Online claiming in the Aged Care sector

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Online claiming in the Aged Care sector
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About Medicare Australia

• Delivering Australia's universal health funding
  programs
• Medicare Australia is an Australian government
  agency in the Department of Human Services
  portfolio and plays an integral role in the
  Australian health sector.
• Its objective is to assist in improving health
  outcomes in Australia.
• Medicare Australia works in partnership with the
  Department of Health and Ageing to achieve the
  Australian Government's health policy objectives.
  
• Our activities are conducted within the
  government policy framework set by the Department
  of Health and Ageing, Department of Veterans'
  Affairs, Department of Families, Housing,
  Community Services and Indigenous Affairs and
  relevant legislation.

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Programmes administered by Medicare Australia

• Some of the programmes administered by
• Medicare Australia include
• Medicare
• Pharmaceutical Benefits Scheme (PBS)
• Aged Care Payments
• Australian Childhood Immunisation Register (ACIR)
• Australian Organ Donor Register (AODR)
• National Bowel Cancer Screening Program
• Practice Incentives Program (PIP)
• 30 Private Health Insurance Rebate
• Veterans Treatment Accounts
• Hearing Services program
• Compensation Recovery program

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Electronic claiming
Medicare Services
Pharmaceutical Benefits Scheme
74 processed electronically
98 processed electronically
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Medicare Australia and Aged Care

• Medicare Australia administers around 6.8
  billion worth of Aged Care
• payments annually to approved providers across a
  range of residential,
• community, and flexible Aged Care programs.
• Medicare Australia 's Aged Care payment
  responsibilities include the
• processing and payment of
• residential Aged Care subsidies and associated
  supplements for provision of high-level and
  low-level residential care
• residential respite care subsidies and associated
  supplements for provision of short-term
  high-level and low-level residential care, to
  provide carers with relief from their caring role
  
• community Aged Care package subsidies for
  provision of support to people with low-level
  complex health needs and their carers, to enable
  them to remain at home
• flexible Aged Care subsidies.

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Overview of Aged Care

• There are approximately 1,500 aged care providers
  managing 4,300 services. Of these services
  approximately 2,860 are residential care services
  and 1,050 community aged care services. The
  remaining 390 care types include e.g. Extended
  Aged Care at Home (EACH) and Dementia care
  packages.
• The sector consists mainly of not for profit
  organisations, however there are some fairly
  large privately run organisations as well as
  State and community run organisations, e.g. Amity
  Group Pty Ltd.
• Medicare Australia processed 34,341 residential
  claims, 12,752 community aged care package claims
  and 5,415 flexible care claims during the 2007/08
  financial year. In addition, our State based Aged
  Care teams process over 500,000 claims related
  forms during the year.
• Payments amounting to 6.8 billion per annum in
  aged care subsides.

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Online Claiming Take-up Strategy

• Key elements of the online claiming take-up
  strategy
• Choice strategy for Aged Care providers
• Integrated software vendor products
• Use of web forms as standalone solution for
  smaller providers
• Active engagement and supporting aged care
  providers
• Transition of early adopters to latest software
  release
• Working in partnership with software vendors
• Supporting Aged Care Assessment Teams (ACATs).

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Aged Care Online Claiming take-up
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Benefits of online claiming
Significantly reduce staff time required to
prepare and submit paper forms
Electronic reconciliation/validation process is
point in time
Improved access to data for use within business
and delivery of care including ACAT assessments
Benefits of Online Claiming
Improved business efficiencies
Its the way of the
Data entry is point in time
future
Reduced time in preparing monthly claims
Improved accuracy of information and payments
Faster feedback
Reduced Paperwork
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eBusiness initiatives

• Three elements to the eBusiness initiatives
• Online Claiming
• Web Forms
• Electronic Aged Care Client Record (eACCR)
  project.

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eBusiness initiatives

• Online Claiming
• Allows Aged Care Providers/Services to lodge key
  forms and claims electronically with Medicare
  Australia.
• View data and payment related information online.
• Replaces current paper forms based processing
  with electronic data lodgement and real time
  validation.
• Integrated solution with software vendor
  products.
• Statistics
• 2,166 (75) aged care services registered for
  Online Claiming.
• 1,391 (49) services transmitting (231 B2B, 1,228
  web forms).
• 14 Software vendors with Notice of Integration.

