Billing Systems

 

Standards and specifications

General requirements

Cyber security

The software must demonstrate ability to effectively achieve mitigation strategies in line with ‘Essential 8’.  

Privacy

Data collected about an individual by medical software is likely to constitute health information. Due to the sensitive nature of this information, it generally has a higher degree of privacy protection than other personal information, under relevant federal, state and territory legislations.

The software must demonstrate adherence to relevant federal, state or territory privacy legislation for example, the Privacy Act 1988 (Federal) or Health Records and Information Privacy Act 2002 (NSW).

The applicable federal legislation is the Privacy Act 1988.

Details of the relevant state and territory legislations are contained under the State and territory requirements section below.

Core requirements

Standards for identification

The software should:  

• be able to discover and validate Individual Healthcare Identifiers (IHI) via the Healthcare Identifier (HI) Service Business-2-Business web services
• utilise Individual Healthcare Identifiers (IHIs) to integrate and link records into the local patient record
• support adherence to Patient Identification best practices as outlined by the Australia Commission on Safety and Quality in Health Care.

Australian Core Data for Interoperability (AUCDI)

The software should support the use of AUCDI Release 1.

Note: The focus of the AUCDI Release 1 is the representation of the clinical content necessary for each of the data groups identified within the Release 1 scope.

Development is continuing to enhance AUCDI.

Standards for terminology, code sets and classifications

The system must:

• support Systematised Nomenclature of Medicine-Clinical Terms AU (SNOMED CT-AU)
• support the use of MBS item numbers as defined on MBS online or the DVA schedule on the DVA website
• support the use of the Private Health Insurance (prostheses) rules and the current versions of the prosthesis list included the drafted Prescribed List Guide
• be capable of collecting all relevant insurance data fields.

The system should:

• support person and provider identification in healthcare National Best Practice Data Set.

National Safety and Quality Health Service (NSQHS) Standards

Connections to National Systems

HI Service

If the software is expected to deal with healthcare identifiers (e.g. in a hospital environment) then it should either:

• be able to discover and validate Individual Healthcare Identifiers (IHI) via the Healthcare Identifier (HI) Service, or

Where the enterprise utilises an enterprise-wide system for discover and validation of Individual Healthcare Identifiers (IHI) the software should:

• be able to manage and interface with this middleware in order to enable discovery and validation of Individual Healthcare Identifiers (IHI).

Medicare Benefit Schedule (MBS) Online and the Department of Veterans Affairs Schedule

The software should:

• be capable of connecting and submitting billing requests to MBS online.

Conformance

The software should:

• have production access to the Health Identifiers Service.

State and territory requirements

The following state and territory requirements must be upheld based on location.