Private Hospital Services Table of Costs - FAQs
WorkCover Queensland (WorkCover) is focused on getting the best outcomes for our customers i.e. injured workers and Queensland businesses. Our priority is to ensure injured workers receive timely and quality medical and rehabilitation services to facilitate their return to work, at the right price for the employer.
As the main insurer for workers’ compensation in Queensland, we are also focused on maintaining the financial viability of the workers’ compensation scheme in Queensland.
In 2018, we started a review of our treating services model. Our medical and allied health expenditure had been rising for a number of years with no substantial change in RTW outcomes. We conducted a jurisdictional analysis against comparable interstate schemes and private health insurers which identified the need for improvements in how we engage these services. This highlighted opportunities for us to optimise the current model for improvements in the quality, responsiveness, consistency and the cost of services.
We then undertook research and consultation with industry experts to explore several initiatives that would help us improve the efficiency and effectiveness of our current provider treating services model for better outcomes.
One of those initiatives included the review of our contracts with private hospitals within the workers’ compensation setting in Queensland.
Private hospital costs are a significant part of annual medical expenses for Queensland insurers.
Queensland insurers have indicated there are challenges with:
- inconsistency in arrangements and fees
- the ability to be responsive to emergent events
- the lack of visibility to analyse and understand compliant to service delivery standards, and
- the impact to BAU functions in maintaining existing arrangements.
Further, the approach of Queensland insurers to private hospital services differs to that of all other medical expenses within our scheme (i.e. these are regulated by a table of costs).
WorkCover will be introducing a table of costs for private hospital services focussing on four key areas:
- Day Facility Fees
- Overnight Facility Fees
- Theatre Fees
- Prostheses Fees (including handling fees).
These are inpatient fees covering surgical, other medical, advanced surgical, same day accommodation fees covering four bandings and type C stays, and theatre fees covering the Independent Hospital Pricing Authority (IHPA) theatre bands from 1A to 13.
These services cover much of the private hospital expenditure for Queensland insurers and align with the Private Health Insurance (Benefit Requirement) Rules 2011.
Section 217 of the Workers’ Compensation and Rehabilitation Act 2003 outlines the costs for which an insurer is liable for hospitalisation of a worker as an inpatient at a private hospital. Specifically, 217(3) states WorkCover can limit the costs published via a gazette notice.
The Private Hospital Services Table of Costs will be maintained in a similar manner to our current Medical and Allied Health Table of Costs with annual and/or interim reviews. This would ensure fees and services are in line with relevant industry and economic factors such as CPI and wage indexes.
WorkSafe Victoria, the New South Wales State Insurance Regulatory Authority (SIRA) and ReturnToWorkSA all publish a private hospital fee structure (although it is important to note that each jurisdiction uses different terms e.g. rate order, fee schedule).
WorkCover will be implementing a Private Hospital Services Table of Costs effective 1 December 2021. The transition will commence on 1 November 2021 when we officially publish the table of costs, with an effective date of 1 December 2021.
We will work with individual providers to assist with the administration of the table of costs and help to get systems ready for 1 December 2021.
Current contracts held with WorkCover will be honoured through to the agreed end date. Any contracts that may expire prior to the proposed implementation date (i.e. 1 December 2021) will be reviewed and negotiated on an individual basis with all contracts finishing in line with the proposed implementation date (i.e. 1 December 2021). WorkCover has contacted all current contract holders and advised them of the initiative.
We have a few broad categories of table of costs:
- Medical - covering MBS Items;
- Allied health – this is broken up into specialties (e.g. physiotherapy, chiropractic, occupational therapy);
- Public hospital – structured using Diagnosis Related Grouping (DRGs) as agreed with Queensland Health;
- Supplementary – covering extra reports and communication fees for GPs and specialists and our custom MRI items.
These table of costs are available on our fees page.
Yes, you will be bound by the Private Hospital Services Table of Costs. However, you can choose to enter into contracts with specific providers to pay more than the identified fee within the table of costs if your business needs dictate this.
No. WorkCover is not exploring partnerships with hospital providers at the current time.
The proposed structure is based on the Private Health Insurance (Benefit Requirements) Rules 2011 and also mimics the current structure within financial agreements. WorkCover considers this approach will have the least impact on resources and stakeholders.
