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Mirus Metrics
Process Companion
© 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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | ii
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 1
Getting Started
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 2
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.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 3
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.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 4
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 5
Care Revenue
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© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 7
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.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 8
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 9
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.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 10
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 11
System view
Menu > Performance > Average Daily Subsidy
Tip: Tap or hover over the bars on the chart to see exact numbers.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 12
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 13
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.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 14
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 15
System view
Menu > Planning > Mandatory > New entry
Tip: Select to see basic information such as Date of Birth and
Care Recipient ID.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 16
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 17
System view
Menu > Planning > Mandatory > Expiring
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 18
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 19
System view
Menu > Planning > Mandatory > Respite
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 20
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 21
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.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 22
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 23
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 24
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 25
System view
Menu > Planning > Identify > Details
Tip: clicking will display more detailed information about a
resident’s current claim.
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 26
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 27
System view
Mirus Metrics > Planning > Identify > Resident Listing
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 28
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 29
Quality & Risk
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 30
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 31
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 32
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 33
System view
Menu > Quality > Rejections
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 34
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 35
System view
Menu > Quality > Submitted vs. Paid
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 36
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 37
System view
Menu > Quality > On Leave
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 38
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 39
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 40
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 41
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
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 42
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)
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 43
System view
Menu > Reporting > ACFI Breakdown & CHC Procedures
© Mirus Australia Mirus Metrics Process Guide v1.0.3 | 44
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
mirusaustralia.com