Section A: Fees for Admitted Patients Part 1 - Fees and Charges for Acute Health Services - Department of Health, Victoria, Australia

Patients who are admitted to a public hospital are classified as one of the following:

- public admitted patient;
- private admitted patient;
- Department of Veterans' Affairs patient;
- compensable patient;
- ineligible patient.

Eligible persons who do not elect to be treated as private patients on admission to a public hospital are entitled to receive all necessary medical, nursing, allied health and diagnostic services at no charge. Charges may only be levied on public admitted patients if they are classified as nursing home type patients.

The following bedday fees are charged for all overnight stay patients who, on admission to a public hospital, have elected to be treated as private patients. Fees for patients in single bed rooms are to be charged only when a patient is accommodated in the single bed room by his or her choice.

* Rehabilitation and Psychiatric fees can only be charged by hospitals with specific rehabilitation or psychiatric programs approved for payment purposes, by individual private health insurance organisations.
Refer Commonwealth Circulars PHI26/05 and PHI48/07 for guidelines for health fund approval of private patient hospital rehabilitation and psychiatric services.

Note: Where a patient is placed into a single room and they have elected to have a single room they are to be charged the single room rate. Hospitals should not retrospectively seek a single room election from a patient after a private patient is placed into a single room for clinical need.

The classifications advanced surgical, surgical and other are defined in Schedule 1 of the Private Health Insurance (Benefit Requirements) Rules 2011, made under the Private Health Insurance Act 2007. The item numbers contained in each classification are taken from the Medicare Benefits Schedule (MBS) and based on the complexity and fee charged for the procedure.

The determinations contain schedules of MBS item numbers for professional services under each patient classification. Schedule 1 specifies:

advanced surgical patient: is specified in Part 2 of this Schedule and the item numbers are derived from the MBS and apply to those MBS items that have an MBS fee that is greater than $837.05.

surgical patient: is specified in Part 2 of this Schedule and the item numbers are derived from the MBS and apply to those MBS items that have an MBS fee within the range of $249.26 to $837.05.

obstetric patient: is specified in Part one of this Schedule. (definition taken from Part 2 of Schedule 1)

psychiatric patient: is a patient in a hospital who is admitted for the purposes of undertaking a specific psychiatric treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient's disease, injury or condition.(definition taken from Part 2 of Schedule 1)

rehabilitation patient: is a patient in a hospital who is admitted for the purposes of undertaking a specific rehabilitation treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient's disease, injury or condition.(definition taken from Part 2 of Schedule 1)

other patient: are deemed to be any patients in a hospital other than advanced surgical, surgical, obstetric, psychiatric, or rehabilitation patients.(definition taken from Part 2 of Schedule 1)

The following fees are charged for all same day patients who, on admission to a public hospital, have elected to be treated as private patients. Same day patients admitted for minor procedures (that is, those procedures contained in the Commonwealth's Type C exclusion list) must be certified as requiring hospital admission.

Please note that the shared fee changes have been made in accordance with the Commonwealth circular PHI 40/07. Single room rates are set by the State.

All matters relating to same day arrangements are summarised in the Commonwealth Department of Health and Aged Care Day Only Procedures Manual 1999. That manual includes a listing at that time, of Type B professional attention procedures (the day list) and Type C professional attendance procedures (the exclusion list), band descriptors, day only forms, and same day patient benefits. The Commonwealth’s Internet site for the Day Only Procedures Manual 1999 is: http://www.health.gov.au/internet/wcms/publishing.nsf/content/health-privatehealth-providers-dayonly-dayonly_1999.htm

Current listing of Type-B (day only) and Type C (exclusion) items are attachments to PHI 15/07.