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Manage Item Codes and Fees

  • Updated

 

Medical Service Item Codes and Fees

DCM uploads the following fee schedules for medical services as they become available:

On fees being updated, old fees are not replaced but kept for any prior billing. The correct fee is populated based on the Date of Service (DOS).

Therefore, if invoicing the following Rates, the correct fee should populate.

  • Bulk Bill
  • DVA In Room
  • DVA In Hospital
  • DVA Allied Health
  • Insured
  • WorkCover
  • Private and Custom Rates if based on an existing Fee Schedule

Fee Updates are pushed out to you as they become available. You will receive a Notification in DCM that the Fees have been Updated.

On logging on to Direct CONTROL, the Splash Screen shows the date of the last fee update. You can also select Utilities - Update Fees and force an Update if necessary.

To view the current fees and their Start and End (ceased) date, select Links and Support - My Fees.

Should Medicare introduce a new Item Code and other Fee Schedules do not include this new Item Code, the fee will be the Medicare Fee.

Disclaimer: We provide these updates to you on our receiving them from the relevant organisations but we do not guarantee that they are correct. It is up to you, to ensure your fees are correct. Please notify support@directcontrol.com.au should you believe a fee is not correct or an item code is missing.

Private Provider Rates and Fees

  • Your Private, Pension/HCC, Uninsured, Cosmetic, Overseas plus three Custom Rates can be selected in Utilities - Entities - (Provider) - per Location
  • Fees can be based on any existing fee schedule or a percentage of. For example:
    • 1.0 = 100%
    • 1.5 = 150%
    • 0.8 = 80%

It is this fee schedule above that will populate on generating the IFC or Invoice unless you have overridden Item Code Fees by selecting the green Edit button on that Rate.

  • Select Add
  • Enter the Item Number
  • Note the MBS and AMA Fee is displayed for your reference
  • Enter the Fee value
  • Overtype the description should you want a shorter description. Know that this description can also be overtyped in Links and Support - My Fees
  • Continue adding as required
  • Select Accept
  • On invoicing and entering an item code, the above table is referenced first
  • If the item code is in the above table, then this value and description populates the invoice
  • If the item code is not in the above table, then the schedule selected in Location Rate and Uplift is used

Private Custom Rates

There are three Private Custom Rates ready to edit and use on the Location Rates Tab. Custom Rate Names will be the same across all Entities and their Locations. However, each Entity per Location and select what this Custom Rate is based on and preferred uplift as well as overriding fees using the green edit button. Should the Custom Rate name be changed, it will change for all.

Additional Custom Rates can be added by selecting the Add button on the sidebar. How?

  • Go to Utilities - Entities and Double click on the Entity to open their record or select them in the list and click on Edit on the Sidebar.
  • Select - Locations (Active) and Select a Location
  • Select Location Rates
  • Select Add
  • Enter a Custom Rate Name
  • The Fee Schedule you want to base this on and the Uplift Percentage

  • Select Save and Close

  • Should there already be a Custom Rate with the same name, you will be prompted with following

  • Select OK to enter a new name
  • Select Save and Close
  • You will then be informed that this new PrivateCustomRate will be available to all Entities across all Locations. Do you want to enable all to to use?
  • Respond accordingly

 

 

 

 

Hospital Health Fund Contracts

  • These are setup in Utilities - Entities - (Hospital) - Insured Rate - Edit

Adding an Item Code

  • Go to Utilities - Lookups - General - Item
  • Ensure you have Group CTRL+G and Filter CTRL+F rows showing

  • Click on Contains: under Item Number and search to see if the Item Code is already listed

  • If not listed, select Click here to add a new row. Suggest clicking under Favourite to start
  • Select Favourite for easier management
  • Enter the Item Number. Only Alpha+Numeric numbers can be added as Medicare and DVA numbers are updated by DCM fee updates
  • Enter the Description 
  • Enter the Amount GST inclusive
    • If this amount does not change, then enter the correct value here
    • If this amount changes often or per Entity, enter 0 here
    • If this amount changes per Entity, go to Utilities - Entities - Private Rate - Edit and Add the item there with the correct detail
    • This value can be overtyped on generating the IFC/Invoice
  • Allocate Other Services Code if a Hospital Item Code
    • Accommodation
    • Allied Health Services
    • Bundled
    • Dental
    • Disposables
    • Labour Ward
    • Nursery Fee
    • Other
    • Pharmaceuticals
    • Prostheses
    • Theatre Ward
  • Custom Category
    • Add your own Item Code Categories for reporting via Utilities - Lookups - General - Item Category

Editing an Item Code

  • Go to Utilities - Lookups - General - Item
  • Ensure you have Group CTRL+G and Filter CTRL+F rows showing
  • Click on Contains: under Item Number and search for the Item Code
  • Edit the detail in the grid noting that only description, Amount, Has GST, Other Services Code and Custom Category can be edited

Deleting an Item Code

  • Go to Utilities - Lookups - General - Item
  • Ensure you have Group CTRL+G and Filter CTRL+F rows showing
  • Click on Contains: under Item Number and search for the Item Code
  • Select the Item and right-click and select Delete Row
  • Only Item Codes not referenced on an IFC or Invoice can be deleted

Item Code Descriptions

  • Medicare Item Codes by default have the description provided by Medicare. These descriptions can be quite lengthy, and you can replace the description as follows:
    • Go to Utilities - Lookups - Items and locate the Medicare Item and overtype the description, or
    • Go to Regular Tasks - Links and Support - My Fees and select the Entity and enter the Item Codes and change the description there, or
    • If you have added an Item Code via Utilities - Entities - Private Rate - Edit, this description will be used instead of the above, or
    • Over type the description on generating the IFC/Invoice (this is not permanent)
    • On transmitting claims electronically to Medicare, the Item Code description is not transmitted

Service Codes and Custom Categories

If the Item Code is to be included on the In Hospital Claim, it needs the Services Code to be flagged. Service Codes can be:

  • Accommodation
  • Allied Health
  • Bundled
  • Dental
  • Disposables
  • Labour Ward
  • Nursery Fee
  • Other
  • Pharmaceuticals
  • Prosthesis
  • Theatre Ward

  • Add Item Sales Categories in Utilities - Lookups - General - Item Categories. 

  • Allocate the Category to Item Codes in Utilities - Lookups - General - Items. If you cannot see the Custom Category column, press CTRL+R to reset the Grid View.

Items allocated to Custom Categories to be reported on by selecting Statistics and Extracts - Total Sales by Category

 

WAGMSS

Department of WA Fee Schedule for Public Hospital Billing.

Currently, we are only doing this for our Anaesthetist clients.

WAGMSS use Modified AMA Codes used for Anaesthetic Billing RVG codes. This is the AMA Alpha letters plus the last four numbers of the MBS code ...

  • AMA Code is CA100
  • MBS Code is 20100
  • WAGMSS Code is CA0100 (CRAZY!)

Of course, they use the 18xxx MBS codes for their other services so do not use AMA Modified Codes.!!! ... and all their fees are GST Inclusive

Valid from 1 December 2023, the WAGMSS is 46.65 per unit plus 10% GST ... 51.315

In DCM - Contact Management - Insurers/Companies you would have listed WAGMSS with the Fund Group AMA.

Basing the Regional Health Service on the AMA Unit of $100 effective 1 November 2023 results in ...

100 - 51.315 = 48.685

This Insurer/Company needs to be added into Schemes and Agreements for the Providers as an Uplift of -48.685

Western Australian Government Medical Services Schedules Policy (health.wa.gov.au)

 

 

 

 

 

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