AN-ACC Funding Review Process: Step-by-Step Guide for Providers

AN-ACC Funding Review Process: A Complete Guide for Aged Care Providers

The AN-ACC funding review process is the mechanism through which aged care providers can request reassessment of a resident's classification when their care needs change. Getting this process right is worth tens of thousands of dollars per resident per year. Getting it wrong — or simply not initiating reviews when they're warranted — is one of the most common sources of revenue leakage in residential aged care.

This guide walks through the review process step by step, from identifying triggers to maximising the probability of a successful reclassification outcome.

When to Initiate a Funding Review

A funding review should be initiated whenever there is a material change in a resident's care needs that may warrant reclassification to a higher AN-ACC class. Common triggers include:

• Significant cognitive decline (new dementia diagnosis, progression of existing condition)
• Increased assistance required for Activities of Daily Living
• New or escalating behavioural and psychological symptoms
• Increased clinical interventions (wound management, medication complexity, palliative care)
• Mobility deterioration requiring additional assistance or equipment
• Hospital admissions that result in changed functional capacity

The key principle is this: if you are delivering more care than the current classification funds, you should be requesting a review. The longer you wait, the more revenue you forfeit.

Step 1: Documentation Preparation

Before submitting a review request, ensure clinical documentation comprehensively reflects the resident's current care needs. The assessor will base their reclassification decision on documented evidence. Review the following documentation areas:

Care Plans: Updated to reflect current needs, interventions, and goals. Ensure care plans reference specific functional limitations and the level of assistance required.

Progress Notes: Minimum 30 days of detailed progress notes that demonstrate the changed care needs. Notes should describe what the resident can and cannot do independently, the type and frequency of assistance provided, and any behavioural observations.

Clinical Assessments: Updated ADL assessments, cognitive assessments (MMSE, PAS, RUDAS as appropriate), mobility assessments, and pain assessments. Use validated tools and document scores.

Specialist Reports: Any recent specialist reports, hospital discharge summaries, or allied health assessments that support the changed needs.

Step 2: Submitting the Review Request

Review requests are submitted through the My Aged Care provider portal. The request must include a clear statement of the reason for the review and identify the specific changes in the resident's condition. Be precise. Generic statements like "resident has deteriorated" are insufficient. Instead, document specific functional changes: "Resident now requires two-person assist for all transfers, previously required one-person assist. Mobility assessment score has declined from X to Y."

Step 3: Preparing for the Assessment Visit

Once the review request is accepted, an assessor will be scheduled to visit. Preparation for this visit is critical. Brief the clinical team — particularly the staff who know the resident best — on the key changes in the resident's condition. Ensure all documentation is organised and accessible. Have the relevant registered nurse available to speak with the assessor and answer questions about the resident's care needs.

Do not coach staff on what to say. Do ensure they can articulate the actual care being delivered and the reasons for any changes in care intensity.

Step 4: Review Outcome and Next Steps

After the assessment, the resident will be assigned a new AN-ACC class (or remain in their current class if the assessor determines the change does not warrant reclassification). If the outcome is a higher class, funding adjusts from the date of the new classification — not retrospectively. This is why timely review requests are so important.

If you disagree with the review outcome, you have the right to request a further review. Document your reasons clearly and provide any additional evidence that may not have been available at the time of the original assessment.

Building a Systematic Review Process

The providers who maximise their AN-ACC funding don't wait for obvious triggers. They build systematic processes that identify review candidates continuously. Implement a monthly screening of all residents by the clinical leadership team. Use a simple scoring matrix that flags residents whose care intensity has increased. Set a KPI for review submission — the target should be that every eligible review is submitted within 14 days of the trigger being identified.

Track your review outcomes over time. Measure your success rate — the percentage of reviews that result in reclassification to a higher class. A success rate below 60% suggests your trigger identification or documentation preparation needs improvement. A success rate above 80% suggests you may be too conservative in initiating reviews and leaving potential reclassifications on the table.