There has been plenty of talk in the industry around the July 1 changes. Of course we won’t know for sure until the changes are launched, but based on our extensive research we have summarised what we think we will see below.
Key Changes
1. Validation
- Validation will be more stringent and larger samples reviewed
- Validators (Review Officers) will expect more stringent assessments and directives for 4b
- The fines everyone is talking about will be limited to providers who “had been caught making multiple, deliberate false claims, not genuine one-off mistakes.”
Tips and how to prepare!
- Be well prepared for validation, inform your team of the validation process and ensure they are ready for and know how to respond to questions they may be asked by the review officers
- Ensure your ACFI packs are complete and accurate! Ensure there are signatures & dates where they are required and that required assessments and directives are complete and in order
- Having a secondary or supporting evidence pack will assist with a stress free validation process. This pack contains all the additional information that validates your claim. This includes Allied health information, hospital discharge information, progress notes, x-ray/pathology results. Having this in place will mean you won’t need to dig through archives during what can be a very stressful period.
2. CHC DOMAIN
The following are possible changes only and may represent the worst case scenarios. This information is all about being prepared; it’s time to start considering how they may impact you but we really won’t know for sure what will happen and what changes we need to make until they are released.
We suspect that on July 1:
Question 11 medication
- Medication timing for a B rating will increase. e.g. 2 – 5 minutes, currently less than 6 minutes
Question 12 procedures
- The point score given for items 4b and 12 and possibly 1 and 4a may be reduced
- It will be harder to obtain a C/ D rating in question 12 therefore making it more difficult to claim a medium or a high level
Tips and how to prepare!
- All claims submitted prior to June 30 will remain under the current business rules and legislation so make sure you get your Voluntary appraisals done
- Look carefully at the number of 4b claims being conducted and consider how this may impact you
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Jacqui Banham – ACFI & Clinical Services Director
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