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Year End Reconciliation

Providers who are contracted to deliver a specified number or amount of treatment in a financial year receive regular payments based on this, regardless of the activity delivered.

Therefore, an annual reconciliation of contracted and delivered activity is required at the end of each financial year.

This is known as the Year-End Reconciliation and is a contractual and regulatory element of routine dental contract management.

The Year-End reconciliation is required for all dental contracts which include:

  • Units of Dental Activity (UDA)
  • Units of Orthodontic Activity (UOA)
  • Courses of Treatment that involve provision of sedation services
  • Courses of Treatment that involve provision of domiciliary services

PDS+ and Advanced Service Providers will be contacted by their  NHS England Local team to explain their contract attainment and the process that will be followed.

The Provider Assurance team support NHS England Local teams to reconcile the details of the contract, as held in CoMPASS, against delivered activity submitted via FP17, and FP17O claim forms.

Health Boards are responsible for any reconciliation of Dental Contracts in Wales.

The Provider Assurance team will aim to complete the year-end reconciliation by September each year:

The Provider Assurance team currently deliver this on behalf of some NHS England Local teams. All teams will be supported in this way from the start of the 2020/21 financial year.

Approximate Date

Description

31 March

The final payment schedule of the financial year is available to Providers to ensure they have achieved their contractual obligations.

 

31 May

Deadline for providers to submit claims for course of treatment with a completion date prior to 31 March.

 

30 June

Deadline for Providers to adjust Performers’ Notional Pensionable Earnings’ and ‘Notional Pensionable Earnings Estimates’ for the previous financial year.

 

30 June

Year-End Statement is available to Providers, Commissioners and the Provider Assurance team via CoMPASS

 

31 July

Letter will be sent to contracts’ principle practice address, detailing contractual vs delivered activity. 

 

Mid-August

Carry forward of under-delivered activity is entered in CoMPASS.  Under-delivered activity amounting to more than 4% of the contracted activity will not be carried forward and will be subject to financial recovery via CoMPASS scheduled payments.

 

Mid-September

Wherever possible, any outstanding carry forward of activity and/or financial recovery will be entered on CoMPASS, available for inclusion in the Mid-Year Review.

 

Information and data

The information and data included in the year-end reconciliation and mid-year review is submitted by Providers via FP17 and FP17O in England and FP17W in Wales.

Claims are accepted in CoMPASS up to two months from the date of completion of the course of treatment.

FP17/FP17O claims submitted later than this will not be included. 

Therefore, it is advisable to ensure that all claims for the financial year have been submitted in time for the year end cut off.

Providers are encouraged to discuss this with members of their teams responsible for submitting claims. 

Submissions made after two months will not be included in the year-end final reconciliation.

Only claims submitted within time and in CoMPASS up to and including 30 September are included in the mid-year review.

‘Late claims’ should still be submitted to ensure accurate reporting of patient treatment and will be processed for patient charge revenue but will not count towards delivery figures.  This includes when a course of treatment is closed before completion.

This information is available to Providers in July every year on the Year-End statement. Providers also have access to monthly schedules and quarterly Vital Signs report available by logging into CoMAPSS.

These reports do not included activity bought forward from a previous financial year.  When this is included it is referred to as adjusted activity.  Adjusted scheduled activity takes in to account any activity brought forward as underperformance (to be delivered in the following financial year) or as over performance (to be deducted from the following financial year)

Exceptional Circumstances

Occasionally there are unforeseen circumstances that a practice or Provider may experience which may have a detrimental effect on the delivery of contract activity.

Where Providers experience an exceptional event or circumstance they should inform their NHS England Local team directly as soon as the event or circumstance occurs.

In some cases where financial recovery of under delivery applies, it may be possible for Local teams to agree a carry forward of this activity

Once considered, NHS England  Local teams in England will update the Provider Assurance team of any actions required in relation to year-end and mid-year processes.

Providers will be required to document their request in an ‘exceptional circumstances report’ and provide evidence to support their report.

Some examples of what may be considered ‘exceptional’ are

Circumstances that may be considered exceptional subject to the provision of supporting evidence

Non-allowable circumstances

Death of, or serious accident or illness to, contract holder (or close relative of contract holder)

Death of, or serious accident to, distant relative or friend of either contractor holder or performer

Death of, or serious accident or illness to, main or significant performer (or close relative of same)

Failure to register with CQC, or comply with CQC registration requirements

Serious fire or accidental damage to practice premises rendering building unfit for business

Minor fire or damage to premises

Recruitment difficulties resulting from undue delay on the local office’s part (eg admission to the dental performers’ list)

Re-decoration of premises

Move to a new premises resulting in operational delays, due to circumstances beyond the contractor’s control, eg unforeseen planning controls

Recruitment difficulties

 

Holidays and other absence such as paternity/maternity or CPD events for provider

 

Patient failed to attend (FTAs)

 

High-needs patients

 

Failure to understand contractual obligations

 

IT system failure

 

Planned absence of a performer

 

Vocational dental practitioner activity taken into consideration

A letter will be sent to these practices directly from their Local team explaining their contract attainment and the process that will be followed.