Surgeons

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As medical practitioners, you play an important role in helping our clients recover from their transport accident injuries.

We can pay the reasonable costs of medical treatment, without prior approval, when it is required as a result of a transport accident injury.  Surgery conducted within three months of the transport accident does not need approval.

Patient consultations, prescriptions, surgery and hospital admissions, with some restrictions are covered. Travel and family or group services are also covered.

You may also refer patients to a number of services that we can pay for – although some may require approval first. Surgical procedures that occur three months after the transport accident will also require approval.

If your patient's accident was prior to 14th February 2018 they may need to meet the medical excess before you can invoice the TAC for treatment.  Some patient reporting may be required.

Click on the links below to see the full Medical Practitioner guideline, to view the fee schedule and to find any documents and forms you may need.

Medical Practitioner Guidelines

This guideline should be read in conjunction with the:

Who can provide medical practitioner services?

You can provide services if:

  • you are a medical practitioner registered under the Health Practitioner Regulation National Law (e.g. AHPRA) to practice in the medical profession (other than as a student).

What we can pay for

We can pay the reasonable costs of medical treatment, without prior approval, when it is required as a result of a transport accident injury.

Patient consultations

  • Medical services with an MBS item number.

Medication

We can pay for medication that is:

  • Prescribed in accordance with the PBS.
  • Registered on the Australian Register of Therapeutic Goods.

See: Medication Guideline for further information.

Equipment

  • Provision of equipment under $1,000.
  • Our approval is required for equipment above $1,000. Use the Equipment Prescription Form to submit written requests.

Travel

  • Travel costs, where it is clinically justified to conduct treatment in the community.
  • Travel time, for travel to and from the practitioner's practice address and the appointment location. When more than one client is visited in a single travel period, total travel costs should be apportioned equally between clients.

Family and group services

  • Family counselling to family members of an eligible client, when paid as a part of the claim of a person who dies or is severely injured as a result of a transport accident. Contact us to check client or family member eligibility.

The Family Counselling Allowance applies per claim, regardless of how many eligible family members access this service. The applicable amount for each claim is dependent on when a family member first accessed the service. This allowance is the maximum amount we can pay for family counselling, as set out in the Transport Accident Act 1986. This amount is indexed annually.

Note: “Family member” refers to any member of the immediate family (i.e. partner, parent, sibling or child) of the person who dies or is severely injured as a result of a transport accident. A parent of a dependent child includes:

  • A person who has day-to-day care and control of the child, with whom the child is normally resident.
  • A guardian of the child.

Referrals

You may refer patients to a number of services.  We will pay for these services without prior approval.

  • Nursing.
  • Allied health.
  • Medical and rehabilitation equipment under $1,000, such as continence equipment and dose administration aids.
  • Family counselling, performed by a social worker or psychologist.
  • Domestic services, such as home help and gardening.

You may also refer patients to specialist services. These services require our approval prior to payment.

  • In vitro fertilisation.
  • Multiple and Complex Needs Initiative (MACNI Outreach Services).
  • Infusion therapy for pain management.
  • Obstetrics including pregnancy (termination of).
  • Spinal injection therapies.
  • Weight loss treatment and services.

Surgery and hospital admissions

  • Surgical procedures that occur in the first three months from the date of the transport accident do not require prior approval.
  • For surgical procedures after the first three months, prior approval from us is required.
  • If the patient has a severe injury, surgery is pre-approved for 12 months from the date of the transport accident.

How do I request surgery approval?

Requests for surgical procedures after three months should be submitted in writing and include:

  • The name and claim number of the client.
  • The name of the medical practitioner performing the surgery.
  • A brief description of the specific elective surgery.
  • The MBS item number(s) associated with the specific elective surgery requested.
  • Clinical indication for elective surgery and the relationship between the surgery and your patient’s transport accident injuries.
  • Details of anticipated prostheses, including clinical justification for the use of a gap-permitted or unlisted item, if required.

