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

• Good coding principles• Endorsements

– Not dispensed items– Owings– Broken Bulk– Out Of Pocket

• Assorted flavours• General Bundling issues

Learning

• 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

Good Coding

Examples of Bad Writing

What’s the Number?

A. 385B. 3851C. 7851D. 7853

3853851

78517853

6%12%

67%

16%

A. 79070B. 79020C. 79026D. 19076

7907079020

7902619076

36%

1%7%

56%

What’s the Number?

• 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)

CodeBook

A code number is a complete endorsement.It includes

Zero DiscountControlled Drug Fee

Coding

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

Endorsements

• 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.

Coding Not Dispended Items

Adalat LA Tabs

20mg

1 Daily

mitte 28

lustral Tabs 50mg

1 Daily

mitte 28

182628

888881

D O GetwellDR DO GETWELL1A HEALTH ROAD

BELFASTBT17 1DA

1234

Code Beside Item Not Dispensed

03/08/15

Place in Amended Batch

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

Owings

Broken Bulk can be claimed in respect of: i. Drugs and preparations not listed in part 2

(Chemical Reagents) of NI Drug Tariffii. 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

Broken Bulk

Which of the categories are you not entitled to claim an OOP expense?

A. Part 1 Cat CB. Appliances listed in

Part 3C. SpecialsD. Oxygen

Part 1 Cat C

Appliance

s list

ed in P

art 3

Specials

Oxyge

n

27%30%

7%

36%

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

Out of Pocket Expenses

• 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

Multiple Dispensing

Adalat LA Tabs 20mg1 Daily

mitte 28Dispense Daily

Lustral Tabs 50mg1 Daily

mitte 28Dispense Daily

24 fees03/08/15

24 fees03/08/15

182628

274128

5432146

D O GetwellDR DO GETWELL1A HEALTH ROAD

BELFASTBT17 1DA

1234

Additional Dispensing Fee Claim

(48* – 2** = 46)

* Total multiple dispensing fees claimed on prescription

** Total number of items multiple dispensed

03/08/15

Pharmacy Open Monday - Saturday

AtorvastatinTabs 40mg1 Dailymitte 28

Dispense Weekly

lustral Tabs 50mg1 Dailymitte 28

Dispense Weekly

Salbutamol inhaler 100mcg

2 Puffs PRN200 Doses

4 fees03/08/15

4 fees03/08/15

1330228

274128

543216

D O Getwell

DR DO GETWELL1A HEALTH ROAD

BELFASTBT17 1DA

1234

3/08/15

12521

Pharmacy Open Monday - Saturday

Additional Dispensing Fee Claim

(8* – 2** = 6)

* Total multiple dispensing fees claimed on prescription

** Total number of items multiple dispensed

• 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.

Coding Assorted Flavours

Fortijuice liquid (mixed flavours) Bottle 200ml

3 Dailymitte 84

4 flavours dispensed

766621

D O GetwellDR DO GETWELL1A HEALTH ROAD

BELFASTBT17 1DA

1234

Item coded 4 times because

4 flavours dispensed

3/08/15

Place inAmended Batch

766621

766621

766621

Ensure Plus (mixed flavours) Milkshake Style

mitte 84 x 220ml3 Daily

Dispense weekly

03/08/1512 Fees

3 flavours dispensed

248228

D O GetwellDR DO GETWELL1A HEALTH ROAD

BELFASTBT17 1DA

1234

Item coded 3 times because 3

flavours dispensed

3/08/15

Place inMultiple Dispensing

Amended248228

248228

543219

Additional Dispensing Fee Claim

( 12 – 3 = 9 )

How to Bundle and Submit Your Prescriptions

• Count your prescription forms

• Batch your forms correctly

• Batch all your invoices and do not attach to

prescription forms

General Bundling Issues

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

A. 30%B. 40%C. 50%D. 60%

30%40%

50%60%

0%

94%

3%3%

• APP requires at least 60% of monthly volume submitted by each contractor in 1st Submission

• Current overall submission level just above 60%

1st 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

20 822 743 655 556 451 368 282 1

1st Submission Volume

• Submit forms in secure and compact packaging

• Contractors must label their submission with the barcode provided

Transfer to Courier (DX)

BSO Receipt of Submissions

APP Requirements

• 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.

Submission Deliveries to BSO – (System Checks)Volume

• 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

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

• 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.

Scanning

Autocoding

Which of the following quantities of Dipyridamole 200mg modified-release

capsules will be autocoded?

A. 28B. 56C. 120D. 240

8% 8%

63%

20%

Which of the following quantities of Diazepam 2mg tablets will NOT be

autocoded?

A. 6B. 56C. 93D. 140

25%

40%

33%

1%

Autocoding RulesYear 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

• Only in fully coded bundles (A,H,L)• When the barcode is read• When the quantity is an integer

When Does Autocoding Occur?

BSO scanners cannot read any of the following characters:• Decimal point – 2.5ml• <Space> – 2 x 28• * - 2*28• X – 2x30• Letters – seven tabletsBSO scanners can only read integers – ie whole numbers. Other characters will cause autocoding to fail and default to MDE input of the contractor code

Quantity Field Information

• 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

When Does Autocoding Occur?

Scan & Count

Manual Data Entry

Price

Validation

Auto Code

Image Process

Payment

Validation

Fully Coded Bundles

Manual Adv

Validation

Scan & Count

Manual Data Entry

Price

Validation

Auto Code

Image Process

Payment

Validation

Manual Adv

Validation

Fully Coded Bundles

Scan & Count

Manual Data Entry

Price

Validation

Auto Code

Image Process

Payment

Validation

Manual Add

Validation

Fully Coded Bundles

MDE partially autocoded

Scan & Count

Manual Data Entry

Price

Validation

Auto Code

Image Process

Payment

Validation

Manual Add

Validation

Fully Coded Bundles

• Any autocodable items on an amended form are at risk of incorrect payment

• These forms are all subjected to manual processes

What’s the Issue with Amendments

• 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.

What Does That Mean To You?

Scan & Count

Manual Data Entry

Price

Validation

AAuto Code

Image Process

Payment

Validation

Amended/Uncoded/Part Coded Bundles

Manual Adv

Validation

Scan & Count

Manual Data Entry

Price

Validation

Auto Code

Image Process

Payment

Validation

Manual Adv

Validation

Amended/Uncoded/Part Coded Bundles

• 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

What Can You Do?

Validation

•Principal•Additional•Advanced

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

Principal 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

Additional Validation

• Ingredient Cost less than 10 p

Types of Additional Validation

Code 2952/1 (£0.06)1 ml Welldorm ElixirCorrect Code 2752/1 (£59.48)

An Ingredient Costs Less than 10p

• Ingredient Cost less than 10 p • Partial Packs • Minor Ailment Consultation fee check

Types of Additional Validation

Coded 79081/1 (£0.06)1 ml Hedrin LotionCorrect code 79070/1 (£8.50)

Minor Ailment Consultation Fee Not Claimed

• Ingredient Cost less than 10 p • Partial Packs • Minor Ailment Consultation fee check• Multiple “Fee” codes claimed

Types of Additional Validation

A maximum of 1 Repeat Dispensing Intervention or RepeatDispensing Non Interventioncan be paid on a form

Multiple “Fee” Codes Claimed

• Ingredient Cost less than 10 p • Partial Packs • Minor Ailment Consultation fee check• Multiple “Fee” codes claimed • Non Minor Ailment drug on PV1 form

Types of Additional Validation

• 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

Future

END