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Understanding Payments Deb Daly – 29 th January 2015.

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Presentation on theme: "Understanding Payments Deb Daly – 29 th January 2015."— Presentation transcript:

1 Understanding Payments Deb Daly – 29 th January 2015

2 Introduction Payments include Locally Commissioned Services (monthly & quarterly reconciliations) Practice Multiclaim forms are processed quarterly by the CCG and forwarded for payment processing once reconciled against the monthly advance payments Payments are processed by the Primary Care Support at Lancing on behalf of the CCG’s (NHS Horsham & Mid-Sussex CCG & NHS Crawley CCG) Drug Payments (Area Team & CCG) Prescribing (Personally Administered items) – Drugs Basic Prices, VAT less Discount – paid by CCG Prescribing (Personally Administered items) – On Cost, Dispensing Fees, etc – paid by Area Team Payments are generated by Exeter Adhoc payments – manual (one-off) Locality Meetings processed on a manual system on a monthly basis and these will appear on the remittance advices with a clear description ie: AUG-2014 ‘Locality Meeting Apr & May14 GG/HH’ Raised and processed directly by the relevant CCG

3 Locally Commissioned Service Payments Each GMS/PMS practice receive a payment each month based on the previous years Actual payments i.e. Actual Total for 2013/14 = £1200/12 = new monthly 2014/15 payment Each quarter the multiclaim form is prepared ensuring that all signed up services are showing on the form as per the Signed Up List provided by Primary Care and then forwarded to the allocated person(s) within the practices approximately 1 week before the end of the quarter informing the deadline date for submissions of completed claims, usually around the 17 th of the month At this stage any omissions are usually indicated by practice, investigated and rectified i.e. new form prepared and forwarded Once received each claim is checked and processed, entered onto a master reconciliation spreadsheet and the total is calculated based on activity and the totals matched to submitted form, any differences investigated! Once all the claims are received, the reconciliation is completed and a summary is sent out to each practice, notifying the total refund/reclaim to be actioned, also to ensure that any errors are identified and corrected before being sent to PCS!

4 LCS Summary Check… Please note that the summaries are sent via NHS mail and can be difficult to print off in the format!!!!.....please note that if you copy the table you can paste directly into Excel for easier reference and printing

5 Payment Dates PMS – paid usually on or around the 15 th of month GMS – paid usually on or around the 23 rd of month On next slide an example of the codes can be seen as per the adhoc section of an Exeter Statement that is sent to the practice Split into ‘adhoc’ and ‘monthly’ payments Monthly - It was requested that the advance payments would be paid with your monthly payments to ensure that a description was available for easy reconciliation. Adhoc – payments can be from the CCG or the Area Team and usually annual types of payments ie: 2013/14 Risk Profiling paid or any arrears on monthly payments. As a rule all codes with a Z***** at the beginning are referring to CCG payments, BUT there are exceptions!....so please be careful!

6 Exeter GMS/PMS Statements DEMCFG Dementia (Ad-hoc) DEMCFG CQRS-Case Finding for P (Ad-hoc) EXTHDG Q1 Extended Hours (Ad-hoc) MENCVG CQRS-Men.'C' Vaccinatio (Ad-hoc) 7.64 MMRVAG CQRS-Measles Mumps and (Ad-hoc) UNPADG Unplanned Admissions (Ad-hoc) ZBPM24 24hr BP (Monthly) ZCBANG Hand Splints (Monthly) ZCOAG Anti-coagulation (Monthly) ZCOPDG COPD - spirometry (Monthly) ZCOPDG COPD management (Monthly) ZDIABG Diabetes (Monthly) ZGPBPG Risk Prof/CareMgmt Qtr1 (Ad-hoc) ZGPBPG Risk Profiling/CareMgmt (Monthly) ZMSIJG Minor surgery (Monthly) ZNPTG Near patient testing (Monthly) ZPHLG Phlebotomy (Monthly) ZPROCG PSA / prostate (Monthly)

7 Important points:- Payment Reference Number – if you have a query please either telephone or and quote this number either from your bank statement or remittance advice, with this the payment can be accessed immediately using this! Payment Date – this is the date the payment will be paid into the practice bank account The total can be several items added together!!!! ……so if more than one payment has been processed for the practice they will be ‘lumped’ together, which could relate to an Area Team or a CCG payment or both!!!! ….this is where it gets frustrating and the date of the payment can help with the ‘detective work!! At anytime you have a query about this please contact Deb Daly (NHS Horsham & Mid-Sussex CCG) or Chris Jarrett (PCS). Open Exeter – Remember that you will now receive your remittance advice on the day that the payment is raised, details will be available on Open Exeter but please note there could be a few days delay! Remittance Advice

8 Any payments that are a ‘-’ or a ‘+’ will be added together which further complicates the process! Remember to check against the dates for clues as to what you will be receiving! Enhanced Service payments will be paid in the month after the deadline falls in, eg: Quarter 1 claim (April to June), deadline 18 th July to be paid with the August payment. Remittance Advice

9 Any payments made manually will show on the remittance as per the 2 nd line! Please note that there are only 40 character spaces for the description, therefore if the payment refers to several items the description will read ‘Please see dated ’, a full summary will be sent separately to be able to use for your reconciliation purposes These will always show on a separate line as the manual payment generates a unique reference! Remittance Advice

10 Remittance - Drug Payments The drugs payment are split into 2 elements that also can cause some confusion, when reconciling to the bank statement! The larger total is paid from the CCG’s budget and the smaller amount is paid from the Area Team’s budget! The problem arises due to the 2 elements being paid on separate days as the Area Team have a payment run each day and the CCG’s only have BACS runs on a Tuesday and a Friday each week, so you could effectively see the 2 lines be paid on different days! The Area Team payments will be paid into the bank 4 days after the payment date & CCG payments will be paid into the bank 3 days after the payment date!

