Transport Accident Commission patients

Invoicing TAC for activity

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

DH receives funding directly from the TAC for NWAU funded separations. DH in turn cash flow hospitals accordingly. Separate uncapped TAC NWAU targets have been incorporated into hospital budgets, based on prior year throughput reported in the VAED. All other service payments are reimbursed directly to the hospital by TAC.

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

How the payment process works

For DH to receive payment from TAC, TAC must accept the claim and issue a claim number. The patient information reported by the hospitals to DH 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)

DH 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 DH. This will ensure that updated records will be accepted by TAC and therefore minimise delays in reconciling activity and payment for records with TAC.

Lodgement and payment process

To assist the TAC’s ability to efficiently determine a patient’s claim entitlement, hospitals are requested to ensure details of the injuries sustained in the transport accident are included when lodging a claim or providing hospital documentation (e.g. discharge summary, certificate of capacity).

TAC Hospital Learning Module

The TAC has an online learning module (TAC Hospital eLearn) 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. This can be accessed in the Hospital Lodgement Portal or on the Transport Accident Commission website.

TAC updates this eLearn annually and it is recommended hospital staff complete the online training at least once per year, so they are equipped with up-to-date information to discuss the TAC with clients and lodge claims for them whilst they are still in hospital.

The TAC can also 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, these can be requested via the below email address.

For more information about the TAC Online Lodgements please email sectors@tac.vic.gov.au.

For hospitals who are not yet engaged with the TAC online lodgements portal, hospitals and/or 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 DH to hospitals following processing of each remit file supplied by the TAC.

• The Remit report includes 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.

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

An additional report will be supplied on a monthly basis following the submission of data from the DH to the TAC. The report will include those claims returned as not processed by the TAC due to missing, incorrect or unmatched data. The report will include details of the rejected claims including a reason for rejection. Corrected claims will be resent to the TAC in subsequent monthly submission files.

Please contact TAC on 1300 654 329 for an up-to-date 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.
• 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.
• If clarification regarding TAC claim details is required, hospitals are encouraged to:
  • Check the record via Provider Online Sales (POS)
  • Call TAC Customer Service on 1300 654 329
  • Email provider@tac.vic.gov.au to reach a member of the Provider team

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 NWAU.

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

TAC payment overview

TAC NWAU throughput is uncapped. All admitted and non-admitted prices will be adjusted annually.

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

NWAU 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; see Victorian Admitted Episodes Data Set (VAED).

The following are published in the DH Policy & 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 DH Hospital Criteria for Reporting. The updated policy is available at the Victorian Admitted Episodes Dataset webpage.

For acute episodes of care, the payment rate for TAC separations is per National Weighted Activity Unit (NWAU).

Emergency Department (ED) only attendance fee

TAC patients attended to in public hospital Emergency Departments (EDs) will be charged an attendance 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.

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, and
• attends for two or more therapy interventions, and
• 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. DH’s VAED Manual lists Designated Rehabilitation Programs for the purpose of Care Type 6.

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 below.

Other TAC patient types

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

Payment rates

For queries relating to the fees in the tables below please contact abf@health.vic.gov.au.

Table 1: NWAU payment rates

Table 2: Emergency department only attendance fee

Table 3: Rehabilitation payment rates

Table 4: Other inpatient fees

Table 5: Non-admitted patient fees

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

Table 7: Medical reports fees

Hospital resource section on the TAC website

The TAC has developed a Hospital Resource section for all hospital staff working with TAC clients, so that allows easy 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 available at Policy and funding guidelines for health services.