Specialist knowledge uncovers £60,000 drugs reimbursement shortfall

The client

The client, a GP partnership in south-east England, holds two practice contracts. Two partners and 9.5 FTE salaried GPs provide services for around 24,000 patients, with weighted list sizes of around 18,000 and 3,000 representing a young, affluent patient demographic.

In 2017 the partnership had merged with another practice, and a third contract had been absorbed into the larger of the two patient lists.

The dilemma

The practice accountants, AISMA firm Albert Goodman, noticed that drug reimbursement income across the two contracts was fluctuating. A historical analysis showed that income for the smaller contracts had been extremely sparse and that the larger contract was carrying a higher proportion of debtors than would usually be expected.

Dawn Mills, healthcare assistant manager at Albert Goodman, said: “We raised this with the client, explaining that we believed they were either failing to claim for some reimbursable drugs or claiming for all reimbursable drugs through one contract.”

Since the NHS limits reimbursements once prescriptions reach 445 per month per prescribing partner, putting all of the drugs claims through the one contract could have resulted in lost income.

Action required

Dawn Mills and her colleagues started by looking at AISMA’s national benchmarking statistics, which are compiled each year to compare the financial performance of GP practices around the UK. The statistics confirmed that drug reimbursement income levels for the partnership were low in comparison with previous years and had been very sporadic with the smaller contracts.

One of the benefits of working with an AISMA accountant is the knowledge they acquire through specialist technical training. Following a session on maximising drugs reimbursement income at a recent AISMA conference, the healthcare team at Albert Goodman invited specialist advisers Ash Lane Consulting to run a client workshop at their offices. The firm’s staff also attended to learn more and help identify where claims may be being missed so they could have the appropriate conversations with their clients and refer them on to Ash Lane Consulting for more guidance.

“The training allowed me to understand how things worked from a practice point of view and allowed me to identify more easily where income may have been missed,” says Dawn Mills. “It was this session that led me to refer our client to Ash Lane Consulting, so they could carry out a more detailed review of the partnership’s drugs reimbursement income.”

What happened next

After carrying out the review, which involved looking at the partnership’s processes, clinical system, claims, purchasing and reporting, Ash Lane Consulting concluded the practice was under-claiming drugs reimbursement income to the value of £60,000.

The conclusion

“The figure was quite a bit higher than I had thought it would be,” said Dawn Mills. “The partners were extremely grateful since this injected a significant amount of income into the practice in one go.”

With the review also helping the partnership to streamline their drugs reimbursement processes, staff time will be saved and income is set to increase year-on-year.