AN-ACC Reconsideration made simple
What is AN-ACC Reconsideration?
Reconsideration is a process of having a resident reassessed by another external AN-ACC assessor, if the initial classification is perceived to be incorrect.
Reconsideration is also referred to as Appeal.
Why is Reconsideration important?
Classification decision made by the external assessors can be incorrect. Some potential reasons are:
subjectivity in clinical judgement
honest human errors
Facility’s short-coming in describing the resident’s usual condition via:
The varying clinical status of the resident
What must you know about AN-ACC Reconsideration?
Unlike that of ACFI, Reconsideration under AN-ACC is completely voluntary.
In other words, if the Providers do not actively identify and request reconsideration, the perceived incorrect classification will not be reviewed.
A provider only has 28 days from the date of the original decision to lodge a reconsideration request.
After the new assessment has been completed, there several possible outcomes:
1. Confirm the original decision = No change
2. Vary the original decision to
1. upgrade to a higher classification, or
2. downgrade to a lower classification
In most cases, the funding changes resulting from a reconsideration take effect from the day of the original decision.
The new decision is final.
Currently, there is no fee for requesting Reconsideration.
What are the Reconsideration triggers?
Two eligible rationales for reconsideration are:
1. The assessor did not compete the assessment in a satisfactory manner, resulting in an inaccurate classification
2. The resident’s condition during the assessment did not accurately reflect their usual condition or relevant information was not considered, resulting in an inaccurate classification.
How to effectively manage AN-ACC Reconsideration?
Tips from our field experience:
A proactive approach, in which all initial classification and reclassification outcomes are systematically reviewed for accuracy.
Randomly requesting a large volume of reconsideration is not a good practice, which can potentially cause significant funding loss and further restrictions from the Department.
If you are still unsure, consider the Health Generation’s RECo framework for managing AN-ACC Reconsideration.
1. Review the original outcome.
Identify in which branch of the AN-ACC tree, the outcome differs from the projection/forecast
1st branch: mobility
2nd branch: cognitive ability, function, pressure sore risk
3rd branch: compounding factors
Review the available clinical evidence
Decide to either request a reconsideration or not
Determine the reconsideration trigger
Prepare a succinct Further Justification statement (1000-character limit)
2. Enable the reassessment
The request must be submitted within 28 days of receiving the original decision.
The facility team must be well prepared for the reassessment visit to enable the most accurate result.
Staff should be educated on the AN-ACC assessment process including the interviews.
Clinical documentation must be accurate, sufficient and up-to-date to support the assessment process
3. Confirm the final decision
Obtain the final classification decision
Ascertain whether it was an
Capture the lessons learned to guide future reconsideration decision.
Do you have gaps in funding knowledge and expertise?
Contact us to discuss how partnering with Health Generation will provide you the resources and expertise to smooth your transition to AN-ACC funding, and position your residential Aged Care home to deliver exceptional services.