Invoicing TAC for activity
Funding arrangements for TAC patients are detailed annually in Volume 2 Health Operations of the Department of Health & Human Services (DHHS) Policy and Funding Guidelines.
New arrangements for the provision and payment of a range of public hospital services for TAC patients commenced in July 2019 and are outlined below.
There are no major changes to the payment processes in moving from the original to the new arrangements. DHHS continues to receive funding directly from the TAC for WIES funded separations. DHHS 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 service payments are reimbursed directly to the hospital by TAC.
How the payment process works
For DHHS to receive payment from TAC, TAC must accept the claim and issue a claim number. The patient information reported by the hospitals to DHHS 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
DHHS 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 DHHS. This will ensure that updated records will be accepted by TAC and therefore minimise delays in reconciling activity and payment for records with TAC.
New lodgement and payment process
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 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, hospitals commit to having 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. Upon successful completion of the online training, the TAC will provide access for hospitals to lodge claims online.
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 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, or by visiting .
Reporting provided to hospitals
Status reports will continue to be provided by DHHS 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 WIES value for the agreed claim and the amount paid by DHHS on this basis. DHHS remuneration rates per WIES are shown in Table 1. All hospital payments by DHHS will be reconciled with the actual WIES as agreed by TAC.
An additional report will be supplied on a monthly basis following the submission of data from the DHHS 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.
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 WIES.
Ultimately, care in data entry will significantly improve and streamline the reconciliation process.
TAC payment overview
WIES funding for TAC admitted patients in public hospitals continue to apply. TAC WIES throughput is uncapped. All admitted and non-admitted prices will be adjusted annually.
Hospitals will continue to receive payments for WIES throughput for TAC patients from DHHS. Hospitals; however, will need to continue to charge TAC directly for other care type such as rehabilitation, other non- WIES 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.
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 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 (also refer to specification changes to the manual; see .
- Definitions for inliers and outliers for TAC admitted patients.
- Cost weights and related parameters for TAC admitted patients.
TAC patient types
Acute admitted patients
For acute episodes of care, the payment rate for TAC separations is per Weighted Inlier Equivalent Separation (WIES).
Fees for TAC compensable separations (Table 1) are based on AN-DRGs with Victorian modifications (VICDRG) and the Victorian DHHS cost weights.
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 EDs.
Inpatient admissions will not be permitted within the ED.
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. DHHS’s lists Designated Rehabilitation Programs for the purpose of Care Type 6. Also refer to specification changes to the manual; see .
The TAC rehabilitation rate is per bed day.
Other admitted patients
Other TAC patient types
Table 1: WIES payment rates
|Base fee||1 July 2019 – 30 June 2020 per WIES||1 July 2020 - 30 June 2021 per WIES|
|All health services||$5,928||$6,076|
Table 2: Emergency department only attendance fee
|Base fee||1 July 2019 – 30 June 2020 per attendance||1 July 2020 – 30 June 2021 per attendance|
|Emergency department only attendance fee||$460||$472 |
Table 3: Rehabilitation payment rates
|Rehabilitation||Care Type||1 July 2019 – 30 June 2020 per bed day||1 July 2020 – 30 June 2021 per bed day|
|Level 1||2||$867 ||$889 |
|Level 2||6||$715||$733 |
|Level 3||7||$715 ||$733 |
|Level 1||Spinal||$1,303 ||$1,335|
|Level 2||Spinal||$1,107 ||$1,134|
|Paediatric||$1,301 ||$1,333 |
Table 4: Other inpatient fees
|Groupings||Other inpatient fees||Metro/rural|| 1 July 2019 – 30 June 2020 |
per bed day
| 1 July 2020 – 30 June 2021|
per bed day
|Geriatric evaluation and management||$667 ||$685|
|Nursing home type - Patient/day||$262 ||$269 |
|Palliative care - Admitted||Metro||$681||$698|
|Mental health||Clinical inpatient - Adult acute||Metro||$707||$725|
|Clinical inpatient - Aged acute||Metro||$645||$661|
|Clinical inpatient - Acute specialist||Metro||$848||$869|
|Extended care adult||Metro||$614 ||$629|
|Specialty clinics||Pain management inpatient||$715||$733 |
|Rehabilitation in the home - Inpatient equivalent||$502 ||$514|
Table 5: Non-admitted patient fees
|Grouping||TAC non-admitted patients||Specifics||1 July 2019 – 30 June 2020 per bed day||1 July 2020 – 30 June 2021 per bed day|
|Specialty clinics||Pain management||Compensable non-admitted patient fees for outpatients|
|Pain education program||Refer policy||$1,080||$1,107|
|Kingston - 1 Assessment||$1,573||$1,612|
|Kingston - 2 Assessment||$2,358||$2,417|
|Rehab in the home||Compensable non-admitted patient fees for outpatients|
|Mental health||Clinical community care||Per visit||Group: $160 per visit, Individual: $274 per visit||Group: $164 per visit, Individual: $281 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
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'.
|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.|| |
$419 (2019-20), $430 (2020-21)
|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.||$252 (2019-20), $258 (2020-21)||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
- Support services
Reviewed 24 February 2016