Hospital Circulars Main Index < Hospital Circulars 2005 Index <

Hospital Circular 8 /2005

Date Issued:14 June 2005

Distribution: Public Hospitals

Subject: Impact of a new TAC contract with DHS for the provision of public hospital services to TAC claimants.

BACKGROUND.

A new contract for the provision and payment of a range of public hospital services for TAC patients has been agreed between DHS and the TAC. The contract will apply for 3 years from 1 July 2004 for all Services described below unless otherwise designated. All admitted and non-admitted prices will be adjusted annually.

PRIOR APPROVAL

Prior approval is required from TAC prior to commencement of several of the services described below. These approvals relate to, Rehabilitation plans, Home Based Rehabilitation, attendance at pain management clinics, gait clinics, highly customised equipment, attendant care, and overnight leave.

Hospitals should contact TAC on 1300 654 329 and speak with the TAC Support Coordinator who manages the claimant's file in order to seek the required approval .

ADMITTED PATIENTS

Under the new contract, effective from 1 July 2004, public hospitals will continue to be funded for both throughput and trauma specific payments. The WIES rate for TAC patients will be the private patient variable rate as published in the Victoria – public hospitals and mental health services Policy and Funding Guidelines 2004-05 and as amended, in 2005-06 and 2006-07.

For acute episodes of care, the WIES payment includes all admitted patient services and items provided to an admitted patient except for medical treatment provided by a medical practitioner with the right of private practice including imaging and diagnostic services and personal services such as telephone calls and hairdressing. The cost of personal services is not payable by TAC.

Pharmaceutical services to TAC patients while they are admitted patients are to be provided free of charge and cannot be claimed against the Pharmaceutical Benefits Scheme (PBS). TAC will pay appropriate discharge pharmacy items at PBS rates, including concession and safety net entitlements.

To facilitate prompt payment from TAC of any discharge pharmacy items, hospitals should provide the following information with invoices:

• PBS item codes
• Full description of medication
• Quantity
• Medication strength
• Date dispensed
• Amount charged per item
• Indication of whether this was supplied at discharge or as an non-admitted patient.
  

REHABILITATION PATIENTS

Effective from 1 July 2004 the following fees will apply for TAC Claimants admitted to rehabilitation programs designated by the Department of Human Services.

• Level 1 $555 per day
• Level 2 $460 per day
• Rehabilitation in the Home – $300 per day (Admitted Patients)

The Level 1 & 2 daily admitted patient bed rates include all admitted patient services and items provided to a TAC Claimant except for medical treatment provided by a medical practitioner with the right of private practice (including diagnostic and imaging services) and excludes personal services.

TAC Claimants receiving “rehabilitation in the home” (therapy in the home) will continue to have the same rights and responsibilities as other hospital admitted and non-admitted patients. However payment for any home based non-admitted patient or admitted patient rehabilitation treatment provided as a substitute for hospital-based care can only be made where prior approval has been obtained from the TAC.

Rehabilitation in the home (non-admitted patients) will be funded on a fee for service basis in accordance with the “Fees and Charges for Acute Health Services Schedule” Section B, 5 Compensable Non Admitted Patient Fees (see link below).

http://www.health.vic.gov.au/feesman/index.htm

The criteria for admission as a same day rehabilitation patient are that the TAC Claimant:

• Attends a rehabilitation program at a public hospital or extended care centre designated by the Department of Human Services as a provider of Rehabilitation Services
• Attends for 2 or more therapy interventions; and
• Receives treatment for a period of 4 hours or more in a single day.

Where the criteria for admission as a same day patient are not met, payment for the TAC Claimant will be on a fee for service basis in accordance with the Fee Schedule for Compensable Non Admitted Patient Services as described above.

A Rehabilitation Assessment and Plan must be submitted by the hospital and approved by TAC before admitted patient rehabilitation treatment can commence.

SUB ACUTE SERVICES –

Effective from 1 July 2004 the following rates apply for TAC Claimants who utilise Sub Acute services:

Geriatric evaluation and management $432 per day

Nursing home type / non acute $170 per day

Palliative Care $432 per day (metro)

$436 per day (rural)

Interim care $270 per day

Interim care in the home $93 per day

The admitted patient bed day rates for all Sub Acute services includes all services and items provided to a TAC Claimant whilst an admitted patient except for medical treatment provided by a medical practitioner with the right of private practice including imaging and diagnostic services and excludes personal services.

Effective from 1 July 2004 the following fees will apply for TAC Claimants admitted to mental health services. Public daily bed day rates are as published in the Victoria – public hospitals and mental health services Policy and Funding Guidelines 2004-05 and summarised below.

