Here is a clear, correct, DVA‑aligned explanation of how to bill Community Nursing services in Australia, based entirely on the current DVA rules and Schedule of Fees.

How to Do Community Nursing Billing for DVA

The DVA Community Nursing Program uses a 28‑day claiming cycle, core item selection, and visit‑length calculation to determine the correct item numbers. Claims are submitted retrospectively to Medicare on behalf of DVA.
Department of Veterans' Affairs

Below is the complete, step‑by‑step method.

1. Confirm you are a DVA‑contracted Community Nursing provider

Only providers contracted under the DVA Community Nursing Program can bill DVA.
You must use your current DVA Community Nursing provider number.
Department of Veterans' Affairs

2. Establish the 28‑day claim period

The claim period begins on the date of the first face‑to‑face visit where the comprehensive assessment is completed.
You submit the claim at the end of the 28‑day period.
Department of Veterans' Affairs

3. Categorise each visit

DVA recognises three visit types:

• Clinical care – wound care, medication administration, palliative care
• Personal care – hygiene assistance, medication prompting
• Other care – overnight care, bereavement follow‑up
  Department of Veterans' Affairs

4. Determine the “majority of care” → this sets the CORE ITEM

Count the number of clinical vs personal care visits (exclude overnight visits).
Whichever has more visits becomes the core category.
If equal, clinical care is the core.
Department of Veterans' Affairs

Example from DVA:

• 10 clinical visits
• 8 personal care visits
  → Clinical care is the core item.
  Department of Veterans' Affairs

5. Calculate average visit length for each category

For both clinical and personal care:

1. Add total minutes delivered in the 28‑day period
2. Divide by number of visits
3. Use the average to select the correct item number from the Schedule of Fees
   Department of Veterans' Affairs

Example:

• 450 clinical minutes ÷ 10 visits = 45 min average
• 240 personal care minutes ÷ 8 visits = 30 min average 
  → Clinical = long visit; Personal = medium/short depending on thresholds.
  Department of Veterans' Affairs

6. Select the correct item numbers from the Schedule of Fees

The DVA Schedule of Fees contains separate tables for:

• Core clinical care items
• Core personal care items
• Add‑on items (the non‑core category)
• Other care (overnight, second worker, bereavement)
  Department of Veterans' Affairs

You choose:

• ONE core item (clinical or personal)
• Add‑on items for the other category
• Other care items if applicable

7. Submit the claim to Medicare

All DVA Community Nursing claims are processed through Medicare on behalf of DVA.
Rejected claims often occur when:

• An inactive provider number is used
• The core item is incorrectly selected
  Department of Veterans' Affairs

For assistance:

• DVA Provider Enquiries: 1800 550 457
• Medicare (claim rejections): 1300 550 017 (option 2)
  Department of Veterans' Affairs

Quick Summary (Operational)