Transcript BSO Pharmacy Roadshow 2015 - Business Services Organisation

Business Services Organisation
Road Show
2015
Agenda
•
•
•
•
•
How To Code and Endorse Effectively
How To Bundle And Submit Your Prescriptions
BSO Receipt of Submissions
BSO Payment Processes
Validation
How to Code and Endorse
Effectively
Learning
• Good coding principles
• Endorsements
– Not dispensed items
– Owings
– Broken Bulk
– Out Of Pocket
• Assorted flavours
• General Bundling issues
Good Coding
• Code Or Diamond Every Item
• No code or diamond may result in the form being
returned to contractor
• All Supporting Endorsements Must Be Made On
Main Body Of Prescription Form
• Always Code Using Up To Date Codes
• Always Code In Same Order As Items Appear On
Prescription Form
Good Coding
• Do Not Code Over Or Deface The 2D Barcode
– Contains Vital Prescribing Information
– Enables Auto-Coding
– Improves payment accuracy
• Code In Black
• Code Clearly
Examples of Bad Writing
What’s the Number?
385
3851
7851
7853
16%
12%
78
53
78
51
38
51
6%
38
5
A.
B.
C.
D.
67%
What’s the Number?
56%
36%
7%
19
07
6
79
02
6
1%
79
02
0
79070
79020
79026
19076
79
07
0
A.
B.
C.
D.
CodeBook
• Doesn’t Have Codes For All Items
• Recently added many more codes for ostomy and
catheters and more will follow
• Several Sections – Also provided as separate
documents Code Book
–
–
–
–
–
–
–
–
Drugs
Dressings (including Wound Management)
Ostomy / incontinence appliances
Catheters
Lymphoedema
Other Appliances
Substitute prescribing supervision codes
Minor Ailment Codes (Not included in full codebook)
Coding
A code number is a complete endorsement.
It includes
Zero Discount
Controlled Drug Fee
Endorsements
ZD / CD
• Only need to endorse if item has no code
• Endorse on main body of form, not in
coding column
• Only endorse ZD on items listed on ZD list in
NI Drug Tariff
Coding Not Dispended Items
• Code every not dispensed item as 88888/1
• N/D endorsement no longer accepted
• Place in appropriate amended batch
• Do not submit forms where no items have been
dispensed. The form should be destroyed and
the destruction recorded
• Items without a code/diamond may cause the
form be returned to Contractor unpaid
Coding Not Dispended Items
• Where the form is a Repeat Dispensing Batch Issue
(RD) remember to add the non-dispensed
Intervention Code 97002/1 once per form
(irrespective of the number of non-dispensed
items) as well.
Place in Amended
Batch
Adalat LA Tabs
20mg
1 Daily
mitte 28
1826
28
lustral Tabs 50mg
1 Daily
mitte 28
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
88888
1
03/08/15
1234
Code Beside Item
Not Dispensed
Owings
1. Item dispensed not collected and able to
reuse
• Item code over zero
• Place in amended batch
2. Item dispensed part collected and able to
reuse remainder
• Item code over quantity supplied
• Place in amended batch
Broken Bulk
Broken Bulk can be claimed in respect of:
i. Drugs and preparations not listed in part 2
(Chemical Reagents) of NI Drug Tariff
ii. Incontinence & Ostomy appliances
Endorsing prescription:
• Always diamond the item
• Endorse BBC, Pack size & date
• Endorse remaining pack BBC & date
• Always refer back to open claims
Which of the categories are you not
entitled to claim an OOP expense?
36%
A. Part 1 Cat C
B. Appliances listed in
Part 3
C. Specials
D. Oxygen
30%
27%
Ap
pl
ia
nc
e
sl
ist
ed
Ox
yg
en
ls
Sp
ec
ia
in
Pa
rt
1
Pa
r
Ca
t
t3
C
7%
Out of Pocket Expenses
Can be claimed in respect of:
i. Drug Tariff Part 1 category “C” drugs
ii. Drugs not listed in Part 1
iii. Reagents and appliances with no Tariff price
iv. Oxygen
Out of Pocket Expenses
Endorsing the prescription:
• Always diamond the item
• Endorse OOP, admin charge, postage & VAT
• Endorse ingredient cost (excluding VAT), if item
has no code
• Must provide supporting invoice for OOP costs
• Endorse prescription serial number on invoice
• Oxygen rental claimed on PO1 form
Multiple Dispensing
• Code 54321 over the number of additional fees
being claimed
– Always code 54321 as last item in coding area
• Contractors must endorse on main body of form:
– Fees claimed for each item
– Date of 1st dispensing
Pharmacy Open
Monday - Saturday
Adalat LA Tabs 20mg
24 fees
1 Daily
03/08/15
mitte 28
Dispense Daily
24 fees
Lustral Tabs 50mg 03/08/15
1 Daily
mitte 28
Dispense Daily
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
1826
28
2741
28
54321
46
Additional Dispensing Fee
Claim
(48* – 2** = 46)
* Total multiple dispensing fees
claimed on prescription
03/08/15
1234
** Total number of items multiple
dispensed
AtorvastatinTabs 40mg
1 Daily
4 fees
mitte 28
03/08/15
Dispense Weekly
lustral Tabs 50mg
4 fees
1 Daily
mitte 28
03/08/15
Dispense Weekly
Salbutamol inhaler
100mcg
2 Puffs PRN
200 Doses
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
Pharmacy Open
Monday - Saturday
13302
28
2741
28
1252
1
54321
6
Additional Dispensing Fee
Claim
(8* – 2** = 6)
3/08/15
1234
* Total multiple dispensing fees
claimed on prescription
** Total number of items
multiple dispensed
Coding Assorted Flavours
• Must be requested by prescriber
• “Flavour not specified” not acceptable
• Code item number of flavours dispensed
• Place forms in the amended batch
• Only Place forms in Batch H amended if also
multiple dispensed.
