Biologics for patients with Behcet’s
Requests for biologics now pass through the Behcet’s Syndrome Centres of Excellence.
Key Principle
The key principle is that NHS England will reimburse the nationally designated centres for all actual and necessary agreed biologic drugs expenditure that is prescribed to patients.
There will be “no gain and no loss” to the designated specialist centres: the cost to be charged must be the actual net cost incurred by the designated centres.
The specialised drugs must be prescribed in accordance with relevant clinical guidelines or service protocols and every effort should be made to reduce waste and ensure cost-effective prescribing. Charges to the Centres of Excellence should adopt the same principle.
Drugs’ Cost
The Behcet’s Syndrome Centres of Excellence are prepared to accept recharges for patients following our agreed care path, where the centre has issued approval via the Behcet’s Centres of Excellence: Biologics Request Form.
Centres have the right to request documentary evidence to support the charges made.
Note: as with normal PbR arrangements the activity for the attendance at host units should be claimed through local commissioners.
For example, if a patient attends as a day case for an IV infusion this activity would be reported and claimed from local commissioners. However the cost of the biologic drug would be recharged to the Behcet’s Syndrome Centre of Excellence supporting this patient.
Providers need to ensure robust reporting and administration arrangements to ensure charges are appropriately levied. Data collection on the part of NHS England will facilitate ongoing audit.
Process
The doctor prescribing the biologic completes a biologics request form (see download box) and emails it to the Behcet’s Syndrome Centre of Excellence.
Once approved by the centre the drug is ordered and administered in the usual way by the requesting hospital.
Each month a Minimum Data Set should be completed by the requesting hospital. This confirms the biologics which have been administered.
This triggers the payment for biologic from NHS England.
The requesting hospital then invoices the Centre of Excellence to be reimbursed for the cost of the biologic.
Invoices
Invoices from External Service providers wishing to reclaim Drugs Expenditure should be sent to:
Birmingham Centre
General Office
Debbie Mitton
Birmingham and Midland Eye Centre
Dudley Road
Birmingham
B18 7QH
Invoicing Timetable for Birmingham Centre
Invoices should be raised within 15 days of the end of the month to which they relate. For example, issue date 8th April 2012 should be billed no later than 15th May 2012.
We would undertake to settle accounts within 28 days of receipt and will endeavour to raise any queries within 10 working days of receipt.
This should enable the Centres of Excellence to respond to NHS England’s reporting timescales and your co-operation with these requirements is appreciated.
Note: London will not reimburse unreasonable late claims and as such we have to adopt the same maxim with regard to charges from external bodies.
Liverpool Centre
Finance Department (Behçet’s Service)
Aintree University Hospital
Aintree House
Longmoor Lane
Liverpool
L97AL
Invoicing Timetable for Liverpool
Invoices should be raised within 15 days of the end of the month to which they relate. For example, issue date 8th April 2012 should be billed no later than 15th May 2012.
We would undertake to settle accounts within 28 days of receipt and will endeavour to raise any queries within 10 working days of receipt. Again we require Trusts to ensure that a response to such queries is made within 10 working days.
This should enable the Centres of Excellence to respond to NHS England reporting timescales and your co operation with these requirements is appreciated. Please note that NHS England will not reimburse unreasonably late claims, and as such we have to adopt the same maxim with regard to charges from external bodies.
London Centre
Behcet’s Manager
Behçet’s Centre Administration
Dental Hospital
The Royal London Hospital
Turner Street
London
E1 1BB
Email:
BHNT.londonBEHCETScentre@nhs.net
Invoices are to be raised to Barts Health NHS Trust by the fifth working day of the month.
Invoicing Timescale for London Centre
MDS returns are to be submitted no later than midday on the fifth working day of the month, except for the first return that can be back dated to April 2012. Please be advised this first return must be raised before 1st April 2013.
Payment is expected to be paid by the NHS England within 60 days of submission. Late MDS returns will automatically be carried over onto the next month’s invoice.
This should enable the Centres of Excellence to respond to NHS England’s reporting timescales and your co operation with these requirements is appreciated. Please note the NHS England will not reimburse unreasonably late claims, and as such we have to adopt the same maxim with regard to charges from external bodies.