Department.

4.2.3

(a) Hospitals which receive funding under Commonwealth/State programs are required to submit regular statistical and financial reports for the monitoring of activity, payment of grants and acquittance to the Commonwealth.

(b) The information required, format and timelines for individual programs are detailed in the Conditions for Commonwealth/State Programs.

4.2.4
Hospitals with a patient clinical costing system are required to provide, to a designated independent party, sufficient information from the system, as specified by the Department in consultation with the VHA, to allow recalibration of the DRG relative weights.

4.2.5
In addition to the monthly reports specified in section 4.2.1, hospitals and aggregated hospitals are required to complete an Annual Return by September 30 1997 in accordance with the detailed requirements specified by the Department.

4.2.6
Agencies opting to cease payroll/budget processing at Health Computing Services - Victoria Ltd will be required to provide to HCS extracts from their new payroll system and satisfactorily complete an accreditation process outlined in the Minimum Employment Data Set Collection System Data Dictionary and Accreditation Procedures Statement/User Guide.

4.3 Transmission of Admitted patient Data
4.3.1
The hospital will transmit data to the Victorian Inpatient Minimum Database (VIMD) collection via PRS or PRS/2 according to Schedule 2.1 (at the end of this section):

(a) admission and separation details for any month are to be transmitted in time for the VIMD file consolidation on the 21st day of the following month (see Section (d) for processing schedule).

(b) diagnosis and procedure details in any month are to be transmitted in time for the VIMD file consolidation on the 21st day of the second month following (see Section (d) for processing schedule).

(c) data for the financial year should be completed in time for the VIMD file consolidation on 21st August. Any final corrections must be transmitted before finalisation of the VIMD database on 21 September.

  1. it is the hospital's responsibility to ensure that data are transmitted to the VIMD to meet the processing schedule for inclusion in the Health Computing Services (HCS) file consolidation on the 21st of each month. Because of the various methods of transmission used by hospitals, and HCS processing schedules, data must be transmitted earlier than the 21st to ensure it is included in the file consolidation. Data must be transmitted by the PRS or PRS/2 feeder systems to the VIMD by, at the latest, the 17th day of the month following the month in which the separation occurred; however, weekends or public holidays may bring the deadline forward to the 14th day.

  1. Amendments and/or additions to previously reported details may result in an increase in the WIES5 for a particular month. If such a WIES5 increase occurs in a consolidation more than one month and 21 days later than the end of that month, the additional WIES5 will be paid at a reduced rate (50%) or will not be recognised for payment, according to Schedule 2.1 located at the end of this section.

(f) If difficulties are anticipated in meeting the relevant data transmission timeframes for either admission and separation data, or for diagnosis and procedure details, the hospital must write to the Regional Office, indicating the nature of the difficulties, remedial action being taken, and the expected transmission schedule. Exemptions for late submission of data will only be considered for computer system problems that are beyond the control of the hospital.

(g) data should be reconciled after each transmission against the hospital's in-house computer or manual systems and against the Monthly Return-Admitted Patients and any required corrections transmitted with data for the subsequent period.

4.4 Coding Audits
4.4.1
The hospital will provide sufficient access to data and records to allow an audit of patient records, patient coding and data transmitted to the Victorian Inpatient Minimum Database.

4.4.2
The hospital will provide sufficient access to data and records to allow an audit of patient records and data transmitted via the Agency Information Management System as part of the Victorian Ambulatory Classification System.

4.4.3
Access to data and records for emergency departments patients and persons on waiting lists will also be required should this Department or the Commonwealth require an audit to verify information used for funding calculations either at the hospital or State level.

4.4.4

If the audit shows a significant difference in assignment of DRGs or that patients fail to meet admission criteria, then the number of weighted inlier equivalent separations and variable throughput payments to the hospital may be adjusted to take account of those differences.

4.4.5

Where the audit indicates that a hospital has been negligent or consistently erroneous in the application of admission criteria and/or coding standards, the Department may adjust or suspend the relevant variable throughput payments until such time as the issue is resolved to the satisfaction of the Department.

4.4.6
The Department also reserves the right to extend the audit to confirm an issue and/or monitor improvement; the cost of which is to be borne by the hospital.

4.4.7
Access to data and records for interstate patients transmitted to the Victorian Inpatient Minimum Database will also be required should State or Territory Health Authorities request an independent audit to verify information on DRG weighted separations.

4.5 Access to Hospital Data

4.5.1
The Department will have direct access to all data transmitted to the VIMD, VEMD and PRISM and to non-confidential aggregate data drawn from systems at Health Computing Services including the transmission of cost data.

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