Invoicing TAC for activity

Funding arrangements for TAC patients are detailed annually in Volume 2 Health Operations of the Department of Health and Human Services Policy and Funding Guidelines.

New arrangements for the provision and payment of a range of public hospital services for TAC patients commenced in March 2018 and are outlined below.

There are no major changes to the payment processes in moving from the original to the new arrangements. The department continues to receive funding directly from the TAC for Weighted Inlier Equivalent Separation (WIES) funded separations. In turn, the department continues to cash flow hospitals accordingly. Separate uncapped TAC WIES targets have been incorporated into hospital budgets, based on prior year throughput reported in the Victorian Admitted Episodes Dataset (VAED). All other service payments are reimbursed directly to the hospital by TAC.

For more information, please visit the Transport Accident Commission (TAC) website.

To seek clarification on TAC issues from DHHS, please contact healthagenciesreporting@dhhs.vic.gov.au.  

How the TAC payment process works

For the department to receive payment from TAC, TAC must accept the claim and issue a claim number. The patient information reported by the hospitals to the department via PRS/2 must match exactly those held by the TAC for each admitted patient separation. Details of the new data elements required to assist in this process are published in the Specifications for Revision to PRS/2 and to the VAED as updated at Health Data Standards & Systems (HDSS).

The department will pay hospitals a rate applicable for all accepted TAC patients matched with TAC records (as reported in the VAED) including numbers in excess of the published target. If hospitals do not achieve their TAC target, any above target funding which has been cash flowed will be recalled at the full TAC rate. It is imperative that hospitals ensure that their own records are complete, comprehensive and timely.

Hospitals should only accrue revenue for accepted TAC records. It is preferable that denied TAC records are resubmitted as public. Any remaining denied records will be automatically funded as public in the prior year adjustment (PYA) process, up to the agreed public or private WIES target.

Hospitals should ensure that TAC records are updated in the PRS/2 with monthly information fed back by the department.  This will ensure that updated records will be accepted by TAC and therefore minimise delays in reconciling activity and payment for records with TAC.

New TAC claim lodgement and payment process

The TAC is simplifying the hospital claim lodgement process for public hospitals and enhancing the TAC client experience. This will allow streamlined lodgement and acceptance of most claims. 

For hospital claims lodged online, the TAC will provide auto acceptance of the claim. This allows the hospital to immediately confirm the claim and generate a TAC claim number for the client. This then allows the hospital to invoice the TAC for hospital-related services in real time. 

TAC Hospital Accreditation Program

The TAC has developed an online learning platform (TAC Hospital Accreditation Program) to provide Patient Liaison Officers (PLOs) or relevant hospital employees with up-to-date information regarding the TAC, and how to lodge electronic claims for clients. Under the TAC Hospital Accreditation Program, hospitals commit to having PLOs (or relevant hospital employees) complete the online training at least once per year, so they are better equipped to discuss the TAC with clients and lodge claims for them while they are still in hospital. 

Upon successful completion of the online training, the TAC will provide access for hospitals to lodge claims online.

As part of this initiative, the TAC will provide hospitals with client brochures so that TAC information is visible to the clients in the hospital and they can access the right information up front. 

For more information about the TAC Hospital Accreditation Program, or to commence the accreditation process to lodge claims online, please email hospital_accreditation_program@tac.vic.gov.au.

For hospitals that are not yet engaged with the TAC Hospital Accreditation Program, hospitals and patients can continue under the existing arrangements and are encouraged to contact the TAC for claim lodgement by calling 1300 654 329

Reporting provided to hospitals

Status reports will continue to be provided by the department to hospitals following processing of each remit file supplied by the TAC.

The remit report will include:

  • all new claims processed by the TAC since the previous remit file – the claims will be either 'paid' or 'denied' and will include a payment description or denial reason
  • a year-to-date update report on all outstanding claims, including those that were paid, denied or not processed due to missing, incorrect or unmatched data.

View an example of a remit file report.

The reporting format includes the WIES value for the agreed claim and the amount paid by the department on this basis. The department's remuneration rates per WIES are shown in Table 1. All hospital payments by the department will be reconciled with the actual WIES as agreed by TAC. 

An additional report will be supplied on a monthly basis following the submission of data from the department to the TAC. The report will include:

  • those claims returned as not processed by the TAC due to missing, incorrect or unmatched data
  • details of the rejected claims including a reason for rejection. Corrected claims will be resent to the TAC in subsequent monthly submission files. 

View the list of reasons for denial, payment adjustment and EDI rejections (claims not processed).

