Section A: Fees for Admitted Patients
7. TAC Patients
Funding arrangements for TAC patients are detailed annually in Part 2 Health Operation of the Victorian Health Policy and Funding Guidelines
There are no major changes to the payment processes in moving from the original to the renewed arrangements. DH continues to receive funding directly from the TAC for WIES funded separations. DH in turn 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 VAED. All other payments are reimbursed directly by TAC.
For more information, please visit the Transport Accident Commission (TAC) website.To discuss TAC issues, contact David Seinfeld (firstname.lastname@example.org)
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)
The department will pay 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 the TAC target, any 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. Any rejected 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.
Errors that are not accurately corrected by health services, such as a patient’s data of birth, continuously cycle through both the DH and TAC databases and remain unmatched and as a result unfunded. This causes additional review, reconciliation and problem solving by the TAC and DH. Hospitals are required to ensure that information is keyed in with a high level of accuracy to prevent future errors and be proactive in identifying and remedying anomalies prior to sending data to the DH.
First Service is a TAC initiative which enables hospitals to directly submit claim forms to the TAC on behalf of patients who have been treated or admitted to hospital as a result of a transport accident. All relevant information is collected at the time of lodgement so TAC can make a decision on the claim more quickly.
Further information on First Service is available in the attachment; hospitals can also contact the TAC directly to seek information or to enquire about specific TAC clients claims.
Note: First Service has developed a streamlined hospital claim form. Commencing in January 2014, this claim form is now available to all public hospitals. This is available on the TAC web site.
For hospitals who are not yet engaged with First Service, 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. Hospitals should make themselves aware of the form’s specific requirements. Where hospital data does not exactly match the details a patient has entered on a TAC claim form this may impact payment timelines and the reconciliation process for both TAC and DH.
Monthly status reports to hospitals include:
The reporting format includes the WIES value for the agreed claim and the amount paid by DH on this basis. DH remuneration rates per WIES are shown in Table 1. All hospital payments by DH will be reconciled with the actual WIES as agreed by TAC. Reports also include the following headers.
For records where claims are not accepted by TAC, either:
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 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 records, as public WIES.
Ultimately, care in data entry will significantly improve and streamline the reconciliation process.
To assist hospitals in understanding the data exchange and payment process a process map has been prepared and made available for downloading:
For issues regarding rejection or hold-up of claims contact:
David Seinfeld: email email@example.com
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
Reference Circular No 4/2008
Hospitals will continue to receive payments for WIES throughput and trauma specific payments for TAC patients from DH. Hospitals, however, will need to continue to charge TAC directly for the specialist medical and imaging costs associated with these admitted patient episodes, rehabilitation and non-admitted patient services.
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 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).
Trauma Appropriateness Payments (TAP) ceases from 2013-14. Funding has been redistributed to relevant Health Services through their emergency department or urgent care centre funding streams based on average Trauma Appropriateness Payment activity over the past three years. Funding will also be used to improve trauma education across the State.
The following are published in the Victorian Health Policy & Funding Guidelines
TAC compensable patients should only be admitted to hospital in accordance with the Minimum Criteria for Admission as specified in the current DH Hospital Admission Policy.
New Admission Policy
Fees for TAC compensable separations (Table 1) are based on AN-DRGs with Victorian modifications (VICDRG) and the Victorian DH cost weights.
The formula for calculating weighted inlier equivalent separations is the same as the general hospital casemix funding formula set out in Victorian Health Policy & Funding Guidelines (Volume 2).
For acute episodes of care, the payment rate for TAC separations is per Weighted Inlier Equivalent Separation (WIES).
With the Victorian Health funding model moving towards the National ABF model, from 2012-13 admissions will no longer be permitted within the Emergency Department(ED).
TAC patients attended to in the ED only in 2015-16 will be charged an attendance per attendance (Note: This is inclusive of the facility fee).
During 2015, the Department of Health and Human Services worked closely with TAC to negotiate a new fee which better reflects the actual cost of providing services. The new attendance fee is $419, and can be charged for all emergency department attendances from 1 February 2016.
TAC should continue to be billed separately for diagnostic and medical services.
Fees may be raised for TAC compensable 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:
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; see Victorian Admitted Episodes Data Set (VAED).
The TAC rehabilitation rate is per bedday.
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 Section B.
Payment rates for non-admitted patients in specialty clinics and mental health, diagnostic imaging and medical reports are shown in Section B.