Adult and Aged Acute $401 (metro) $404 (rural)

Acute specialist $529 (metro) $532 (rural)

CAMHS acute $477 (metro) $480 (rural)

Extended care adult $385 (metro) $388 (rural)

The admitted patient bed day rates for all Mental Health services include all services and items provided to a TAC Claimant whilst an admitted patient except for medical treatment provided by a medical practitioner with the right of private practice including imaging and diagnostic services and excludes personal services.

SPECIALTY CLINICS PAYMENT

These rates are effective from 1 July 2004. Medical treatment for TAC patients provided by a medical practitioner with the right of private practice may be charged separately to this payment including diagnostic and imaging services.

The pain management program provider must, following eligibility assessment, submit the information nominated on the TAC Pain Management Program (PMP) request form to TAC for consideration and approval. The PMP form should include an outline of the specific program that has been recommended for a claimant. On receipt of this information the TAC will determine its liability to fund the requested program. The PMP form can be downloaded at www.tac.vic.gov.au by selecting Provider Resources/Medical services/hospitals (public). Once completed this form must be posted back to TAC at GPO Box 2751, Melbourne Vic 3000.

Admitted patients: $460 per day (billed at Level 2 Rehabilitation for admitted patient programs).

Non-admitted patients: Non-admitted patient programs are to be billed fee for service in accordance with the Compensable Non-admitted Patient Fee Schedule.

Non-admitted patients:$72.60 per occasion of service.

Travel time to homes and outreach services is included in the TAC rate. When billing for this service please include the TAC item number PUB004 on invoice.

Psychiatric Clinical Community

Community patients: $104 per visit. As a public hospital salaried psychiatrist will be involved in the claimant’s treatment, a separate charge should not be raised for any associated medical treatment received from the psychiatrist overseeing the management of a client in Psychiatric Clinical Community care. When billing for this please include the TAC item number PUB003 on invoice.

Gait Analysis

Royal Children’s Hospital $1350 per assessment

Kingston Centre $1000 for a single assessment, $1500 for a dual assessment.

POST ACUTE CARE (PAC) SERVICES FROM 1 APRIL 2005

Effective from 1 April 2005 PAC Services may claim from TAC payment for patients that:

• At the date of their discharge from a public hospital have the potential to make a TAC claim and are in the process of doing so; or
• Have lodged a Claim but the TAC has not made a decision regarding liability.

Where TAC subsequently accepts liability, reimbursement, based on a daily fee of $23.50, will be made. The daily rate will apply from the period after the patient leaves hospital and commences receiving PAC services until the patient is transferred to TAC Service providers or ceases to require post acute care services.

Reimbursements will apply to patients whose potential eligibility to claim from TAC commences on or after 1 April 2005.

PAC Services will be required to submit individual claims for each eligible TAC client.

PAC Services will require a TAC Provider number. TAC will issue a provider number for a PAC Service as part of the first claim process.

When billing for reimbursement of PAC services please include the TAC item number PAC999 on invoice.

Information that TAC requires to be provided on invoices

• Client details
• Client’s family name and given name(s)
• Client’s date of birth - if claim number not known
• Date of transport accident - if claim number not known
• Client’s TAC claim number, if known

Service details

• Services will need to submit an invoice for each TAC client.
• Dates of service
• TAC Item number (PAC999)
• Service description e.g. PAC service
• Charge for the service in accordance with the TAC agreed fee ($23.50 daily fee)
• Total charge for invoiced items

Service provider details

• TAC provider billing number
• Service provider billing address
• Service provider practice/clinic address

Account information

• Accounts must be addressed to the TAC
• All invoices must comply with Australian Taxation Office requirements
• The provider’s Australian Business Number (ABN) for accounts in excess of $50

MEDICAL REPORTS PROVIDED BY PUBLIC HOSPITALS FROM 1 MAY 2005

Where prepared by a hospital on behalf of the treating medical practitioner, under the new Agreement an all inclusive fee of $165 (incl.10%GST) will be paid by the TAC to a public hospital for a medical report. However a charge cannot be raised by a public hospital for a standard discharge report.

When billing for a medical report please include the TAC item number 9163 on the invoice.

Where the treating medical practitioner completes the medical report, payment will be in accordance with TAC’s Fee Schedule titled ‘Maximum Reimbursements for Medical Reports’. However, 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.

