GOS audit tool explained

What is the General Ophthalmic Services (GOS) audit tool?

The AOP’s GOS audit tool is an online tool that AOP members in England can use to audit their GOS claims.

In recent years NHS England has, in some areas, been actively reclaiming GOS fees where they believe practices have been claiming incorrectly or over-claiming. The AOP’s GOS audit tool can help to highlight any areas where practices may be vulnerable to such a reclaim.

Previously, we gave members a spreadsheet to fill in and it would tell them how many claims it thought were valid or invalid. This was certainly useful, but I felt an online version would be easier to use, more accessible and could produce more accurate results.

Consequently, a couple of years ago, we developed an online version and have since ran the tool as a pilot, with around 60 members using it during that period.

If a practice has already been audited by NHS England and been told they are liable for a reclaim, contractors can use the AOP audit tool to see whether there is scope to challenge this. Even if a practice has not yet been audited, contractors can use the tool to highlight areas where they might be vulnerable if they were audited in future.

What feedback did you receive from the pilot?

Practitioners found it useful to see whether the tool agreed with an NHS audit, and also to highlight possible areas for improvement. I think it was quite eye opening for some practitioners, especially with GOS4 repair voucher claims, which are often poorly justified in the records and consequently a big area of vulnerability for many practices.

NHS England may dispute the validity of GOS claims going back up to six years, leading to significant reclaims in some cases. Therefore, it is a good idea for all contractors to make use of the AOP’s GOS audit tool to see if there are areas that they could improve on

How do you hope the GOS audit tool will support members?

Although the AOP does not assist individual contractors in dispute with NHS England over reclaims, we hope the audit tool will help practices verify if their claims are accurate and, if not, where they could be vulnerable for a reclaim as well as how they can improve their claims in the future.

GOS1, GOS3 and GOS4 claims can be entered into the audit tool, and, for each type of claim, it will show the percentage of claims that it thinks can be verified.

Even if the NHS is not actively looking at claiming in a contractor’s area currently, it does not mean that they will not be active at some point. NHS England may dispute the validity of GOS claims going back up to six-years, leading to significant reclaims in some cases. Therefore, it is a good idea for all contractors to make use of the AOP’s GOC audit tool to see if there are areas that they could improve on.

What tips would give AOP members using the tool?

Using the GOS audit tool is fairly self-explanatory; it does quite a lot of sanity checking to ensure the results are as accurate as possible. For example, it won’t let you enter the details of a claim for a sight test that was performed before a patient was born. At each step of the process, it will try to justify the claim in the simplest way possible and if there is not enough information to justify a claim on the first count, it will ask for more information. It is designed to be as quick and accurate as possible, and only asks for more detailed information where necessary to justify the claim.

We would recommend auditing about 100 GOS claims in order to really get an idea of if you are claiming accurately

How long does using the tool take?

We would recommend auditing about 100 GOS claims in order to really get an idea of if you are claiming accurately. You get faster as you do it, but it is likely to take around three hours. If you think about the amounts that some practices have had to repay following an audit by NHS England, three hours once or twice a year is a good investment in time.

What would you say to encourage members to use the tool?

It is very simple to use and is built into the AOP website now so all you need to do is log in and gather the records that you require for the audit, but it is really just about putting aside some time to do it – it’s pretty straightforward to use after that.

It is best if the contractor does the audit themselves. Also, you have to be very honest when you are doing it. There is no point in pretending that something is on a claim when it is not –the whole point is to identify your areas of weakness.

If members have any questions about the GOS audit tool, they can contact the regulatory team by telephone on 020 7549 2009 or by email.

• Since the tool was launched last month, the AOP has confirmed that a total of 53 members have already logged in to the tool, with 55 practices created.