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Healthcare Professionals

Specialised Services Tariff and Payments

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.

Prescribed Specialised Services 2021/22 Operational Tool 

·          Prescribed Specialised Services 2021/22 Operational Tool

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. 

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 2021. 

Should users have any questions or issues regarding the functionality of the PS 2021/22 Operational Tool please contact us on: enquiries@nhsdigital.nhs.uk

The National Casemix Office (NCO) has published an update to the Prescribed Specialised Services Identification Tool for use in the financial year 2021/22. 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. 

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 2021. 

Prescribed Specialised Services 2021/22 Identification Tool 

·          2021-22 Prescribed Services Guide to Identification Rules

The National Casemix Office (NCO) has published an update to the Prescribed Specialised Services Identification Tool for use in the financial year 2021/22. 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. 

For enquiries regarding the Identification Rule derivation then please contact NHS England on: england.boffice_speccom@nhs.net

 

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