Payment rates for medical and allied health services in outpatients, casualty and accident and emergency are shown in Section A, under the heading TAC Patients.
Table 1 WIES Payment Rates
Table 2 ED only attendance fee
* NOTE: From 1 February 2016 the new attendance fee is $419.
The TAC has developed a Hospital Resource section for all hospital staff working with TAC clients, so that allows easy access to information regarding:
To access this resource go to the Hospital Resources section on the TAC website.
7.6.1 Prior Approval
The TAC must approve a range of hospital services before they commence. And equipment items before they are supplied. The approvals relate to:
The patient’s TAC claim number should be quoted on all correspondence (including invoices). Written requests will be assessed by a TAC Claims Officer.
An Early Support Coordinator (ESC) will manage claims for TAC patients who sustain a severe injury. The ESC will also work with the patient and hospital to plan for the client’s future needs. Please note that a ‘severe injury’ is defined by TAC, and is considered to be conditions such as a significant acquired brain injury, paraplegia, quadriplegia, amputation of the limb, permanent blindness, burns the cause severe disfigurement, and a brachial plexus injury that results in the loss of the use of a limb.
7.6.2 TAC Claim Lodgement
The TAC Hospital Claim Form can be found online at the Hospital Claim Form section on the TAC website.
With permission from the patient, a hospital representative can help the patient complete the TAC Hospital Claim Form and submit it directly to the TAC by secure email or by fax to number (03) 9656 9437. By completing the Hospital Claim Form, the patient is submitting a claim to the TAC to assess their entitlements.
Patients who do not want to complete the Hospital Claim Form can lodge a claim at a later date by telephoning the TAC on 1300 654 329. The TAC will then make a decision about the claim and notify the patient. The patient will receive a TAC claim number if their claim is accepted.
To access this resource go to www.tac.vic.gov.au, select “Provider Resources” and then the “Hospital Resources” tab on the website. It contains links to relevant TAC policies and the TAC’s expectations in regard to the provision of hospital based services.
7.7 Admitted Patient Services
7.7.1 Acute Services
The Weighted Inlier Equivalent Separation (WIES) price for TAC patients are published in the Policy and Funding Guidelines as amended and available at Victorian Policy and Funding Guidelines.
For acute episodes of care, the WEIS payment includes all admitted patient services and items provided to an admitted patient, and excludes medical treatment provided by a medical practitioner with the right of private practice, imaging and diagnostic services.
TAC WIES are included in the Statement of Priorities. Payments are included in fortnightly cash flow to hospitals. Reconciliation and prior year adjustments as calculated based on accepted TAC records only. TAC records that are not accepted by the TAC will be treated as public WIES for reconciliation purposes. The TAC will reimburse hospitals directly for payments for other services.
7.7.2 Rehabilitation Services
The admitted patient bed rates include all admitted patient services and items provided to a TAC patient.
The exception is medical treatment and diagnostic services provided by a medical practitioner with the right of private practice.
TAC patients receiving "rehabilitation in the home" are regarded as Admitted Patients and continue to have the same rights and responsibilities as other hospital admitted and non-admitted patients. In these circumstances, the following conditions apply;
The criteria for admission as a same-day rehabilitation patient are that the TAC patient:
When a TAC patient does not meet the criteria for a same-day admission patient, the TAC will pay for the patient on a fee-for-services basis in accordance with the Fee schedule for compensable Non Admitted Patient Services.
7.8 Other Admitted Patient Services
7.8.1 Mental Health
All mental health treatment and services provided to a TAC admitted patient are included in the bed day rate. This is with the exception of medical treatment provided by a medical practitioner with the right of private practice including imaging and diagnostic services. The admitted patient bed day rates exclude personal services.
7.8.2 Specialty Clinics
Medical treatment, including diagnostic and imaging services, may be charged separately for TAC patients who receive treatment from a medical practitioner with the right of private practice.
7.8.3 Pain Management
Following an eligibility assessment, the Pain Management Program provider must submit the TAC Pain Management Program (PMP) Request Form to the TAC for consideration and approval. The PMP form should include an outline of the specific program that has been recommended. The TAC will then determine its liability to fund the requested program.
The inpatient PMP form can be downloaded at the TAC website.
The outpatient PMP form can be downloaded at the TAC website.
