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Mirus Metrics Process Companion

Mirus Metrics Process Companion · © Mirus Australia Mirus Metrics Process Guide v1.0.3 | 2 Executive Summary Mirus Australia is an advisory business helping Aged Care organisations

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Page 1: Mirus Metrics Process Companion · © Mirus Australia Mirus Metrics Process Guide v1.0.3 | 2 Executive Summary Mirus Australia is an advisory business helping Aged Care organisations

Mirus Metrics

Process Companion

Page 2: Mirus Metrics Process Companion · © Mirus Australia Mirus Metrics Process Guide v1.0.3 | 2 Executive Summary Mirus Australia is an advisory business helping Aged Care organisations
Page 3: Mirus Metrics Process Companion · © Mirus Australia Mirus Metrics Process Guide v1.0.3 | 2 Executive Summary Mirus Australia is an advisory business helping Aged Care organisations

© Mirus Australia Mirus Metrics Process Guide v1.0.3 | i

Contents

Getting Started ........................................................................................................................ 1

Executive Summary ............................................................................................................. 2

Key Functions ........................................................................................................................ 3

Glossary ................................................................................................................................. 4

Care Revenue .......................................................................................................................... 5

Performance ......................................................................................................................... 7

Planning (Mandatory Assessments) ................................................................................ 13

Planning (Voluntary Assessments) ................................................................................... 21

Quality & Risk .......................................................................................................................... 29

Rejections & Reconciliation .............................................................................................. 31

Risk ........................................................................................................................................ 41

Finance ................................................................................................................................... 47

Performance ....................................................................................................................... 49

Index ........................................................................................................................................ 58

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© Mirus Australia Mirus Metrics Process Guide v1.0.3 | ii

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Getting Started

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Executive Summary

Mirus Australia is an advisory business helping Aged Care organisations provide the

best care for their residents through improved funding and clearer operational

insights. Mirus Metrics is a Business Intelligence tool which presents care revenue

data from Medicare in an easy to read and insightful format.

Whether the user is responsible for ensuring ACFI claims are submitted on time or

preparing analytical reports for the Board, there are many benefits to using Mirus

Metrics.

Clear actionable insights – encourages a targeted approach to ensure ACFI funding

is sustainable. Improves quality of Medicare information by reducing the risk of

incomplete or incorrect Medicare data.

Up to date reporting – a snapshot on the facility’s performance, including historical

tracking of ACFI subsidies and supplements, resident classifications and occupancy

to quantify improvements or provide early alerts on future revenue impacts.

Reduced staff time – less time is spent preparing and reviewing management

information, thus allowing clinical staff to act on insights and focus on care activities.

This following guide has been designed to help users understand how to operate a

sustainable ACFI function. Most importantly, this guide will show users how to

navigate and fully utilise the power of Mirus Metrics.

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Key Functions

Care Revenue

The primary output of this function is to ensure ACFI funding is

optimised for every resident. Responsible for preparing the

claim, coordinating the assessment process and ultimately

lodging the claim with Medicare.

Typical roles: ACFI Coordinator, Care Manager, Registered Nurse.

Quality & Risk

This function operates to manage and mitigate any risks

associated with care revenue. This includes ensuring payments

received match payments expected and documentation is of

an exceptional standard.

Typical roles: ACFI Coordinator, Quality Officer, Facility Manager and

CFO.

Finance & Operations

Accountable for ensuring the goals of the business are met. In

support of this, financial reports and a comprehensive set of

controls and budgets are required to mitigate risk and

enhance the accuracy of the company's reported financial

results

Typical roles: ACFI Coordinator, Facility Manager, CFO and CEO.

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Glossary

Aged Care Funding Instrument (ACFI)

The classification instrument used to

pay residential aged care services.

On average 70% of Aged Care

Providers’ revenue comes from ACFI.

Approved Places The number of bed

licences to a Provider

Average Daily Subsidy (ADS) Average

subsidy for Permanent Residents

(excluding default rates). Calculated

daily for current month or at last day

of the month for previous months.

Business Intelligence (BI) Tools and

processes which are used to organise

and present raw data into an

insightful and intuitive format.

Care Recipient ID The unique

identification number of a resident.

Congruence The logical consistency

between ACFI questions that may

relate to one another.

Default Rate A basic daily rate paid by

Medicare in lieu of an ACFI being

submitted.

Key Performance Indicator (KPI) A

measure of performance for an

individual or organisation. Common

KPIs or targets include ADS and

Occupancy.

Respite days The current balance of

Respite days remaining for the

remainder of the Financial Year as

per the most recent Medicare

Payment Statement.

Service ID The unique identification

number of a Residential Aged Care

Facility. Also referred to as the RACS

ID.

Supported Resident Determined as any

resident who receives either the

concessional resident supplement;

the hardship supplement; or the new

accommodation supplement.

Validation An audit of ACFI

documentation conducted by the

Department to confirm the accuracy

of an ACFI claim.

Occupancy Calculated daily as

actual bed days used versus

potential bed days. Supported

resident % is as per the most recent

Medicare Payment Statement.

Payment Statement Report provided

monthly by Medicare documenting

the total payments and deductions

on a resident by resident basis.

Reconciliation The process of ensuring

that payments received match

payments expected.

Rejections During the processing of

submitted events, Medicare will

highlight inconsistencies and errors as

not accepted. These must be

addressed to avoid financial penalty.

Tip: selecting the icon will display a detailed explanation about the

information displayed

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Care Revenue

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Performance

Procedure details

Monitor lead KPIs against target to understand performance sooner and before the

payment file finalises. The high level tasks and related outcomes are detailed below

along with the report required to complete them.

Tasks

Calculate and review Average

Daily Subsidy (ADS)

Review submission activity

Outcomes

Develop an understand of how

funding is tracking sooner so that

strategies can be put in to place as

required.

Confirm ACFI claims have been

accepted by Medicare.

Average Daily Subsidy

This is a lead KPI and is a measureable figure that can be easily influenced based on

a Provider’s ability to identify and submit higher funded ACFI claims. This is figure

especially important as it provides insight into Medicare payments before they get

paid.

Submission Activity

ACFI is based on acuity which means there is a natural tendency for revenue to

drop as new admissions enter with lower care needs (therefore lower funding) and

discharges leave with higher care needs (and therefore higher funding). The driver

of sustainable revenue is a consistently strong voluntary assessment rate.

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Procedure steps

Calculate and review Average Daily Subsidy (ADS).

Overview

Calculate Average Daily Subsidy (ADS) for all residents

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Under ‘View Payment Statement by’

select ‘Care recipient payments’

4. Calculate ADS as follows:

o Sum the total Adjusted

Subsidy for each resident

under column ‘RATE Per Day’.

o Divide this figure by the total

number of residents.

Note: Exclude any Default Rate

Adjusted Subsides from the calculation.

Where there is more than one Subsidy,

only use the most recent in the

calculation.

5. Record output for month end

reporting.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Performance dashboard

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System view

Menu > Performance > Average Daily Subsidy

‘Industry’, ‘Organisation’ and ‘State’ on and off, the user can compare the

ADS of the selected facility against these benchmarks.

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Procedure steps

Review submission activity.

Overview

This procedure allows the user to confirm ACFI submissions have been processed

and accepted by Medicare and determines the effectiveness of the ACFI review

and submission process.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Event

Search’

2. Search for recently submitted claims

by selecting:

o ‘Date from’ and ‘Date to’ to

choose date range

o Service ID from ‘Aged Care

Service Number’

o ‘Residential Aged Care

Funding Instrument Event’

from ‘Event Type’

o Click ‘Search’.

3. Confirm ACFI submissions have been

accepted by Medicare as expected

under ‘Status’

4. If event has been rejected, allocate

action to resubmit to appropriate

owner.

5. Otherwise, click ‘View’ and note

whether submission is ‘New Entry’,

‘Mandatory Re-Appraisal’ or

‘Voluntary Re-Appraisal’.

6. Record output for month end

reporting.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Activity Dashboard

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System view

Menu > Performance > Average Daily Subsidy

Tip: Tap or hover over the bars on the chart to see exact numbers.

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Planning (Mandatory Assessments)

Procedure details

Medicare needs to be checked for upcoming mandatory ACFI submission dates

and the type of submission required. The high level tasks and related outcomes are

detailed below along with the report required to complete them.

Tasks

Identify upcoming new entry claims

and their mandatory submission

dates

Identify upcoming expiring claims

and their mandatory submission

dates

Review respite residents to ensure

they have been successfully

processed into permanent beds or

out of the facility

Outcomes

Ensure all claims are submitted on

time avoiding financial penalty

Ensure all respite residents’

documentation is processed,

ensuring no delay in formally

entering residents into your facility.

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Procedure steps

Identify upcoming new entry claims and their mandatory submission dates.

Overview

Check Medicare for mandatory ACFI submissions, noting the required submission

date and type of assessment.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Click ‘Print Payment Statement’

4. Scroll down to ‘Permanent Care

Recipient Details’

5. Visually assess which residents have

neither Reappraisal nor Appraisal

Expiry date.

6. Click ‘Care recipient profile’

7. Enter surname and Care Recipient

ID of resident lacking Reappraisal

and Appraisal Expiry dates on

Payment Statement.

8. Click ‘Display Profile’

9. Click ‘Classification Details’

10. If there is no detail under this tab,

the resident is a New Entry and must

be submitted 60 days after the Date

of Entry found on Payment

Statement.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Planning dashboard

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System view

Menu > Planning > Mandatory > New entry

Tip: Select to see basic information such as Date of Birth and

Care Recipient ID.

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Procedure steps

Identify upcoming expiring claims and their mandatory submission dates

Overview

Check Medicare for mandatory ACFI submissions, noting the required submission

date and type of assessment.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Click ‘Print Payment Statement’

4. Scroll down to ‘Permanent Care

Recipient Details’

5. Visually assess which residents have

Appraisal Expiry dates.

6. Click ‘Care recipient profile’

7. Enter surname and Care Recipient ID

of resident with Appraisal Expiry date

on Payment Statement.

8. Click ‘Display Profile’

9. Click ‘Classification Details’

10. View ‘Type’ in order to determine

which form of resubmission is

required.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Planning dashboard

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System view

Menu > Planning > Mandatory > Expiring

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Procedure steps

Review respite residents to ensure they have been successfully processed into

permanent beds or out of the facility.

Overview

Check Medicare for residents currently on respite. This provides insight into potential

future workload and also ensures individual respite entitlements are not exceeded.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Review residents under ‘Respite’

heading.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Planning dashboard

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System view

Menu > Planning > Mandatory > Respite

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Planning (Voluntary Assessments)

Procedure details

Medicare needs to be checked to identify which residents’ claims are eligible for

voluntary resubmission. The high level tasks and related outcomes are detailed

below along with the report required to complete them.

Tasks

Review all ACFI claims to determine

which are currently eligible for

voluntary resubmission and should

be reviewed.

o Identify claims >12 months old,

excluding HHH claims

o Identify claims <12 months old,

excluding MHH and HMH

claims

Extract detailed claim data from

Medicare on a per resident basis

Discuss residents care needs and

record details of review discussions

Outcomes

Ensure all residents’ changing care

needs are reported to Medicare as

soon as possible, maximising funding

Ensure time is not spent reviewing

the ACFI claims of residents claims

that are ineligible for resubmission.

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Procedure steps

Review all ACFI claims to determine which are currently eligible for voluntary

resubmission and should be reviewed.

Overview

Check Medicare for mandatory ACFI submissions, noting the required submission

date and type of assessment.

Procedure steps via Medicare

Identify claims >12 months old,

excluding HHH claims

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Click ‘Print Payment Statement’

4. Scroll down to ‘Permanent Care

Recipient Details’

5. Visually assess which residents have

a Reappraisal dates of the current

date minus 1 year. These are

residents with claims > 12 months old.

6. Scroll down to ‘Permanent Care

Recipient Payments’ and check

each identified resident to

determine their current claim level.

7. Note which residents are non-HHH

for follow-up.

Identify claims <12 months old,

excluding MHH and HMH claims

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Click ‘Print Payment Statement’

4. Scroll down to ‘Permanent Care

Recipient Details’

5. Visually assess which residents have

a Reappraisal dates within 12

months of the current date. These

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Planning dashboard

2. Click ‘Identify’ pane

3. Click ‘Resident Listing’ tab

4. Click ‘Remove HHH & (MHH & HMH

<12 months)’ button

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Procedure steps via Medicare (cont.)

are residents with claims < 12 months

old.

6. Scroll down to ‘Permanent Care

Recipient Payments’ and check

each identified resident to

determine their current claim level.

7. Note which residents are non-MHH or

HMH for follow-up.

System view

Menu > Planning > Identify

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Procedure steps

Extract detailed claim data for each resident to be reviewed.

Overview

Existing claim data for each resident must be extracted for use in review discussion

to identify where residents’ care needs have changed.

Procedure steps via Medicare

1. Log in to Medicare Aged Care

Online Claiming and click ‘Care

recipient search’

2. Enter surname and Care Recipient ID

of a resident

3. Click ‘Display Profile’

4. Click ‘Classification Details’

5. Click ‘View Webform’

6. Click ‘ACFI Checklists’

7. Click ‘Expand All’

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Planning dashboard

2. Go to Identify pane and click

‘Details’ next to each resident

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System view

Menu > Planning > Identify > Details

Tip: clicking will display more detailed information about a

resident’s current claim.

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Procedure steps

Discuss residents care needs and record details of review discussions

Overview

Record outcome of review discussion and prioritise based on the financial impact of

each projected claim.

Procedure steps via Medicare

Calculate the difference between the

existing claim level and the projected

revised claim.

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Click ‘Print Payment Statement’

4. Scroll down to ‘Permanent Care

Recipient Payments’

5. Identify the resident for reassessment

in this section.

6. View their current daily payment

under the ‘RATE Per Day’ column.

7. Identify the daily payment amount

of their projected revised claim by

viewing (GVMT DOC – FIND

NAME/SOURCE)

8. Deduct current payment from

projected, revised payment in order

to identify financial outcomes of

resubmission on a daily basis.

Based on these calculations and the

requirements of each claim, organise

these claims into a priority list.

1. Organise all identified claims into a

list.

2. Sort list by potential uplift value.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Planning dashboard

2. Navigate to the ‘Identify’ pane

3. Click the ‘Note’ button to the right of

the relevant resident’s name

4. Then:

o Select Target ACFI or Review

no action (1)

o Enter note (2), submission

date (3) and target ACFI (4).

o Click Submit

5. Navigate to ‘Voluntary’ pane to

review priority listing

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System view

Mirus Metrics > Planning > Identify > Resident Listing

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Quality & Risk

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Rejections & Reconciliation

Procedure details

Medicare needs to be checked for rejections and reconciliations once ACFI events

have been submitted. The high level tasks and related outcomes are detailed below

along with the report required to complete them.

Tasks

Review rejections with Medicare

and action as appropriate

Reconcile ACFIs submitted versus

ACFIs paid and action as

appropriate

Review residents on extended

hospital leave and action as

appropriate

Review Oxygen and Enteral Feeding

supplements in line with ACFI claims

Review ACFI claims in line with

Oxygen and Enteral Feeding

supplements

Outcomes

Ensure claims are received and

accepted by Medicare

Ensure paid ACFIs reflect ACFIs

submitted

Ensure leave events have been

processed correctly Identify

potential workload for ACFI process

Ensures all supplement entitlements

are being received

Ensures all ACFI Complex Health

Care procedures are claimed

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Procedure steps

Review rejections with Medicare and action as appropriate.

Overview

Confirm ACFI related events submitted to Medicare have been accepted to ensure

there are no discrepancy which could cause reduced payments and/or increased

workload.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Event

Search’

2. Select ‘Residential Aged Care ACFI

Event’ in ‘Event Type’ drop down

menu

3. Select ‘Rejected’ from the ‘Event

Type’ drop down menu

4. Click search to view list of rejected

ACFI events

5. Click ‘view’ next to each rejected

claim

6. Look under ‘Processing

errors/messages’ to view the

rejection code and code meaning.

7. Allocate action to appropriate

owner

8. Repeat steps 2-4 to confirm rejection

has been processed; when the

event no longer appears in the list of

rejections, this is the case

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Rejections dashboard (Menu >

Quality > Rejections)

2. Review code for each rejected

event (see xyz)

3. Allocate action to appropriate

owner and add note

4. Follow up until resolved and mark as

closed

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System view

Menu > Quality > Rejections

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Procedure steps

Reconcile ACFIs submitted versus ACFIs paid and action as appropriate.

Overview

Confirm ACFI claims submitted to Medicare are being paid correctly. If there are

discrepancies payments may be reduced.

Note: The following steps can only be completed once the previous month has

finalised.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Click ‘Print Payment Statement’

4. Return to ‘Event Search’

5. Enter dates for the previous month

6. Select ‘Residential Aged Care ACFI

Event’ in ‘Event Type’ drop down

menu

7. Click ‘view’ next to the individual

resident you wish to investigate the

payment for

8. Compare the submitted claim to the

paid claim sourced on payment

statement

9. Allocate action to appropriate

owner

10. Repeat steps 2-8 to confirm variance

has been cleared or record reason

for variance

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Submitted vs. Paid dashboard (Menu

> Quality > Submitted vs. Paid)

2. Review each resident’s payments

(Details > More)

3. Allocate action to appropriate

owner and add note

4. Follow up until resolved and mark as

closed

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System view

Menu > Quality > Submitted vs. Paid

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Procedure steps

Review residents on extended hospital leave and action as appropriate.

Overview

Confirm hospital leave events have been processed correctly with Medicare and

identify potential workload for ACFI Planning.

Procedure steps via Medicare

1. Obtain clinical report with list of

residents currently on leave

2. Log in to Medicare and click ‘Event

Search’

3. Select ‘Residential Aged Care ACFI

Event’ in ‘Event Type’ drop down

menu

4. Select ‘Leave’ from the ‘Event Type’

drop down menu

5. Click search to view list of leave ACFI

events

6. Click ‘view’ to the right of the

individual resident you wish to

investigate to get the details of their

leave event.

7. Compare leave report with ‘Start

Date’ and ‘End Date’ under the

Leave heading

8. Record any discrepancies and

allocate action to appropriate

owner

Procedure steps via Mirus Metrics

1. Obtain clinical report with list of

residents currently on leave

2. Log in to Mirus Metrics and view On

Leave dashboard

3. Compare leave report with residents

listed

4. Record findings by adding a note

and mark as investigated

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System view

Menu > Quality > On Leave

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Procedure steps

Review Oxygen and Enteral Feeding supplements in line with ACFI claims.

Overview

Confirm ACFI related supplements have been claimed in line with residents’ care

needs to ensure there are no discrepancies which could cause reduced payments.

Procedure steps via Medicare

1. Obtain report from Care Manager

which flags residents receiving

Oxygen and/or Enteral Feeding

2. Log in to Medicare Aged Care

Online Claiming and click ‘Care

recipient search’

3. Enter surname and Care Recipient ID

for the first resident on your list of

Oxygen/Enteral Feeding recipients.

4. Click ‘Display Profile’

5. Click ‘Classification Details’

6. Click ‘View Event’ on the most

recent ACFI event

7. Click ‘Complex Healthcare’

subsection

8. Scroll to the bottom and confirm

whether the resident’s claim includes

Procedure 13 and/or 17

9. Return to ‘Care recipient search’

10. Repeat steps 3-5

11. Click ‘Oxygen Details’ and

determine whether the resident is

receiving the Oxygen Supplement.

12. Click ‘Enteral Feeding Details’ and

determine whether the resident is

receiving the Enteral Supplement.

Procedure steps via Mirus Metrics

1. Obtain report from Care Manager

which flags residents receiving

Oxygen and/or Enteral Feeding

2. Log in to Mirus Metrics and view

Supplements dashboard

3. Click on each tab and compare

against (BLA) report

4. Record findings by adding a note

and mark as investigated

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Procedure steps via Medicare (cont.)

13. Follow up any disparities between

claimed supplements, ACFI claims

and administered care by:

Resubmitting ACFI claim reflecting

new, higher care requirements

Submit supplement application, with

start and end dates as appropriate

System view

Menu > Quality > Supplements

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Risk

Procedure details

Medicare needs to be checked to ensure all ACFI claims are congruent. The high

level tasks and related outcomes are detailed below along with the report required

to complete them.

Tasks

Perform congruence review of all

ACFI claims

Review currency of complex health

procedures

Outcomes

Reduced risk of downgrades during

validation

Ensure funding is received for

procedures being carried out

Ensure treatment records are

reflective of complex procedure

claims

Common Congruence Checks

Mobility ‘D’ + Wandering

If Mobility has been claimed as a D and any non-A level of Wandering has been

claimed, please review claim

Repositioning + Mobility non ‘D’, Wandering or Physical Behaviour

If 12.5 is selected, and Mobility has been claimed as a D, or a non-A level of

Wandering or Physical Behaviour has been claimed, please review claim

Palliative >12m old

If 12.14 is selected and the claim is >12 months old, please review claim

Depression ‘D’ + Cognition ‘D’

If Cognitive Skills and Depression have both been claimed as a ‘D’, please review

claim

Special Feeding + Nutrition ‘A’

If 12.6 is selected and Nutrition has been claimed as an ‘A’, please review claim

Stoma Care + Toileting ‘D’

If 12.15 is selected and Toileting has been claimed as a ‘D’, please review claim

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Procedure steps

Perform congruence review of all ACFI claims.

Overview

Confirm congruency of ACFI claims to ensure claims do not pose a validation risk.

Procedure steps via Medicare

1. Log in to Medicare Aged Care

Online Claiming and click ‘Care

recipient search’

2. Enter surname and Care Recipient ID

of a resident

3. Click ‘Display Profile’

4. Click ‘Classification Details’

5. Click ‘View Event’ on the most

recent ACFI event

6. Scroll down to the ACFI details

section to view the resident’s current

ACFI claim levels

7. Perform congruence check - see

Common Congruence Checks (p13)

8. Each congruence check has

different requirements – please see

below for some common examples

9. If there is a discrepancy, flag the

resident on an internal report for

immediate reassessment and

resubmission in order to avoid

validation risk

10. Repeat for all residents

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Reports dashboard

2. Select report ‘ACFI Breakdown and

CHC Procedures’, run for current

month and export as Excel

document

3. Perform congruence check - see

Common Congruence Checks (p13)

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System view

Menu > Reporting > ACFI Breakdown & CHC Procedures

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Procedure steps

Review currency of complex health procedures.

Overview

Confirm that all complex health procedures being undertaken are being claimed

and ensure all claimed procedures do not pose a validation risk.

Note: Internal clinical report must be available indicating which residents are

currently receiving any of the 19 Complex Health Care Procedures.

Procedure steps via Medicare

1. Log in to Medicare Aged Care

Online Claiming and click ‘Care

recipient search’

2. Enter surname and Care Recipient ID

of a resident

3. Click ‘Display Profile’

4. Click ‘Classification Details’

5. Click ‘View Event’ on the most

recent ACFI event

6. Click ‘ACFI 12: Complex Health

Care’

7. Compare the selected responses in

this section to the list of procedures

currently being provided

8. If there is a discrepancy,

9. If the resident has had their complex

health care procedure discontinued:

10. View the ‘Date/time event received’

11. Identify when the procedure was

discontinued

12. If this gap is >6mo, no action is

needed

13. If this gap is <6mo, please review

claim

Procedure steps via Mirus Metrics

1. Obtain clinical report (123)

2. Log in to Mirus Metrics and view

Reports dashboard

3. Select report ‘ACFI Breakdown and

CHC Procedures’, run for current

month and export as Excel

document

4. Referring to report (123), use filters to

compare procedures being

delivered with procedures being

claimed

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Procedure steps via Medicare (cont.)

14. If the resident is receiving a new

complex health care procedure

which is not being claimed:

o Flag ACFI claim for

resubmission reflecting new,

higher care requirements

o Repeat for all residents

System view

Menu > Reporting > ACFI Breakdown & CHC Procedures

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Finance

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Performance

Procedure details

Monitor and set lead KPIs against target to understand performance quicker and

before the payment file finalises. The high level tasks and related outcomes are

detailed below along with the report required to complete them.

Tasks

Set ADS KPI and monitor

performance

Set Assessment KPI and monitor

performance

Set Occupancy and Supported

Resident KPIs and monitor

performance

Review Payment Summary and

historical performance

Outcomes

Provides insight into future funding

and allows staff to understand how

they are performing sooner

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Procedure steps

Set ADS KPI and monitor performance.

Overview

The high level tasks and related outcomes are detailed below along with the report

required to complete them.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under View Payment

3. Under ‘View Payment Statement by’

select ‘Care recipient payments’

4. Calculate ADS as follows:

o Sum the total Adjusted

Subsidy for each resident

under column ‘RATE Per Day’.

o Divide this figure by the total

number of residents.

Note: Exclude any Default Rate

Adjusted Subsides from the calculation.

Where there is more than one Subsidy,

only use the most recent in the

calculation.

5. Repeat steps 1 to 4 for each Service

ID

6. Record output for month end

reporting.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Facility Overview dashboard

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System view

Menu > Facility Overview > Overview

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Procedure steps

Set Assessment KPI and monitor performance.

Overview

Existing claim data for each resident must be extracted for use in case

conferencing, allowing staff to identify where residents’ care needs have changed.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Event

Search’

2. Search for recently submitted claims

by selecting:

1. ‘Date from’ and ‘Date to’ to

choose date range

2. Service ID from ‘Aged Care

Service Number’

3. ‘Residential Aged Care

Funding Instrument Event’

from ‘Event Type’

4. Click ‘Search’.

3. Click ‘View’ next to each event and

note whether submission is ‘New

Entry’, ‘Mandatory Re-Appraisal’ or

‘Voluntary Re-Appraisal’.

4. Record output for month end

reporting.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Facility Overview dashboard

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System view

Menu > Facility Overview > ADS vs Reassessments > Reassessments

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Procedure steps

Set Occupancy and Supported Resident KPIs and monitor performance.

Overview

Existing claim data for each resident must be extracted for use in case

conferencing, allowing staff to identify where residents’ care needs have changed.

Procedure steps via Medicare

Calculate Occupancy %

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under ‘View Payment’

3. Click ‘Print Payment Statement’

4. Navigate to ‘Permanent Care

Recipient Details’ section

5. Calculate the total number of actual

bed days:

o Multiply the number of days in

the month by the number of

residents who were

permanent for the entire

month

o For residents who were

permanent for part of the

month, sum only the number

of days they were permanent

o Add these two figures

together

6. Calculate the total number of

potential bed days:

o Number of days in the month

multiplied by the total number

of approved places

7. Calculate the Occupancy % using

the figure from step 4 as a

percentage of the figure from step 5

8. Record output for month end

reporting.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Facility Overview dashboard

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Procedure steps via Medicare (cont.)

Calculate Supported Resident Ratio

9. Log in to Medicare and click ‘Claim

Search’

10. Select Service ID then click ‘Latest’

under View Payment

11. Click ‘Print Payment Statement’

12. Navigate to ‘Supported Residents

Details’ section

13. Sum the number of residents in this

section and calculate Supported

Resident Ratio as a percentage of

total permanent residents

System view

Menu > Facility Overview > Occupancy

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Procedure steps

Review Payment Summary and historical performance.

Overview

Existing claim data for each resident must be extracted for use in case

conferencing, allowing staff to identify where residents’ care needs have changed.

Procedure steps via Medicare

1. Log in to Medicare and click ‘Claim

Search’

2. Select Service ID then click ‘Latest’

under ‘View Payment’

Reporting on most recent finalised

month performance

3. Ensure ‘Payment Summary’ is

selected under ‘View Payment

Statement by’

4. Record output for month end

reporting

Reporting on historical monthly

performance

5. After logging in, Select Service ID

then click ‘Historical’ under ‘View

Payment’

6. Click on claim month required. Note:

this step will need to be repeated for

all months to be reported on.

Procedure steps via Mirus Metrics

1. Log in to Mirus Metrics and view

Facility Overview dashboard.

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System view

Menu > Facility Overview > Funding

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Index

A

Average Daily Subsidy

Care Revenue ................................................ 8–9

Finance & Operations ................................ 50–51

C

CHC Procedure Listing ................................... 44–45

E

Expiring .......................................................... 16–17

Extended Hospital Leave ............................... 36–37

F

Finance .......................................................... 47–57

N

New Entry ...................................................... 14–15

R

Reconciliation ................................................. 38–39

Rejections ....................................................... 32–33

Respite ........................................................... 18–19

S

Submission Activity ........................................ 10–11

Submitted vs. Paid ......................................... 34–35

V

Validation Review .......................................... 42–43

Voluntary ....................................................... 21–27

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If you would like further information, please contact Mirus Australia.

T 1300 738 145

E [email protected]

mirusaustralia.com