1. CYCLE 2 RESULT 86% of procedures had been correctly booked in iClip. If all tariffs had been correctly coded in, the dermatology department would have been eligible for £7,536.However, the department was only entitled to £6,253– representing a recovery rate of just 83% CHANGE implemented as result of CYCLE 1. CHANGE implemented as result of CYCLE 1. CYCLE 1 RESULT Only 14% of procedures had been correctly booked in iClip. As a result, while the dermatology department was eligible to receive £14,581, it in fact only received £10,363 – representing a recovery rate of just 71%. INTRODUCTION Payment by Results (“PbR”), and its tariff system, was first introduced in the NHS in 2003 (1) to fairly match the actual cost of patient care to funding. Different tariff levels were set for different types of care; higher cost of care would attract higher tariff, and therefore greater funding. Ensuring that correct tariff levels are applied, and correct funding is obtained, is therefore of critical importance in the administration of a dermatology – or indeed, any - clinic. INTRODUCTION Payment by Results (“PbR”), and its tariff system, was first introduced in the NHS in 2003 (1) to fairly match the actual cost of patient care to funding. Different tariff levels were set for different types of care; higher cost of care would attract higher tariff, and therefore greater funding. Ensuring that correct tariff levels are applied, and correct funding is obtained, is therefore of critical importance in the administration of a dermatology – or indeed, any - clinic. OBJECTIVE The audit sought to determine (i) the accuracy of tariff coding at St George's Healthcare dermatology department; and (ii) what procedures could be implemented to improve its accuracy OBJECTIVE The audit sought to determine (i) the accuracy of tariff coding at St George's Healthcare dermatology department; and (ii) what procedures could be implemented to improve its accuracy A penny saved is a penny earned Importance of correctly coding dermatology outpatient tariffs STANDARDS AND TARGETS The target/standard for the correct tariff coding was deliberately set at 100% out of the principle that the dermatology clinic should be properly reimbursed for all its costs – no more, no less. STANDARDS AND TARGETS The target/standard for the correct tariff coding was deliberately set at 100% out of the principle that the dermatology clinic should be properly reimbursed for all its costs – no more, no less. 1) Payment by Result. Department of Health (online). (Accessed on 11 February 2012). 2010. Available from http://www.dh.gov.uk/en/Managingyourorganisation/NHSFinancialReforms/DH_077259 You-Jin Chang & Victoria Akhras (yjchang@doctors.org.uk) METHOD: accuracy of tariff coding was determined by comparing data recorded by clinicians on outpatient forms against data recorded by tariff coders on iClip software. 1 st cycle: Dermatology outpatient forms completed during 09/05/12 – 11/05/12 were reviewed to determine type & frequency of patient care provided during that period. The results were compared against the tariffs recorded in iClip (software used by the dermatology department to code tariffs). Additionally the number of procedures recorded in the minor op Lanesborough clinic B dermatology theatre book was compared against (i) outpatient forms completed by clinicians and (ii) iClip results recorded by the coders. 2 nd cycle: Based on the results of the 1 st audit, suggestions were made to improve the coding accuracy. Once the suggestions had been implemented, a 2 nd audit was made to gauge improvement, if any. The new and improved dermatology outpatient forms completed during 09/11/12 – 11/11/12 were reviewed and compared against IClip in the same manner as set out in the 1 st cycle. The comparison of the minor op Lanesborough clinic B dermatology theatre book against clinician forms and iClip was also repeated. METHOD: accuracy of tariff coding was determined by comparing data recorded by clinicians on outpatient forms against data recorded by tariff coders on iClip software. 1 st cycle: Dermatology outpatient forms completed during 09/05/12 – 11/05/12 were reviewed to determine type & frequency of patient care provided during that period. The results were compared against the tariffs recorded in iClip (software used by the dermatology department to code tariffs). Additionally the number of procedures recorded in the minor op Lanesborough clinic B dermatology theatre book was compared against (i) outpatient forms completed by clinicians and (ii) iClip results recorded by the coders. 2 nd cycle: Based on the results of the 1 st audit, suggestions were made to improve the coding accuracy. Once the suggestions had been implemented, a 2 nd audit was made to gauge improvement, if any. The new and improved dermatology outpatient forms completed during 09/11/12 – 11/11/12 were reviewed and compared against IClip in the same manner as set out in the 1 st cycle. The comparison of the minor op Lanesborough clinic B dermatology theatre book against clinician forms and iClip was also repeated. CONCLUSION The 1 st audit cycle identified multiple shortfalls that impeded correct coding of tariffs: wrong OPCS code were documented on dermatology OP forms ( MDT); dermatology OP forms lacked sufficient detail such that procedures such as phototherapy were not receiving correct tariff; and basic human errors by clinicians and iClip coders alike. However, the 2 nd cycle shows that even with minor changes such as improving the outpatient forms, significant increase in correct coding of tariff can be made with department being better reimbursed for its cost. Nevertheless, there is still room for improvement. We still need to determine (i) the tariff the department is currently charging for cryotherapy and (ii) the actual tariff the department is eligible for, and ensure any discrepancies are corrected. In addition, currently longer biopsy slots (e.g. 45 mins) attract the same tariff as shorter biopsy slots (e.g. 5 mins). The department will need to negotiate a higher tariff based on time engaged so as to eliminate the current shortfall in revenue receipt. CONCLUSION The 1 st audit cycle identified multiple shortfalls that impeded correct coding of tariffs: wrong OPCS code were documented on dermatology OP forms ( MDT); dermatology OP forms lacked sufficient detail such that procedures such as phototherapy were not receiving correct tariff; and basic human errors by clinicians and iClip coders alike. However, the 2 nd cycle shows that even with minor changes such as improving the outpatient forms, significant increase in correct coding of tariff can be made with department being better reimbursed for its cost. Nevertheless, there is still room for improvement. We still need to determine (i) the tariff the department is currently charging for cryotherapy and (ii) the actual tariff the department is eligible for, and ensure any discrepancies are corrected. In addition, currently longer biopsy slots (e.g. 45 mins) attract the same tariff as shorter biopsy slots (e.g. 5 mins). The department will need to negotiate a higher tariff based on time engaged so as to eliminate the current shortfall in revenue receipt. Procedure ( tariff) Potential Recovery Actual RecoveryLoss Biopsy (£140)£4,620£2,520£2,100 Cryotherapy (£135) £1,350£540£810 Phototherapy (£79) £8,611£7,303£1,308 Patch test (£102) NA PDT (£120)NA MDT ( £167/£117) £NA£0NA TOTAL£14,581£10,363£4,218 Procedure ( tariff)Potential RecoveryActual RecoveryLoss Biopsy (£140)£1,820£1,260£560 Cryotherapy (£135)£540 £0 Phototherapy (£79)£3,476£3,160£316 Patch test (£102)NA PDT (£120)NA MDT ( £167/£117)£1,220£1,053£167 Steroid subcutaneous injection ( £120) £480£240 Attention to dressing (£0) £0 TOTAL£7,536£6,253£1,283 ProcedureOPCS CryotherapyS11.2 BiopsyS15.9 S/C injection of steroid X38.1 Patch TestU27.3 Photodynamic Therapy S07.8 PhototherapyS12.2 Attention to skin dressing S57.5 Assessment by MDTX63.2 X62.2 This is the new dermatology outpatient form. The additions and changes made to the old form as a result of cycle 1 is highlighted in RED.