PHARM26.2016 Process pharmacy information for appropriate reimbursement and remuneration

Overview

This standard is about the procedures involved in ensuring reimbursement and remuneration for prescriptions and pharmacy services. Your practice will be consistent with your occupational role and carried out under the regulatory, professional and ethical frameworks established in the context of current legislation. You will need to take a reflective approach to your work. You will work at all times within Standard Operating Procedures that relate to the way in which a pharmacy service is provided in your work place. A caring and compassionate approach should be adopted in line with current healthcare guidance. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 2

Knowledge and Understanding

You will need to know and understand:

1. the Standard Operating Procedures and the importance of adhering to them at all times
2. the importance of working within the limits of your competence and authority, when to seek agreement or permission from others and when to refer on to an appropriate person
3. current health and safety legislation and how it applies to the working environment
4. legal, organisational and policy requirements relevant to your role, the role of others in your organisation and the activities being carried out
5. the relevant national and local guidelines, policies and procedures that are available and how and when they should be accessed
6. the importance of adhering to information governance policies and maintaining confidentiality when sharing information about individuals with others
7. the duty to report any acts or omissions that could be detrimental to individuals, yourself, colleagues or your employer
8. the purpose of the Drug Tariff including:
1. the regulations that govern the supply of items that are allowed on prescriptions
2. the classifications and criteria for the reimbursement/remuneration of prescriptions
9. the proprietary and generic names of medicines and the difference between them
10. resources to assist with the submission of prescription and service reimbursement claims
11. the action to take when presented with an incomplete or unclear prescription
12. the systems and documentation required to complete the returns for reimbursement
13. the systems and documentation required to complete the returns for remuneration
14. the correct procedures to ensure reimbursement of prescriptions and services
15. the reasons why reimbursement/remuneration may not be made by the relevant authority
16. the implications of incorrect claims for reimbursement of prescription charges and services where appropriate
17. the importance of recording, storing and retrieving information in accordance with organisational procedures

Performance Criteria

You must be able to do the following:

1. work within the relevant Standard Operating Procedures including the relevant health and safety procedures and within your own limits of competence
2. clarify any missing information with the appropriate person
3. confirm items allowed on prescription with the appropriate section of the Drug Tariff or local formulary if appropriate
4. make accurate and appropriate claims for prescription or service reimbursement/remuneration
5. check that any information on the prescription meets legal requirements and is complete and legible
6. record the number of prescription forms, items and or charges in accordance with Standard Operating Procedures
7. complete accurate reimbursement/remuneration returns in accordance with Standard Operating Procedures
8. submit reimbursement/remuneration returns to the relevant authority according to specified guidance where required
9. promptly deal with any prescriptions rejected by the relevant authority in accordance with Standard Operating Procedures
10. complete all relevant documentation and store appropriately in accordance with legal and organisational requirements

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: Core 1 Communication