The 2020/21 National Tariff Payment System came into effect from 1 November 2020.
NHS England and NHS Improvement are running the national tariff for two years. It is intended to give providers and commissioners of NHS-funded services time to restore financial balance and support all organisations to develop and delivery ambitious longer-term plans for their local health economies.
National Prices and Tariff workbook
There are separate prices for first and follow-up attendances, for the Adult Dermatology (330) and paediatric dermatology (257) TFC, as well as for single professional and multi-professional clinics. For patients with multiple distinct pre-booked outpatient attendances on the same day (e.g. one first attendance in the morning and a second separate follow up attendance in the afternoon) each attendance is counted separately and will attract a separate national price unless a local pathway price has been agreed with commissioners.
The tariffs for 2020 -21 are designed to over-reimburse first attendances and under-reimburse corresponding follow up attendances. While this approach may incentivise less follow ups in other specialities this approach is not financially viable for dermatology departments. It is important for departments to record all procedures and treatments including dermatoscopy (S605) at follow up regardless of existing block contracts.
Departments are also advised to record all photodynamic therapy (JC46Z, JC47A and JC47B) treatments as day cases to cover the cost of treatment due to an oversight by NHS England in its tariff pricing.
For some procedures undertaken in an outpatient setting, there are national prices based on HRGs. If more than one procedures is undertaken in a single outpatient attendance, only one price is applicable.
Outpatient attendances do not have to take place on hospital premises. Therefore consultant-led outreach clinics held in a GP practice or a children’s centre should be eligible for the national price. For these clinics, it is important to make sure the data flows into SUS+ to support payment for this activity.
To further incentivise the use of new delivery models for follow-up appointments, increased use of non-face-to-face appointments or wider adoption of technology, NHS England want to encourage providers and commissioners to agree local prices, at a TFC level, for non-face-to-face activity. Reference costs are available as a reference point for local price setting.
The Science of Casemix
The Clinical Services Unit has produced a guide to Dermatology coding in conjunction with the Expert Working Group (EWG) and NHS Digital with the aim to consolidate codes used in Dermatology departments.
The following booklet should be read in conjunction with The Science of Casemix, which is a general guide to the work of the National Casemix Office, its context within the health service, casemix methodology and the development and design of Healthcare Resource Groups (HRGs). This is available from the National Casemix Office website.
The Science of Casemix- Under the Microscope: Dermatology Coding for non specialised services