NHS England and NHSBSA have published new Post Payment Verification (PPV) guidance for GOS.
Post payment verification for General Ophthalmic Services (GOS) payments: Guidance for Commissioners
The NHSBSA said the new guidance aims to standardise the PPV process nationally to ensure it is “fair, consistent and proportionate”. It said its new guidance will result in the following:
- A risk-based and targeted approach to select contractors for PPV sampling.
- A focus on a smaller number of practices by the NHSBSA, but that it will review a larger number of claims at each practice.
Contractors will also receive local and national benchmarking data so they can see how they compare to their peers regarding some key data metrics.
The OFNC was consulted late in the guidance development process but has worked hard to ensure the new guidance:
- Takes a sensible and evidence-based approach – e.g. looks to understand outliers rather than automatically assuming something must be wrong.
- Is clear that if the PPV process discovers underpayments, these are paid to the contractor.
- Will be monitored carefully during implementation to ensure any issues with the new process are quickly addressed.
We know that in the past, PPV processes have not always been well implemented and at points based upon flawed logic. This has increased costs for practices, delivering no benefit for the NHS and have also in some instances reduced patient access. However, NHSBSA said it hopes this new guidance will provide “improved value for money and quality”.
One challenge for all contractors, who are busy meeting patient needs, is the cost and time associated with PPV. Therefore, we advise all providers and clinicians to ensure record cards clearly show why an early retest was necessary, and where there has been a dispensing supplement claimed such as a prism or a tint has been claimed, that the clinical reason for prescribing is clearly defined and easy to find on the record.
If you have any questions about PPV, please contact your membership body:
ABDO mhalford@abdo.org.uk
AOP regulation@aop.org.uk
FODO membership@fodo.com