Place in
Amended Batch
Fortijuice liquid (mixed
flavours) Bottle 200ml
3 Daily
mitte 84
4 flavours dispensed
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
7666
21
7666
21
7666
21
7666
21
3/08/15
1234
Item coded 4
times because
4 flavours
dispensed
Ensure Plus (mixed flavours)
Milkshake Style
mitte 84 x 220ml
3 Daily
Dispense weekly
03/08/15
12 Fees
3 flavours dispensed
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
2482
28
2482
28
2482
28
54321
9
Place in
Multiple Dispensing
Amended
Item coded 3
times because 3
flavours
dispensed
Additional Dispensing
Fee Claim
3/08/15
1234
( 12 – 3 = 9 )
How to Bundle and Submit
Your Prescriptions
General Bundling Issues
• Count your prescription forms
• Batch your forms correctly
• Batch all your invoices and do not attach to
prescription forms
General Bundle Issues
• Don’t use sellotape, staples or sticky labels
• Use current HS30 forms and don’t swap
• Actual number of counted forms endorsed
on HS30
• HS30’s and address labels can be ordered
on Tel:02895 363678
What Should Be Placed In Amended
• Computer generated forms with hand
amended item
– Quantity, Drug or Presentation
•
•
•
•
•
Prescriber has handwritten additional item
Dispensing quantity other than prescribed
Item not dispensed
Intervention claim
Assorted flavours claim
Where should I bundle hand
written forms?
• Fully coded bundle
What is the minimum percentage of
prescriptions you are expected to achieve in
your 1st submission
94%
3%
60
%
3%
50
%
0%
40
%
30%
40%
50%
60%
30
%
A.
B.
C.
D.
st
1
Submission Volume
• APP requires at least 60% of monthly volume
submitted by each contractor in 1st
Submission
• Current overall submission level just above
60%
st
1
Submission Volume
• Rising number of contractors failing to
achieve 60% level on multiple occasions
Contractor's <60% Sub 1 (2015)
Number of
Contractors
Number of Months
less than 60% during 8 month period
20
22
43
55
56
51
68
82
8
7
6
5
4
3
2
1
Transfer to Courier (DX)
• Submit forms in secure and compact
packaging
• Contractors must label their submission
with the barcode provided
BSO Receipt of Submissions
APP Requirements
Submission Deliveries to BSO –
(System Checks)Volume
• Box count from DX delivery van must match
paperwork.
• DX to introduce procedure of scanning each
box coming off delivery van.
• Paperwork signed by both BSO and DX.
Submission Deliveries to BSO –
(System Checks)Volume
• Scanning report to be emailed to both BSO and
CPNI.
• Deliveries opened and receipted individually
from HS30 information.
• BSO follow up on submissions not received
during delivery period.
Scanning Validation Checks
• Submissions scanned into EPES and system
reporting checked against contractor HS30’s.
• System tolerance levels set at 99.8% and 100.2%
– All submissions above or below stated
tolerance levels are subject to a recount
• HS30 amended if count confirmed
Scanning Validation Checks
• Recount outcomes may result in contractor being
contacted.
• Contact recorded on HS30.
• BSO can facilitate contractor inspection of their
submission if requested.
BSO Payment Processes
Scanning
• All prescriptions scanned/photographed
• All prescription images kept
• Barcode contains all text on form + dm+d
codes.
• Large barcode read on >90%
• BSO reads the small barcode. Read rate is
99%. Avoids duplication.
Autocoding
Which of the following quantities of
Dipyridamole 200mg modified-release
capsules will be autocoded?
63%
20%
24
0
8%
12
0
8%
56
28
56
120
240
28
A.
B.
C.
D.
Which of the following quantities of
Diazepam 2mg tablets will NOT be
autocoded?
40%
33%
25%
14
0
93
1%
56
6
56
93
140
6
A.
B.
C.
D.
