Checking that the Pricing Authority received your EPS prescriptions

Checking that the Pricing Authority received your EPS prescriptions

[View factsheet version of this process.]

Contractors can consider checking each month that the Pricing Authority received the number of EPS prescriptions which the pharmacy team believes to have been sent. This involves a comparison between totals which should have been declared, and totals which should have been priced.

To ease this EPS reconciliation you can consider an eight step process:

  1. Understanding the EPS five day payment logic;
  2. Understanding how PMR monthly totals may support FP34C completion;
  3. Consider whether certain prescription messages should not be sent during the 1st to the 5th;
  4. Completing the FP34C pre-prepared totals boxes as usual – potentially with some help from PMR totals reports.
  5. Noting EPS totals onto FP34C: Consider whether to make a note of EPS items and forms onto the submission form as per Figure 2;
  6. Copying the FP34C: Consider taking a copy of each FP34C before it is posted;
  7. Comparing the EPS totals declared vs priced: Consider comparing the numbers of declared EPS forms with the number of priced EPS forms as listed on the FP34 Schedule of Payment when it arrives two months later; and
  8. Understanding differences: If there are significant differences with (7), consider why this may be, and whether further action may be needed.

1.  Understanding the EPS five day payment logic

In order to reconcile, teams will need to be familiar with EPS five day payment logic which allows for the first five days to be used to finalise EPS submissions.

EPS forms and items will be priced within a ‘dispensing month bundle’. The dispensing month which EPS prescriptions fall into is determined by three factors:

  1. the date in which the dispense message is sent;
  2. the date in which the claim message is sent; and
  3. the relationship between the two dates (5 day window logic).

For example the dispensing month will be August where:

  • the dispense message is sent during that calendar month (by 31st August); and
  • the claim message is then sent by the end of the fifth day of the following month (by 5th September).

eps timing mini tableFig 1

2. Understanding how PMR monthly totals may support FP34C completion

Each month you will need to determine your EPS dispensing month totals so that you can complete your submission form.

Your PMR system supplier can be asked to develop the monthly reports which are available, so that they can more effectively assist with completing the submission form. The EPS totals listed in some of the reports might include breakdowns by form/item, paids/exempts, and might take into account the 5 day window logic – those prescriptions marked as dispensed during a calendar month which were also claimed by the end of the fifth day of the following month (see above). Where you feel improvements can be made to these system supplier totals reports refer to your system supplier help desk.

3. Consider whether certain prescription messages should not be sent during the 1st to the 5th

To ease reconciliation of EPS totals, some contractors will decide not to send certain prescription messages during the first five days of the month.

For example during the five day window, some contractors may not mark prescriptions as ‘claimed’ where these had been marked ‘dispensed’ between the 1st and the 5th.

This may mean that their PMR EPS totals report (depending on how these are calculated) provide some more relevant totals to contribute towards declared totals which can be directly compared with the totals priced.

4. Completing the FP34C pre-prepared totals boxes

As usual the FP34C pre-prepared boxes regarding totals require completing (Figure 2).

5. Consider making a note of EPS items and forms onto the submission form

Some contractors note the EPS form and item sub-totals onto the top of the form, above the pre-prepared boxes as this can help with reconciliation later.

In this example PMR reports have helped determine that there are 1,587 EPS forms and 3,502 EPS items which should fall into the relevant dispensing month:

FP34C EPS example

Fig 2

6. Taking a copy of each FP34C before it is posted

Taking a copy of the submission form will allow a comparison with the Schedule of Payment once it is received.

7. FP34 Schedule of Payment EPS totals

Reports might be used to help complete the FP34C submission form, but also after your Schedule has arrived, check that your calculated EPS totals approximately match with what the Pricing Authority priced.

Your Schedule provides information on:

  • [1] the number of EPS prescription forms; and
  • [2] items received electronically.

The EPS totals will appear in the ‘Prescription Data’ section of your Schedule (normally on page 2) as below:

Schedule EPS items forms

Fig 3

The number of EPS forms and items priced according to the Schedule should correspond with the number of EPS forms and items declared on the FP34C submission document. The overall total of items is also visible on your Schedule listed in the ‘Prescription Fees’ section on page 1 as below. This should also correspond with your declared total items:

Schedule Total items

Fig 4

8. Differences between the EPS totals counted processed according to the PMR and the numbers priced?

fp34c vs fp34SoP - EPS-b

Fig 5

Small differences are common because of factors such as:

  • the EPS five day payment logic;
  • some suppliers may adjust/improve their totals reports;
  • methadone instalment prescription;
  • elastic hosiery items; and
  • multiple strengths/flavours.

Where the EPS difference is significant, the Pricing Authority can be asked to re-count the forms and/or items within the bundle. The relevant recheck form can be completed and the ‘Item count’ box can be ticked as needed. PSNC may also be able to assist further.

Related resources

eps arrow green-previous eps box green- home eps box green- Endorsing, submission& reconciliation eps arrow green-next

 

 



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