Billing Review Program
The TAC can pay the reasonable costs of medical and allied health services required by TAC clients because of their transport accident.
Why does the TAC have a Billing Review Program?
Through the Billing Review Program, the TAC conducts periodic reviews of payments made to providers for medical and allied health services delivered to TAC clients. The program's primary focus is to ensure payments made to providers are appropriate and comply with TAC policies and fee schedules.
The TAC may review payments made to you for services provided to TAC clients at any time.
How is the Billing Review Program different to reviews by the Clinical Panel?
The TAC Clinical Panel reviews the services provided to TAC clients to ensure they are clinically justified, are in line with the Clinical Framework and improve health and return to work outcomes.
The Billing Review Program focuses instead on ensuring that payments made to providers are appropriate. The TAC obtains clinical advice when completing billing reviews.
How will I be notified of a review?
When seeking information and documents directly from a provider as part of the Billing Review Program, the TAC may formally notify you of a requirement for patient health information and documents pursuant to section 127A of the Transport Accident Act 1986. This section provides the authority for the supply of the requested patient health information and documents to the TAC. As such, a provider is not required to obtain patient consent in order to release the patient information and documents requested under these provisions.
If you are a contracted provider, the TAC may, in some circumstances, rely on the audit provisions contained in the relevant provider’s services agreement when requesting information and documentation.
The TAC will contact you about a review before a visit, and arrange a time to collect the requested information and documentation that is convenient to you. Documentation will be returned to you within an agreed timeframe. The TAC may also contact other parties to obtain information and documentation, including hospitals and other health facilities, to assist with the billing review.
The TAC seeks to communicate and obtain requested information and documentation from providers in a co-operative way. In some circumstances, the TAC also has the authority to inspect, examine or make extracts from, or copies of any information within premises that may be required to complete a billing review.
The information and documentation obtained by the TAC is not utilised for any other purpose other than the billing review and, in particular, is not used for the management of TAC client claims.
What about confidentiality and secure storage of patient information?
The TAC appreciates any concerns providers may have with respect to the security of confidential patient information. The TAC is required to comply with the Information Privacy Act 2000 (Vic), the Health Records Act 2001 (Vic) and the Information Privacy Principles and Health Privacy Principles set out in those Acts. Patient information collected from providers as part of the Billing Review Program is not placed on claim files and is managed in accordance with the TAC's privacy policies.
What is considered in a review?
A TAC billing review focuses on ensuring that payments made to providers are appropriate and comply with TAC policies and fee schedules. The TAC consider's billing data, client information, clinical records and relevant policies and fee schedules when conducting reviews. The TAC obtains and relies upon clinical advice from appropriately qualified peers during a billing review.
Who will I be dealing with?
If payments made to you are under review, you may receive requests for information from a representative of the TAC’s Forensics Group.
How long will the review process take?
The review process can take up to several months to complete depending on the time taken to collect the required information and the number of reviews being undertaken at any one time. The TAC endeavours to communicate any issues identified as part of the review and to seek any necessary clarifications from you as soon as practicable. The TAC also encourages providers to communicate with them or their professional bodies if they have any queries.
What happens at the end of the review?
At the conclusion of the review the TAC will communicate with you about the outcome of the review. Potential outcomes include one or more of the following:
- no further action being taken
- a further explanation being required
- reimbursement of any incorrect/inappropriate payments
- referral to a relevant regulatory body (e.g. AHPRA), and/or
- referral for further investigation.
Where appropriate, the TAC will provide you with practical and constructive advice about how to comply with the relevant policy and billing rules.
Where professional conduct issues are identified, the TAC may also propose referral of the issues identified to the relevant regulatory body for review and have the power to suspend payments for services provided to TAC clients pending the outcome of that further review. Prior to a referral to the relevant regulatory body, the TAC will give the provider an opportunity to respond to the issues identified. Any response received will be taken into account when determining whether a referral to the relevant regulatory body is appropriate.
The TAC encourages all providers to reconcile payments with invoices and to review their billing practices relating to TAC claims as a matter of course.
If, during a self-audit, you discover any billing errors or incorrect billing practices in relation to services provided to TAC clients, you should contact the TAC on freecall 1300 654 329 or toll free on 1800 332 556, or email firstname.lastname@example.org.
Where can I get more information?
You can contact Mr Greg O’Neil, Manager, Forensic Accounting and Review at the TAC on (03) 5225 7098 with any queries regarding the Billing Review Program.