We will accept the above information in a letter from a surgeon to a third party, such as the referring GP, if it is provided to us with notification from the surgeon clearly stating that this is a request for funding.

For surgical procedures performed in a public or private hospital operating theatre, the principal surgeon must provide the hospital operation report generated at the time of the surgical procedure.

This should include:

  • Patient's name and date of birth.
  • Date of surgery.
  • Date of report.
  • Name of the principal surgeon.
  • Name of assistants.
  • Description of all services performed - the approach, procedure, closure, any prostheses used and the side and site of the procedure. This is particularly important when more than one procedure is being performed.
  • Appropriate item numbers.
  • A signature/authorisation.

Reporting

In some cases we may contact you regarding your patient’s treatment and services. We may send you a customised request for a report and ask you to include information regarding the patient’s history, diagnosis, prognosis, progress, outcomes, capacity for work and medical management.

Types of reports we may request:

  • Short Report - up to 3 questions.
  • Standard Report - 4 to 6 questions.
  • Comprehensive Report -  7 to 10 questions.
  • Other specific reports.

GPs: We will pay for these reports in line with the Treating Medical Practitioner Reports fee schedule.

Other medical practitioners: We will pay for these reports in accordance with:

You only need to provide a report when we request it.

Other things to note

Medical excess

For accidents that occurred prior to 14th February 2018 a medical excess may apply. Visit the medical excess page to see if it applies to your patient.  If the medical excess applies you will need to invoice the client directly.

Certificate of capacity

  • As part of your patient’s treatment, you may be required to complete certificates of capacity to assess and certify your patient’s capacity for work.

Patients with a severe injury

  • If your patient has a severe injury, your discussions, referrals and approval of services may form part of the independence planning process between the patient's treating team and our TAC coordinator.
  • If your patient already has an individualised funding package, medical services may be included as part of that.

How much we can pay

Medical services

We pay for services in line with the Medicare Benefits Schedule (MBS).  We do not accept Australian Medical Association item numbers.

For more information see: TAC Reimbursement Rates for Medical Services information sheet and TAC fee schedule.

Surgical services

For payment of surgical services, we have adopted the MBS explanations, definitions, rules and conditions for services provided by medical practitioners – with the following exceptions:

Multiple operations – orthopaedic operations only

  • 100% for the item with the greatest TAC fee, plus 75% for each other item
  • For multiple dislocations or fractures requiring an operative or manipulative procedure, the fee for each dislocation or fracture shall be 100% of the TAC fee.
  • For multiple dislocations or fractures where the second or subsequent conditions do not require operative or manipulative treatment, the fee for the second and each subsequent procedure shall be 75% of the TAC fee.
  • When fractures or dislocations are associated with a compound (open) wound, an additional fee of 50% of the fracture or dislocation fee shall apply. The additional 50% applies only to the fracture or dislocation fee and does not apply to the fees for any other procedures that may be performed during the surgery. The medical practitioner must state on their invoice 'Open' or 'Compound' next to the procedure item number.
  • Except where otherwise specified by the TAC, the fee for a fracture-dislocation to the same site shall be the fee for the fracture or dislocation, whichever is the greater, plus 50% of the TAC fee for the lesser procedure.

Fracture and dislocations for two or more operations performed on a patient on the one occasion:

What we cannot pay for

We cannot pay for:

  • Treatment and services that are included in a hospital inpatient bed fee.
  • The provision of a hospital operation report.
  • GP participation in a GP return to work case conference that is not initiated by us or the vocational rehabilitation provider.
  • Hire charges for surgical equipment associated with a patient’s surgery procedures.

Fee Schedules

Medical Services Reimbursement Rates

The TAC has adopted the Medicare Benefits Schedule (MBS) items, explanations, definitions, rules and conditions for services provided by medical practitioners.  When invoicing for medical services, medical practitioners are expected to adhere to the MBS rules unless otherwise specified by the TAC in the Reimbursement Rates for Medical Services booklet or its medical policies.

