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Business Services Organisation Road Show 2013

Business Services Organisation Road Show 2013. Programme. Accelerated Payment Project Scanning/ Autocoding New Payment System Coding and Batching Concessionary Pricing Minor Ailments MUR. Contractor adjustments. 1. EPES duplication Mar – O ct 2008

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Business Services Organisation Road Show 2013

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  1. Business Services Organisation Road Show 2013

  2. Programme • Accelerated Payment Project • Scanning/Autocoding • New Payment System • Coding and Batching • Concessionary Pricing • Minor Ailments • MUR

  3. Contractor adjustments • 1. EPES duplication Mar – Oct 2008 • 2. Oxygen duplication Oct – Dec 2008 • 3. Glucosamine price differentials Apr – Oct 2009 • 4. Dispensing fee adjustments 2010/11 • 5. Dispensing fee adjustments 2012/13

  4. EPES Duplication March – October 2008 • Random forms (18k out of 11.7m) were processed and paid more than once. • Duplicated forms identified by BSO. • Lengthy investigation was carried out by BSO in conjunction with the 3rd party supplier • System fixed and tested • CPNI informed 2010 • Ongoing discussion 2010 - 2013

  5. Oxygen Duplication • During EPES implantation phase manual entry of oxygen claim was duplicated • Duplicated forms identified by BSO. • Investigation was carried out by BSO • Process fixed and tested • CPNI informed 2010 • Ongoing discussion 2010 - 2013

  6. Glucosamine price differentials Apr – Oct 2009 • Glucosamine AAH price surge from April 2009 (eg £19.98 - £150) • Contractors written to in order to clarify which product was dispensed (Feb. 2010, May 2010 and Jan 2012) • Discussions with CPNI 2010 – 2013 • Agreement reached on methodology for reclaim • Letter sent 12th November 2013

  7. Dispensing fee adjustment • 2010/11 • OD fees exceed global sum. • MD fees less than global sum • Net effect £717k underpayment • 2012/13 • OD fees exceed global sum. • MD fees less than global sum • Net effect £473k overpayment

  8. Process to date • Mispayments identified • CPNI notified and ongoing discussions since 2010 • Specific examples and anonymised contractor level data provided • Communication to contractors in November 2013 • Significant number of queries raised by contractors • BSO sought agreement with HSCB to defer making any adjustments until further information provided to contractors

  9. Accelerated Pharmacy Payment Project

  10. APP Update • 30 day payment cycle from April 2013 • Special Advance removed June 2013 • APP Implementation Team has become APP Maintenance Team (meet every 2 months) • APP Project Board has become Advisory Group and will only meet when required • Schedule of Courier collection dates for next year has been agreed by APPMT • Calendars and wall charts will be provided • Contingency arrangements agreed

  11. BSO VIDEO

  12. APP On-going Monitoring

  13. APP Monitoring September 2013 • Timeliness • Excellent • % First Submission • 64% • Prepping Time • 18 minutes

  14. APP Contingency Arrangements • System Level e.g. BSO system failure • BSO will invoke Business Continuity Plan • Individual Contractor Level late submission • Late Submission Business Rules will apply

  15. Late Submission Business Rules • Agreed by APP Contingency Sub-group of Pharmaceutical Committee, BSO and CPNI. • APP Contingency Sub-group will monitor and manage on on-going basis • Aim is to act as a deterrent rather than punitive • All extenuating circumstances will be taken into consideration

  16. Late Submission Business Rules • In place from July 2013 • Will apply if: • a contractor fails to submit their prescriptions in time for BSO to process OR • an individual contractor repeatedly fails to meet submission dates i.e. has three consecutive red second submissions

  17. Submission Too Late For Processing i) Extenuating Circumstances • 100% estimated payment • Adjusted following month ii) No Extenuating Circumstances • 100% estimate payment calculated and reduction in payment will be 5% NIC • Refunded once two consecutive months green submissions • Repeated for a maximum of three months.

  18. Three Consecutive Red 2nd Submissions i) Extenuating Circumstances • 100% payment ii) No Extenuating Circumstances • 100% payment made • Visit by BSO staff • £75 non-refundable Administration Fee charged.

  19. Late Submission Business Rules • Summary • Purpose is to deter rather than punitive • BSO will make every effort to process in correct month • Individual contractor discount will be manually adjusted • BSO should be informed of potential problems as soon as possible • Extenuating circumstances will be considered

  20. Scanning/Autocoding/New System

  21. Scanning • All prescriptions scanned/photographed • All prescription images kept • Large barcode read on >90% • Barcode contains all text on form + dm+d codes. • Pharmacy hand held scanners scan the big barcode.

