EmailHospital Circular 13/2002
Date Issued: 26 June 2002
Publication: 13/2002
Contact: Manager, Information Analysis Unit
Distribution: Public Hospitals
Subject: Revised Funding Arrangements for WIES Fundable Admitted Patient Separations Relating to Transport Accident Commission (TAC) claimants
Purpose: The purpose of this circular is to advise hospitals that provide services to TAC claimaints of revised funding and reporting arrangements.
In an arrangement similar to that previously struck with the Department of Veteran's Affairs (DVA), the Department has entered into an arrangement with the Transport Accident Commission (TAC), commencing 1 July 2002 for the funding of TAC admitted patient separations eligible for WIES funding. As a result, the Department will cash flow hospitals for estimated TAC WIES throughput rather than hospitals billing TAC directly.
Current Scope
At this time, the funding arrangements will apply only to the WIES component of TAC admitted patient separations. It does not include the medical services charges for such treatment. These services will continue to necessitate direct billing of TAC by the hospitals.
In the future, these arrangements may be extended to include other admitted patient throughput including rehabilitation.
Reporting
Eligibility for payment will be determined on the basis of information transmitted to the Victorian Admitted Episodes Dataset (VAED) and as agreed with TAC. In order to streamline the processing of claims, new data items have been incorporated into the PRS/2 V2 record (the submission system for the VAED).
These include:
- TAC claim number;
- Date of accident; and
- Patient name;
Combined with the clinical and demographic information already collected in VAED, and with the incorporation of new PRS/2 edits that will reject incomplete TAC patient records, the Department will be able to forward TAC all required information for claim assessment. That is, a TAC record will only be regarded as complete and forwarded to TAC for processing if, in addition to general reporting protocols, the "E2" record contains an "T" code in the account class AND has a matching completed "V2" record that contains additional details of the TAC claimant.
Please note that for TAC separations relating to 2001-2002 activity, TAC admitted patient statements will continue to be generated and sent to hospitals up to including 17 September 2002 - the established cut-off date for PRS/2 submissions relating to the previous year.
TAC admitted patient statements will not be generated by Allegiance Systems for 2002-2003 activity given these new funding arrangements.
As part of the funding and reconciliation process, the Department will develop a series of reports for all hospitals submitting TAC WIES activity. This will include reports as to the status of all TAC claimant records forwarded to TAC for payment.
The Department will be actively monitoring these reports and liaising with the hospitals to ensure that for records where claims are not accepted by TAC, either (i) additional information is transmitted to allow the claim to be accepted or (ii) hospitals retrospectively reclassify these patients to the appropriate patient type.
Payment
The Department will publish model budgets with a separate uncapped TAC notional WIES target in the Victoria-Public Hospitals Policy and Funding Guidelines 2002-2003. It will be based on the TAC WIES throughput in 1998-1999 and adjusted for WIES conversion factors since then. The Department will fund hospitals in advance in accordance with the published WIES price and the estimated TAC WIES throughput. Inpatient revenue targets will also be adjusted to reflect the new funding arrangement.
Actual throughput will be reconciled with TAC on a monthly basis. Reconciliations will take place, following the receipt of completed TAC claimant, diagnosis and procedure details. Cash flow adjustments may be made to hospital budgets where there is a significant variance from target (more than 2%) although this will generally not occur without prior consultation with the relevant hospital.
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Shane Solomon |
Dr C W Brook Executive Director Rural and Regional Health & Aged Care Services |
