ACFI validation downgrade rates are increasing… and this is even before the stronger compliance regime that the Minister for Aged Care announced has even been implemented.
The changes – including closer scrutiny of claims and stronger auditing – aim to clawback $60m over the next four years.
We don’t over-claim, so we should be okay? Right?
Well, these measures are in response to the increasing number of ACFI claims that were audited and were deemed to be “incorrect or false”.
Our position is that national downgrade rate (currently as high as 18% and 24% in some states) is not because of fraudulent activity, but largely because of administration, lack of supporting evidence or a misinterpretation of the guidelines… and that it’s entirely preventable.
Below are some system related issues that might help identify if there’s any risk that should be addressed:
- Residents eat their meals in their rooms
- There is no living document of all residents receiving complex health care procedures
- There is no documented process regarding a specific order of charting and clinical assessments
- Care plans are not reviewed in their entirety and updated prior to submission
- Q11 Medication and Q12 Complex Health Care claims are a mathematical impossibility
- Assessments and supporting evidence are not printed out at the time of appraisal
- Pain management claims include application of heat packs for 20 minutes per week
- There’s been previous question downgrades (even if there was no financial decrease)
There are also a number of common clinical documentation issues that should be considered – for more information see the article ‘ACFI Validation Red Flags – Signs You’re Currently at Risk’
One single-category downgrade in the ADLs domain can be a reduction in annual funding of over $15,000 (and could be entirely preventable).