Unlike Patient Claiming, Bulk Billing, DVA Billing or ECLIPSE for the Medical Service, you cannot transmit the IHC from the invoice. The IHC is transmitted from the admission form. This IHC option is only available when for privately insured patients and when the data entered on the Admission meets your Health Fund contract requirements. Therefore, there is no need to wait for the Clinical Coder unless you are unsure of the Principal ICD code, or your contract is based on the DRG. This allows for improved cash flow prior to meeting HCP data requirements for the Statutory Reporting.

Provider Resources

Provider Resources | Private Healthcare Australia (PHA)

What is clinical coding?

Clinical coding is the translation of written clinical documentation about patient care into code format. For example, acute appendicitis is represented by the code 'K35.8'.

A standardised classification system, The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), is applied in all Australian acute health facilities.

It is based on the World Health Organisation ICD-10 system, updated with the Australian Classification of Health Interventions (ACHI), Australian Coding Standards (ACS) and ICD-O-3 (International Classification of Diseases for Oncology, 3rd edition).

What does a clinical coder do?

A clinical coder is responsible for abstracting relevant information from the medical record and deciding which diagnoses and procedures meet criteria for coding as per Australian and WA Coding Standards. The coder then assigns codes for these diagnoses and procedures based on ICD-10-AM conventions and standards.
Clinical coding is a specialised skill requiring excellent knowledge of medical terminology and disease processes, attention to detail, and analytical skills.

Coded information is used for:

The assigned codes and other patient data are processed by grouper software to determine a Diagnosis Related Group (DRG) for the episode of care, which is used for funding and reimbursement. This process allows hospital episodes to be grouped into meaningful categories, helping us to better match patient needs to health care resources. Other common uses of coded data:

• Clinical research and audits
• Resource allocation
• Health services planning
• Statistics
• Epidemiological studies
• Clinical benchmarking
• Education

About Hospital Casemix Protocol (HCP)

Hospitals submit Hospital Casemix Protocol (HCP) data to Health Insurers, who then submit to the Department of Health and Aged Care.

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-cas...

About Private Hospital Data Bureau (PHDB)

The PHDB is legislated de-identified data from all Private Hospitals and Day facilities. This is then submitted to the Department of Health and Aged Care who then supply it to the Australian Institute of Health and Welfare (AIHW)

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-cas...

Know your states requirements ...

Private Hospital Licensing and Data Collection