  22. dm+d • A common medicines dictionary that will reduce the chance of medical errors by ensuring all staff who work in the NHS and healthcare use the same common language when referring to medicines – DH, England • An online database of all pharmaceutical products listed by generic and brand name (Virtual Actual)

  23. dm+d • Populated by manufacturers with all product particulars ie price, special container status, CD status, etc • Now present in all GP prescribing and pharmacy systems and many information and payment systems. • dm+d is used as the primary source of pricing information and is integral to the master (pricing) file

  24. Autocoding • Occurs only on forms in non-amended batches of fully coded, repeat dispensing and multiple dispensing forms • dm+d code & quantity + autocoding rules = chemcode/quantity. • Autocoding 66% of all items 2.2m per month. • All other items are sent for manual data entry

  25. New Payments System • Covers Pharmacy, Dental and GP Payments • Performs the calculations and sends the payments to the financial system • Developed with Kainos, owned by BSO • Contractors will input claims and receive payment information online.

  26. Developments • New autocoding rules for products • Multiple units of measure eg inhalers • Creams • Expansion into items like appliances and foods is in planning • New validation checks are in place and will be continue to be developed. • New improved process for applying BSO drug codes to pharmacy systems • APP related automation of masterfile price setting is in place.

  27. Hand-held Scanner Project • APP Feasibility Study • Project Board – BSO/HSCB/CPNI/IT • System supplier engagement • Development of Specification for Interpretation of Bar Codes – use of DM and D codes • Development of Business Case • Implementation/Evaluation plans pending Business Case approval

  28. General Coding and Batching Tips

  29. WHY? • Ensures That You Receive Correct Payment For What Has Been Dispensed • Ensures That Your Prescriptions Are Processed Quickly And Efficiently • Minimises The Risk Of Delay In Payment Of Prescription Items

  30. GOOD CODING • Code Or Endorse Every Item • All Supporting Endorsements Made Outside The Coding Area • Always Code Using Up To Date Codes • Code Book Is Online And Can Be Downloaded • Always Code In Same Order As Items Appear On Prescription Form

  31. GOOD CODING • Run Monthly Updates From Supplier • Code Drug Tariff Part 1 Codes When Prescribed Generically • Code Clearly • Code In Black

  32. GOOD CODING • Do Not Code Over Or Deface The 2D Barcode • Contains Vital Prescribing Information • Enables Auto-Coding • Improves payment accuracy

  33. CURRENT ISSUES • Out of Pockets on Part 1 Cat C drugs • Returned forms items not paid • Inhalers • Printer Ribbons

  34. What should be placed in the amended batches? • Additional item added to the prescription form after printing. • Amendment to the prescribed drug or quantity after printing. • Dispensing a quantity different to that originally prescribed.

  35. What should be placed in the amended batches? • Any prescription form where an item that has not been dispensed. • The item should also be clearly endorsed ND. • Repeat Dispensing forms where the pharmacist has made an intervention claim by code

  36. Northern Ireland Concessionary Prices

  37. 3 Possible Scenarios • Concessionary price granted by DH in England • NCSO* status granted by DH in England • NI specific shortages * No Cheaper Stock Obtainable

  38. 1. Concessionary Price granted By Department of Health • If English Concessionary Price is allocated, this will be paid in NI. • Always code for the generic product • BSO will identify all items with generic code and make appropriate concessionary price adjustment

  39. 2. NCSO granted by DH &3. NI Specific Shortages • NI Concessionary Price is currently being negotiated – DHSSPS and CPNI • Methodology currently being developed taking into account wholesaler information • Outstanding retrospective element to be resolved asap and then monthly meetings moving forward.

  40. Minor Ailments Scheme (MAS)

  41. Minor Ailments Scheme Existing therapy areas Therapy areas added Oct 2012 • Head lice • Athlete’s foot • Threadworms • Vaginal Thrush • Diarrhoea • Dhobie itch • Cold Sores • Removal of Ear Wax • Mouth Ulcers and Inflammation • Oral Thrush

  42. MAS – summary of key points • Uptake – what can you do to promote the scheme and referrals from patients and local GP practices? • An option is advice only • Remember to follow the treatment algorithms • Further information available on BSO website http://www.hscbusiness.hscni.net/services/2055.htm

  43. Medicine Use Reviews (MURs)

  44. MURs: Uptake

  45. Initial MURS completed

  46. Number of initial MURs completed MURs: Activity

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