7.9 Overnight bed leave
Public hospitals must notify the TAC when a patient takes overnight or weekend leave.
The patient must have prior approval for the TAC to provide support services needed by the patient on overnight or weekend leave. The TAC is not liable for any charge by a public hospital for bed holding fees for patients on overnight or weekend bed leave.
The TAC can consider paying for the necessary transport directly to and from home for approved hospital overnight leave.
7.10 Hospital Subcontracted Services
If a public hospital sub-contracts or outsources the services of allied health professionals, the costs of those services are included in the agreed rates and are the responsibility and liability of the hospital. To prevent incorrect invoicing, public hospitals that contract or outsource any services are required to make known (to the contracted party) the arrangements in place with the TAC for funding of public hospital services.
7.11 Services not covered by the TAC
The TAC is not responsible for any costs associated with a TAC patient’s telephone, facsimile and communication services use or for purchase of personal items such as toiletries or services such as hairdressing and television hire.
7.12 Patient Discharge
7.12.1 Discharge planning
Public hospitals have a responsibility to facilitate the safe and effective discharge of TAC patients. The TAC will work with hospitals to ensure this happens. This process can be streamlined with early notification of a patient’s expected discharge date, patient assessment, clear communication with the TAC and external parties about discharge needs, and a copy of the discharge summary (where the patient has provided their consent).
7.12.2 Post-Acute Care (PAC)
Post-Acute Care (PAC) programs are hospital-initiated services funded by the TAC and provided through the department. PAC programs are delivered at the discretion of the hospital and provide short-term home-based services, such as home help and personal care, to patients requiring short-term support to facilitate recuperation following discharge from an acute or sub-acute hospital. Plans to use PAC are preferably made in collaboration with the TAC.
PAC providers work collaboratively with hospitals to ensure public hospital patients referred to PAC are assessed and the required short-term services are arranged for all patients discharged from acute or sub-acute hospitals across Victoria.
Where the TAC accepts liability for the patient's claim, the PAC provider will be reimbursed for coordinating and arranging services at a daily rate. The PAC provider should complete a PAC Closure Summary to notify the TAC of the start and end date of the program, including a summary of the supports provided. The provider should also make recommendations for further service requirements two weeks before to the PAC program ends to enable the TAC to arrange alternative services.
7.12.3 Post Acute Services (PAS)
Post-Acute Services (PAS) are TAC-arranged services which can be performed after PAC services have finished, or, in the absence of PAC services.
The TAC requires the following information in writing to consider funding PAS for patients:
The TAC will review each request to determine the patient’s eligibility for the requested service(s) as well as the number of hours that can be approved. The TAC will then contact the patient to arrange the services.
7.12.4 Return to Work
The TAC can provide help for patients to return to work. The completed Certificate of Capacity provides a patient’s employer with details about suitable duties. The Certificate of Capacity form is available online at the TAC website.
The TAC can also provide income support to patients. A patient needs to supply the TAC with completed Certificates of Capacity and evidence of their pre-accident earnings for the TAC to determine their entitlement to income support. For employees, this is usually in the form of a payroll report for the 12 months before the accident. Self-employed patients should call the TAC to discuss what information they need to provide.
7.12.5 Referrals for Community Therapy
Copies of all referrals made to community therapy providers must be sent to the TAC. If direct referrals are not made and the TAC patient requires therapy in the community, this information must be sent in writing to the TAC.
7.12.6 Discharge summary
7.13 Aids and Equipment
Bed fees paid in Victorian public hospitals (i.e. acute, sub-acute, or rehabilitation patients) includes the aids and equipment (e.g. a walking frame) provided while an inpatient.
7.13.1 The First 30 Days Post Discharge
Victorian public hospitals are responsible for the provision of aids, equipment and domiciliary oxygen free of charge (no deposits or hire fees) to facilitate a safe and effective discharge for 30 days post discharge following an acute, sub-acute or rehabilitation admission see Section C. If necessary, the equipment item can be ordered via the Hospital Direct Equipment Order Form (available at the TAC website) and sent directly to TAC's contracted equipment suppliers.
7.13.2 After 30 Days Post Discharge
Following the initial 30 days after discharge, the TAC is responsible for providing aids and equipment once the claim is accepted. Victorian public hospitals must contact the TAC to ensure that appropriate arrangements are made to extend the hire of necessary aids and equipment beyond the initial 30 day period.
