Elective Surgery

Elective surgery funding

Elective services contract

Our elective services contract lets health providers request elective surgery on behalf of their patients.

The contract covers the costs of surgery and six weeks of post procedure care after the client has been discharged from hospital.

This includes the follow-up assessments, short term hire of equipment, and the majority of pharmaceuticals.

The elective services contract is usually held by hospitals. Individual service providers, eg medical specialists, who work under the contract need to be named on the service agreement.

A specialist can be named on more than one elective services agreement.
How to apply for a health services contract with ACC
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Non-contracted surgery

ACC also pays or contributes to the cost of surgery under
Regulation 18: Elective surgery costs of the Injury Prevention, Rehabilitation and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (‘non-contracted surgery’)
(external link)

Non-contracted surgery covers the costs of surgery and the six weeks of post procedure care after the client has been discharged from hospital.

It’s up to clients to decide whether they have non-contracted surgery, so it’s important that medical specialists provide clients with all the information available to support them with their decision.

This includes the amount that we contribute towards their non-contracted surgery costs.

We send clients a letter to inform them that their surgery can be performed by a contracted provider.

Clients sign and return this letter to us so we know they are aware of all their options.

Our contributions towards non-contracted surgery

  • District Health Boards (DHBs) are paid at 100% of the contracted rate.
  • Private hospitals are paid at 60% of the contracted rate.
  • Implants are paid at 100% of the contracted rate.

Funding request process

It’s important we’re satisfied that the requested treatment is for the covered injury and not for an underlying or non-accident related condition.

We need to approve surgery before it can be booked and completed.

To request surgery we need providers to send us an Assessment Report and Treatment Plan (ARTP).

The ARTP can be sent to us electronically by either emailing us at ARTPS4ESU@acc.co.nz or through the HealthLink address ‘acceartp’.

While all funding requests for elective surgery are considered on a case by case basis we base our decisions on the information provided in the ARTP, all contemporaneous notes and imaging provided and information we request and/or already hold.

Enabling rapid decisions for elective surgery requests

The time it takes us to make a decision for surgery requests is affected by the quality of information we receive, the time it takes to receive requested information, the complexity of the surgery, the client’s medical history and whether we need a second opinion on the surgery from an external specialist.

We are working with sub-specialty groups of the New Zealand Orthopaedic Association (NZOA) to develop guidelines so that surgeons understand the factors we take into consideration when assessing surgery requests and what information we need to make a rapid decision.

Surgery requests can be fast tracked if they are for a condition that meets all our criteria.

Finalised Fast Track Assessment Criteria for particular conditions are available on the right hand navigation bar.

Funded procedures

Elective surgery procedures are categorised into core, non-core and red list procedures.

Core List procedures

Under the current Elective Services contract, a core procedure is a procedure which has a service item code and a standard description. These procedures are usually less complex and frequently requested.

Non-core procedures

Non-core procedures are those that are not able to be identified on the list of ACC Elective Services core procedures.

They are considered by us when clients require services outside normal core procedures due to the complexity of their surgery and post-operative care or due to their physical condition or medical co-morbidity.

Red list procedures

Red list procedures are limited to providers who have a red list variation in their contract or are named within the Elective Services contract.
Elective Surgery red list procedures (DOC 816KB)
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Invoicing and payment

Before any payment can be made for surgery, we need to receive an invoice and a copy of the procedure’s operation notes.

All invoices must be submitted electronically within 12 months of the treatment provided.

Providers can submit their invoice for payment from the date of discharge.
How to work online with ACC

If the cost of an implant(s) is greater than $8,000, a copy of the supplier’s invoice must also be provided to ACC.

Distributing payments to other health providers

If a surgeon requests non-contracted surgery they are responsible for ensuring that associated payments are made to the hospital, anaesthetist, and others.

The surgeon can request that a hospital take on the role of Lead Provider and in this instance the hospital is responsible for distributing payments to all relevant parties.

Retrospective payments

If an alternative, unanticipated procedure is found to be necessary and more appropriate after commencing an approved surgical procedure, the procedure can still be carried out.

However we may not pay for any surgery unless it meets the criteria for retrospective reimbursement.

A detailed invoice requesting retrospective funding must be submitted to us along with other relevant supporting information before we can make any payment.

Resources

Submitting ARTPs electronically

For providers who want to set up an ARTP template in their PMS, we’ve set up some PMS compatible templates and user guides.

Practice Management System

PMS user Guides

ARTP template

Gensolve

Gensolve guide (PDF 1.4MB)

Gensolve template (DOC 77KB)

Houston VIP

Houston guide (PDF 1.8MB)

Houston VIP template (DOC 91KB)

Incisive Medical Systems

Incisive guide (PDF 551KB)

N/A

MedTech32

MedTech32 guide (PDF 1.4MB)

MedTech32 template (DOC 90KB)

Other

N/A

General template (DOC 90KB)

To find out more about submitting electronic ARTPs or working online, give us a call on 0800 222 994 (option 1) or email us at ebusinessinfo@acc.co.nz – we’ll be happy to help.

Elective Services Operational Guidelines

The elective services operational guidelines are designed to help suppliers holding the ACC Elective Services Agreement interpret the contract, and access it when appropriate.
Elective services operational guidelines

Other resources

Surgery publications

Treatment provider handbook

Related legislation

Accident Compensation Act 2001

Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003

For more information

If you have further queries please contact the ACC Provider Helpline on 0800 222 070 or email us at providerhelp@acc.co.nz.

To have a discussion about contracting with ACC, please contact our Health Procurement Team on 0800 400 503 or email us at health.procurement@acc.co.nz.

Reviewed: 25 August 2016