The Reimbursement Rates for Medical Services booklet below must be read in conjunction with:

At the time of production this publication contained up to date information as released by Medicare Australia (Medicare).  The relevant publication will be updated to reflect any further changes that are implemented by Medicare each year.  Please check our website for the latest version.

If you have any questions about these publications or the reimbursement rates, please contact the TAC on 1300 654 329. Alternatively, e-mail info@tac.vic.gov.au.

Medical Services - General Practitioner Return to Work Activities

Effective 1 July 2017

Service DescriptionTAC Item Number2017/18
Maximum
Payment
Rate
GP Participation in a RTW Case Conference✝
< 20 minutes RTWCC1 $112.66
20 - 40 minutes RTWCC2 $180.18
> 40 minutes RTWCC3 $247.60
 
GP organise and coordinate a RTW Case Conference✝ RTWCC4 $236.58
GP RTW Worksite Visit (employer agreement required) RTWWV $450.00
RTW Phone call between GP & Employer RTWPC $30.34
Service DescriptionTAC Item Number2016/17
Maximum
Payment
Rate
GP Participation in a RTW Case Conference✝
< 20 minutes RTWCC1 $110.74
20 - 40 minutes RTWCC2 $177.12
> 40 minutes RTWCC3 $243.39
 
GP organise and coordinate a RTW Case Conference✝ RTWCC4 $232.56
GP RTW Worksite Visit (employer agreement required) RTWWV $450.00
RTW Phone call between GP & Employer RTWPC $29.82

Note : These items are restricted for use by General Practitioners only and should be read in conjunction with the Medical Practitioner policy and the General Practitioner Participation in RTW Activities information sheet.

The General Practitioner can either organise and coordinate or participate in a case conference, the practitioner cannot bill both items at the same case conference.

Medical Reports (TAC Requested) - Treating Medical Practitioner Reports

The fees below outline the reimbursement rates for Treating Medical Practitioner reports when requested by the TAC

Effective 1 July 2017

Service Description TAC Item Number TAC FEE GST 2017/18 Maximum Payment Rate
Treating Medical Practitioner Reports
Specialist Standard Report TTR010 $714.76 $71.48 $786.24
Specialist Follow-up Report*** TTR020 $357.39 $35.74 $393.13
General Practitioner Short Report
(up to 3 questions)
TTR310 $68.71 $6.87 $75.58
General Practitioner Standard Report
(4-6 questions)
TTR320 $171.72 $17.17 $188.90
General Practitioner Comprehensive Report
(7 - 10 questions)
TTR330 $343.44 $34.34 $377.78

*** A follow-up report obtained from a treating practitioner is interpreted as a report providing additional in relation to the ongoing treatment of the patient. A follow-up report will only be requested subsequent to the provision of a standard report.

Service Description TAC Item Number TAC FEE GST 2017/18 Maximum Payment Rate

Impairment Treating Medical Practitioner Reports

Specialist Standard Report (12 questions) TTR070 $714.76 $71.48 $786.24
Specialist up to date Report (5 questions) TTR080 $344.86 $34.47 $379.35
General Practitioner Comphrensive report
(13 Questions)
TTR090 $362.73 $36.26 $398.99
General Practitioner up to date report
(5 questions)
TTR100 $182.43 $18.24 $200.67
Copy of Treater Clinical Records per page IN0025    20c
Psychiatrist Report TTR070 $714.76 $71.48 $786.24
Psychology Report TSP010 $239.67 $23.97 $263.64

Effective 1 July 2016 to 30 June 2017

Service Description TAC Item Number TAC FEE GST 2016/17 Maximum Payment Rate
Treating Medical Practitioner Reports
Specialist Standard Report TTR010 $702.61 $70.26 $772.87
Specialist Follow-up Report*** TTR020 $351.31 $35.13 $386.44
General Practitioner Short Report
(up to 3 questions)
TTR310 $67.54 $6.75 $74.29
General Practitioner Standard Report
(4-6 questions)
TTR320 $168.81 $16.88 $185.69
General Practitioner Comprehensive Report
(7 - 10 questions)
TTR330 $337.60 $33.76 $371.36

*** A follow-up report obtained from a treating practitioner is interpreted as a report providing additional in relation to the ongoing treatment of the patient. A follow-up report will only be requested subsequent to the provision of a standard report.

