Mirus Metrics Process Companion

Transcription

1 Mirus Metrics Process Companion

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3 Contents Getting Started... 1 Executive Summary... 2 Key Functions... 3 Glossary... 4 Care Revenue... 5 Performance... 7 Planning (Mandatory Assessments) Planning (Voluntary Assessments) Quality & Risk Rejections & Reconciliation Risk Finance Performance Index Mirus Australia Mirus Metrics Process Guide v1.0.3 i

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5 Getting Started Mirus Australia Mirus Metrics Process Guide v

6 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 v

7 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 v

8 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 v

9 Care Revenue Mirus Australia Mirus Metrics Process Guide v

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11 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 v

12 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 o Sum the total Adjusted Subsidy for each resident under column RATE Per Day. 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 v

13 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 v

14 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 o o o Date from and Date to to choose date range Service ID from Aged Care Service Number Residential Aged Care Funding Instrument Event from Event Type 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 v

15 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 v

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17 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 v

18 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 v

19 System view Menu > Planning > Mandatory > New entry Tip: Select Care Recipient ID. to see basic information such as Date of Birth and Mirus Australia Mirus Metrics Process Guide v

20 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 v

21 System view Menu > Planning > Mandatory > Expiring Mirus Australia Mirus Metrics Process Guide v

22 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 v

23 System view Menu > Planning > Mandatory > Respite Mirus Australia Mirus Metrics Process Guide v

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25 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 v

26 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 v

27 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 v

28 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 v

29 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 v

30 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 o o Select Target ACFI or Review no action (1) Enter note (2), submission date (3) and target ACFI (4). Click Submit 5. Navigate to Voluntary pane to review priority listing Mirus Australia Mirus Metrics Process Guide v

31 System view Mirus Metrics > Planning > Identify > Resident Listing Mirus Australia Mirus Metrics Process Guide v

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33 Quality & Risk Mirus Australia Mirus Metrics Process Guide v

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35 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 v

36 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 Procedure steps via Mirus Metrics 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 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 v

37 System view Menu > Quality > Rejections Mirus Australia Mirus Metrics Process Guide v

38 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 Procedure steps via Mirus Metrics 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 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 v

39 System view Menu > Quality > Submitted vs. Paid Mirus Australia Mirus Metrics Process Guide v

40 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 v

41 System view Menu > Quality > On Leave Mirus Australia Mirus Metrics Process Guide v

42 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 Return to Care recipient search 10. Repeat steps 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 v

43 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 v

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45 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 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 is selected and Toileting has been claimed as a D, please review claim Mirus Australia Mirus Metrics Process Guide v

46 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 v

47 System view Menu > Reporting > ACFI Breakdown & CHC Procedures Mirus Australia Mirus Metrics Process Guide v

48 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 Mirus Australia Mirus Metrics Process Guide v

49 Procedure steps via Medicare (cont.) 14. If the resident is receiving a new complex health care procedure which is not being claimed: o o System view Flag ACFI claim for resubmission reflecting new, higher care requirements Repeat for all residents Menu > Reporting > ACFI Breakdown & CHC Procedures Mirus Australia Mirus Metrics Process Guide v

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51 Finance Mirus Australia Mirus Metrics Process Guide v

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53 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 Mirus Australia Mirus Metrics Process Guide v

54 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 o Sum the total Adjusted Subsidy for each resident under column RATE Per Day. 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 Mirus Australia Mirus Metrics Process Guide v

55 System view Menu > Facility Overview > Overview Mirus Australia Mirus Metrics Process Guide v

56 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 Mirus Australia Mirus Metrics Process Guide v

57 System view Menu > Facility Overview > ADS vs Reassessments > Reassessments Mirus Australia Mirus Metrics Process Guide v

58 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 o o Multiply the number of days in the month by the number of residents who were permanent for the entire month For residents who were permanent for part of the month, sum only the number of days they were permanent 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 Mirus Australia Mirus Metrics Process Guide v

59 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 Mirus Australia Mirus Metrics Process Guide v

60 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. Mirus Australia Mirus Metrics Process Guide v

61 System view Menu > Facility Overview > Funding Mirus Australia Mirus Metrics Process Guide v

62 Index A Average Daily Subsidy Care Revenue Finance & Operations C CHC Procedure Listing E Expiring Extended Hospital Leave F Finance N New Entry R Reconciliation Rejections Respite S Submission Activity Submitted vs. Paid V Validation Review Voluntary Mirus Australia Mirus Metrics Process Guide v

63 If you would like further information, please contact Mirus Australia. T E info@mirusaustralia.com mirusaustralia.com Mirus Australia Mirus Metrics Process Guide v