Karo Data Management LogoKaro Data Management Logo

Pre NES Practice FFS analysis

This spreadsheet is a summary of the amount of fee for service deductions, number of fee for services visits and average deductions for patients for your practice.  View a sample report (pdf 540kb) 

A description of each sheet follows.

 

Contents

This page sets out all the sheets in this spreadsheet. There are clickable links to each sheet, except to the graphs (it is not possible to create a clickable link to a graph in Excel).

Deductions summary

Summary of FFS deductions for this month

This sheet summarises the amount of FFS deductions (GST inclusive) since the practice's register has been processed through Karo.

First Contact Care summary for this month

This shows the First Contact Care (FCC) calculation for this month. It takes the FCC, adds GST, then subtracts FFS deductions to show the balance for the month. Some of the monthly variation is due to claiming patterns rather than visiting patterns.

VLCA payment (if applicable)

This shows the monthly VLCA payment that the Ministry of Health is paying to your practice this month if you have met the eligibility criteria (i.e., low fees).

Under 6 payment (if applicable)

This shows the additional Under 6 payment that the Ministry of Health is paying to your practice this month if you have met the eligibility criteria (i.e., zero fees for under 6 year olds).

Under 13 payment (if applicable)

This shows the additional Under 13 payment that the Ministry of Health is paying to your practice this month if you have met the eligibility criteria (i.e., zero fees for under 13 year olds).  

Deductions history by date of deduction

This information shows seasonal and other trends over time, such as

  • people using after-hour medical clinics
  • people using doctors in another area e.g., when on holiday
  • people using other doctors for personal reasons

 Some of the monthly variation is due to claiming patterns rather than visiting patterns.

This information can guide management decisions eg longer opening hours. You may also observe other practices' speed in administering their claiming processes. See the graph on the next sheet to see this information visually.

Deductions graph

This graph shows total FFS deductions for [practice name] (for a maximum of the previous two years) in graph form. It shows the dollar amounts for the previous two years.

It is useful for you to track trends. The number of months for which data is shown will be fewer if you have not yet had your register processed by Karo for a full two years.

This month's detail

This shows all FFS deductions for [practice name] on 15 mm/yy. Do NOT contact patients about their reasons for visits elsewhere. They are entitled to do this, although, if a patient has had a significant number of visits elsewhere, you may contact them to see if they still want to be enrolled with your service.

Patients matched against current register

The patients in this table have made a visit to another medical practice. Repeat visits to another practice may mean they have moved to that practice. You may want to contact them to ask them if this is the case or if they still wish to be enrolled with your service.

The table also shows the day of the week. Lots of weekends visits possibly indicates visits to after-hours clinics. It also shows the date of the last visit (DLV) with you. You may want to compare the DLV with the information on the Six Months Total sheet.

This month's totals

This table shows total FFS Deductions for this month. It shows the total dollar amount that has been claimed for each patient, with the highest total at the top. 

Six month totals

This table shows total FFS deductions for current patients for the last six months. It shows the total visits and total amount of deductions for each patient over the last six months.

For comparison, the last column shows the total amount of First Contact Care funding for six months (based on the current quarter funding). Follow the instructions as for 'This month's detail'. It also shows the date last visit (DLV) to help you work out what to do.

NOTE: If you have not yet been with your PHO for a full six months or your PHO has not had its data processed by Karo for a full six months, this data will not be accurate.

Visit numbers

This table is a summary of FFS visits for the practice. It shows the actual numbers of visits by month, eliminating the issues around the time that claims were made.

The table also shows the number of visits to other practices where a casual GMS claim has been made, in each month. This information is based on patient behaviour, not practice administration processes. Trends that may show here are flu or a norovirus outbreak in your community.

Visit numbers graph

This graph shows total FFS visits for [practice name] (for a maximum of the previous 24 months). It is a graph of the information on the previous sheet. It shows the pattern of FFS visits for your practice over time. This eliminates the claiming patterns effects.

 

Common questions about FFS deductions

1. Why is the FFS amount deducted sometimes $0?

The FFS amount paid is the amount paid to the other doctor who the patient visited. The FFS deducted amount is the amount deducted from your PHO. Usually they are the same but if the patient goes elsewhere more than three times in a month, the fourth and subsequent visit is not deducted from your PHO.

 

2. Why do I keep getting FFS deductions months after a patient has transferred to another practice?

The key reason is the length of time between a patient leaving a practice and the funding for that patient ceasing.

Practices have to send their register to Karo (and then on to MOH) anywhere from 4.5 to 6.5 weeks before the start of the quarter. This determines who is funded for the full quarter.

So, taking the worst case scenario, if the practice sends the register on 15 November and the patient transfers on 16 November, the patient will still be funded at the practice up until 31 March. This means the practice is still 'liable' for any casual GMS claims made for that patient for 4.5 months after they transferred.

In addition, the other practice that saw the patient has up to six months to lodge the casual GMS claim with MOH. So, taking the example above, if the patient visited the other practice on 30 March and that practice was a bit slow to get their claims in (maybe their practice manager was on leave), the claim might be lodged with MOH at the end of April. HPAC would then process that claim during May and the FFS deduction would come to the PHO/practice in June. So it is possible for you to still be getting FFS deductions seven months after a patient has transferred from your practice.

If you are concerned about the validity of a deduction, you need to look in your FFS spreadsheet and note the 'date of the visit' that the claim was for (N.B., not the 'date of the deduction'). Then check back on your PMS to see if the patient was actually funded on that date.