Service Description TAC Item Number TAC FEE GST 2016/17 Maximum Payment Rate

Impairment Treating Medical Practitioner Reports

Specialist Standard Report (12 questions) TTR070 $702.61 $70.26 $772.87
Specialist up to date Report (5 questions) TTR080 $339.00 $33.90 $372.90
General Practitioner Comphrensive report
(13 Questions)
TTR090 $356.55 $35.65 $392.20
General Practitioner up to date report
(5 questions)
TTR100 $179.33 $17.93 $197.26
Copy of Treater Clinical Records per page IN0025    20c
Psychiatrist Report TTR070 $702.61 $70.26 $772.87
Psychology Report TSP010 $235.60 $23.56 $259.16

Effective 1 July 2015 to 30 June 2016

Service Description TAC Item Number TAC FEE GST 2015/16 Maximum Payment Rate
Treating Medical Practitioner Reports
Specialist Standard Report TTR010 $694.00 $69.40 $763.40
Specialist Follow-up Report*** TTR020 $347.01 $34.70 $381.71
General Practitioner Short Report
(up to 3 questions)
TTR310 $66.71 $6.67 $73.38
General Practitioner Standard Report
(4-6 questions)
TTR320 $166.75 $16.67 $183.42
General Practitioner Comprehensive Report
(7 - 10 questions)
TTR330 $333.47    $33.34 $366.81

*** A follow-up report obtained from a treating practitioner is interpreted as a report providing additional in relation to the ongoing treatment of the patient. A follow-up report will only be requested subsequent to the provision of a standard report.

Service Description TAC Item Number TAC FEE GST 2015/16 Maximum Payment Rate

Impairment Treating Medical Practitioner Reports

Specialist Standard Report (12 questions) TTR070 $694.00 $69.40 $763.40
Specialist up to date Report (5 questions) TTR080 $334.85 $33.48 $368.33
General Practitioner Comphrensive report
(13 Questions)
TTR090 $352.19 $35.21 $387.40
General Practitioner up to date report
(5 questions)
TTR100 $177.13 $17.71 $194.84
Copy of Treater Clinical Records per page IN0025    20c
Psychiatrist Report TTR070 $694.00 $69.40 $763.40
Psychology Report TSP010 $231.58 $23.15 $254.73

Forms and brochures

View Certificate of Capacity form

Certificate of Capacity form

Summary:

The Certificate of Capacity form is for authorised providers to provide information about their TAC patient's transport accident conditions and to assess and certify their capacity for work as a result of these injuries.

IMPORTANT NOTICE:
It is an offence under the legislation to provide false or misleading information. A person who provides a false or misleading certificate of capacity could be liable to prosecution.

Please provide feedback about the Certificate of Capacity to medicalcertificatefeedback@tac.vic.gov.au

View General Practitioner Participation in Return to Work Activities factsheet

General Practitioner Participation in Return to Work Activities factsheet

Summary:

This fact sheet is for GPs to outline the process for participation in Return to Work Activities

View Urgent psychiatric admission: Request for funding form

Urgent psychiatric admission: Request for funding form

Summary:

This form is to be completed by a registered medical practitioner to request urgent psychiatric admission for TAC clients. It requires a clinical diagnoses of the client's condition and an explanation of why the admission is needed urgently.

View Clarification of Medicare Benefits Schedule (MBS) rules

Clarification of Medicare Benefits Schedule (MBS) rules

Summary: This information sheet clarifies what the TAC and WorkSafe can and cannot pay for in relation to a number of specific MBS item combinations.

View Reimbursement Rates for Medical Services Information Sheet

Reimbursement Rates for Medical Services Information Sheet

Summary: This Information sheet provides an introduction to TAC's fee schedule for Medical Practitioners.

