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Section B Conditions of Funding: Acute Health

6. Reporting

6.1 Definitions.

6.1.1 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 1999 - 2000 Annual Return, the PRS/2 Manual Version 9.0, the Agency Information Management System Public Hospital User Manual Version 7.0, and any other amending documentation prepared by the Department.

6.1.2 The hospital will code patient episodes in accordance with the current Australian Coding Standards effective 1 July 1998, Victorian Additions to the Australian Coding Standards and ICD Coding Newsletters issued by the Department.

6.1.3 During 1999 - 2000, hospitals will be advised of details of the operation of the Victorian Hospital Patient Register which will be developed for the linking of multiple admissions.

6.2 Supply of Statistics and Information.

6.2.1 The hospital will provide data to the Department as specified in the Health Service Agreement.

The following categories of reporting are specified:

1. Agency Level/Aggregated Hospital. The hospital will report on each of the Agency Level forms by the due dates.
2. Program Specific. The hospital will report on the forms relevant to the hospital's program sources of funding. in accordance with the Agency Information Management System Public Hospital User Manual 1999 - 2000.

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

F1 financial returns are required 14 days after the end of the month for which the financial data is provided (e.g. November F1 is required by 14 December).

6.2.2 Hospitals receiving 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.

The information required, format and time lines for individual programs are detailed in the guidelines applicable to the appropriate Commonwealth or State Programs.

6.2.3 Networks and major hospitals are required to operate and maintain, to a minimum standard, patient costing systems to allow recalibration of the DRG funding formulae. Such hospitals are required to provide, to a designated independent party, sufficient accurate and timely information from the system, as specified by the Department to allow recalibration of the DRG relative weights. Penalties for non-provision of costing data will be based on the average cost of operating an appropriate clinical costing system according to the operating size of the agency.

6.2.4 In addition to the monthly reports specified in section 6.2.1, hospitals and aggregated hospitals are required to complete an Annual Return by 30 September 2000 in accordance with the detailed requirements specified by the Department.

6.2.5 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.

6.3 Transmission of Minimum Employment Data Set.

Hospitals are required to transmit information detailed in the Minimum Employment data set. Hospitals who have their payroll/budget processing undertaken by Allegiance systems will continue to have their data forwarded direct to the Department. Agencies opting to cease payroll/budget processing at Allegiance Systems should provide to Allegiance Systems extracts from their new payroll system and satisfactorily complete an accreditation process outlined in the Minimum Employment Data Set.

The Employment Minimum Data Set and Collection procedures are under review. A Departmental and hospital steering committee has been created to refine future information requirements. Agencies will be advised of the revised arrangements as soon as possible.

6.4 Transmission of Admitted Patient Data.

6.4.1 The hospital will transmit data to the Victorian Admitted Episodes Dataset (VAED) formerly called the Victorian Inpatient Minimum Database (VIMD) via PRS/2 according to the timelines detailed in clauses 6.4.1.(a) and 6.4.1(b).

1. Admission and separation details for any month are to be transmitted in time for the VAED file consolidation on the 21st day of the following month (see Section (d) for processing schedule).
2. Diagnosis and procedure and sub-acute details in any month are to be transmitted in time for the VAED file consolidation on the 21st day of the second month following (see Section (d) for processing schedule).
3. Data for the financial year should be completed in time for the VAED file consolidation on 21 August. Any corrections must be transmitted before finalisation of the VAED database on 21 September.
4. It is the hospital's responsibility to ensure that data are transmitted to the VAED to meet the processing schedule for inclusion in the Allegiance Systems file consolidation on the 21st of each month. Because of the various methods of transmission used by hospitals, and Allegiance Systems processing schedules, data must be transmitted by the PRS/2 feeder systems to the VAED by, at the latest, the 17th day of each month; however, weekends or public holidays may bring the deadline forward to the 14th day.
5. Amendments and/or additions to previously reported details may result in an increase in the WIES7 for a particular month. Such a WIES7 increase will be:
   1. 1.fully paid if the increase results from changes to data previously submitted in accordance with the deadlines specified in clauses 6.4.1.(a) and 6.4.1(b); or
   2. 2.paid at a reduced rate (50%), or not recognised for payment, according to Schedules 2.1 and 2.2 located at the end of this section if the data has not been submitted in accordance with either deadline specified in clauses 6.4.1(a) and 6.4.1(b); or
   3. 3.not recognised for payment, if data has not been submitted in accordance with both deadlines specified in clauses 6.4.1(a) and 6.4.1(b).
6. This clause applies to all account classes including DVA.
7. If difficulties are anticipated in meeting the relevant data transmission timeframes for either admission and separation data, or diagnosis and procedure details, the hospital must write to the Department, indicating the nature of the difficulties, remedial action being taken, and the expected transmission schedule. Exemptions for late submission of data will generally only be considered for computer system problems that are beyond the control of the hospital. (Hospitals undertaking the PRS/2 data submission testing process are automatically exempted). Exemptions for late submission of admission and separation data will also be considered for staffing problems that are beyond the control of the small rural hospitals. Exemptions for late submission of admission and separation data will be automatically granted to hospitals maintaining a consistently high level of timely data submission.
8. 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.

6.5 Coding Audits.

6.5.1 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 Admitted Episodes Dataset (VAED).

6.5.2 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.

6.5.3 Where the audit indicates that a hospital has been 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.

6.5.4 The Department also reserves the right to undertake supplementary audits to confirm an issue and/or monitor improvement; the cost of which is to be borne by the hospital.

6.5.5 Access to data and records for interstate patients transmitted to the Victorian Admitted Episodes Dataset (VAED) will also be required should State or Territory Health Authorities request an independent audit to verify information on DRG weighted separations.

6.5.6 The hospital will also 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.

6.5.7 Access to data and records for emergency department 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.

6.6 Access to Hospital Data.

The Department will have direct access to all data transmitted to the VAED, VEMD, ESIS and PRISM and to non-confidential aggregate data drawn from systems at Allegiance Systems including the transmission of cost data.

Schedule 2.1 

Month of Separation 1999	21 September	21 October	21 November	21 December	21 January	21 February	21 March	21 April
July	Full Rate	Full Rate	Full Rate	Half Rate	Nil	Nil	Nil	Nil
August	Full Rate	Full Rate	Full Rate	Half Rate	Nil	Nil	Nil	Nil
September		Full Rate	Full Rate	Half Rate	Nil	Nil	Nil	Nil
October			Full Rate	Half Rate	Nil	Nil	Nil	Nil
November				Full Rate	Half Rate	Nil	Nil	Nil
December					Full Rate	Half Rate	Nil	Nil
January						Full Rate	Half Rate	Nil

Month of Separation 2000	21 March	21 April	21 May	21 June	21 July	21 August	21 September
January	Half Rate	Nil	Nil	Nil	Nil	Nil	Nil
February	Full Rate	Half Rate	Nil	Nil	Nil	Nil	Nil
March		Full Rate	Half Rate	Nil	Nil	Nil	Nil
April			Full Rate	Half Rate	Nil	Nil	Nil
May				Full Rate	Half Rate	Nil	Nil
June					Full Rate	Half Rate	Nil

Schedule 2.2 

Month of Separation 1999	21 September	21 October	21 November	21 December	21 January	21 February	21 March	21 April
July	Full Rate	Full Rate	Full Rate	Half Rate	Nil	Nil	Nil	Nil
August		Full Rate	Full Rate	Half Rate	Nil	Nil	Nil	Nil
September			Full Rate	Half Rate	Nil	Nil	Nil	Nil
October				Full Rate	Half Rate	Nil	Nil	Nil
November					Full Rate	Half Rate	Nil	Nil
December						Full Rate	Half Rate	Nil

Month of Separation 2000	21 March	21 April	21 May	21 June	21 July	21 August	21 September
January	Full Rate	Half Rate	Nil	Nil	Nil	Nil	Nil
February		Full Rate	Half Rate	Nil	Nil	Nil	Nil
March			Full Rate	Half Rate	Nil	Nil	Nil
April				Full Rate	Half Rate	Nil	Nil
May					Full Rate	Half Rate	Nil
June						Full Rate	Half Rate