THE REASON FOR PROBITY CHECKS
The Health and Social Care Board has a responsibility to gain assurance that payments received by a practice are fully justified and in accordance with the relevant Statement of Fees.
Undertaking Probity Checks does not imply lack of trust in General Ophthalmic practices, but is a normal requirement to make available evidence of service provision to support financial reimbursement.
The aim of the verification exercises is to gain an assurance that the claims being submitted are proper and in accordance with the Statement of Fees.
Departmental circular HSS(F)43/2001 instructs that each practitioner should normally receive a Probity record review once every three years.
However, a review of available payment information held within the HSC Board and the Business Services Organisation may prompt a visit to the practice sooner than this instruction.
WHAT IS THE PROCESS?
Every quarter Probity Services carry out a review of payment information in respect of payments made to all general ophthalmic contractors.
On a quarterly basis Probity Services will select a number of ophthalmic contractors for a verification check. The check will normally consist of one or both of the following:
Checking Clinics – where patients are invited to bring their spectacles along to a local health facility where this is checked and verified against claiming details.
Post Payment Verification Visit – where the Probity team will visit the ophthalmic contractor’s premises to carry out checks on a sample of patient records to seek assurance that claims being made are appropriate and in accordance with the relevant statement of fees.
POST PAYMENT VERIFICATION
HOW WILL YOUR PRACTICE BE NOTIFIED?
A letter will be issued to the practice detailing the date and time of the visit, the names of the visiting Probity Officers and the format of the visit and payment areas to be covered.
Attached to the notification will be a reply slip for the practice to complete and return to Probity Services along with a systems questionnaire to be completed either prior to the visit or during the visit.
WHAT HAPPENS AT THE VISIT?
The ophthalmic contractor will be requested to complete a questionnaire and to make available patient records in respect of claims being checked.
Systems Questionnaire – this enables Probity Services to assess the strength of systems in place at the practice in terms of submission and completion of claim forms.
Verification of Service – the Ophthalmic Adviser will check a sample of patient records to gain assurance that the service provided has met all relevant criteria for payment purposes.
Any clinical issues identified at the visit will normally be discussed at the visit and may sometimes be followed up under separate correspondence from the Ophthalmic Adviser.
WHAT HAPPENS AFTER THE VISIT?
- After the visit the ophthalmic contractor will be sent a draft report which provides an opportunity for comment on the findings.
- Following this a copy of the final report will be issued to the contractor for their own records.
- Follow up visits may be required to verify changes to procedures where recommendations have been made and accepted.