TAC adopts tougher approach to billing and compliance

29 Jul 2009

MEDIA RELEASE: 29 July 2009

The TAC has indicated its support of the recommendations made by the Ombudsman in his report tabled in State Parliament today.

“I am pleased that the Ombudsman has recognised that the TAC has adopted a tougher approach to compliance. We have implemented a series of state-wide reforms to improve the accountability and transparency of our billing processes,” said TAC Chief Executive Officer, Janet Dore.

“The TAC processes 1.5 million services annually and has established rigorous procedures for checking their accuracy.”

“I think it is fair to say that our billing system was in need of an overhaul and that’s what we’ve done. We’ve already introduced tougher systems and processes that bring medical practitioners under a higher level of scrutiny,” continued Ms Dore.

The TAC has a team of investigators who look at:

• Allegations that services were billed but not provided
• Incorrect coding of services provided in an attempt to gain a financial advantage and
• Over-servicing which could be intentional or unintentional.

Actions taken by the TAC to strengthen its billing processes include:

• Scrutinising the bills provided by medical practitioners who treat trauma patients to ensure that all medical services are appropriate and necessary. This is reflected in 28% of all items for payment being placed “on hold for review” and 10% of services claimed being denied.
• Requiring all invoices for surgical services to have an operation report submitted to verify that services were provided and they are consistent with MBS (Medicare Benefits Schedule) rules.
• Implementing an improved payment workflow system (in conjunction with WorkSafe Victoria ) that provides a more efficient basis for electronic payments and
• Ensuring TAC claims and accounts staff consider the appropriateness of medical services provided, especially in trauma settings. Theatre nurses have also been employed to assist with the manual review of all submitted surgical invoices.

Ms Dore concluded, “The TAC has a responsibility to the Victorian community to ensure all invoices provided by service providers are accurate and appropriate. And if there is any suggestion of fraud, we will exercise our strong legislative powers to investigate and prosecute.”