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Fees and Charges for Acute Health Services in Victoria
 
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Section A: Admitted Patients
Section B: Non-Admitted Patients
Section C: Other Services
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Section A: Fees for Admitted Patients

7. TAC Patients

7.1 Invoicing TAC for Activity

Funding arrangements for TAC patients are detailed annually in Part 2 Health Operation of the Victorian Health Policy and Funding Guidelines

The arrangements for the provision and payment of a range of public hospital services for TAC patients are outlined in Circular 04/2008.

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 (david.seinfeld@health.vic.gov.au)

7.2 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)

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:

  • A monthly report which includes all NEW claims and any claims with a status change since the previous month
  • A year-to-date update report on all outstanding claims, including those held and/or denied.

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.

Microsoft Excel icon TAC Status Codes Ready Reckoner (MS Excel File 52kb)

Status     refers to the remittance advice code provided by TAC, which will appear in reports from DH to hospitals.
Description on Remittance is a description of the status code.
Business Explanation is a more detailed explanation as to what has occurred to produce the reported status.
Account Action    indicates the action to be taken.

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

  • Additional information is required to be transmitted by hospitals to allow the claim to be accepted, or
  • Hospitals retrospectively reclassify these patients to reflect any changes in Care 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 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 david.seinfeld@health.vic.gov.au

7.3 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

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

  • Definitions for inliers and outliers for TAC admitted patients
  • Cost weights and related parameters for TAC admitted patients.

7.4 TAC Patient Types

7.4.1 Acute admitted patients

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.

For acute episodes of care, the payment rate for TAC separations is per Weighted Inlier Equivalent Separation (WIES).

7.4.2 Emergency Department (ED) only attendance fee

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 2014-15 will be charged an attendance fee of $276 per attendance (Note: This is inclusive of the facility fee). TAC should continue to be billed separately for diagnostic and medical services.

7.4.3 Rehabilitation patients

Fees may be raised for TAC compensable patients admitted for same-day rehabilitation for 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 the 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 the DH payment schedule (see Table 3). The Department’s VAED Manual lists Designated Rehabilitation Programs for the purpose of Care Type 2, 6 or 7. Also refer to specification changes to the manual; see Victorian Admitted Episodes Data Set (VAED)

The rehabilitation rate is per bedday.

7.4.4 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 at Table 4 .

7.4.5 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 5-7 respectively.

Payment rates for medical and allied health services in outpatients, casualty and accident and emergency are shown in Section B: Fees for Non-admitted Patients.

7.5 Payment Rates

Table 1 WIES Payment Rates

Base Fee

1 July 2014 - 30 June 2015 per WIES

Major Provider $3,931
Outer Metro and Large Regional $3,998
Regional & Rural $3,840

Table 2 ED only attendance fee

Base Fee

1 July 2013 - 30 June 2014
per attendance

1 July 2014 - 30 June 2015
per attendance
ED only attendance fee $267 $276

Table 3 Rehabilitation Payment Rates

Rehabilitation Care Type 1 July 2013 - 30 June 2014
per bedday
1 July 2014 - 30 June 2015
per bedday
Level 1 2 $751 $771
Level 2 6 $619 $636
Level 3 7 $619 $636
Level 1 Spinal $1,128 $1,159
Level 2 Spinal $959 $985
Paediatric
  $1,127 $1,158

Table 4 Other Inpatient Fees

Grouping Other Inpatient Fees Metro/Rural 1 July 2013 - 30 June 2014
per bedday
1 July 2014 - 30 June 2015
per bedday
  Geriatric Evaluation and Management   $578 $594
  Nursing Home Type - Patient/Day   $227 $233
  Palliative Care - Admitted Metro $590 $607
Rural $595 $612
Mental Health Clinical Inpatient – Adult Acute Metro $612 $629
Rural $615 $632
Clinical Inpatient – Aged Acute Metro $558 $574
Rural $561 $577
Clinical inpatient – Acute Specialist Metro $740 $760
Rural $743 $763
CAMHS Acute Metro $665 $683
Rural $668 $686
  Extended Care Adult Metro $536 $550
Rural $539 $554
Specialty Clinics Pain Management Inpatient   $619 $636
  Rehabilitation in the Home – Inpatient Equivalent   $435 $447

Table 5 Non-Admitted Patient Fees

Grouping TAC Non-Admitted Patients Specifics 1 July 2013 - 30 June 2014
per bedday
1 July 2014 - 30 June 2015
per bedday
Specialty Clinics Pain management  

Compensable non-admitted patient fees for outpatients

Continence   $97 $100
Gait analysis RCH $1,814 $1,864
Kingston - 1 Assessment $1,344 $1,381
Kingston - 2 Assessments $2,016 $2,072
  Rehab in the home   Compensable non-admitted patient fees for outpatients
  PAC   $32 $33
Mental Health Clinical Community Care  Per Visit Group: $137 per visit Individual: $234 per visit Group: $141 per visit Individual: $240 per visit

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 imagining 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 does prepare the medical report.

As listed in the TAC Fee Schedule titled: 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 his own private practice provider number.

This report is prepared by a Public Hospital's Medical Officer as opposed to the treating medical practitioner.

$368

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.

$222

 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 Medial Reports

Reasonable costs incurred.

Public Hospital may charge the TAC for the reasonable costs incurred in making those arrangements as prescribed in the FOI Act and the Freedom of Information Access Charges Regulations 2004 (Regulations).

7.6 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 you may now easily access 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

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.

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Last updated: 5 November, 2014

For information relating to this site, contact: Peter Lewis Ph: (03) 9096 9050

This website is managed and authorised by the Finance, Policy and Operations Unit, Chief Finance Officer Branch of the Finance and Corporate Services Division of the Department of Health, Victorian State Government, Australia

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