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41 Cards in this Set
- Front
- Back
When was PPS introduced and put into effect?
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Introduced July 1998, went into effect Dec 1, 1998
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How are RUGs determined? How many are there?
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Using Minimum Data Set resident assessment instrument
53 RUGs (now 66) |
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3 variables to describe nsg home residents?
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Clinical Characteristics (first letter)
Self performance on ADLs (third letter) Counts of services received (second letter) |
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7 categories a resident may be classified into?
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1. Rehabilitation
2. Extensive services 3. Special Care 4. Clinically complex 5. Impaired cognition 6. Behavioral problems 7. Reduced physical function |
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How are the groups initially divided for Rehab and Extensive services group?
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First broke into groups by total min/wk of thearpy, days therapy/wk, # of therapy types
Then by ADLs |
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How are Rehabilitation residents divided when figuring out what RUG category they fit in.. after put into an ADL group
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Based on minutes of rehab, days/wk and # of therapy services receiving OT, PT, ST
(RU, RV, RH, RM, RL) |
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After a pt in the Rehabilitation group has been put into an intesnity level, what are they further divided into?
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ADL's
A, B, or C |
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2 sections of the MDS we are concerned with?
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P - record minutes
T - Project minutes |
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What is the MDS Schedule assessment days and what days does it pay
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5th: 1-14
14th: 15-30 30th: 31-60 60th: 61-90 90th: 91-100 |
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What are grace days? Why do we have them?
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Period of time after the "Schedule" where this no penalty for late MDS
Due to illness, weekends Offset insentive to begin a pt before he/she is ready Allow time for pt to qualify for higher RUG category |
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When do you record minutes for the MDS during a schedule period?
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The last 7 days
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How do you record minutes for the MDS?
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Actual minutes (not rounded)
Time starts when first tx initiated Ends when last tx ends Set-up time is included IE don't count, but re-evals do Documentation doesn't count |
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Which of the following either counts or does not count toward minutes on the MDS:
1. Set up time 2. IE 3. REeval 4. Documentation 5. Group therapy 6. PTA's/Aids 7. Students |
1. Set up included
2. IE not included 3. Reevals Count 4. Documentation not included 5. Group counted, but must be <25% of minutes/week 6. Counted - general supervision 7. Students count - DIRECT supervision |
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Explain the stipulations of Group therapy and the MDS./
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Less than or equal to 4 pts/PT or PTA
No more that 25% of minutes can be group |
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When can section T be used to project minutes?
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Only in the first few days of pt's stay
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Can services outside the building be included on the MDS?
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They may be considered... but are you really gonna take someone out of the building with PPS?
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Do family services count toward minutes on the MDS?
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Yessir as long as the patient is hangin out
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How many bills does Medicare accept from SNF each day?
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ONE per day. They must use consolidated biling.
This includes shit billed under Part B (ie. vaccinations) This only applies to Medicare Participating SNF's |
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Name some services that are not covered under "consolidated billing"
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Physician fees
PA and NP fees Some homedialysis if they want to continue it when they enter the facility |
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When is SNF negated from responsibility ... ie. they don't have to accept a pt back after they leave?
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B admitted to another medicare hospital/CAH/SNF
B receives care under POC from HHA B receives outpt hospital/CAH B discharged or departs SNF >24 hrs |
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Difference btw concurrent and group therapy
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Concurrent: 2 or more pts receiving very different tx's
Group: 4 or less pts receiving similiar tx's |
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What's the deal with Physician Certification?
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Doc must agree to POC - must sign it in reasonable amt of time... before facility bills Medicare
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When must the IE be?
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During the B's stay... even tho it doesn't count on the MDS
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What does it mean to be "Skilled?"
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Professoinal req'd: licensed PT
Supervision: PTA supervised by PT Pertain to active POC containing complexity and sophistication and potential for pt resoration |
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Routine vs. skilled
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Routine is performed by supportive personnel (ie aids doing ROM). This is not billable for Rehabilitation.... but time developing and trang personnel to do routine shit is billable
Skilled pertains to POC w/ complexity and sophistication and potential for pt restoration |
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How often does rehab need to be if it is "skilled'
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5 days, 7 days if offer those services t/o whole week
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What is "Routine Restorative Services"?
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PT oversees, manages, administers, trains, and instructs others to do restorative care
Used wehn potential of pt is insignificant to achieve with PT IMP b/c R&R can get reimbursed if delivered by salaried employees of resotrative dept, managed by PT dept. |
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When would you bill Part B in a SNF
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Didn't get 3 day qualifying stay
Vaccinations and shit B only pays coinsurance and deductible Still req's doc certification/recert |
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How are pt's ranked for ADLs?
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4-18 with 18 req'ing most assistance
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What is the OMRA?
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IF therapy is d/c, shit is no longer skilled and MDS nurse needs to fill this out
Need to do 8 days from last tx |
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How does a pt require for "rehab extensive"?
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Need therapy
ADL > 7 Another extensive qualifier (trach, vent, parenteral, suctioning) All RUGs with an "X" |
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Qualifiers for Ultra High category?
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720 mins therapy
2 types of therapy 1 therapy at least 5x/wk |
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How does a pt qualifty for "Very High" category?
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500 mins/week
1 therapy at least 5x/wk |
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How does a pt qualify for "High" category?
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325 mins/wk
1 therapy 5x/wk |
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How does a pt qualify for "Medium" category?
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150 mins/wk
5 days, can be combined across 3 therapies |
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How does a pt qualify for "low" category?
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45 min/wk
1 therapy service plus resotrative nursing 3 days or more/wk combined therapy |
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What if you get 458 mins? What category?
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Rehab High - need 500 to go into Very High
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How are non rehab and extensive service pts divided in groups?
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Based on nursing rehab and depression signs
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Coninsurance for SNF
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$0 for first 20 days
$141.50 for 21-100 >100 days its all on the pt |
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Medicare part B:
Deductive Co-insurance Premium Cap |
$135
20% coinsurance 25% premium $1870 cap for therapy services combine OT/PT |
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Deductible for part A do get into a SNF?
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$1132
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