Health Amendment Act rejected claims

[Fleegle]

The GMS in their infinite wisdom have started to reject HAA claims. It appears if but one uncoded item appears on my submission, they bump the whole script back to me unpaid. I am under the impression that ALL HAA submissions will be re-imbursed without question, considering the government balls-up re Hepatitis B patients a few years back which led to the introduction of the HAA scheme in the first place.

I would like to know whether any others are encountering a similar problem. I use Helix third generation claims, so I assume my software's up to date.

I'll say no more until some of you hopefully get back to me, as I'm sure you can see where I intend to go with this.

Fleeg.

[lamzee]

AS far as I know it's illegal for them NOT to pay HAA claims, since the scheme was brought in by a government act, which would need to be overturned first ! Must just have been an incompetent clerk!

I would phone the PCRS helpline and see if you can find out more

(PS it was hepC they got not hepB)

[Fleegle]

(PS it was hepC they got not hepB)

Doh! Still po'd with GMS 'payments' though!

[hibernia]

They have to pay but can ask for a copy of script and a copy of the invoice. If so it is paid manually a month later.
Best to submit the uncoded item as a seperate claim so at least you get other items paid promptly and write on the claim form that you have attached the copies.
I find payments staff are generally helpful, despite their obnoxious boss, and will usually authorise payment if you fax them the copies they need. It seems they are under pressure about "governance" and have to have all the boxes ticked, that boss of theirs again, so help them to help you and they will. Get up their nose and an awful lot of your claims could go "missing". This is one of those times to bite your tongue, be really polite and GET PAID.

[lamzee]

So, would it be worthwhile from now on just automatically attaching a copy of the script and invoice to uncoded HAA claims, to be on the safe side, as a matter of routine?

[hibernia]

No harm at all. It only takes a minute at the time and saves a lot of time and hassle looking for them later.
I always make a copy of the invoice when the goods come in and keep it beside the item so it is there when you want it. Same for uncoded items on LTI and hardship.

[angeldelight]

This is going to sound like a terrible question coming from someone at the end of their pre-reg year but what do you mean when you say uncoded? Is it basically nything without GMS code e.g. unlicensed, covered on named patient basis - the 77750/77751 etc codes? Sorry for asking, my tutor knows very little about schemes

[hibernia]

You are right to ask if you don't know, a pharmacist who won't ask a question in case they look silly is a dangerous pharmacist. If you learned to look for answers you learned a lot during pre-reg.

In fact you are absolutely right, uncoded is anything that doesn't have a a GMS code number. You use the 77750/77751 codes for DPS/LTI and 33333 for GMS when claiming electronically, because there has to be a number. In the old days when claims were coded manually those claims had a symbol not a number and so were called "uncoded" - your tutor is just too young to remember!

Just be careful that the item can be claimed for if it doesn't have a code. There is a protocol for DPS and for LTI and Hardship they have to be pre-approved by your local HSE office and what gets approved can vary from region to region. The golden rule is CHECK first, especially if it is an expensive item, and then CHECK you have been paid and that you have been paid correctly (that's why it's a good idea to keep a copy of the invoice or a note of the cost price and have the evidence if they don't pay or underpay).

Good luck in your future career, you may need it!

[Fleegle]

Epic post Hibernia. You are of course 100% correct. Putting uncoded items into a separate claim makes perfect sense. I will do that in future. I still however have major problems regarding reimbursement for expensive LTI items, especially with 'special cases' eg. cystic fibrosis, which have been approved but are not paid..I can only assume the reason is that they are only prescribed sporadically.

I also keep copies of invoices for all 'unusal' items and submit them with my paper claim as a matter of course. I find they are frequently ignored. Regarding HAA though, it would now appear I will now have to submit invoices for toothpaste, band-aids, a plethora of vitamins, mouthwashes, panadol actifast etc. etc. etc.

It's becoming a nightmare...by definition, my staff are employed to make the pharmacy money, but now one of my best assistants spends most of her time dealing with unnecessary reclaims such as these.

I find this totally unacceptable. Whatever is happening to patient care when we are in a constant position of stand-off with the payments board regarding items we have supplied in good faith?

I'm getting worried.

Fleeg.

[hibernia]

I'm not just getting worried I have been worried for a long time.

Like you my best assistant is on this task because so much money is at stake, one claim was over €400, and while she does that and I scramble to find the best price or discount for every single item patient care does suffer.

PCRS, despite the helpful staff, just don't get the concept of "good-faith" or putting the patient's needs first. They see these patients as numbers where we see sick and vunerable people and tehy have been left this way by the actions of the state. The HAA scheme was little enough compensation and the numbers are so small the costs can't be that high.
Sadly now our clout to improve things is zero. My only hope is that a certain senior person will take early retirement or be redeployed anywhere and a more common sense attitude may come in.