Given the strengthening of claims oversight for Medicare and private health insurance for services provided in public hospitals, it is timely to review billing policies, procedures, and training for Medicare staff to ensure that claims are invoked only in the circumstances authorized by the new addition. In addition, public health providers have the opportunity to participate in the development of the trade rules for comparing data with the administrator and in any proposed changes to the rules by the Commonwealth. The Commonwealth is committed to consulting states on any changes to these rules affecting the practices of public hospitals. It is recognised that changes to data provision requirements should prevent excessive additional administrative burdens on public hospitals. According to the rules, private insurers cannot ask public hospitals for certification documents beyond those prescribed by the National Private Patient Hospital Hospital, nor delay or refuse payment of fees for legitimate hospital care. In the event of insufficient or erroneous information, insurers should first cooperate with the public hospital in order to obtain more information. As of July 1, 2020, Annex J – Addendum to the National Health System Reform Agreement will enter into force. [PDF 2.71 MB | DOCX 182KB] The new addition also provides that the administrator as of July 1, 2020, cases that should not have qualified for the payment of a Medicare, PBS or private health insurance payment should be sent to the appropriate Commonwealth representative to support compliance activities through mechanisms outside the new warrant officer. The commercial rules relating to the comparison of data are defined by the administrator in consultation with the parties. In August 2011, COAG approved the National Health Reform Agreement [PDF 1.10MB], which sets out the common intention of Commonwealth, state and territory governments to cooperate in partnership to improve health outcomes for all Australians and ensure the sustainability of the Australian healthcare system. It is important that public health changes are beneficial, such as the new addition: 3. Provision of data to private health insurers and certification documentation An amendment to Annex G (Commercial Rules) stipulates that the Commonwealth, as the regulator of private health insurers, will annually verify compliance with the minimum standards of the new addus, the Rules and the Private Health Insurance Act of 2007 (Cth).
communicate all relevant results to the COAG Health Council and publish the review. On 29 May, the Council of Australian Governments (COAG) approved several amendments to the National Health Reform Agreement (NHRA), which will come into force on 1 July 2020. Compliance with NHRA conditions is critical for public health facilities seeking access to Medicare discounts for private health services at those facilities. The amendments include strengthening the monitoring and notification of rights to private services in public hospitals. In February 2018, COAG drew up an agreement on new public hospital funding schemes for the period 2020/21-2024/25. As part of these agreements, coAG has negotiated a new addition to the NHRA that will come into effect on 1 July 2020 (new addendum). An external review of the new addendum will be completed by December 2023. The new addendum includes two new sections of Annex G (trade rules). Hospitals will continue to provide data on private patients treated in a public hospital to private insurers in accordance with the agreed application form for private patients.
Local hospital networks and the Australian Institute for Health and Welfare are required to ensure that data relating to privately insured patients treated in a public hospital is passed on to insurers, as provided for in the rules of the Private Health Insurance Act 2007 (Cth). . . .