7.13.3 Continence Equipment
The TAC can fund continence products such as catheters, consumables and other related products required by a TAC patient on discharge.
Public hospital staff are required to complete a Continence Equipment Request and Order Form and refer to the accompanying Continence Equipment Request and Order Form Notes, before a patient's discharge to ensure the TAC orders the appropriate products. If a hospital supplies continence items to a patient when they are discharged, a full description of the item(s) is to be included on the hospital invoice when billing the TAC.
7.13.4 Surgical Supplies
The TAC can fund surgical supply products, such as wound care dressings, required by a TAC patient on discharge.
7.13.5 Highly Customised Equipment
The TAC will fund highly customised equipment needed by TAC patients with a certifiable permanent or long-term disability for long-term use beyond 30 days post discharge. This includes a power wheelchair, prosthetic equipment (artificial limbs), including interim and definitive limbs.
The TAC expects public hospitals to request prior approval for this equipment. For further information, refer to the Equipment (Medical) - Prosthetic Equipment and the Equipment policies.
Where a patient is in receipt of aids or equipment from the TAC prior to admission, the TAC will continue to provide those aids and equipment upon discharge, if required.
7.14 Non-admitted Patient Services
Non-admitted patient programs will be billed for services in accordance with the Compensable Non-admitted Patient Fee schedule. An Outpatient Rehabilitation Plan must be submitted by the hospital and approved by TAC before outpatient rehabilitation treatment can commence.
The form for this plan can be downloaded from the TAC website.
7.14.1 Specialty Clinics
Medical treatment for TAC patients provided by a medical practitioner with the right of private practice may be charged separately to this payment as well as diagnostic and imaging services. Travel time to a patient’s home and to outreach services is included in the TAC rate.
7.14.2 Mental Health: Clinical Community Care
A public hospital salaried psychiatrist may be involved in a patient’s treatment when required. This will result in a separate charge being raised for any associated medical treatment received from the psychiatrist overseeing the patient in psychiatric clinical community care.
7.14.3 Interpreter Services
The TAC does not have an in house TAC interpreter service.
When a therapist requires an interpreter to engage with a TAC patient in the community, the therapist can:
7.15 Family Support
7.15.1 Visiting expenses for the members of the immediate family
The TAC can pay the reasonable travelling and accommodation costs incurred by members of the immediate family to visit an injured patient when:
More information can be found at the TAC website.
7.15.2 Family Counselling
The TAC can pay the reasonable costs of family counselling for any member of the immediate family of the person who dies or who is severely injured in a transport accident. Family counselling is paid as part of the claim of the person who is severely injured or dies.
7.16 MEDICAL REPORTS PROVIDED BY PUBLIC HOSPITALS
7.16.1 Hospital Report
This is a report prepared by clerical staff on behalf of the public hospital’s medical officer and provides a summary of the medical record.
7.16.2 Medical Officer’s Report
This is a report which is prepared by the public hospital’s medical officer.
7.16.3 Treating Medical Officer Reports
Where the treating medical officer completes the medical report, payment is in accordance with TAC’s Fee Schedule titled 'TAC Reimbursements for Medical Reports'. If the treating medical officer fees are to be raised under a hospital provider number this should be discussed with the TAC before any charges are raised.
It is expected that all medical reports prepared by a public hospital, should include (where possible) the following information:
All fees payable by the TAC for reports are inclusive of GST.
7.16.4 Medico-legal Reports
The TAC advises that under the Transport Accident Act 1986, a legal firm can make a request for reimbursement of costs for medical and hospital reports obtained in support of their client’s claim for compensation.
The TAC has formally communicated this advice to the legal profession and asked legal firms to state in their application that the patient is a TAC client, in order to facilitate the billing process.
7.17 Freedom of Information requests
Where the TAC makes a request under the Freedom of Information Act 1982 (Vic) (FOI Act) for Medical Records of a TAC client, a public hospital may charge the TAC:
All FOI requests made by the TAC to public hospitals should contain a TAC client authority consenting for the public hospital to release the patient’s documents to the TAC.
For more information about TAC policies, contact the TAC on 1300 654 329 or visit the TAC website.
Public hospital specific information can also be found at the TAC website
More information about public hospital fees can be found in the Public Admitted Patients section.
Last updated: 18 March, 2016
For information relating to this site, contact: Peter Lewis Ph: (03) 9096 9050
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