PM Systems

Each practice will have their own systems but a basic list of the general systems in the practice all relate to the below:

• Income
• Expenditure
• HR
• Health & Safety
• Building Maintenance
• IT Maintenance
• Year end accounts checklist

Each item above will need monthly checks run on each:

• Outstanding charges – review private patients and third party outstanding bills
• Download GMS Panela and import to your practice management system
• Submit all claims for STCs/vaccines/maternity and immunisations
• Claim any GP leave entitlements for Annual/Sick & study leave
• Review your monthly GMS income and all itemised items
• Review all CDM claims and payments

Income: 

You need to know the sources of all the income in the practice. Either develop an excel spreadsheet to record and reconcile your income or consider investing in professional accounting software that would also allow you to produce profit and loss (P&L) reports in house.

Private fees – 

• Create an agreed price list to cover all services provided by the team. 
• Have a protocol for when reduced fees are applicable – example for repeat visits. 
• Ensure all reception team are trained in using the practice management software (Health one, Socrates Helix Practice Management) to run reports to balance the days takings against that reported. 

This can either be at the end of the session or at the end of the day. Ensure that cash and card incomes are correct or that differences are identified and explainable (eg, a refund). 

• Lodgements should be made at agreed periods to suit the practice and local banking facilities and records kept of lodgement values to be reconciled to bank statements. Good practice would see the lodgements being prepared by one team but the bank reconciliation by another.
• Unpaid Private fees – develop systems to monitor attendance and for unpaid consultations and ensure bills are issued in a timely manner. Use the practice software reports to identify attendances unpaid.  Outstanding bills should also be followed up with patients perhaps one month after bill issued but also, each time a patient attends and it is noted that there is an outstanding account.

Maternity & Infant:

All women ordinarily resident in Ireland and with a PPS number are entitled to care free of charge under the shared maternity scheme. Ensure all obstetric consultations are identified for claim purposes – including the post delivery 2 and 6 week checks for baby and 6 week check for mum. Note, visits by pregnant women for matters other than pregnancy related are chargeable or covered by GMS cards and not covered under the maternity scheme. Claims are now online and claimed per visit. Agree a practice protocol depending on resources as to whether these claims are daily, weekly , or monthly and that regular reconciliations are done to ensure claims are up to date. 

Further information click HERE

Primary Care Immunisation:

Utilising the practice software , set up the vaccine schedule per infant. This allows for monitoring of vaccines administered or overdue. Return detail to the HSE monthly of all primary vaccines given at the end of each month. Recall any patient overdue vaccines and keep the HSE informed of refusals or patients who have moved, thus working towards the aim of reaching the target of vaccinating 95% of your cohort and qualifying for bonus payments.

Palliative care 

A grant is payable to the GP for the end of life care given to patients who have either a terminal neurological or cancer diagnosis providing a house call has been carried out . A simple paper form is completed with patient name / dob etc notifying of the diagnosis. Following death of the patient, another simple claim form is signed by GP and submitted for payment.  Further information HERE

GMS Income

• Capitation Fees 

Utilise your PM software to reconcile your patient categories. ( Socrates, PCRS Importer, Healthone, Pcrs Parser) . 

Keeping a private patient wrongly categorised as GMS can lead to patients not being charged correctly for consultations. 

It is also important to change categories when a GMS patient moves off your list or when a GMS patient moves onto your list and that the change of Dr process is completed.

Monitor patients in nursing homes and register this with the HSE to receive the enhanced payment 

All of this ensures that your capitation fees will be correct.  Further information GP Circulars click HERE

• Practice Support Subsidies:

 New starters ( admin or practice nurse) – complete a PSN1 and forward to HSE 

Leavers or change in regular hours – notify to HSE 

Yearly – complete end of year required payroll reports and submit to HSE 

Reconcile your subsidies received to your employment records to ensure you are receiving correct amounts. ( One nurse grant and one admin grant per GMS list and is paid pro-rata to the number of patients on list)

• CDM: Chronic Disease Management:

Working with the clinical team , ensure protocols in place to identify qualifying patients. 