11 Example – Payment Query Payment received for £ – first thing to check is the payment reference ****, this is the view seen by Finance on Oracle which shows all the payments made on that reference, 3 lines £ , £ and (£336.36)

12 Next step is to check the Summary for the practice and see if the totals agree using the summary that is forwarded prior to processing for payment, the main columns to check are the monthly payment sum and the last column! H Code Practice Name Local DescriptionFull Year Amount Monthly Amount (Apr- Jun only) 2.3% UpliftRevised Full Year Amount 2014/15 Revised 2014/15 from July 2014 (inc 2.3% uplift) Paid M1-3 (Apr-Jun) Q1 Claim 2014/15 Diff. to be paid (Aug14) H820 28CourtyardMinor surgery 18, , , , , , H820 28CourtyardHelicobacter pylori H820 28CourtyardDiabetes 25, , , , , , H820 28CourtyardPhlebotomy 5, , , , H820 28CourtyardAmbulatory 24hr BP 3, , H820 28CourtyardCOPD - spirometry 3, , H820 28CourtyardNeonatal checks H820 28CourtyardCare Homes , H820 28CourtyardRisk Profiling 3, H820 28Courtyard Shared Care Drug (NPT) , Courtyard Total 55, , , , , , ,449.17

13 The Practice summary is checked against the ledger download, follow the colour coding as a guide! Cost centre code Cost centre name Subjective code Subjective name Analysis 1 code Analysis 1 name Analysis 2 code Analysis 2 name Analysis 3 code Analysis 3 name (£) LOCAL ENHANCED SERVICES521610BWC&M-GMS NES Intra Partum Care0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT(14.01) LOCAL ENHANCED SERVICES521610BWC&M-GMS NES Intra Partum Care0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT LOCAL ENHANCED SERVICES521610KAC&M-GMS LES 24 Hour ABPM0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT(319.62) LOCAL ENHANCED SERVICES521610KAC&M-GMS LES 24 Hour ABPM0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT LOCAL ENHANCED SERVICES521610KTC&M-GMS LES Risk Profiling0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT LOCAL ENHANCED SERVICES521610KV C&M-GMS LES Care Home/Nursing Home0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT4, LOCAL ENHANCED SERVICES521610L3C&M-GMS LES COPD0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT LOCAL ENHANCED SERVICES521610LHC&M-GMS LES Diabetes-Insulin (GTT)0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT2, LOCAL ENHANCED SERVICES521610M2C&M-GMS LES H Pylori0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT(2.73) LOCAL ENHANCED SERVICES521610M2C&M-GMS LES H Pylori0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT LOCAL ENHANCED SERVICES521610MVC&M-GMS LES Near Patient Testing0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT1, LOCAL ENHANCED SERVICES521610N3C&M-GMS LES Phlebotomy0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT LOCAL ENHANCED SERVICES521610VCC&M-GMS DES Minor Surgery0DefaultH82028THE COURTYARD SURGERY RH12 1AT0DEFAULT1,801.01

14 ……there is a difference!!! AUG- 2014Courtyard Surgery13/08/2014 2,054.70Locality Meeting Apr to Jun14 MC/MG The difference is £ which is a manual payment!!...query explained!

15 Reports – Payment Summary

16 Any payments you are unable to reconcile please either telephone or with details, only time there could be a delay in responding is the 1 st week in the month during the month end period! For contract queries please contact David Claxton Care Homes – available from June 2014 (if applicable), just June should have been claimed on Quarter 1 claim, if not please include on Quarter 2 claim if applicable There have been many changes as Enhanced Services have transitioned to Locally Commissioned Services, thank you for your understanding while the forms were being upgraded! All services were uplifted by 2.3% and Qtr1 claims paid at this new rate! Points to Remember!

17 Main Contacts Primary Care Support Chris Jarrett – Payments Officer NHS Horsham & Mid-Sussex CCG Deb Daly – Management Accountant ext 4160

18 Locally Commissioned Service Payments Previously known as Enhanced Services At the start of the financial year, each GMS and PMS practice is ed out a master multiclaim form, This shows all of the services that the individual practice has signed up to for the year. At this stage any omissions are usually indicated by practice, investigated and rectified i.e. new form prepared and forwarded Completed claims should be returned on a monthly basis and returned to CCG no later than 7 th of the following month. Payments are made via PCSS in the month following the claim ie: April claims to be returned by 7 th May, paid May

19 Example multiclaim Snapshot example of part of multiclaim Claim numbers to be entered in green cells, value and totals calculated automatically

20 Main Contacts NHS Coastal West Sussex CCG Jaclyn Foster – Finance Assistant – Claire Byram – Management Accountant –

21 Any Questions……. Please feel free to ask any questions, if unable to respond now we will feedback direct to you at a later date…..


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