GOS 1 Returns and Early Re-test Reason Codes (12/07/2018)
A number of you have contacted Staffordshire LOC because you have had a number of GOS claims (particularly GOS 1 forms) returned to you by PCSE recently. Apparently this is happening across the board, and there has been a recent spike in the volume of returns.
The criteria for rejecting GOS 1 claims hasn't changed, but contractors are reminded to make sure all mandatory information is included. Many of these returns have arisen because the date of last sight test hasn't been written down, but a significant number of others have been returned because an early re-test reason code hasn't been entered.
The LOC wants to help optical practices ensure that returns are kept to a minimum. One resource the committee wishes to share with its contractors and performers is FODO's "Vouchers at a Glance" table, which lists the Early Re-test Reason Codes among other items. The link to the table is as follows: < http://www.fodo.com/downloads/fodovouchers-at-a-glance2018-final.pdf >
Further guidance on how to avoid rejected GOS claims can be found in LOCSU Hot Brief Issue 71, which Alison sent to you on 25 June.
The LOC wishes to add it is important that early re-test codes are also recorded on the patient records, and that the reason for visit is recorded to justify the claim.
The guidance is not intended to prevent patients who have visual symptoms from having early re-tests. The decision is to be made by the testing optometrist as to whether or not a test is necessary. Remember - a MECS appointment may be more appropriate - providing the patient is registered with a GP surgery from a participating CCG locality.
Patients should not be told "if there is no change they will have to pay". The code for no change should be used if that is the result of the test.
Contractors should be regularly checking that their performers are diligently completing all the information. Record audit is a good tool for this, and also checking GOS forms before submission can reveal omissions. With feedback to clerical staff and performers, this should improve accuracy.
Follow College guidelines on small prescriptions, and make sure the record shows why a small Rx or change has been given.
We ask that you continue to monitor the LOC website for further updates, together with our recently launched Facebook and Twitter pages.
Our grateful thanks to Delia Cliffe, Clinical Advisor (Optometry), NHS England – North Midlands, for her help in this matter.
Staffordshire LOC Chair and Officers