Erlösverluste durch Fehlklassifikation von Behandlungsphasen und Leistungsumfang

Definition

The AMHCC links funding to prospectively assessed mental health phases of care (acute, functional gain, intensive extended, consolidating gain) and requires that the phase reflect the primary treatment goal and be reviewed when symptoms or functioning change.[2] An inter‑rater reliability study found only poor to fair reliability in clinicians’ application of phases, prompting IHACPA to refine guidance.[2] This documented variability shows that, without structured utilization review, many episodes are likely misclassified into lower resource phases than clinically justified, reducing casemix funding. The guide also notes that “assessment only” is a separate data item that does not require outcome measures and is not a full treatment phase, yet if cases are left in this state due to missing review, subsequent work may not be grouped into higher‑funded phases.[2] In PHN‑commissioned stepped‑care services, service utilisation data are linked to cost and hospital utilisation to assess impact and value.[3] Under‑recording session types, intensity, or duration reduces reported activity and can lead to lower contract renewals or performance‑based payments, representing structural revenue leakage. For a provider with AUD 3–5 million in annual mental health funding, a 3–7% leakage from miscoding and incomplete utilisation capture equates to AUD 90,000–350,000 per year (logic based on known coding‑error leakage ranges in activity‑based funding environments).

Why This Matters

The Pitch: Mental health services in Australia 🇦🇺 lose geschätzt 3–7 % ihres potenziellen Budgets each year because phases of care and service utilisation are mis‑ or under‑recorded. Automating phase‑of‑care prompts, utilisation audits, and charge capture can recapture AUD 75,000–250,000 annually per medium‑sized service.

Affected Stakeholders

Clinical coders and data managers, Mental health clinicians assigning phase of care, Service managers responsible for activity‑based funding, PHN contract managers, Finance and revenue assurance teams

Related Business Risks