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Transcript
PHARMACY:
Working with the TAC and WorkSafe
The Pharmacy Guild Member Forum
February 2015
Objectives
 To better understand the Transport Accident
Commission (TAC) and WorkSafe Victoria (WorkSafe)
invoicing processes and requirements for pharmacists to
allow prompt processing and payment of your accounts.
 Become familiar with the TAC and WorkSafe resources
available to pharmacists.
 Understanding of when and how to escalate any
unresolved issues.
Agenda
 Who is HDSG?
 Overview of pharmacy invoicing requirements for TAC &
WorkSafe
 Requirements for submitting an account
 Case studies
 TAC & WorkSafe pharmacy contacts
 Questions
Health & Disability Strategy Group
 Who is HDSG?
 What is our role?
 HDSG Provider Support
 HDSG working with the Pharmacy Guild
Pharmacy Invoicing: What’s
required?
 The TAC & WorkSafe can only pay for pharmacy items
to treat a transport accident or work related injury or
illness, that have been prescribed or requested by a
medical practitioner.
 Over the Counter (OTC) items must be requested by a
medical practitioner but a copy of the script is not
required to be sent to TAC or the WorkSafe Agent.
 The request may be in the form of a prescription or
message on letterhead requesting the use of the OTC
item at the initiation of treatment.
 Requests should be kept on file at the pharmacy.
Before submitting an account:
 Ensure your patient has an accepted TAC or WorkSafe
claim and has met the medical excess.
 Only one patient appears on each account.
 Ensure you do not issue the TAC or WorkSafe Agent
with receipts or patient history reports.
 Ensure that your account is in the form of a dispensary
computer-generated tax invoice.
 Include the status of an item, which may be handwritten
on the tax invoice (e.g. OTC).
Invoicing requirements:
Your patient can also choose to pay for their pharmacy items
themselves and seek reimbursement from the TAC or WorkSafe Agent;
therefore the patient may ask you for a dispensary generated tax
receipt.
Privately prescribed items
All TAC clients and injured workers with a Medicare card
are entitled to medications under the Pharmaceutical
Benefits Scheme (PBS).
TAC & WorkSafe can pay the reasonable costs of
medications that are provided in accordance with the PBS.
Privately prescribed items outside
the PBS
Useful resources
TAC & WorkSafe: www.tac.vic.gov.au/providers/for-healthprofessionals/other-medical-professions/pharmacists/howto-invoice-the-tac
Pharmaceutical Benefits Scheme
www.pbs.gov.au
Medicare – compensable patients
www.medicareaustralia.gov.au/public/services/scripts/pbscompensation.jsp
Over the Counter
TAC & WorkSafe can pay the reasonable costs of OTC
items in accordance with the following:
Contact information
If you have a TAC query about a specific item for payment
on your pharmacy invoice, you can contact the TAC on
Freecall 1300 654 329
If you have a query regarding other matters related to a
particular client (e.g. to check if TAC/WorkSafe is still liable
to pay for a particular medicine) contact the client’s Claims
Manager, have the claim number on hand if possible.
Contact information
If you have a WorkSafe query about a specific item for
payment on your pharmacy invoice you can contact the
WorkSafe Agent:





CGU
QBE
Gallagher Bassett
Allianz
XChanging
8630 1000
9246 2226
9297 9000
9234 3800
9947 3000
Escalating unresolved issues
For escalation of unresolved issues you can contact The
Pharmacy Guild, who will work with HDSG Provider Support to
have the matter resolved.
You can also contact The Pharmacy Guild for:
 Enquiries as a result of formal communication from the TAC
or WorkSafe
 To make a formal complaint to the TAC or WorkSafe
 Interpretation of TAC or WorkSafe policies, guidelines or item
codes
Case studies:
Pharmacy
calls
1300 654 329
Can the TAC
representative
answer the
query?
Provider Support
Contacts Pharmacist by
phone / email
Yes
TAC
representative
No
emails
Provider
Support
Escalate to
Clinical
Panel
Can HDSG
Provider
Support
answer?
No
Y
e
s
Pharmacy
contacted
Clinical Panel may speak
directly to Pharmacist
Case studies:
Agent answers
the enquiry
Communicates
IMA’s
feedback to
Pharmacist
Pharmacist
has a
WorkSafe
enquiry
Agent
writes to
Pharmacy
WorkSafe
emails answer
to Agent rep.
Contacts the
Agent
WorkSafe consults:
Clinical Panel
HDSG
Commercial
Agent cannot
answer and
communicates
with their IMA
IMA communicates
with WorkSafe
Agent contacts
Pharmacist
Questions?
17