07 July 2015
It is normal for the BSA to scrutinise the performance of individual performers (and the contract as a whole) and to compare different elements of a performer’s profile against a series of standardised values that have been collected from their wider database.
In this way, unusual patterns of claiming stand out and may prompt the BSA to find out why. The term 'outlier' is sometimes used to describe the contract of a performer with an unusual claims profile.
An audit of the cases involved ‒ either by yourself or the BSA ‒ will help to establish the reason for the outlier profile. It doesn't imply that there is anything wrong with the pattern of claiming; indeed there are a variety of valid reasons why clinicians will occasionally have different profiles.
The important thing is that the associated notes about treatment should contain sufficient detail about, amongst other things, the treatment that was undertaken and should demonstrate the reason for any repeated claim that might be queried.
Dental Protection has been advised that the BSA has written to practices about their prescribing profile in relation to claims repeated within a 28 day period. The national average for such claims is 2.5% of all claims.
You can request a copy of your own data via the BSA website
We understand that approximately 1,000 practices are 'outliers' above the national average for repeat claims within a 28 day period.
Three-hundred practices have received a letter with a Code C. These practices are 50% above the national average in relation to the aforementioned repeat claims. The BSA is due to be writing to all three-hundred practices asking for records but in the meantime have suggested an audit should be undertaken by the practice.
Seven-hundred practices have received a Code B letter where they are above the national average, but to a lesser degree. It has been suggested that you audit all your claims for the past year. This is a vast job and we suggest that you audit claims that are under one month apart in the first instance
The remaining practices will receive a Code A letter, meaning they are not 'outliers'.
Whichever category of letter you receive about your contract, it would be sensible to periodically review your claiming procedures and making sure that you, as provider, are not claiming improperly, as you are responsible for what you claim. The review should involve your performers and other staff in order to ensure that the legitimacy of all the claims made by the practice.
Although the business of running a dental practice is outside the remit of Dental Protection’s advisory service, members are welcome to contact the telephone advice line if they need to discuss any correspondence they might have received from the BSA in this regard or if they would like advice about how best to undertake an audit.