For records where claims are not accepted by TAC, either:

  • hospitals are required to transmit additional information to allow the claim to be accepted, or
  • hospitals retrospectively reclassify these patients to reflect any changes in Admission Type and the preferences indicated by the patient on the form of election for admission.

Hospitals are expected to review rejected claims promptly and revise and resubmit claims if further information is required. Where there is no further recourse to the TAC, these records will be designated as denied on the monthly report. Hospitals should then recode these separation records as public.

As TAC claimants have 12 months to lodge a claim with the TAC, following the end of each financial year, any resulting hospital funding adjustments will be undertaken through the PYA process. This will generally only apply to hospitals that are over target, since hospitals below target will automatically be funded up to target for outstanding TAC records, as public WIES.

Ultimately, care in data entry will significantly improve and streamline the reconciliation process.

For issues regarding rejection or hold-up of claims contact: healthagenciesreporting@dhhs.vic.gov.au

TAC payment overview

WIES funding for TAC admitted patients in public hospitals and separate trauma-related specified payments continue to apply. TAC WIES throughput is uncapped. All admitted and non-admitted prices will be adjusted annually.

Hospitals will continue to receive payments for WIES throughput and trauma-specific payments for TAC patients from the department. Hospitals, however, will need to continue to charge TAC directly for other care types such as rehabilitation, other non-WIES funded admitted patient services and non-admitted patient services. The specialist medical, diagnostic and imaging costs associated with all these episodes will need to continue to be charged to TAC directly.

WIES will be paid at the TAC-specific payment rate shown in Table 1.

The rehabilitation 1 and rehabilitation 2 rates will be paid at the TAC specific payment rate shown in Table 3. All other admitted patient services will be paid at the published  public rate.

Patients may only be coded to rehabilitation care types in accordance with the department's Victorian Admitted Episodes Dataset (VAED) specifications as set out in the VAED Manual (also refer to specification changes to the manual).

The following are published in the Department of Health and Human Services Victorian health policy and funding guidelines:

  • definitions for inliers and outliers for TAC admitted patients
  • cost weights and related parameters for TAC admitted patients.

TAC patient types

Acute admitted patients

TAC patients should only be admitted to hospital in accordance with the minimum criteria for admission as specified in the current Department of Health and Human Services Hospital Admission Policy available at VAED criteria for reporting 2018-19.

For acute episodes of care, the payment rate for TAC separations is per WIES.

Fees for TAC compensable separations (Table 1) are based on AN-DRGs with Victorian modifications (VICDRG) and the department's cost weights.

The formula for calculating WIES is the same as the general hospital casemix funding formula set out in the Department of Health and Human Services Victorian health policy and funding guidelines (Volume 2).

Emergency department only patients

TAC patients attended to in public hospital emergency department will be charged an attendance fee per attendance. (Note: This is inclusive of the facility fee.)

TAC should continue to be billed separately for diagnostic and medical services provided in emergency departments.

Inpatient admissions will not be permitted within the emergency department.

Rehabilitation patients

Fees may be raised for TAC patients admitted for same-day rehabilitation for the provision of same-day treatment. Criteria for admission as a same-day admitted patient are that the patient:

  • attends a rehabilitation program designated for payment purposes by the department
  • attends for two or more therapy interventions
  • receives treatment for a period of four hours or more.

Where these criteria are not met, the fees raised for attendance for rehabilitation would be in accordance with the appropriate non-admitted patient fee rate.

Fees for patients separated from designated rehabilitation programs are paid at the rate specified in Section A. The department's VAED manual lists designated rehabilitation programs for the purpose of Care Type 6. Also refer to specification changes to the manual.

The TAC rehabilitation rate is per bed day.

Other admitted patients

Fees for other separated patients are paid at the rate published in the Policy and Funding Guidelines. Payment rates for other admitted patients are summarised in Table 4.

Other TAC patient types

Payment rates for non-admitted patients in specialty clinics and mental health, diagnostic imaging and medical reports are shown in Tables 5, 6 and 7.

TAC non-admitted patient fees

Payment rates for medical and allied health services in outpatients, casualty and accident and emergency (other than emergency departments) are shown in the Fees Manual under Section B. 

