Never miss a payment or be caught out by a clawback
Bob Senior advises on how to protect your cashflow even as the rest of the NHS fragments around you
As workload has increased for practice managers, instances of clawbacks and delayed payments have shot up. With enhanced services being 10-15% of average practice income, sums can be huge - for example, last month my colleague found a practice had failed to claim £34,000 of its flu income. Clawbacks are becoming more frequent too; expect some in the next few months as the 2014/15 contract has expired. These tips explain how to improve financial stability for the coming year.
1 Track performance closely
For enhanced services contracts rewarded with ‘flat’, non-activity-related monthly payments, practices should carefully record their activity targets for each enhanced service. They should also track activity against targets every month to prepare accurately for the annual ‘reconciliation’ (when the monthly estimates can be clawed back). Partners should also take urgent action if the practice consistently underperforms on any service.
2 Prepare for clawbacks
If the practice can’t get back on track, or can foresee that performance will fall - for example, if the doctor who fits copper IUCDs will be absent for a period - money must be aside for clawbacks. Assess how far below contracted levels the activity is likely to be and move the predicted cost of the clawback into a savings account. Depending on scale (and ready cash) you might also review your overdraft facilities, particularly if you are still waiting on the lump sum due from QOF 2014/15.
3 Track payments using a traffic light system
Even if the practice faces no clawbacks, late claims can disrupt cashflow. To find them and prevent them in the future, prepare a schedule in a spreadsheet that lists all services by activity down the side, and months along the top. Make an entry for every deadline to submit a claim.
Change the deadline cells to amber so that they are easy to spot. After submitting claims, change the cells to red and record the sum the practice expects to receive. After receiving payment, make the cell green if the practice has been paid correctly. If not, investigate why.
Bob Senior is chair of the Association of Independent Specialist Medical Accountants and head of medical services at Baker Tilly