Adopt recall procedures to ensure appropriate attendances

Review practice management software reports for outstanding or incomplete claims and establish systems for keeping up to date. 

Diabetic / Asthma schemes

Further Information click HERE

• Professional Indemnity refunds

Annually submit evidence of insurance and relevant payment to HSE. Grants payable prorata to list size. (note, other HSE depts will require evidence of up to date insurance yearly and can withhold payment if not submitted)

Drs vaccination programmes • 

Following covid 19 , these claims for seasonal vaccines, such as Covid and Flu are now submitted directly via the practice management software when correctly input during or after the consultation. Monitor for any rejections and make necessary corrections. 

• Doctor leave grants – Annual, Maternity, Sick and Study leave. 

ALF1 forms need to be completed and submitted to local primary care office. 

Include required paperwork, such as evidence of study, or doctors certificate for illness. o Two part application – first part submit for approval , second part, submit approved application to PCRS for payment once the leave has been taken. 

Leave is paid pro-rata to list size. Further information GP Circulars HERE

• Ukrainian patient registration 

A one off payment to reflect the additional work by the practice involved with Ukrainian patients is paid once the patients generic medical card ( Dr no 66666) is changed to your own practice. Ensure the transfers are done on first visit. 

• Special Type Claims ( STCs) 

Payments can be claimed for certain services provided to GMS card holders

 Evidence of procedure, eg, ECG, or APBM must be recorded

 Documentation signed by patient and retained for 7 year period per HSE guidelines 

Claims are electronic – so similar to other daily incomes, this should be reconciled to activity on your practice management software and someone should have responsibility for reconciling activity , to claims, to payments. Eg, in Socrates, if the relevant procedures are recorded via the investigation module, then a report can be retrieved for claim purposes.

Free Contraception Scheme info click HERE

Other Income Supports 

Garda Members

 • Sign up to this scheme and bill Garda HR direct for attendance for members. Attendance form completed on each visit and submitted with member number. Payment is per visit. CIE / Dublin Port and other similar schemes

. • Evaluate whether these schemes are suitable to your practice. Payment is by capitation per employee irrespective of attendance and paid quarterly or monthly. 

Local Enterprises 

• Some businesses have a welfare scheme that covers their employees for GP attendance. Make enquiries in your locality and negotiate terms direct 

Cervical Check

 • Scheme open to women in agreed age groups. 

• Eligibility should be checked at the appointment and the reference number recorded as otherwise payment will be rejected. 

• Reconcile attendance for smears to payments received and query discrepancies.  Health Professionals Click HERE

Insurance companies

 Insurance can request a variety of reports. An example, someone arranging a mortgage, will complete a medical questionnaire and may then be offered their mortgage protection insurance. However, that questionnaire may raise some queries and therefore the company will request a PMAR ( Private Medical Attendants Report) from the clients GP. This is completed from file to a format prescribed by the company and a fee is payable. 

Or, the questionnaire may raise queries, that the company then requests a Life Assurance Examination to be carried out. Often this is at a practice other than the clients own GP. Practices can contact companies and seek to be on their panel of examiners. A Fee is payable. Additional supplementary reports may be required, and fees are payable for those.

The practice should have a protocol in place for monitoring this activity from inception to billing to payment. 

Legal Reports 

There are many instances where patients will require legal forms or reports for their solicitors. Eg, Enduring Power of Attorney, Medical reports for injury claims. Fees are payable. Reports for various public bodies are not covered by medical card schemes and fees are payable. Eg, Driving Licences, Disabled parking permits, TUSLA adoption reports, National learning Network assessments and many others. 

Dept of Social Welfare

If your patient attends for the purpose of requesting an illness certificate to claim social welfare illness benefit, that is covered by the fee paid by DSW. Submission is online and a process should be in place to monitor rejections. Payment is quarterly.

