Some health funds include Band Mapping within their contracts that differs from the bands assigned to item numbers in the National Procedure Banding List.
As this information is specific to each hospital’s individual health fund contracts and is not publicly available, each hospital is responsible for reviewing and updating the Band Mapping for their own contracts to ensure it reflects their agreed contractual arrangements.
To add or update Band Mapping, go to Settings > Band Mapping
Here you will Add Band Mapping
To add in Band Mapping:
Fund – select the fund or fund group, eg; AHS – Australian Health Service Alliance (Group)
Item – enter the MBS item number
Description – add a description is required, however this is not compulsary
Band Mapping – enter the band mapping as per the document sent from the health fund
Save
The Band Mapping you have just entered will now show on the Band Mapping screen
When creating an IFC and on billing, you will now see the banding you have added
Hospital Same-Day Accommodation Bands
Same-day accommodation bands apply to hospital admissions that do not include an overnight stay. They help determine the minimum accommodation benefit payable by a private health insurer for eligible treatment.
These accommodation bandings are established under Australian Government private health insurance legislation, specifically the Private Health Insurance (Benefit Requirements) Rules 2011.
The applicable band depends on the procedure performed, the anaesthetic or sedation used and, for Bands 3 and 4, the actual time spent in theatre.
Band
Criteria
Band 1
Procedures specifically listed as Band 1 under the Medicare Benefits Schedule (MBS), as well as other eligible same-day admissions that do not meet the criteria for Bands 2–4.
Band 2
Procedure performed under Local anaesthetic without sedation, excluding Band 1 treatments.
Band 3
Procedure performed under general or regional anaesthetic, or intravenous sedation, with less than 60 minutes of actual theatre time, excluding Band 1 treatments.
Band 4
Procedure performed under general or regional anaesthetic, or intravenous sedation, with 60 minutes or more of actual theatre time, excluding band 1 treatments.
Theatre time means the actual time the patient spends in theatre, rather than just the duration of the procedure.
Where a hospital has a negotiated agreement with a health fund, the benefit payable is determined by that agreement.
Hospital Inpatient and Ward Bed Tracker for Overnight Patients
FYDO allows you to seamlessly book Inpatient admissions and procedures whilst also tracking your overnight patients and their bed movements.
When booking a patient to stay overnight at the hospital, ensure the correct Patient Category is selected at the time of booking. This will be Inpatient. You will also need to select the estimated number of nights the patient will stay and enter this information in the Discharge field.
Once the patient has been booked in, you can access their Inpatient screen by right clicking on the appointment and selecting Inpatient.
On the Inpatient screen, you can book a theatre procedure and assign the patient a bed.
To book a theatre procedure in:
Click the Inpatient tab
This is the procedure schedule where you can see the procedures that are booked in
Select the date the procedure will be performed
Enter the time the patient is expected in theatre
Select the appropriate theatre/ list
Select the surgeon/ doctor
Select the correct theatre roster
Enter the procedure notes if different to the notes added when the admission was booked
If required, select the booking code
Click Save
Once the procedure has been booked into theatre, the patient will appear on the Appointment screen with an X as the status, which means the patient is an inpatient and this isn’t their primary admission booking.
To allocate the patient a bed, navigate to the Inpatient screen.
Click the Bed History tab
Enter the date the patient is expected to arrive in the ward
Enter the time the patient is arriving to their bed
Enter the ward the patient will be admitting to
Enter the bed the patient will be staying in
The status will show the patient as Booked, prior to admission, and Admitted once they have been admitted
You can add Bed Notes here if required as this is a free text field
Click Save
Bed Tracker
Now we will look at navigating the Bed Tracker screen.
On this screen, the wards will be listed individually. There is also a colour-coded Key at the top of the screen to easily determine a patients bed status.
To access the Bed Tracker, click the icon on the left-hand side of the screen
The patients name will display in the bed allocated
The bed is light blue, which as per the Key, the patient has been Booked in this bed for the day
The patients bed status is Bed Change From on this date as they have been booked in the Bed History tab to change to another ward today
The patients bed status is on the new ward, and shows as Bed Change To as per the Key
The patient is showing as Estimated Discharge on this day from the number of days entered into the Booking screen when the appointment was made
If you hover over the information symbol on the patient’s bed, this will show the admission information for this patient also, and the Length of Stay.
The Bed Tracker is able to be viewed in Day, Week or Month mode by changing the dropdown menu on the calendar.
The Bed Tracker also has a filter function. You can filter the screen to All Wards or choose a specific ward to view, as well as the number of days you wish to view.
You can also print a Clinical Handover report from this screen.
