Contractors “losing tens of thousands” over EPS claims

Latest

Contractors “losing tens of thousands” over EPS claims

In Latest

Some contractors are “losing tens of thousands of pounds” due to errors made when submitting EPS claims for medicines they have dispensed, according to a member of PSNC’s funding team.

Speaking at the Sigma conference in Heathrow on Sunday December 1, PSNC drug tariff and reimbursement manager Suraj Shah warned there were contractors who were losing large sums over 12-month periods.

Mr Shah spoke of contractors who had “come to us to say they’ve seen a huge reduction in their end of month totals”.

He said that while it was difficult to give a “firm answer” as to why discrepancies occurred, PSNC had become aware of contractors who were failing to select the exemption category code when submitting EPS claims for patients who are exempt from paying NHS prescription charges.

When this happens, “the system defaults to ‘paid’, so that’s transmitted to NHS BSA and they will assume you’ve taken a charge off the patient and deduct that charge off the pharmacy,” he said, adding that pharmacies are “losing £9 each time this happens”.

Contractors need to ensure they check the correct exemption or paid status is applied on their electronic messages, he said, adding that while some PMR systems prompt users to do so others “default to paid”.

Mr Shah also stressed the importance of submitting regular claims for items, saying that according to NHS BSA “almost 30 per cent of all EPS claims are received on or after the last couple of days of the month and before the submission deadline.”

He described this as a “staggering amount” and said this could pose problems if any issues occur with the systems used to process claims.

EPS error rates "significantly lower"

Overall, EPS seems to promote accuracy, Mr Shah said: “What we’ve seen through our audit work is that the error rates on EPS prescriptions are significantly lower than with paper.”

He noted that 75 per cent of all items are currently dispensed with EPS, and that with the rollout of EPS phase 4 “we are now moving to 90 per cent in a few years’ time”.

However, there are still issues with inaccurate end-of-month submissions, he told contractors: “Your declared item totals, as we’ve seen through our audit work, hardly ever match the totals NHS BSA receive.”

Such discrepancies can occur due to claims being submitted after the EPS ‘five-day window’ (meaning they are carried over to the following month) but can also be caused by transcription or transposition errors by NHS BSA when processing claims, he said.

Invalid claims for items dispensed through the Serious Shortage Protocols are an ongoing issue, said Mr Shah, urging contactors to follow NHS BSA's SSP endorsement guidance.

Record my learning outcomes

Latest

Inspiring stories related to health, fitness and the pursuit of wellbeing

Share:

More like this

bookmark_icon_off
Latest

DH sets ambitious targets for winter flu programme

The Department of Health and Social Care announces that it aims to vaccinate 85 per cent of people aged 65 and over against influenza.

1 Min Article

bookmark_icon_off
Latest

Dukes to leave PSNC in September

PSNC chief executive Simon Dukes will leave his post at the end of September after just over three and-a-half years in the role.

1 Min Article

bookmark_icon_off
Latest

E-cig loophole puts minors at risk, Government told

A charity criticises the government for failing to close a loophole allowing companies to hand out free e-cigarettes to under-18s. 

1 Min Article

bookmark_icon_off
Latest

GPhC too soft on corporate multiples claims PDA

The GPhC is disproportionately tough on individual registrants compared to pharmacy owners and premises, the PDA has claimed. 

1 Min Article

bookmark_icon_off
Latest

Reports of potential bidding war over LloydsPharmacy

LloydsPharmacy could be the target of a three-way bidding war fought among financial investors over the next few weeks, it has been reported.

1 Min Article

bookmark_icon_off
Latest

New NHS clinics to provide pelvic floor support for women

Pregnant women and new mums are to receive support from new NHS clinics.

1 Min Article

Recommended Learning

Sponsored education

Treating fungal nail infections

Understand how fungal nail infections develop and help manage customer expectations around treatment

10 Min Module

bookmark icon off
Sponsored education

How to advise on head lice

Despite them being so common, many people still don't know how to get rid of head lice. This training will arm you with the facts so that you can help customers choose the best treatments and answer their questions with confidence.

15 Min Module

bookmark icon off
Sponsored education

Relief from the nasal symptoms of allergy

With NHS England advising that OTC products should no longer be prescribed to treat mild-to-moderate hayfever, pharmacy’s role in supporting sufferers is more important than ever. This module includes self-care advice and product recommendations to aid customer conversations.

5 Min Module

bookmark icon off
Sponsored education

Understanding abdominal pain, cramps and IBS

This short video explains the symptoms of irritable bowel syndrome (IBS) and how it differs from abdominal cramps to help you recommend a suitable product for your customer’s needs.

3 Min Module

bookmark icon off
Sponsored education

Confident pet health conversations

Learn 3 key steps to having more confident conversations with customers about pet health products.

3 Min Module

bookmark icon off
Sponsored education

Helping customers treat & care for their scalp

Understanding the causes and symptoms of some common scalp conditions will help you to make a real difference to your customers’ lives. Complete this module to discover self-care and product advice to help ease symptoms and maintain scalp health.

10 Min Module