The adoption of the new Tariff and Top up payments in 2017 represents a significant change to the revenue flows associated with specialised care, more accurately reimbursing complexity. Following the adoption of HRG4+ and the associated revisions to specialist top ups, services will be eligible for top ups when the treatment provided attracts a top up and the provider is contracted to deliver it, unless otherwise stated. Substantial improvements in data quality are needed to drive the reforms set out in NHS England Commissioning Intentions to driving compliance with national standards.
The National Casemix Office (NCO) has published an update to the Prescribed Specialised Services Identification Tool for use in the financial year 2017/18. This is a workbook which is a guide to understanding the details of the code sets and associated logic used in the derivation of the PS flags as generated by the product.
· 2017-18 Prescribed Services Guide to Identification Rules
The Operational Tool is based on the Identification Rules (IRs) in the PS 2016/17 Planning Tool, updated with additional logic as used by healthcare providers involved in the IR baselining exercise, and has been updated for OPCS-4.8 which came into effect on the 1 April 2017.
In order to accurately capture specialist services provided in the dermatology outpatient setting services require specialist diagnosis codes to be recorded. The list of expected diagnosis codes are documented in the Inpatient patient rule for dermatology services. For many of the identification rules the selection of specialised outpatient activity is based solely on the presence of the appropriate treatment function code. Providers should take great care to ensure that relevant treatment function codes are used particularly for specialised paediatric clinics.