 DSW also pay fees for the completion of many applications for social welfare benefits. Ensure the doctor who has signed a DSW contract identifying number is included on the form and that you record forms submitted.

GP Training Scheme

Some practices participate in the training of GP Registrars. There are grants and payments available to practices that participate in the training schemes. 

GMS FEES AND STC CODES - Download HERE

GMS CHECKLIST – BEFORE END OF MARCH EACH YEAR

• Check you have claimed all your GP Medical Indemnity / Study Leave / GMS Annual Leave/ GP Trainers Grants / Winter Grant
• Submit all practice subsidy PSN1 Forms for Nurses Manager and all Admin staff

Expenditure:

What is the practice outgoing costs:

• Building facilities: Rent / heat/light/phones/ alarm systems/ maintenance contracts: System in place for where to store invoices for each supplier, who makes the payment and record keeping
• Insurance: Keeping records of the practice insurance and any GP Indemnity expen
• Staff wage: Accountant or person responsible to keep on top of staff salaries weekly/ monthly – its more expensive to pay your staff weekly with bank charges so it’s a good system to start everyone on monthly wage if possible.
• PAYE: This needs to be processed online monthly to revenue
• Suppliers: stationary/ medical/IT/ etc : Keep a record of costs for each supplier and shop around for the best prices. Ask for discounts, 
• Services: Shredding / Couriers etc
  

Human Resources: 

You should have a file or spreadsheet for every staff member in the practice unless you have a professional company recording for you:

Admin & Medical: 

• Accurate Annual leave records along with records any leave both sick and annual taken
• Records of extra hours covered /paid
• Contracts for all staff members (to include probation period/ disciplinary policy/ Internet,phone and social media policy – CONFIDENTIALLY AGREEMENT
• EMPLOYEE ACCEPTANCE OF COMMUNICATION / PRIVACY NOTICE /DATA PROTECTION / VARIATION TO TERMS & CONDITIONS FORMS 
• Records of all payments or pay increases for both GPs and Admin
• Records including staff that have viewed your health and safety documents
• Records of all annual appraisals and outcome of each meeting
• Records of training for all new staff signed off when complete
• Records of staff vaccinations
• Records of staff pension deductions
• Nursing indemnity & NBMI Registrations
• GP / Locums:
• Recording of all GP Contracts for HSE / Cervical Check etc
• Copy of all indemnity certs 
• Copy of IMC registration 
• GP daily Rota
• CPD CERTS 
• GARDA VETTING
  

Health & Safety:

Every practice is required to have their own health and safety document. You can use an external private company or log into BESmart.ie  & HSA to make your own.

• Access etc. for people with a disability or impairment
• Emergencies – equipment/drugs
• Fire
• First aid
• Fridge temperature logs
• Health and safety
• Infection control
• Legionella
• Lone working
• PPE
• Premises
• Risk assessments and planning
• Sharps handling and needle-sticks
• Waste management
• Bulling &harassment & dignity at work 
• Accident reporting
  

Building Maintenance:

• Security Alarms and codes and keyholders
• Panic alarms and maintenance
• Contract cleaners
• Fire Drills & extinguishers
• Internal maintenance & repairs
• Waste contracts
• Courier services
  

IT Maintenance:

• IT maintenance covers both hardware and software
• All your PCs, Monitors, Printers, scanners and servers are your hardware – you may need to have IT Specialist company to cover the event of errors on this structure
• Software is your GP practice software, antivirus, Microsoft products you may use on your system.
• Backup system of data – either done remotely by a specialist company or manually by someone in the practice. This needs to be tested regularly to be sure there are no corrupt files on the system
• Purchasing of new equipment
  

Year End Account Checklist:

• All invoices and receipts to match
• All bank statements 
• Credit card statements
• GMS pink income sheets
• Methadone income sheets
• Cheque book stubs if used
• Petty Cash records

If you start out with some easy spreadsheets to help you record each one of the above for both Income and expenditure it will be easy to track and record what you are taking in and spending.