Department of Health

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

The TAC has simplified the hospital claim lodgement process for public hospitals to enhance the TAC client experience. This will allow streamlined lodgement and billing certainty for hospitals.

For hospital claims lodged online, the TAC will provide hospitals access to Provider Online Services (POS). This is a digital platform for the hospital to confirm the claim and access a TAC claim number for eligible patients within three to five business days of the lodgement. This then allows the hospital to invoice the TAC for hospital-related services in a timely manner.

TAC Hospital Accreditation Program

The TAC has developed an online learning platform (TAC Hospital Accreditation Program) to provide Patient Liaison Officer's (PLO’s) or relevant hospital employees with up-to-date information regarding the TAC, and how to lodge electronic claims for clients. Under the TAC Hospital Accreditation Program, hospital PLO's (and/or relevant hospital employees) complete the online training at least once per year, so they are better equipped to discuss the TAC with clients and lodge claims for them whilst they are still in hospital. In addition to the online learning platform, the TAC can provide access for hospitals to lodge claims online via a secure portal.

As part of this initiative, the TAC will 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.

For more information about the TAC Hospital Accreditation Program, or to commence the process to lodge claims online, please email provider@tac.vic.gov.au

For hospitals who are not yet engaged with the TAC Hospital Accreditation Program, 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:

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 Admission.

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. Also refer to specification changes to the manual; see Victorian Admitted Episodes Data Set (VAED).

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

 Base fee  1 July 2021 – 30 June 2022  NWAU 1 July 2022 - 30 June 2023 NWAU
 All health services  $5,190  $5, 320

Table 2: Emergency department only attendance fee

 Base fee 1 July 2021 – 30 June 2022 per attendance  1 July 2022 – 30 June 2023 per attendance
Emergency department only attendance fee $484 $496

Table 3: Rehabilitation payment rates

 Rehabilitation Care Type  1 July 2021 – 30 June 2022 per bedday   1 July 2022 – 30 June 2023 per bedday
Level 1 $913 $936
Level 2 6 $753 $772
Level 3 $753 $772
Level 1 Spinal  $1,370 $1,404
Level 2  Spinal  $1,165 $1,194
Paediatric    $1,369 $1,403

Table 4: Other inpatient fees

 Groupings Other inpatient fees   Metro/rural   1 July 2021 –  30 June 2022
 per bed day
 1 July 2022 –  30 June 2023
 per bed day
  Geriatric evaluation and  management ` $703 $721
  Nursing home type - Patient/day    $276 $283
  Palliative care - Admitted  Metro  $717 $735
 Rural  $724 $742
 Mental  health Clinical inpatient - Adult acute  Metro  $743 $762
 Rural $748 $767
Clinical inpatient - Aged acute  Metro  $679 $696
 Rural $683 $700
Clinical inpatient - Acute specialist  Metro  $892 $914
 Rural $895 $917
CAMHS Acute  Metro  $807 $827
 Rural  $811 $831
  Extended care adult  Metro $646 $662
 Rural $650 $666
 Specialty  clinics Pain management inpatient   $753 $772
  Rehabilitation in the home -  Inpatient equivalent   $529 $542

Table 5: Non-admitted patient fees

 Grouping TAC non-admitted patients   Specifics

1 July 2021 – 30 June 2022

per bed day

1 July 2022 – 30 June 2023

per bed day

Specialty clinics Pain management   Compensable non-admitted patient fees for outpatients
Continence    $120  $123
Gait analysis RCH  $2,234  $2,290

Kingston - 1

Assessment

 $1,656  $1,697

Kingston -

2 Assessment

 $2,482  $2,544
Rehab in the home   Compensable non-admitted patient fees for outpatients
Mental health Clinical community care Per visit

Group: $170 per visit,

Individual: $288 per visit

Group: $174 per visit,

Individual: $295 per visit

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

 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 imaging 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 prepares 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.

$441 (2021-22), $452 (2022-23)
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. $265 (2021-22), $272 (2022-23) 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 medical 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).

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.

Reviewed 19 July 2022

Health.vic

Contact details

Street address: 50 Lonsdale Street, Melbourne, Victoria, 3000

Department of Health and Human Services GPO Box 4057, Melbourne, VIC 3000

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