View Billing review program information sheets

Billing review program information sheets

Summary:

These Information sheets outline the Billing Review program conducted by the TAC which covers periodic reviews of payments made to providers for medical and allied health services provided to TAC clients. 

Working with the TAC

Below you will find information relevant to all providers about working with TAC clients, including:

  • How to register
  • Approvals process
  • Travel
  • Compliance requirements
  • Medical excess (for accidents before 14th February 2018)
  • Requests for further information
  • Subsequent, pre-existing and non-accident related injuries
  • Treatment by a family member
  • How to get paid
  • What we cannot pay for

Click on the General Provider guideline below to find out more.

General Provider Guidelines

If you are a registered TAC provider, you can provide treatment and services to our clients when they:

  • Are required as a result of a transport accident injury.
  • Are safe and effective.
  • Promote recovery, functional independence or self-management.

How to register as a provider

To register, you may:

During the registration process you may be asked to provide evidence of your qualification or other documentation requested by us.

What we can pay for

Approved services

The following services are approved for all our clients:

  • ambulance
  • hospital (including surgery for the first three months from the date of accident)
  • medical  (including medical imaging)
  • pharmacy
  • allied health
  • mental health
  • domestic services and gardening
  • interpreting services
  • equipment under $1,000

We do not require requests, clinical notes or reports before we will pay for the above services.

Other services

We must approve in writing any services not listed above.

Requests for approval must be in writing from an appropriately qualified health professional and include the following information:

  • claim number
  • transport accident injury being treated
  • type of treatment or service being requested
  • rationale as to why it is required
  • proposed date of the service/treatment
  • number of services proposed or expected duration
  • date treatment will be reviewed
  • functional goals/outcome measure that will be used to evaluate the treatment
  • self-management strategies in place

We will consider the principles of the Clinical Framework when considering whether a treatment or service request is reasonable and appropriate. We will then respond to written treatment and service requests as set out in our TAC Service Charter.

Travel

We can pay the reasonable cost of travel without prior approval where:

  • It is clinically justified for you to conduct treatment in the community, or you are the most appropriate option in that locality, and
  • The treatment has an associated scheduled fee/item number.

The following requirements apply:

  • Travel time will only be paid for travel to and from your practice address and the patient’s residence or place of appointment.
  • Where you visit more than one TAC client in a single travel period, total travel costs should be split equally for each.
  • If you book multiple appointments on the same day, please organise them efficiently, as we cannot pay for down time between appointments.
  • When invoicing for travel, keep a record of travel details – points of origin, destination and duration of travel – in case we need it.

Other things to note

As providers, you are expected to:

Health professionals should also follow the principles of the Clinical Framework for the Delivery of Health Services (Clinical Framework) into their clinical practice. This is based on the following principles:

  • Measurement and demonstration of the effectiveness of treatment.
  • Adoption of a biopsychosocial approach.
  • Empowering the client to manage their injury.
  • Implementing goals focused on optimising function, participation and/or return to work/health.
  • Base treatment on best available research evidence.

Medical excess (applies to accidents before 14th February 2018)

Client's whose accidents occurred prior to 14th February 2018 are required to pay the first $629 of treatment costs for medical services (excluding hospital and ambulance) before the TAC can fund their ongoing treatment unless:

  • the client or an immediate family member were admitted to hospital as an inpatient; or
  • an immediate family member dies as a result of the transport accident.

If a TAC client hasn't reached the medical excess, you need to invoice them directly for any medical treatment and services they receive. Bulk billed services can be used to reach the medical excess amount.

Once the client has provided a declaration to the TAC that they have reached their medical excess, you can begin invoicing the TAC directly.

You can find out if a client is subject to medical excess by:

  • using the medical excess tool
  • checking if they are available to invoice using Lantern Pay
  • checking client correspondence via the client’s letter or myTAC app

When further information is needed

In some cases we may contact your patient or yourself to seek further information about the treatment or service. We will send in writing any requests for reports or information.

