ACFI and Consulting Articles

Which ACFI claims should be submitted between now and June 30?

The specific resident scenarios that are impacted by the July 1 changes account for 22.0% of the resident population.

So which ACFI submissions do I need to focus on?

Which submissions can I leave until July, and still submit based on the current business rules?

If you have limited resources and need to focus on prioritising your work then:

Appraisals that Must Be Submitted Before June 30

The two specific residents scenarios that, depending on the day you submit them can lead to an $11,000 or $7,500 difference in funding for the same care provision are:

  • Voluntary appraisals where there’ll be a Q11 A-Claim and a Q12 C-Claim
  • Voluntary appraisals where there’ll be a Q11 D-Claim and a Q12 C-Claim

If these are voluntary appraisals using the ‘Significant change in dependency’ business rule, this is even more important… otherwise a mandatory reappraisal will be due and there may be a further decrease in rating if needing to resubmit after 1 Jan 2017

Appraisals That Can Wait Until July 2016

If there are any residents who have a mandatory reappraisal due in June or July you may be able to reprioritise your time. The date of effect is not the submission date. The new classification takes effect from day 6 months after major change reappraisal took effect, or 6 months after resident enters care from hospital. This means:

  • If the expiry date is in June, even if submitted in July then it will be under the existing business rules
  • If the expiry date is in July, even if submitted in June then it will be under the new business rules

Conducting an ACFI Funding Gap Analysis and prioritising workload has just become more complex. Now it’s not just about the gap in funding, it’s also about ensuring that submitting the same resident’s ACFI on the wrong date doesn’t lead to an inadvertent decrease in funding (despite providing exactly the same level of care).

For more information on identifying all of the funding your facility is eligible for in the complex health care domain click here