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eBusiness initiatives

• Web Forms
• Allows direct entry of Residential and Community
  Care events through a form based interface.
• No software vendor required access through
  internet via logon ID and Password.
• Available since 20 March 08 (only Aged Care
  Funding Instrument - ACFI).
• Developing additional web forms over the next 12
  months.

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ACFI Web Form

• The Aged Care Funding Instrument (AFCI)
  implemented in March 2008 introduced a new
  concept to the Aged Care sector to allow for
  direct entry of ACFI data into a web form via our
  website.
• Services were enabled to log onto the Aged Care
  Online Claiming website and submit their ACFIs
  for processing with simply, the click of a
  button.
• With the ACFI Web Form take-up increasing within
  the Aged Care sector, this provides the impetus
  for other claiming events to be developed using
  web forms.

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ACFI statistics
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Web Forms - future

• Conceptual design discussions were undertaken and
  requirements were identified to enable
• Provision for direct entry of web forms for all
  event types.
• A data management tool.
• A single access point for submitting and
  updating web forms.
• Consolidation of a Care Recipients web forms,
  B2B and File Upload events.
• Links to claim and payment statement
  information.

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Web Forms - future
To view Care Recipient Profile, a search must be
performed for your care recipient
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Web Forms - future
Selection of a Register New link will allow
the operator to submit a new Web Form for that
Care Recipient
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Web Forms - future
Register Residential Leave Web Form Different
Web Form, same deign
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Web Forms - future

• Care Recipient Profile will provide
• A data management tool in the form of a Care
  Recipient Profile.
• Web Forms details submitted for care recipients
  will be Immediately displayed on the Care
  Recipient Profile with a processing status.
• View links to existing web form information.
• More Info pop up icons will be available to
  assist operators
• with detailed information required for each
  section within the Care Recipient Profile.
• A tab structure for Accepted, Outstanding and
  Historical to easily identify where your web
  form is at.
• A success message on submission of a web form.

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Web Forms - future

• Web Forms will provide
• Introduction of a total of 13 new web forms, all
  accessed via the Care Recipient Profile
• - Residential Permanent Entry (REN)
• - Residential Respite Entry (REN)
• - Residential Departure (RDP)
• - Residential Leave (RLE)
• - Residential Extra Service (RES)
• - Residential Enteral Feeding End Date (REE)
• - Residential Oxygen End Date (ROX)
• - Residential Liability (RLI)
• Existing ACFI (RFI)
• - Community Commencement (CEN
• - Community Departure (CDP)
• - Community Leave (CLE)
• - Community Hours of Service (CHS)
• - Community Location (CLO

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Web Forms - future
Implementation will take a phased approach, with
the Care Recipient Profile and several of the
Residential web forms being available in early to
mid 2009. A second staged release of the
remaining Residential and all Community Web Forms
being implemented in mid 2009.
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eBusiness initiatives

• Electronic Aged Care Client Record (eACCR)
  Project
• Provides Aged Care Assessment Teams (ACAT) with
  ability to electronically capture, lodge
  correct an Aged Care Client Record (ACCR) with
  Medicare Australia.
• Medicare Australia has been working closely with
  DoHA, State/Territory Evaluation Units and
  participating ACATs.
• Blacktown ACAT first team in NSW to send an eACCR
  on 14 Sept 07.
• Around 117 ACATs across Australia.
• Statistics
• 9 ACATs participating in demonstration phase
  (Blacktown, Goulburn, Swan, Geraldton,
  Heidelberg, Eastern Vic, Bathurst, Warrnambool,
  Caulfield).
• About to commence Westmead, ACT (1 team) and
  Tasmania (3 teams).
• 3 State based evaluation units received notice of
  integration (NSW, VIC, WA).
• 7,377 electronic aged care client records sent to
  Medicare Australia to date.

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What providers are saying?
With the introduction of Business to Business
(B2B) channel with Medicare Australia I can now
submit not just my RER, RCS and RDP events but
also leave, supplements and liability. I am also
able to finalise, check and submit the claim at
the end of the month. Plus I have the ability to
check on the progress of what I have submitted to
Medicare Australia. That way I can ensure that
they have received, processed and accepted what I
have submitted, or if we have made an error in
the data we have submitted. Eileen Kielty,
Director of Care, Assisi Centre Aged Care Victoria
"We have been a long term supporter of electronic
business and encourage other providers to look at
the short and long term benefits to be gained for
your organisation in joining us now. Phillip
Parry, Torbay Aged Care and Retirement Village
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Questions
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Thank you