Payment rates 

Table 1: WIES payment rates

 Base fee  1 July 2017 – 30 June 2018 per WIES 1 July 2018 - 30 June 2019 per WIES 
 All health services  $4,198  $5,700

Table 2: Emergency department only attendance fee

 Base fee 1 July 2017 – 30 June 2018 per attendance  1 July 2018 – 30 June 2019 per attendance
Emergency department only attendance fee $440  $451 

Table 3: Rehabilitation payment rates

 Rehabilitation Care Type  1 July 2017 – 30 June 2018 per bed day   1 July 2018 – 30 June 2019 per bed day
 Level 1 $829  $850 
 Level 2 6 $684 $701 
 Level 3 $684  $701 
 Level 1 Spinal  $1,246  $1,277
Level 2  Spinal  $1,059  $1,085
Paediatric    $1,244  $1,275 

Table 4: Other inpatient fees

 Groupings  Other inpatient fees   Metro/rural   1 July 2017 –  30 June 2018 
 per bed day
 1 July 2018 –  30 June 2019 
 per bed day
   Geriatric evaluation and  management   $638  $654 
   Nursing home type - Patient/day    $251 
$257 
   Palliative care - Admitted  Metro  $652 $668
 Rural  $658   $674
 Mental  health  Clinical inpatient - Adult acute  Metro  $676  $693
 Rural $679   $696
 Clinical inpatient - Aged acute  Metro  $617 $632
 Rural $620 $636
 Clinical inpatient - Acute specialist  Metro  $811 $831 
 Rural $814 $834
 CAMHS Acute  Metro  $734 $752
 Rural  $737 $755
   Extended care adult  Metro $587  $602 
 Rural $590 $605 
 Specialty  clinics  Pain management inpatient   $684 $701 
   Rehabilitation in the home -  Inpatient equivalent   $480  $492

Table 5: Non-admitted patient fees

 Grouping TAC non-admitted patients   Specifics  1 July 2017 – 30 June 2018 per bed day  1 July 2018 – 30 June 2019 per bed day
Specialty clinics Pain management   Compensable non-admitted patient fees for outpatients
Pain education program Refer policy  $1,033   $1,059
Continence    $109  $112
Gait analysis RCH  $2,030  $2,081
Kingston - 1 Assessment  $1,504  $1,542
Kingston - 2 Assessment  $2,256  $2,312
  Rehab in the home   Compensable non-admitted patient fees for outpatients
  PAC    $36  $37
Mental health Clinical community care Per visit Group: $153 per visit, Individual: $262 per visit Group: $157 per visit, Individual: $269 per visit

Pain Education Program (Non-admitted)

Pain Education Programs are 8 - 10 hour multi-disciplinary group education programs. To deliver this service, TAC must approve the provider and their pain education program.

Table 6: Diagnostic imaging fees

 Report type  Amount TAC will reimburse  hospital   Details 
MRI

As listed in the TAC fee schedule for Medical Practitioner Services. The rates payable depend on the MBS item billed in relation to the MRI procedure undertaken.

Access the TAC fee schedule for medical practitioner services. 
Other diagnostic imaging services

Table 7: Medical reports fees

 Report type  Amount TAC will  reimburse hospital  Conditions/Details
Standard discharge report $0 Hospitals may not bill TAC for standard discharge reports.
Medical  report The treating medical practitioner prepares the medical report.

As listed in the TAC Fee Schedule Maximum Reimbursements for Medical Reports.

See TAC fee schedules for details

The fees in this schedule can only be considered for payment where the treating medical practitioner raises the charges under their own private practice provider number. 
This report is prepared by a public hospital's medical officer as opposed to  the treating medical practitioner.

$411

This rate is based on an average report preparation time of 1.5 hours.

Hospitals billing the TAC for a medical report must include item number THR010 on the invoice. This is an all inclusive fee – includes GST (10%).
Hospital  report The report is  prepared by clerical staff on  behalf of the public hospital's medical officer and provides a summary of the medical record. $247 Hospitals billing the TAC for a medical report must include item number 9163 on the invoice. This is an all inclusive fee – includes  GST (10%).
FOI request from TAC to access medical reports Reasonable costs incurred.  Public hospital may charge the TAC for reasonable costs incurred in making those arrangements as prescribed in the Freedom of Information Act 1982 and the Freedom of Information (Access Charges) Regulations 2004. 

Health providers section on the TAC website

The TAC has developed a health providers section (for all health and service providers working with TAC clients) that allows access to information regarding:

  • clinical justification
  • commonly used outcome measures, guides to selecting and using outcome measures, case examples
  • TAC claim lodgement
  • discharge planning
  • form downloads
  • TAC policies
  • fee schedules
  • equipment
  • support services.

To access this resource under 'providers' go to the 'health professionals' section on the TAC website and choose 'hospitals'.

For more information about TAC policies and fees contact the TAC on 1300 654 329. 

Prices are published annually in the Policy and Funding Guidelines.