Ensuring your practice is being paid for the work it does
November 27, 2017
In the ever-changing world of medical finance, the way in which GP practices are paid is also ever changing. New organisations are being introduced, such that the practice’s income may now come from many different sources.
So how do you ensure that your practice is being paid for all of the work that is does? We examine the main income streams and how you may ensure you are paid for that work.
NHS Contract income
NHS contract income consists of your GMS/PMS monthly income; aspiration and achievement payments under the Quality and Outcomes Framework (QOF); seniority payments; reimbursements for certain premises costs and Enhanced Services paid by NHS England.
GMS contract payments are calculated based on a fixed price per patient (currently £85.35) per weighted patient. These are paid monthly and are recalculated at the beginning of each quarter.
PMS contract payments vary enormously across the country and it can be particularly difficult to check what your payment covers as much of the detailed information has been lost over time. You should be aware of the local arrangements for the redistribution of PMS funding. There may come a point where it would be beneficial to move back onto a GMS contract.
Enhanced Services income
Enhanced services paid by NHS England will be paid as part of your monthly GMS/PMS payment. Those paid by the CCG may be paid as part of your monthly contract payments or separately, with the local council being responsible for Public Health payments. Some Enhanced Services are also now delivered through Commissioning Companies.
You should ensure that all staff involved in Enhanced Services are aware of which services the practice has signed up for; what the criteria is to achieve maximum payment and, very importantly, how to make a claim. There then needs to be a robust system to ensure that the correct claims have been made and that the practice is paid in a timely fashion. Ideally these can be invoiced and monitored via the practice’s accounting software package.
Monitoring NHS Contract and Enhanced Services Income
A good way to monitor Monthly NHS Income is to download the monthly statements from Open Exeter either as csv files into an excel spreadsheet or by making use of the facilities in many of the accounting packages now available by importing the monthly statements.
Accounting packages such as Quick Books Online and the IRIS GP Accounts can now directly import the monthly Open Exeter Statements. Once these have been downloaded into the practice’s accounting software, reports can be run that will allow you to see the income month by month and category by category. A review of the monthly income will allow you to see what has been paid each month. This then needs to be compared to the amounts due.
A CQRS achievement report can also be run that will enable the practice to track Enhanced Services activity through to it being paid. Auto extraction of data by GPES doesn’t always work!
Don’t forget to keep up to date with contract changes to see what new sources of income are available and how they can be claimed. For 2017/18, practices are now able to claim for CQC costs, but may lose out on Extended Hours if they have a half day closure.
Private sources of income
GP practices have many other sources of private income available to them. Some practices may actively seek outside sources of income such as private schools or prison work. Other practices will be able to generate income from their own patients through insurance reports, cremations fees, forms etc. Whilst these may not be significant sources of income, all staff should be aware of when a fee should be charged. Ideally payment in advance should be requested from the patient and requests from insurance companies etc invoiced and paid before the work is carried out. Most accounting packages will allow you to raise invoices and monitor outstanding amounts.
Remember you have a statutory right to charge interest at 8% plus Bank of England base rate and debt recovery charges for late paid invoices.
If you would like to discuss the above blog in more detail, or you would like to speak with a member of our team, please contact Barbara Domanska or call 0115 972 1050 to be put in contact with a member of our Healthcare team.