A penny saved is a penny earned
You-Jin Chang & Victoria Akhras ([email protected])
Importance of correctly coding dermatology outpatient tariffs
INTRODUCTION
OBJECTIVE
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.
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
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.
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.
1st 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.
2nd cycle: Based on the results of the 1st audit, suggestions were made to improve the coding accuracy. Once the suggestions had been implemented, a 2nd 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 1st cycle. The comparison of the minor op
Lanesborough clinic B dermatology theatre book against clinician forms and iClip was also repeated.
CYCLE 1 RESULT
CYCLE 2 RESULT
CHANGE implemented as result of CYCLE 1
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%.
Procedure
( tariff)
Potential
Recovery
Actual Recovery
Loss
Biopsy (£140)
Cryotherapy
(£135)
£4,620
£1,350
£2,520
£540
£2,100
£810
Phototherapy
(£79)
£8,611
£7,303
£1,308
Patch test
(£102)
NA
NA
NA
PDT (£120)
MDT (
£167/£117)
NA
£NA
NA
£0
NA
NA
TOTAL
£14,581
£10,363
£4,218
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.
Procedure
OPCS
Cryotherapy
S11.2
Biopsy
S15.9
S/C injection of
steroid
X38.1
Patch Test
U27.3
Photodynamic
Therapy
S07.8
Phototherapy
S12.2
Attention to skin
dressing
S57.5
Assessment by MDT
X63.2 X62.2
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%
Procedure ( tariff)
Potential Recovery
Actual Recovery
Loss
Biopsy (£140)
Cryotherapy (£135)
Phototherapy (£79)
£1,820
£540
£3,476
£1,260
£540
£3,160
£560
£0
£316
Patch test (£102)
PDT (£120)
MDT ( £167/£117)
Steroid subcutaneous
injection ( £120)
NA
NA
£1,220
£480
NA
NA
£1,053
£240
NA
NA
£167
£240
Attention to dressing
(£0)
TOTAL
£0
£0
£0
£7,536
£6,253
£1,283
CONCLUSION
The 1st 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 2nd 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.
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>