Autocoding Rules
Year
Month
DMADCODE
CHEM
CODE
DRUG_ITEM_DESC
MIN QTY
MAX
QTY
BREAK
ABLE
PACK
SIZE
2015
9
375668004
12334
Betamethasone dipropionate 0.05% cream 100 gram
100
300
N
100
2015
9
375668004
12333
Betamethasone dipropionate 0.05% cream 30 gram
30
150
N
30
2015
9
321196004
624
Diazepam 2mg tablets 28 tablet
7
140
Y
28
2015
9
319766001
12713
Dipyridamole 200mg modified-release capsules 60
capsule
60
180
N
60
When Does Autocoding Occur?
• Only in fully coded bundles (A,H,L)
• When the barcode is read
• When the quantity is an integer
Quantity Field Information
BSO scanners cannot read any of the following
characters:
• Decimal point – 2.5ml
• <Space> – 2 x 28
• * - 2*28
• X – 2x30
• Letters – seven tablets
BSO scanners can only read integers – ie whole
numbers. Other characters will cause autocoding to fail
and default to MDE input of the contractor code
When Does Autocoding Occur?
•
•
•
•
•
Only in fully coded bundles (A,H,L)
When the barcode is read
When the quantity is an integer
When a product has a rule.
When the conditions of the rule are met
– Min & Max
– Breakability
Scan &
Count
Fully Coded Bundles
Image
Process
Auto
Code
Validat
ion
Manual
Data Entry
Valida
tion
Price
Manual
Adv
Validation
Payment
Scan &
Count
Fully Coded Bundles
Image
Process
Auto
Code
Validat
ion
Manual
Data Entry
Valida
tion
Price
Manual
Adv
Validation
Payment
Scan &
Count
Fully Coded Bundles
Image
Process
Auto
Code
Validat
ion
Manual
Data Entry
Valida
tion
Price
Manual
Add
Validation
Payment
MDE partially autocoded
Scan &
Count
Fully Coded Bundles
Image
Process
Auto
Code
Validat
ion
Manual
Data Entry
Valida
tion
Price
Manual
Add
Validation
Payment
What’s the Issue with Amendments
• Any autocodable items on an amended
form are at risk of incorrect payment
• These forms are all subjected to manual
processes
What Does That Mean To You?
• Slows processes
– Manual intervention when choosing a product to
dispense if using a scanner.
• Error rate
– Dispensing
– Payment
• Won’t have to repeat manual intervention if
prescriber informed and prescription
amended at source.
Scan &
Count
Image
Process
Amended/Uncoded/Part
Coded Bundles
AAuto
Code
Validat
ion
Manual
Data Entry
Valida
tion
Price
Manual
Adv
Validation
Payment
Scan &
Count
Image
Process
Amended/Uncoded/Part
Coded Bundles
Auto
Code
Validat
ion
Manual
Data Entry
Valida
tion
Price
Manual
Adv
Validation
Payment
What Can You Do?
• Keep amended items to a minimum
• Communicate with the prescriber to correct
amendments on repeat items
• Contact the practice’s MMA for help if needed
• Don’t automatically substitute items without
getting prescribing amended
• This will reduce the manual intervention in
the pharmacy and BSO
Validation
Validation?
•Principal
•Additional
•Advanced
Principal Validation
• This validation falls into 4 categories, is
carried out on every prescription item.
• Has been present in various systems for 20
years
– Invalid drug code
– Item over maximum quantity
– Targeted checks over £200
– Invalid prescriber
Additional Validation
• System developments have brought greater
visibility and potential for improved
validation and automation.
• Is now possible to react to pharmacy
concerns or filter for specific complex issues.
• Principal validation was enhanced to include
– Specific drug codes where payment issues were
identified
– Specific quantities where payment issues were
identified
Types of Additional Validation
• Ingredient Cost less than 10 p
An Ingredient Costs Less than 10p
Code 2952/1
(£0.06)
1 ml Welldorm Elixir
Correct Code
2752/1
(£59.48)
Types of Additional Validation
• Ingredient Cost less than 10 p
• Partial Packs
• Minor Ailment Consultation fee check
Minor Ailment Consultation Fee
Not Claimed
Coded 79081/1 (£0.06)
1 ml Hedrin Lotion
Correct code 79070/1
(£8.50)
Types of Additional Validation
•
•
•
•
Ingredient Cost less than 10 p
Partial Packs
Minor Ailment Consultation fee check
Multiple “Fee” codes claimed
Multiple “Fee” Codes Claimed
A maximum of 1
Repeat Dispensing
Intervention or Repeat
Dispensing
Non Intervention
can be paid on a form
Types of Additional Validation
•
•
•
•
•
Ingredient Cost less than 10 p
Partial Packs
Minor Ailment Consultation fee check
Multiple “Fee” codes claimed
Non Minor Ailment drug on PV1 form
Future
• Increase codes in code book – lymphoedema
• Increase autocoding
• Advanced validation will allow for increased
identification of potential issues and also
automate the correction in some cases
• Align BSO Unit Of Measure to the dm+d
therefore achieving consistency across all
products
END