What is my income going to be in August?


What reports do we run to forecast our income in August 2014?

Case Mix Service Fee payments under CPSA4 are paid, in advance, based on 3 month old claim data accepted by the MOH payment system. These are adjusted three months later (August is adjusted in November) when the majority of deferred items have been claimed. A final wash-up is done annually.



Is the dispensary summary report still relevant?

YES! Everything processed in the Dispensary software except the Case Mix Service Fees for Core and LTC dispensings and monthly LTC patient fees is reported here.



What does the new Service Fees Summary tell me?

There is a great deal of information here but if you are interested in forecasting your August income, run the report for MAY and go to the last page and record the $ fees reported for:

  • Initial Case Mix (Base) Fee*
  • Repeat Case Mix (Base) Fee*
  • LTC Monthly Service Fees

* These fees are based on your actual dispensing in May, there is no seasonal adjustment (for length of month) nor is there any reconciliation with claimed/accepted items. So the figures reported should initially be higher than those paid in advance for August because they will include any adjustments the MOH will not make until November.



Add the 3 Service fee $amts to the Disp Summary Report GP.

Run the report GST exclusive for the last whole month. This gives you a guide only for what you might expect next month (?). Again there will be fluctuations based on the number of working days in the month.
If your pharmacy has been recording transition/core/LTC fees as BSO’s – subtract these figures since the Case Mix fees replace them.
NB: If additional service like MUR, CPAM’s etc are provided and payments are not recorded in the Dispensary software, manually add these too.



A3/J3 Unders clarification:

At the end of the stage 4 CPSA negotiations, decisions were made to ensure that at least $5.30 (excluding GST) case mix fee would be made on A3/J3 prescriptions initial items (and $3.00 for /2 and /3) for subsidised medicines.
To do this transparently required electronic claiming system changes (end to end) and this could not be done in the time frames.
Toniq have included the A3/J3 under copayment /1 and repeat prescription items in the new Service Fee summary report BUT it does not include the /0 A3/J3 under copayment, fee payments.


No seasonal adjustment payments are calculated.



For reference

From MOH A3/J3 Seminar:


A3 without repeats (/0) with a Drug Cost

>$11.58 will automatically attract an initial case mix service fee and is not impacted by the quarterly recalculation.
>$ 7.446 but less than $11.58 will turn positive on quarterly recalculation and will be paid a case mix service fee at RVU of 1.01 ((Toniq)> less negative R.)

J3 without repeats (/0) with a Drug Cost

>$7.404 will automatically attract an initial case mix service fee and is not impacted by the quarterly recalculation.
>$ 3.265 but less than $7.404 will turn positive on quarterly recalculation and will be paid a case mix service fee at RVU of 1.01 ((Toniq)> less negative R)



NB: If your pharmacy does significant numbers of A3/J3 prescriptions and you cannot work out how this will affect your income contact us and we will try to help!