Where the TAC makes an FOI Request in relation to accessing the Medical Records of a TAC Claimant, a 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). The same fee and payment arrangements will apply when a legal firm representing the TAC client requests a medical report from a public hospital. When billing a legal firm, hospitals should include on their invoice the TAC item number THR510.

ATTENDANT CARE SERVICES

The TAC does not fund attendant care for any admitted patient services. In the event that a public hospital deems that Attendant Care Services are essential for the effective management of an admitted TAC Claimant, then the hospital is responsible for the cost.

The TAC will pay the reasonable costs of the training of public hospital clinical staff prior to admission of the TAC Claimant to ensure that the Claimant’s specific care needs are met during their admitted patient episode of care. However payment will only be considered if prior approval is obtained from the TAC.

If during an initial or subsequent admitted acute, sub-acute or rehabilitation episode, it is determined that training of attendant carers (to provide Attendant Care Services) by clinical or allied health staff is required to ensure the safe discharge of an admitted TAC Claimant the cost of such training is included in the inpatient fee for acute care, sub-acute or rehabilitation services.

DISCHARGE EQUIPMENT PROVIDED TO TAC CLAIMANTS

Where a TAC claimant is in receipt of aids or equipment from TAC prior to admission the TAC will continue to provide these aids and equipment upon discharge.

For the first 30 days following 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 safe and effective discharge for a period of 30 days post discharge following an Acute, Sub Acute or Rehabilitation admission other than those provided by TAC as described in the previous paragraph.

Hospitals should note that TAC will not reimburse public hospitals the costs relating to the installation of home equipment, such as hand rails or hand held shower heads and these should be arranged if required as per the same process for public patients.

Following the initial 30 days after discharge TAC will be responsible for providing aids and equipment - once the claim is accepted. Victorian public hospitals must contact the TAC to determine whether the TAC will organise alternative provision of the hired aids and equipment or whether the current hire arrangements will continue.

The TAC may be invoiced directly for any hire costs incurred only after 30 days post discharge.

Equipment hires or purchases required after the first 30 days post discharge can be organised through the TAC's equipment services provider, Lifestyle & Rehab. The Lifestyle & Rehab Customer Help line for enquiries regarding orders is 1300 133120 or 9384 1846.

Highly Customised Equipment : all equipment for admitted TAC Claimants who have a certifiable permanent or long term disability that is highly customised and is to be used beyond 30 days of being discharged from a public rehabilitation hospital will be funded by TAC. This includes prostheses such artificial limbs, including interim and definitive limbs. However, it is mandatory that the public hospital contacts the TAC to discuss the Claimant’s needs, as payment for any highly customised equipment or prostheses can only be made where TAC has provided prior written approval.

OVERNIGHT OR WEEK-END BED LEAVE

To enable the TAC to make any necessary arrangements for support services that the TAC Claimant may require while on overnight or week-end leave, prior approval is required and Public Hospitals must notify the TAC when a Claimant takes overnight or weekend leave. In such circumstances the TAC is not liable for any charge by a Public Hospital for bed holding fees for Claimants on overnight or weekend bed leave.

HOSPITAL SUBCONTRACTED SERVICES

Where a Public Hospital sub-contracts the services of allied health professionals or out sources services, the costs of those services are included in the agreed rates and are the responsibility and liability of the hospital. 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 to prevent any inappropriate invoicing.

SERVICES NOT COVERED BY THE TAC

The TAC is not responsible for any costs associated with TAC Claimants’ utilising telephone, facsimile and communication services or for purchases of any personal items, or services such as toiletries and hairdressing.

TAC REVENUE AND DATA ISSUES

TAC revenue should be accrued by hospitals on the basis of TAC confirmed eligibility as advised to hospitals in the TAC reconciliation report that DHS sends to hospitals each month.

Where the TAC claim has been rejected and hospital is prepared to accept the rejection, hospitals must change the account class of the record to public and re-transmit that record to PRS/2 in the next available transmission.

Where the TAC claim has been rejected and hospital believes the claim is valid, the hospital should either provide the additional information requested and resubmit the claim or contact DHS to discuss the matter further.

Outstanding claims held at 30 June should be accrued at the private patient rate until rejected formally by TAC at which time they will be treated as public WIES and payments adjusted in the PYA process as appropriate.

DHS Contacts:

For Metropolitan hospitals: Mignonne de Witt (Phone 9616 8092)

For Rural hospitals: Teresa Guerrieri (phone 9616 1441)

Shane Solomon
Executive Director
Metropolitan Health and Aged Care Services

Dr C W Brook
Executive Director
Rural Health and Aged Care Services