Enhanced Services Newsletter Issue 3, Winter 2013

Enhanced Services Newsletter – Issue 3, Winter 2013

NHS England | East Anglia Area Team | Primary Care

Enhanced Services Newsletter

Issue 3 – Winter 2013

Preparing for the end of Quarter 3

Christmas will be over, a new year will have begun and claims for the work completed in the last three months of 2013 will need to be sent to the Area Team for payment. On the plus side we will all be thinking about Summer Holidays!

Seven months into this new structure, despite a bumpy start, we are confident that the systems and processes we are developing will ensure that Practices can receive timely payment, when claims are made within timescales.

Claims and Payments

As I am sure you are aware the timescales for submitting claims to the Area Team are very tight;the 6th working day following the end of the quarter. This is due to the national timescales set for payments to be processed by our payments processing service; however this will ensure that you receive payment in the month following the quarter-end. (ie Q3 claims made within timescales will be paid at the end of January).

CLAIMS PROCESS

To ensure that you receive payment in the month following the end of the quarter please ensure that:

Your claim is submitted to email address only
It is submitted by no later than, the close of play on the 6th working day following the end of the quarter
Your Practice Code is included in the subject line
You only submit claims on the correct claim form
You only submit a claim once

NEW!

From Quarter 3 onwards, when you submit your claim to the DES activity email account you will automatically receive a receipt stating that your claim has been received. Please keep this receipt in case of query.

By submitting your claim within the 6 working day deadline it provides the Area team with less than 5 working days to process and authorise all the claims for East Anglia, before sending them to a number of different payment organisations for processing.

Help us, to help you!

By submitting your claims early, it will help us to make payments in timely manner

Deadlines:

In the past, we have extended deadlines for submission of claims. We will no longer process claims received after the deadline in that month, as this penalises those practices that do submit timely claims, by delaying their payments.

Submission Dates for 2013/2014:

Quarter 3 – by Thursday 9th January 2014, 5pm

Quarter 4 – by Tuesday 8th April 2014, 5pm

However, we will now process claims in the DES activity box on a monthly basis – this will enable practices that have submitted their data after the deadline for each quarter to receive payment.

Lastly, and most importantly please can we reiterate that:

ALL claims must be sent to the dedicated DES activity email address

with your practice code in the subject line

This will ensure that claims are not misplaced, and that we do not spend additional time reconciling different claim data, which will impact on our ability to make timely payments.

On a positive note, there are a reducing number of claims that will need to be submitted manually by this route. These are:

Extended Hours:

Please use this claim form

If you have signed up to Extended Hours you will be paid quarterly.

The information on the claim form enables the Area Team to ensure that the practice has offered the correct number of hours in relation to its list size over the 12 month period. The Area Team will honour previous arrangements for this financial year.

Please note – additional hours do not need to be spread evenly over the year. For example, a practice may offer additional hours during the winter months, and not during the rest of the year. Provided the total number of additional hours offered over the 12 month period matches the target calculated by list size, full payment will be made on a quarterly basis. This is honouring a previous PCT methodology and may not be the case next year.

PVC & Men C, Pneumococcal under 65’s at risk,Pertussis, HPVand Minor Surgery:

All these claims can now be submitted on the same claim form, see attached

(Please note Pneumococcal under 65’s at risk can be claimed on this form unless you have already included these with the OVER 65’s on CQRS – we are happy for you do use either method for claiming these).

Claim/Payment Queries:

Please do not send queries to the DESActivity Email account, as this delays the processing of your claims. Please direct any queries, in the first instance, to the primary care generic email address :

CQRS/GPES

The National project team have stopped work on automated extraction from GP clinical systems for Enhanced Services 2013/2014. This will allow the developers to concentrate on extracting the Quality and Outcomes Framework data. It is expected that the automated extraction for Enhanced Services will be available in 2014/15.

Q: What does that mean for practices?

Practices will need to manually upload data onto CQRS in order to receive payment (Guidance documents circulated previously via the gateway, are useful)
Practices will need to set the management boxes to “0” (zero) in order to be able to enter activity data
The submission must be declared as correct! If the declaration screen is not completed the Area Team does not see the submission and cannot process the claim. See attached an extract from the CQRS User Guide (pages 79-81)

Deadlines:

CQRS will require the data to be submitted and declared in the same time frame as the manual entries.

Submission Dates for 2013/2014:

Quarter 3 – by Thursday 9th January 2014, 5pm

Quarter 4 – by Tuesday 8th April 2014, 5pm

The Area Team’s process for approval both by the Primary Care Team and the Finance Team within CQRS is longwinded due to one part of the system not being fully functional. This process is expectedto improve in 2014/15.

Discrepancy in payment for Pneumococcal & Shingles :

We are aware that there is a discrepancy between the amount shown in the DES and the amount paid by CQRS for the following services :

Service / Amount shown in DES / Amount paid by CQRS / Remedial Action
Pneumococcal / £7.64 per IOS / £7.63 per IOS / Area Team will pay single lump sum at end of FY to reflect £0.01 difference per IOS
Shingles Routine / £7.63 per IOS / £7.64 per IOS / None – Area Team will honour CQRS payment.
Shingles Catchup / £7.63 per IOS / £7.64 per IOS / None – Area Team will honour CQRS payment.
Enhanced Services being reported through CQRS using manual data entry:
Rotavirus: / Monthly count of patients who have had complete course
Childhood influenza: / Count of target group who have been vaccinated
Pneumococcal: / Count of target group who have been vaccinated
Shingles: / Count of 70 year olds who have been vaccinated
Shingles catch up: / Count of 79 year olds who have been vaccinated
MMR: / Count of cohort invited and count of cohort vaccinated
Seasonal influenza: / Count of target group who have been vaccinated
Learning disabilities: / Count of target group who have had a LD health check

Norfolk only (except South Norfolk):

MMR please manually enter those vaccines given since you started the DES in CQRS. Those given under the old CCG LES should be reported as in previous months.

Enhanced services that should be supported by CQRS at the end of Financial Year:
Alcohol related risk reduction scheme: / If systems are not in place to extract this data electronically from your practice’s clinical system, a manual entry will be required onto CQRS.
The number of newly registered patients who were screened using a recommended tool.
Facilitating timely diagnosis and support for people with dementia: / If systems are not in place to extract this data electronically from your practice’s clinical system a manual entry will be required onto CQRS.
The number of patients who had a health check for dementia using the appropriate tool.
Improving Online access: / No information currently, we will inform you when we have details.
Enhanced Services that will be paid following the end of the financial year not by CQRS
Patient Participation: / Following evaluation of the report published on the practice website no later than 31/03/2014.
(5 steps payment from 22p per registered patient to a max of £1.10 per registered patient)
Risk Profiling and care management scheme: / Due to be paid in May 2014. CCG provide assurance 28 days post financial year end, AT pay within one month of receiving assurance from CCG.

Enhanced Services via Exeter:

GMS will be paid quarterly from the Exeter System. PMS practices that do not have this DES in their baseline, we are currently paying practices a payment based on historical data and are working with SERCO to obtain accurate data and will reconcile the payment as soon as possible.

And Finally …

Please see attached DES Summary which we hope you will find useful.

And Finally, Finally …

May we be the first to wish you all a very Merry Christmas and a Happy New Year!!

NEXT EDITION: Issue 4, Spring 2014

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