MULTIPLE DOWGRADES IN ACFI 12.3 – SEE HOW W&L ARE BEATING THE VALIDATORS!

Resident Choice

• Most sites have had residents chosen for validation that have had their application for appraisal submitted in the previous 3 months, and only occasionally going further (eg up to 6 months)
• Frequent resubmissions are targeted
• In Ageing-In-Place facilities frequently residents with higher claims (HHH, HHM, MMH, etc) have been chosen

Q11: Medication

• Duration (Total): Common theme that validators are commenting on excessive time allowance, and there have been multiple downgrades in this category
• Duration (Creams): Feedback from one site indicated that the validators thought that their timing was excessive, and that allowance of time for rubs of medicated creams be no more than 30 seconds per application
• Timing: Request by validators that evidence of timing be in seconds, rather than rounded up to minutes
• Type: Validators are acknowledging that only certain medications as defined in the ACFI User Guide may be claimed (Schedule 2, 3, 4, 4D, 8 or 9 drugs); this excludes food supplements, with or without vitamins, and emollients (e.g. sorbolene cream, aqueous cream, etc)

Q12 Part-12: Management of oedema, DVT, arthritic joints or chronic skin conditions, etc

• Oedema: Despite the fact that oedema is a sign and is directly caused by other medical conditions (eg – heart and renal failure), feedback from one site is that validators are now requesting this to be listed as a diagnosis by the medical practitioners. Nil reports of downgrades
• Arthritis: There has been indication at two sites that medical practitioners will be requested to specify which joints are affected by arthritis, as opposed to a general diagnosis of OA. Nil reports of downgrades
• Chronic Skin Conditions: Some facilities have been claiming, and being downgraded on, this directive for protective bandaging/skin protectors for frail skin without a specific diagnosis (not even accepting protective bandaging with a history of skin ulcers)

Q12 Part 3, 4a, and 4b: Pain Management

• Question 12 Part-3: MULTIPLE DOWNGRADES! Validators are now requesting the treatment records! A common theme has been that the diagnosis has been documented, the directive completed, and an appropriate pain assessment in place, however lack of treatment records is the cause of the downgrade
• Question 12 Part-3: Feedback from one site has been that at one validation a directive of 20 minutes once per week was downgraded as the validator thought that there was less of a clinical indication for this than say 5 minutes daily! (The site is considering appealing this decision, as it was in contrast to the recommendation by the prescribing health professional who knew the resident and their needs!)
• Duration of treatment: Recommendation of at least three weeks of treatment being evident prior to appraisal submission
• Wording: Ensuring that frequency and duration is defined is important; use of the term ‘PRN’ does not fit in with the required prescription of a total of 20 minutes and frequency at least weekly

DON’T FORGET WE CAN HELP!!!

• We can provide a W&L Physiotherapy Assistant who we train in the ACFI and Complex Health Care procedures and documentation standards, so that way you can be assured that you will get AND KEEP this increased funding
• The 1-category cut point achieved from question 12 part 3 of the ACFI Complex Health Care Supplement is often enough to make the difference between a ‘C-Claim’ and a ‘D-Claim’, which can make the difference between a CHC Medium ($38.17/day) and a High ($55.12)
• The difference is worth $16.98/day, or $118.86/week, or $6,180.72/year

To find out more, call Wellness & Lifestyles now on 08 8331 3000 or