We can release a treatment report to the client, another health practitioner or the client's legal representative upon receipt of a verbal or written request from a client or their legal representative.

If you are a health practitioner, clinical notes will be paid for in accordance with Schedule 2 of the Health Records Regulations 2012 and under the guidelines set out in the Health Records Act 2001.

See the relevant provider guideline or policy for information relevant to these services.

Subsequent, pre-existing and non-accident related injuries

Notify us if your patient has sustained a subsequent or exacerbation of an existing injury.

  • Where a pre-existing injury has become aggravated as a result of a transport accident, we will fund treatment for the exacerbation of that injury.
  • When a patient is being treated for non-accident related injuries at the same time as accident related injuries, you may only invoice us for the treatment relating to the patient’s accident related injury.
  • We will only accept liability for an injury sustained after the transport accident if it is established that a patient’s subsequent injury is a direct result of the injury or injuries originally sustained in the transport accident.

Treatment by an immediate family member

We cannot pay for treatment or services provided by a member of a client’s immediate family, unless exceptional circumstances exist such as:

  • Treatment was provided in an emergency situation.
  • A client resides in a remote area and the distance to access an alternative health care professional is excessive.

When the TAC client has been treated by a family member, care should be transferred to another suitably qualified healthcare professional as soon as practicable.

How to get paid

Use LanternPay

If you’re an eligible provider, LanternPay lets you:

  • check if your patient or client has a TAC approved claim.
  • submit invoices online.
  • view payment decisions immediately.
  • receive payment the next business day.

To find out more about LanternPay and to register, watch our short video or visit www.lanternpay.com/TAC.

Mail your invoice

You may also invoice us by mail. Services subject to GST must be submitted on a GST compliant invoice. Your invoice must include:

payee details

  • group/company/agency
  • ABN
  • TAC payee number (if you have one)
  • billing address and practice/clinic address

client details

  • given and family names
  • TAC claim number

service details

  • name of service provider and Medicare number (if applicable)
  • date of service and time of service (if applicable)
  • TAC item number as per the TAC fee schedule
  • duration of service
  • itemised fee
  • service location (if different to practice address)
  • total charge for invoiced items

If multiple providers are required on one invoice, you must clearly identify the service listed under each service provider. Duplicate accounts, such as statements, photocopies or facsimiles will not be processed for payment.

Send your invoice to:

Transport Accident Commission (TAC)
GPO Box 2751
MELBOURNE   VIC   3001

Payment dates

We process invoices each week. Payment will be made to your bank account.

Is this your first TAC invoice?

In order to receive payment in your bank account, please complete an EFT/Direct Deposit Authority form.

Note:

Invoices you submit to us should accurately reflect the goods and/or services that have been provided. Inaccurate, inappropriate or fraudulent invoicing may result in requests for supporting documentation, prosecution, recovery of inappropriately paid funds or other actions.

If you become aware of an error in your invoicing for services provided to our clients, or where there is a concern over the accuracy of the payments that we have made, contact us on 1300 654 329 to rectify the situation.

What we cannot pay for

Services

We cannot pay for:

  • Services for a person other than the client (except for family counselling where applicable).
  • Services subcontracted to, or provided by, a non-registered provider.
  • Services provided outside the Commonwealth of Australia.
  • Services where there is no National Health and Medical Research Council level 1 or 2 evidence that they are safe and effective. See: Non-established, new or emerging treatments and services policy.

Expenses and travel

We cannot pay for:

  • The cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals. The exception is GPs coordinating return to work programs approved by us.
  • Downtime between appointments or travel expenses unrelated to a consultation.

Invoices

We cannot pay for:

Reports

We cannot pay for:

  • The same medical report provided more than once – for example, a re-issue of a previous report or multiple copies.
  • A consultation used for the purposes of preparing a medical report. When we request a report, please complete it using your existing clinical notes.

Other guidelines that may be relevant for you include: