Transcript BSO Pharmacy Roadshow 2017 - Business Services Organisation

Business Services Organisation
Road Show
2017
Community Pharmacy Assurance Framework
Why?
“to ensure that throughout
life, in accordance with their
clinical needs, people have
access to timely, safe,
quality assured medicines
supplied with appropriate
advice and support to help
them gain the best
outcomes from their
treatment and avoid harm.”
Aim
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The aim and purpose of the framework is to
monitor compliance with:
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Terms of Service
Service specifications,
Related professional standards and,
Best practice guidance
What it is…
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New
Open and transparent
process
Formative & facilitative
Opportunity to share
good practice
What it isn’t…
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An inspection!
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Duplication
HSCB trying to catch you
out!
Summative or punitive
Anything to be anxious
about
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Structure of the framework
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An annual assurance
declaration
3 year cycle of pharmacy
visits
The Visit
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Observe evidence of the requirements in practice
Seek to view records and documents as
appropriate
Discuss any aspect of service provision relevant to
the service requirements
May include taking of photographs
Output of the Process
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Report of Compliance
Highlight areas of good practice and areas for
improvement
Next steps?
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Don’t panic!
Be prepared
Use the resources
available
http://www.hscbusiness.hscni.net/services/2693.htm
How to Code and Endorse
Effectively
Good Coding
• Always Code Using Up To Date Codes
• 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 In Same Order As Items Appear On
Prescription Form
MDE partially autocoded
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
CodeBook
• Doesn’t Have Codes For All Items
• Several Sections – Also provided as separate
documents Code Book
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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
NB. You must always diamond any items
when making a broken bulk or OOP claim
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 Dispensed 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
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
09/01/17
1234
Code Beside Item
Not Dispensed
Coding Of Repeat Dispensing Not
Dispensed Items
• Code non dispensed item 88888/1
• Where the form is a Repeat Dispensing Batch Issue
(RD) remember to add the non-dispensed
Intervention Code 97002/1 once per batch issue
(irrespective of the number of non-dispensed
items) following consultation with the prescriber
Place in RD
Amended Batch
Adalat LA Tabs 20mg
1 Daily Mitte 28
Lustral Tabs 50mg
1 Daily Mitte 28
Co-codamol Tabs 30mg/500mg
2 MDU Mitte 100
88888
1
2741
28
88888
1
97002
1
Repeat Dispensing 2 of 6
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
09/12/16
RD
Code Beside
Item Not
Dispensed
Non dispensed
intervention
code
CODING ASSORTED FLAVOURS
• Code 98765 over the number of additional fees being
claimed
• Always code 98765 as last item in coding area
• Contractors must endorse on main body of form:
• Number of flavours dispensed
• Assorted flavours must be requested by prescriber
• Place in appropriate multiple dispensing batch
Place in
Multiple Dispensing
Place in Multiple Dispensing
ITEM CODED AS NORMAL
Fortijuice liquid (mixed flavours)
Bottle 200ml
3 Daily
mitte 84
98765
3
4 flavours dispensed
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
7666
84
ADDITIONAL DISPENSING
FEE CLAIM
(4* – 1 = 3)
* Number of flavours
dispensed on prescription
9/01/17
1234
Place in
Multiple Dispensing
Ensure Plus (mixed flavours)
Milkshake Style
mitte 84 x 220ml
3 Daily
Dispense weekly
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
ADDITIONAL DISPENSING
FEE CLAIM
98765
2
(3* – 1 = 2)
54321
11
09/01/17
12 Fees
3 flavours dispensed
D O Getwell
2482
84
* Number of flavours
dispensed on prescription
ADDITIONAL MULTIPLE
DISPENSING FEE CLAIM
9/01/17
1234
( 12 – 1 = 11 )
Broken Bulk
Broken Bulk can be claimed in respect of:
1. Drugs and preparations not listed in part 2
(Chemical Reagents) of NI Drug Tariff
2. Incontinence & Ostomy appliances
Endorsing prescription:
1.
2.
3.
4.
Always diamond the item
Endorse BBC, Pack size & date
Endorse remaining pack BBC & date
Always refer back to open claims
Out of Pocket Expenses
Can be claimed in respect of:
1. Drug Tariff Part 1 category “C” drugs
2. Drugs not listed in Part 1
3. Reagents and appliances with no Tariff price
4. 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
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Endorse prescription serial number on invoice
• Oxygen rental claimed on PO1 form
HOW TO ENDORSE AN
OUT OF POCKET CLAIM
Always Diamond The Item
Accupro Tabs 20mg
Mitte 60
Endorse on main body of
prescription the following:
One to be taken daily
• OOP
• Cost if item has no code
• Admin Cost
• Post Cost
• VAT
OOP
ADMIN £10
POSTAGE £12
VAT
D O Getwell
DR DO GETWELL
1A HEALTH ROAD
BELFAST
BT17 1DA
9/01/17
1234
What Should Be Placed In Amended
Batches?
• Computer generated forms with prescriber
amended item
• Quantity, Drug or Presentation
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Prescriber has handwritten additional item
Dispensing quantity other than prescribed
Item not dispensed
Intervention claim
Assorted flavours claim
How to Batch and Submit Your
Prescriptions
General Batching 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 by
email – [email protected]
• Batch all your invoices and do not attach to
prescription forms (11 digit number endorsed
on invoice)
• Submit submissions in boxes for security
BSO Payment Processes
Scanning
• All prescriptions scanned/photographed
• Barcode contains all text on form & dm+d
codes.
• Large barcode read on >90%
• BSO reads the small barcode. Read rate is
99%.
Autocoding
Autocoding
Why?
