Are You Ready for 2023/25 NHSPS?

The NHS have just released their much-anticipated 2023/25 Payment Scheme (NHSPS) details, confirming that Providers will now be paid 100% of NHSPS unit prices for elective activity to help reduce the huge backlog that all NHS Trusts are facing. The amount payable is the volume of activity priced against the national unit prices, which is very much a return to the ‘payment by results’ scheme seen pre-COVID and, as we all know, this is a marked change from the 22/23 NHSPS, which only paid 75% of the tariff for elective activity above agreed levels.

What does this mean for my Trust?

In short: it’s more imperative than ever to ensure that your clinical coding is accurate. Inaccurate or incomplete documentation and clinical coding can mean that activity will be in a lower priced HRG category than it should be, as correct HRG derivation is based upon accurate and complete clinical coding of the admission.

For non-elective activity, the price payable to your Trust is a single payment for the financial year, based upon an agreed initial fixed element for the provision of these services.  There are tools used to support fixed element calculation, which use clinical coding and HRGs as the currencies to categorise activity and complexity. This is therefore another important reason to continue to ensure the coding accuracy of non-elective activity, as taking an eye off the ball could have a detrimental impact in terms of future fixed element baselines and positioning of in-year negotiations.

How can the Maxwell Stanley solution help?

The Maxwell Stanley solution identifies any elective admissions in which a higher unit price should be charged, therefore directly improving the amount payable (income recovery) each month.

Additionally, the solution identifies any non-elective admissions in which there should be a higher complexity and unit price value. This therefore enables your Trust to improve the accuracy of the complexity of non-elective activity, accurately monitor in-year performance against the fixed element, provide evidence against any in-year requested clawback, and support increased fixed element values going forwards.

Clients of the solution see direct income gains of between £1m to £2.5m per annum specifically from the prioritised activity flagged in the Solution , therefore yielding a 10 to 25 times return on investment.  Clients will also achieve a wider financial benefit of activity being coded ‘right first time’ as learnings from errors identified in the Solution are made.

These admissions are identified through chronic comorbidities recorded in previous admissions that are not present in the current admission, plus identification of areas of incomplete or common clinical coding errors which impact on the unit price. The Maxwell Stanley solution can also help to improve performance metrics, such as data used to calculate mortality rates and improving SHMI scores, by identifying missing or incorrect charlson comorbidities.

Contact us today to find out more about how we can help.