No. WorkCover is not pursuing a tender arrangements for the provision of private hospital services at the current time.
WorkCover reviews all Medical Items Table of Costs annually with changes applying from 1 December each year. The Private Hospital Services Table of Costs will form part of this process.
The annual and/or interim reviews will incorporate analysis of scheme data, broader jurisdictional comparisons, and consultation with stakeholders. This will ensure fees and services are in line with relevant industry and economic factors such as CPI and wage indexes.
WorkCover will first need to understand how private hospitals are delivering these services, including the nature of the programs on offer, current pricing, and outcomes. Once this information is better understood, we can then develop a standardised fee for these specialised services.
The table of costs effective 1 December 2021 will include specialised services (eg. psychiatric, multidisciplinary programs) but no fee will be listed. We will gather and analyse the data on the invoicing practices and treatment outcomes over the first 12 months and make more informed decisions on price setting for these services from 1 December 2022 onwards.
WorkCover has undertaken extensive external consultation with self-insurers, public hospitals, other insurers, and jurisdictions in the development of the pricing model for the Private Hospitals Table of Costs.
At this time, we will not be looking at performance measures however we will do so in the future.
The impact of the new fee schedule will vary between providers given the diversity of the existing contracts.
By implementing the standard fee structure, we will be able to have the visibility around best outcomes and service offering, including impacts on recovery durations and return to work.
Our approach has been focussed on implementing a standard fee structure across all private hospitals. We currently have multiple individual contracts with private hospitals and there has been an identified need for consistency and simplification. Given the research and data analysis done to date, there has been no consideration in establishing varied pricing arrangements in the new table of costs.
No there is no option to negotiate a different fee. Once the Private Hospital Services Table of Costs is gazetted then that is the formal rate applicable to that service. WorkCover cannot and will not pay above the gazetted rate.
The current invoicing method will not change. However, we are very keen to work with you to establish a more efficient approach to invoicing. We will contact you directly to help you move towards this approach i.e. B2B.
This new approach is simpler, quicker, and more streamlined; it is designed to reduce administrative demand for you and expedite payments to you.
We will take you through what this looks like when we contact you to discuss options.
Normal Department of Health prostheses invoicing codes need to be applied. This is set out in the Public Hospital Table of Costs.
WorkCover is committed to five core customer strategy principles in all our interactions:
- Fair and transparent
- Empowered
- Valued
- Easy
- Consistent
Any interested external party or stakeholder has the opportunity to provide feedback which valued and will be considered in the design and implementation of a Private Hospital Services Table of Costs.
Yes – the option for anonymous feedback is available.
However, if you have any specific concerns and you would like to discuss these, we encourage you to contact the Project Owner, Tanya Cambey on either phone 07 3006 6824 or email tanya.cambey@workcoverqld.com.au.
All information collected will be handled in accordance with the Information Privacy Act (2009). WorkCover will collate and consider all feedback received and the information will only be used internally to inform future strategy and design decisions relating to the Private Hospital Services Table of Costs initiative. Any submissions or feedback received will not be published on our website.
WorkCover has taken on board the initial feedback from stakeholders regarding the potential impact of the MBS Taskforce findings and the timing of the Private Hospital Services Table of Costs implementation. WorkCover is committed to continuous improvement and will undertake a post implementation review, including the collection of stakeholder feedback. This is currently being considered for mid-2022.
Unfortunately as we navigate the transition between existing contract arrangements and the introduction of the Private Hospital Services Table of Costs, there will be a need to issue two invoices – one for the period covered under the relevant contract (i.e. for services up to and including 30 November 2021) and one for services delivered after the implementation of the Private Hospital Services Table of Costs (i.e. for services from 1 December 2021).
Yes, WorkCover requires the information relating to the specialised program to be captured in the Request for Specialised Program form. This form can be found on our website.
Any approvals provided prior to 1 December 2021 will be honoured. You may however still be required to complete a Request for Specialised Program form for any extensions to existing admissions.
All invoices must be submitted within 60 days of the service being undertaken. All services provided will be paid according to the relevant fee structure in place at the time the service was delivered.
Please call us on 1300 362 128 if you have further invoicing questions.
WorkCover endeavours to provide decisions relating to treatment in a timely manner. A Customer Advisor will contact you within 48 hours to confirm receipt of the request and obtain any additional information that may be required.