August 1, 201

The recent round of ACFI validations has caused significant trauma amongst providers. Leaving them with potential for significant revenue losses.

The Validation auditors have a new ‘tool’ for claw back which has and will result in significant downgrades in the ADL domain. The basic premise of the downgrades is that the auditors consider any assessments and care plans done in the first 7 days as being irrelevant to funding. The legislation being quoted to support this argument is outlined below:-

Providers are effectively being asked to compromise care by not doing a full assessment of ADL’s (particularly) in the first 7 days, and if they have been done they must do a new set rather than reviewing what has already being assessed. Notwithstanding the obvious, this poses an unnecessary burden.

The situation appears to be driven by semantics. If the review was called new or initial, the data would be accepted. But not otherwise!

One of Health Metrics client has been told by the auditors that they will accept a progress note on the 8th day, with a pdf of the generated assessments and care plans completed from day one to seven and attached to the note. This makes no sense at all but provides one alternative for a work around.

What is the solution we all ask? In the first instance providers should consult with their peak body to help them in challenging this play on words. We are aware that some of our clients have also written to Canberra and are yet to receive a response some 8 weeks after alerting the Federal Government. We also encourage our clients to reach out to their local federal members in protest.

Whilst Health Metrics is reluctant to make a change to the software. Changes that arguably, potentially compromise care outcomes, we and our valued clients are somewhat at the mercy of the Validation auditors.

Stay tuned for the Health Metrics solutions; Coming ASAP, via consultation with the Health Metrics user base. Please share this story amongst the Residential Aged Care community in order to increase awareness of the issue.

–  Lisa Papettas, Chief Operations Officer


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