Correctly coding patients in residential institutes to receive the increased global sum payment

  • Latest news

Practices who look after patients in CQC registered residential homes may not be receiving the 43% additional global sum weighted payment.

There is a process of configuration within a practice’s clinical system that must be in place, and patients must be assigned a specific code (V0) that ensures a practice is remunerated at a higher value level than the normal weighted capitation payment. Patients who reside in a residential institute (RI) attract a factor of 1.43 to the global sum payment, which is an uplift of 43% due to the increase in associated workload.

Adding an RI code to a patient record is the responsibility of the practice. The disparity between the number of patients residing in a care home and the payment received by the practice, has become more visible with the detailed PCSE statements, than with the previous Open Exeter ones. Although we do not yet have a sense of how widespread the issue is.

We are discussing this issue with PCSE and the five London ICBs and will provide further updates in due course. In the meantime, to ensure that your coding is correct for payments, please see the below links to relevant guidance which should enable you to check your coding and your clinical system configuration: