Desktop validation of your ACFI palliative care claims

Desktop validation of your ACFI palliative care claims

Are there are any ACFI Q12.14 claims that have been made for existing residents in your facility?

If so (and it hasn’t happened already) then feedback across the industry indicates that it is likely you will receive notification that this individual residents’ ACFI Appraisal Answer Pack will be subject to an external ‘desktop validation’

To prepare for this type of desktop validation, you should ensure that:

• The initial claim meets the definition of palliative care vs. a palliative approach
• That the directive has been made by a registered nurse (or medical officer) with the approved post-registration nursing qualifications and experience
• Documentation supports that program involved very intensive clinical nursing and/ or complex pain management
• The rest of the ACFI Appraisal Answer Pack (not just Q12.14) meets the requirements of the ACFI User Guide

This last point is especially important – even though a legitimate claim for palliative care may have been made initially, downgrades will occur in other areas of the ACFI claim if records for complex pain management aren’t readily available between the date of submission and today, errors are made in the way behaviours are described, etc

If the ACFI Complex Health Claim domain claim is entirely reliant on this directive, the loss of funding may be as high as $24,000 p.a.