Autocoding
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Accurate
No manual intervention
Speeds up processing
Reduces queries
Enables 30 day payment
When Does Autocoding Occur?
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Only in fully coded batches
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
Autocoding Rules
Year
Month
DMADCODE
CHEM
CODE
DRUG_ITEM_DESC
MIN QTY
MAX
QTY
BREAK
ABLE
PACK
SIZE
2016
12
375668004
12334
Betamethasone dipropionate 0.05% cream 100 gram
100
300
N
100
2016
12
375668004
12333
Betamethasone dipropionate 0.05% cream 30 gram
30
150
N
30
2016
12
321196004
624
Diazepam 2mg tablets 28 tablet
7
140
Y
28
12
323192008
13447
Cabergoline 1mg tablets 20 tablet
20
100
N
20
2016
Quantity Field Information
• BSO scanners cannot read any of the following
characters:
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Decimal point
<Space>
*
X
Letters
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2.5ml
2 x 28
2*28
2x30
seven tablets
• BSO scanners can only read integers – i.e. whole
numbers
• Other characters will cause autocoding to fail and
default to MDE input of the contractor code
<xml>
<sc id="0080111312161429477" ft="HS21" t="2016-12-13"/>
<pa l="Turner" f="Kathryn" s="Mrs" h="3477342989" b="1973-05-15" x="2" a="2
Franklin St, Belfast" pc="BT2 8DQ"/>
<pb i="8011" d="Dr Damien" n="The Health Centre" pi="Z00566" a="SURGERY, 25
CHURCH STREET, BELFAST " pc="CO ANTRIM"/>
q="56" sq="428641000"
do="1 DAILY" dm="317310006" u="capsule"/>
<dd d="Lansoprazole Capsules (Gastro-Resistant) 15mg"
</xml>
Manual Data Entry (MDE)
Manual Data Entry
Which forms go to MDE
• All forms in the amended batches
• Any form in the fully coded batches which isn’t fully
autocoded
• Oxygen
• Stock
• Specials
• Hospice
• PV1
• SP1/SP2
• All handwritten forms
Pricing team
• Handle escalated queries from manual data
entry (MDE).
• Diamonded items - source a price / code /
associated fees.
Prescription Forms
3.57%
Pricing
26.31%
MDE
70.12%
Fully
Autocoded
dm+d Unit Of Measure
What is the dm+d & Unit of Measure?
• Dictionary of medicines and devices is the UK wide reference
source for all products.
• When to comply with the Standard
– Health and care organisations, system suppliers and pharmaceutical
companies must comply by 30th June 2017.
• It populates all the clinical systems
• Currently we have inconsistent application of units of
measure and need to align these within the payment system
What is the dm+d & Unit of Measure?
• dm+d have defined the unit by which
volume of products are measured.
• Tablets, capsules, grams, ml, doses
dm+d Challenges
• Prescribing by dm+d unit of measure – not in BSO
control
• Inconsistency due to limitations of previous
system
• Part packs coded
• We cannot change all at once
• Starting with borderline substances
What's changing?
• We will align all products in the borderline substance list to
the dm+d unit of measure on 1st April 2017.
• This alignment mainly affects foods.
• Communication will be issued to contractors, pharmacy
system suppliers, prescribers and wholesalers.
• This will be a test for BSO and contractors and the learning
from this exercise will lead us to aligning the UOM to the
dm+d for all other products in the codebook.
Codebook Examples
• Old codebook description
• New codebook description
• Validation will be in place to protect against payment of
part packs for items in special containers.
What does this mean to you?
• You must:
1. Update BSO codes in your dispensing system each
month
2. Always refer to the updated codebook.
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
1. Invalid drug code
2. Item over maximum quantity *
3. Targeted checks over £200
4. Invalid prescriber
Additional Validation
• Principal validation was enhanced to include:
• Specific drug codes where payment issues
were identified
• Specific quantities where payment issues
were identified
• This is carried out manually before the
payment is made
Types of Additional Validation
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Ingredient Cost less than 10 p - 77,000 items
Part Packs - 63,000 items
Minor Ailment Consultation fee check
Multiple “Fee” codes claimed
Non Minor Ailment drug on PV1 form
209,000 items checked
Currently 19,000 items per month
Future
• Increase autocoding – Jan 17 forms +2%
• Align BSO Unit Of Measure to the dm+d
– Borderline substances April 2017
– All others ?
• Automated Advanced Validation
– Prescribing / dispensing comparison
– Quantity checked against UOM and special container
status
– Workflow dependant on batch
What Can You Do?
• Keep forms in the amended batches to a
minimum
• Communicate with the prescriber to correct
amendments on repeat items
• Don’t automatically substitute items without
getting prescribing amended
• Apply your system supplier updates as soon as
you receive them.
• Check the code book to ensure you code the
correct quantity/unit of measure
Cryptotoken roll out
• All pharmacies to be supplied with a cryptotoken
between February and August
• This will enable pharmacies to access the
community pharmacy landing page.
• Landing Page
• From the landing page you can access secure web
services NIECR and FPPS Portal using the
individual usernames and passwords for each
system
FPPS Portal Access
• Each business will nominate a sponsor
• The sponsor will determine who can have access
and their level of access and be responsible for
maintaining this
• The sponsor will sign a user agreement for each
premises they are responsible for
• Each individual will have a unique user name and
password for the FPPS portal
• Different levels of access
New System - FPPS Pharmacy
• System went live August 2014
• We have been using it on the contractors behalf
– HS30
– Residential Nursing Home (RNH)
– Oxygen
– Rota/OnCall
– PreReg
• New System Portal access will replace current emailed and
printed reports
END
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