PSNC prescription pricing audits
PSNC prescription pricing audits
PSNC’s Pricing Audit Centre
The Pricing Audit Centre (PAC) team conducts independent checks to verify the accuracy of the pricing of prescriptions by the NHS Business Services Authority (NHSBSA). See below our video: An Introduction to PSNC’s Prescription Pricing Audit Centre.
The Pricing Audit team consists of 12 members of staff:
- 8 Pricing Auditors
- PAC Administrator
- Administration Secretary
- Assistant Managers – Dave Wellbrook and Janine Rowe
- PAC Manager – Nicole Shersby
The team is lead and overseen by Komal George, Payment Accuracy Manager who is based at PSNC’s head office in London.
PSNC independently audits the pricing of individual monthly prescription batches (bundles) processed by NHSBSA, on behalf of Local Pharmaceutical Committees (LPCs). Where errors are identified during the auditing process, these are corrected and NHSBSA are notified so that they can make the appropriate adjustment(s) to the contractor’s account. Where potential processing issues are identified, PSNC raise these with NHSBSA directly, not only ensuring that the issue is corrected for the affected contractor but also to ensure that NHSBSA takes the necessary steps to prevent re occurrence for other contractors.
PSNC holds bi-monthly liaison meetings with NHSBSA; where patterns and trends of errors identified during auditing are discussed to try and improve overall pricing accuracy. PSNC’s auditing work has helped to improve pricing accuracy by introducing such initiatives as the red separator, where prescriptions are priced by a specialist team of handlers and it also feeds into the work completed by NHSBSA’s Pricing Accuracy Team whose primary focus is to ensure that contractor accounts are priced as accurately as possible.
The NHSBSA audits its own pricing on a monthly basis by selecting and re-pricing a random sample of 50,000 items from all priced items within that month. Results of these internal audits can be found here.
PSNC undertakes retrospective pricing audits by examining the scanned images of full prescription bundles usually covering an average of 21 accounts per dispensing month. These bundles are selected on a random basis with the inclusion of set criteria to ensure that the sample is geographically representative and includes a mix of contractor size and types.
All identified errors are notified to NHSBSA and any resulting adjustment to the contractor’s account (which can be an under or over payment) will appear on their next payment schedule. Information regarding the auditing of the account as well as useful advice which may assist with endorsing, sorting and submission of prescription bundles in future is sent to the individual contractor concerned. An anonymous copy of the audit results is also sent to the LPC.
The audit process
PSNC’s electronic auditing system – PRISM
Contractors submit their prescription bundles to NHSBSA for payment every month where they are checked, scanned and then priced. Some prescriptions are automatically priced using Intelligent Character Recognition (ICR) software and NHSBSA’s Pricing Rules Engine while others require manual input of information.
Prior to 2012, audit checks were conducted at the PAC by examining the paper prescriptions and cross-checking the prescribed items with what had been paid by NHSBSA against a paper line by line payment report.
PSNC’s electronic auditing system, PRISM (Pricing/Reimbursement Information & Systems Management) was developed to enable automated auditing through the ability to view scanned prescription images and electronic prescription data and make amendments to the original pricing on the same screen. The system also contains product and pricing information previously only obtainable in NHSBSA publications.
Each month PSNC receives the following information from NHSBSA:
- Pricing Data for Drugs & Appliances (used to update PRISM)
- Schedule of payment (FP34) for every contractor
For accounts to be audited:
- Image of FP34c submission document
- Images of all priced prescriptions
- Data for all priced electronic prescriptions
- Line by line pricing information for each prescription item
- Any paper re-submissions/other items “keyed from paper”
The redacted prescription image and line by line payment details are shown side by side on the PRISM system which enables the auditor to compare what has been prescribed and endorsed against what has been priced by NHSBSA. An example of the PRISM screen is shown below:
Benefits of PRISM
Analysis of the data established during auditing enables detection of trends in pricing errors and this information is used in discussions with the Department of Health and Social Care and NHSBSA to drive improvements in pricing accuracy.
PRISM has also allowed PSNC to collate data for more specific analysis work relating to policy issues such as NCSO claims and instalment dispensing.