When selecting Print Handover, you can:
Choose the Template you wish to print
Choose the Order you wish to print the report
Select the Doctors you wish the print, you can choose one or all which is useful for doctors who wish to only see their patients on the ward
You can choose all or a specific Ward to print
You can choose a Religion if required which is useful for religious visits to patients on the ward
Select Exclude Empty Beds if you only wish to view occupied beds
Print Handover
Your handover report template can be customised to suit your facility and the information you wish to see. If you need assistance with this, please reach out to our FYDO Hospital Support Team.
Hospital Type B & Type C Certificates
What is a Type B or Type C Certificate?
The Australian Government classifies certain MBS procedures as Type A, Type B or Type C for private health insurance purposes.
In general:
Type A procedures are usually performed in hospital and include part of an overnight stay.
Type B procedures are usually performed in hospital without part of an overnight stay.
Type C procedures do not normally require hospital treatment or accommodation.
There may be circumstances where a patient requires a different level of hospital treatment than would normally be expected for the procedure being performed.
For example, a patient undergoing a Type B procedure may require an overnight stay due to their medical condition or other special circumstances.
In these situations, appropriate certification may be required from the treating medical practitioner to support the hospital treatment provided.
Important: The requirement for a certificate and the clinical justification for the patient’s admission are determined by the relevant private health insurance requirements and the treating practitioner. If you are unsure whether certification is required for a particular patient, procedure or health fund, please confirm this with the relevant health fund or refer to the Australian Government Department of Health, Disability and Ageing.
Although the Department page is titled Type C hospital certification, it also explains Type A, Type B and Type C procedure classifications and certification requirements.
Certificates in FYDO
Within FYDO, the certificate used for this purpose is referred to as the HC21 Back.
FYDO allows the certificate to be:
printed for completion;
scanned and stored against the patient; and
included electronically with an Eclipse claim where it has been loaded correctly before the claim is transmitted.
Patient Class
The relevant Patient Class is loaded into FYDO with each National Procedure Banding update.
This classification is used as part of the claiming information associated with the patient’s episode.
FYDO shows this classification on numerous screens to assist users, such as the Make Appointment Screen and the Create Invoice screen.
FYDO uses the Patient Category to determine if a certificate is required for the particular item numbers entered. For example, if an Inpatient has a Type B item number entered, FYDO will warn the user with the below pop-up:
Printing the Certificate from FYDO
To acess the HC21 Back:
Navigate to the Appointment screen
Right click on the patient line
Click HC21 then select HC21 Back
The certificate will then download
The certificate will need to be completed by the medical practitioner, ensuring they also sign it.
Completing the Certificate
The certificate should be completed by the appropriate medical practitioner in accordance with the applicable certification requirements.
The Department of Health advises that certification documentation should include sufficient information to identify:
the patient;
the certifying medical practitioner;
the procedure being certified;
the relevant medical condition or special circumstances; and
the practitioner’s certification supporting the hospital treatment being provided.
The Department does not prescribe a specific certificate format; however, the required certification information must be documented appropriately.
Loading the Certificate into FYDO
Once the certificate has been completed, it can be imported into FYDO via the patients Documents tab.
Select the certificate file and drag into the import box, alternatively, you can click in the box to select the file manually
Change the Document Name if required
Select the Document Type
Select the Doctor
Select the Admission the certificate relates to
Save Import
Electronic Transmission with Eclipse Claims
Where the completed certificate has been loaded into FYDO before the Eclipse claim is transmitted, FYDO can include the certificate electronically with the claim.
For this reason, the certificate should be completed and loaded into FYDO before transmitting the applicable Eclipse claim.
If the claim has already been transmitted before the certificate is loaded, the certificate can not retrospectively be attached to the previously transmitted claim.
To send the Certificate electronically with the claim, complete the details on the Certificate screen. This can be found in the Right Click Menu under the heading Certificate:
Always Keep a Scanned Copy
Even where the certificate has been transmitted electronically with an Eclipse claim, some health funds may still request a manual copy of the certificate.
For this reason, always scan and save the completed certificate within the patient’s FYDO Documents.
This ensures a copy is readily available if the health fund requests further information or asks the hospital to provide the certificate manually.
Need More Information?
For questions regarding:
whether a certificate is clinically required;
what medical circumstances justify certification;
private health insurance requirements; or
whether a particular health fund will accept a certificate,
please contact the relevant health fund or refer to guidance provided by the Australian Government Department of Health, Disability and Ageing.
FYDO Support can assist with questions relating to printing, loading and transmitting certificates within FYDO.
Obtaining Country of Birth Statistical Data (Hospital)
From time to time, it will be necessary to report on County of Birth statistics. FYDO makes this extremely easy using the Episode Stats report.
Select Reports from the main menu
Select Episode Stats
In the Group By (Primary) field select Country of Birth
Select the date range required in the From & To fields
Click Update
The report will give you the total number & percentage total of episodes that fall under each category.
