Avoiding Common Financial Pitfalls in Enhanced Services Claims

Avoiding Common Financial Pitfalls in Enhanced Services Claims

Overview

Enhanced Services provide valuable additional income for GP practices, but errors in claims submission can result in lost revenue, rejected claims, and cash flow issues. This guide outlines common financial pitfalls and how to avoid them, ensuring practices receive the full funding they are entitled to.

Key Risks in Enhanced Services Claims

·      Missed submission deadlines – Late claims may not be processed, leading to lost income.

·      Incomplete or inaccurate coding – Errors in SNOMED codes can cause automatic claim rejections.

·      Failure to meet service requirements – Practices must ensure activity meets NHS England specifications.

·      Lack of audit trails – Insufficient documentation can lead to disputes or funding clawbacks.

Action Points:

·      Establish clear processes for timely claims submission.

·      Train staff on accurate data entry and coding.

·      Maintain detailed records to support claims audits.

 

How to Ensure Accurate & Timely Enhanced Services Claims

Stay on Top of Submission Deadlines

·      Create a submission calendar to track all Enhanced Services claim deadlines.

·      Assign specific staff members to oversee claim processing.

·      Set automated reminders to avoid last-minute submissions.

Checklist:

·      Maintain an up-to-date tracker of submission deadlines.

·      Ensure claims are submitted well before cut-off dates.

·      Check submission confirmation receipts to verify claim processing.

 

Ensure Data Accuracy & Correct Coding

·      Use correct SNOMED codes when recording Enhanced Service activity.

·      Implement EMIS/SystmOne/Medicus templates to reduce human errors.

·      Run regular audits to verify coding accuracy before submission.

Checklist:

·      Validate all activity codes before claims submission.

·      Ensure staff are trained in Enhanced Services data entry.

·      Regularly review coding accuracy reports to identify issues early.

 

Verify That Services Meet NHS England Requirements

·      Review contract specifications for each Enhanced Service to ensure compliance.

·      Ensure clinical staff understand service criteria and how to document activity correctly.

·      Implement internal quality checks before claim submission.

Checklist:

·      Regularly review Enhanced Services specifications and updates.

·      Ensure all activity meets minimum criteria before submitting claims.

·      Train clinicians and admin teams on service documentation requirements.

 

Maintain a Robust Audit Trail

·      Keep detailed records of service delivery, patient encounters, and claims submissions.

·      Store confirmation receipts for all submitted claims.

·      Conduct internal audits to check for discrepancies before NHS audits occur.

Checklist:

·      Ensure all claims have corresponding patient records and documentation.

·      Store submission confirmations securely for at least two years.

·      Perform regular internal checks on claim accuracy.

 

Next Steps & Deadlines

🗓 Immediately: Review Enhanced Services specifications and align processes.

🗓 Before April 2025: Ensure final claims for the financial year are submitted.

🗓 Ongoing: Monitor claim accuracy and maintain an audit trail.


Immediate Actions:

·      Implement a system to track submission deadlines and automate reminders.

·      Ensure staff training on correct SNOMED coding and data entry.

·      Conduct regular internal audits to verify claim accuracy.