In our last Insight, we discussed AN-ACC Initial Assessments and Reassessments. The evidence is clear that providers need to focus on reassessing their residents, however, the process does not end there. The final step in managing your AN-ACC assessments is AN-ACC reconsideration requests.

 

JC Yap
Principal

Reconsiderations
What are they? 

Reconsideration assessments can be requested by a provider who believes the classification outcomes from the AN-ACC assessment, either initial or reassessments, are not reflective of the resident’s care needs/acuity.

This could result from inaccurate or insufficient information about the resident’s actual care needs (documentation or from staff interviews) being presented to the assessor at the time of the visit. This is to be distinguished from a situation where there has been a further deterioration in resident function. In these cases, a reassessment request rather than a reconsideration request is required.

Reconsiderations are performed by a different assessor, usually from a different assessment management organisation. The classification outcome from the new assessment, if different, will replace the original classification outcome and have the same date of effect as the original classification.1

Looking at Numbers

Since December 2022, the Department has been providing data on reconsideration requests in their AN-ACC Dashboard updates.

As of 9 December 2022, 472 reconsideration requests had been lodged with just over 50% completed2. As of 13 January 2023, the number of reconsideration requests was 690 with around 71% completed3. This increase in completion rates indicates that the Department is keeping up with provider requests.

Say a provider identifies an increase in a resident’s care need. The resident is currently classified as a Class 5 and has been reclassified to a Class 2. The change in classification has resulted in a 20.9% drop in daily funding equating to $14,245.95 per annum*.

Without a reconsideration assessment, the provider will continue to receive this level of funding for the care that is continued to be delivered for the same resident. Whilst a reconsideration does not guarantee that the classification will return to the original level or higher, it allows the provider to have an opportunity to have the resident reassessed.

As highlighted in the table above, any mismatch in AN-ACC classification relative to a resident’s care needs means the service is not being funded for the care provided. In today’s challenging aged care financial environment, underfunding care increases the risk of poor care outcomes or the viability and sustainability of the provider. Neither of these outcomes can be ignored.

Best Practice
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In our last Insight, we explained how an organisation with low levels of false positives and false negative reviews will lead to better assessment outcomes. We can further build on that by:

Incorporating the evaluation of reassessment outcomes to minimise the risk of downgrade in classifications
Reviewing clinical documentation, including assessments and care plans for changes over time
Coaching care staff on the importance of proper documentation, including progress notes, to ensure the provider is being paid for care given
Reinforcing to care staff the resident’s care plan to ensure care delivered is aligned with needs, goals and preferences

There is a 28-day window from the notification of the assessment outcome to lodge a reconsideration request4. Within that period and until the assessment visit, providers should focus on the action items above.

How we can help

Fresh eyes bring fresh perspectives. As an external party, we bring fresh eyes. Our data driven approach gives us objective benchmarks to assess the confidence of individual providers’ assessments. If you are unsure whether you are maximising your AN-ACC funding, we can assist by:

Guiding your clinical team through the documentation requirements or
Partnering with you in evaluating assessment outcomes,
Providing tailored education sessions to staff on documentation and care planning

To see how we can assist you with AN-ACC,

contact JC Yap on 02 9060 6445 or email jc.yap@prideliving.com.au

1 Department of Health, 2022, Can I ask for an AN-ACC reclassification
2 Department of Health, 2022, AN-ACC Assessments Dashboard 09 December 2022
3 Department of Health, 2023, AN-ACC Assessments Dashboard 13 January 2023
4 Department of Health, 2022, AN-ACC Provider Process Map
* Assuming a resident in MMM 1-4