Some GP practice seasonal influenza vaccination activity is not being correctly identified by the TPP monthly CQRS payment searches. This means that, unless further action is taken, practices will not receive payment for all activity. This is normally due to a coding issue.
The main reasons that a coding anomaly will affect CQRS claims are as follows:
- 'Carers' are not included in the Flu CQRS Business Rules
- 'Shielding patients' are not included in the Flu CQRS Business Rules
- Patients identified as clinically appropriate for vaccination but not coded correctly
In order to receive payment for these flu vaccinations practices should review the records of those patients not included in the CQRS extraction and, where appropriate, add the 'Needs Influenza Immunisation (9OX4)' clinical code to their record.
We have a suite of reports to assist practices with managing the flu season and claims:
1. Review before reports
A set of 28 reports are available for reviewing patient records before vaccination and can help to identify and resolve many issues in advance. These can be found in;
'Reporting > Clinical Reporting > Arden's Ltd > Vaccinations > Seasonal Influenza I 1 Review before'
These are some of the areas these reports assist with;
- Pregnant - check if patients are still pregnant and if not a delivery outcome should be recorded
- Carers - not in another risk group - Not included in the business rules, add 9OX4
- Cerebral Palsy - Not included in the business rules, add 9OX4
- Multiple Sclerosis - Not included in the business rules, add 9OX4
- COVID-19 high-risk patients - Not included in the business rules, add 9OX4
2. Review after reports
A set of 14 reports are available for reviewing vaccination activity. It is recommended that these are run regularly, particularly leading up to a CQRS data extraction. These can be found in;
'Reporting > Clinical Reporting > Arden's Ltd > Vaccinations > Seasonal Influenza I 5 Review after'
These are some of the areas these reports assist with;
- Not in a payment risk group - Patients who have been vaccinated and do not qualify for payment, add 9OX4
- Duplicate vaccinations recorded - Patients with multiple vaccinations recorded, review and mark one in error if appropriate. if you have duplicates it can cause your ImmsForm data extraction to fail
- Non-QOF codes used - Review and amend codes
- Vaccinated too early - Some practices started recording vaccinations before 1st September. As the service didn't start until that date these won't show in CQRS
- Payment validation - Reports to compare Ardens to CQRS reports and identify patients that should be reviewed. These are only available to compare the data for the current CQRS data extraction month.
3. CQRS in SFLU011, SFLU012 or SFLU013 (50-64y)
Guidance has not been published yet to commence vaccination of the 50-64y group. If you have patients appearing in CQRS in SFLU011, SFLU012 or SFLU013 these are most likely patients on your shielding list, household contacts or carers who are not in another risk group and have not been coded to identify them to CQRS.
- Patients coded as COVID-19 high risk should be coded with 'Needs influenza immunisation (9OX4)'
- Household contacts should be coded if appropriate with 'Lives with immunocompromised person (XaRG1)'
- Carers should be coded as mentioned above with 'Needs influenza immunisation (9OX4)'
There are some reports in 'Seasonal Influenza I 1 Review before' folder called;
- 'For review before ordering and invitations | Consider adding 9OX4 after 1/09/2020 if vaccination indicated as COVID-19 high risk without a more recent mod or low risk + not eligible'
- 'For review before ordering and invitations | Consider adding 9OX4 after 1/09/2020 if vaccination indicated as carer + not in age or at-risk group'
Patients that appear in these reports should be reviewed and coded with 9OX4.
4. Audit trail mode to review a record
Occasionally, a patient is vaccinated and there may be a need to look back to see why the patient was eligible. In SystmOne there is a way to retrieve a patient record in 'Audit Trail' mode so that it appears exactly as it was on that day.
If you go to;
- ‘Patient > Patient Locator’
- Enter the NHS number etc and click search
- Select the patient name in the results and click on the ‘Audit Trail’ button
- Set a date (before the patient was vaccinated)
The record will then be retrieved as it was on that date and you should be able to see any alerts etc that were present on that date. You can even open the influenza vaccination template and look on the home screen for any clues as to why the patient was eligible.
5. Deadline to complete this work by
The above reports should all be run regularly throughout the month and appropriate actions such as adding "9OX4" code to records each month before the CQRS extraction to avoid having to do a 'manual adjustment'.
6. Manual Adjustments
A 'Manual Adjustment" is where a practice can make an additional manual submission after the CQRS auto-extraction. If practices miss the monthly deadline then please use this method to submit a retrospective claim for payment to your local NHSE team.
7. ImmsForm data extraction failures
We are also aware of an issue with ImmsForm data extraction this year. Validation has been added to the data extraction so that if any duplicate vaccinations are found in any records the entire data extraction will fail to upload to the ImmsForm website. Some affected practices have been sent a manual data submission spreadsheet to complete and return to ImmsForm. We are unable to identify all the reports practices should be using for this data and after communicating with ImmsForm it appears they are also unable to offer any advice about which reports to use for this data collection.
The ImmsForm reports can be found in the 'Reporting > Clinical Reporting > System Wide > DH Flu Return 2020 to 2021’ folder. The image below shows which report names we can find that match the requirements but there are some we are not sure of. Practices will need to contact NHSE to ask for advice on which of the reports should be used to collect these numbers.