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78 Cards in this Set
- Front
- Back
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PPS
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Prospective Payment Systems
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CMS
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Centers for Medicare and Medicaid Services
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SNF
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Skilled Nursing Facility
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MDS
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Minimum Data Set
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RUG
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Resource Utilization Group
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ADL
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Activities of Daily Living
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STRIVE |
Staff time and resource intensity verification |
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LTCH
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Long-Term Care Hospital
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MS-LTC-DRGS |
Medicare Severity Long Term Care diagnosis related Groups |
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MS-DRGs
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Medicare Severity Diagnosis Related Groups
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IRF
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Inpatient Rehabilitation Facilities
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PAI
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Patient Assessment Instrument
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FIA |
Functional Independence Assessment Tool |
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IGC |
Impairment Group Code |
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RIC |
Rehabilitation Impairment Category |
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CMG
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Case Mix Group
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HIPPS
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Health Insurance Prospective Payment System
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IRVEN |
Inpatient Rehabilitation Validation and Entry |
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HHA
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Home Health Agency
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OASIS
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Outcome and Assessment Information Set
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HAVEN
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Home Assessment Validation and Entry System
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HHRG
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Home Health Resource Group
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HIPPS
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Health Insurance Prospective Payment System (Intelligent Code)
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LUPA
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Low Utilization Payment Adjustment
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Conversion Factor for LTCH (Long term Care Hospital) |
Standard federal rate |
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Conversion Factor for IRF (Inpatient Rehabilitation Facility) |
standardized payment |
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Conversion Factor for HHA (Home Health Agency) |
national standard episode amount |
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Forms to fill out for SNF (Skilled Nursing Facility) |
MDS (Minimum Data Set) |
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Forms to fill out for IRF (Inpatient Rehabilitation Facility) |
FIA & PAI (Functional Independence Assessment Tool) (Patient Assessment Instrument) |
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Forms to fill out for HHA (Home Health Agency) |
OASIS (Outcome and Assessment Information Set) |
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PPS (Prospective Payment Systems) Group - SNF (Skilled Nursing Facility) |
RUG (Resource Utilization Group) |
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PPS (Prospective Payment Systems) Group -
LTCH (Long Term Care Hospital) |
MS-DRG (Medicare Severity Diagnosis Related Group) |
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PPS (Prospective Payment Systems) Group -
IRF (Inpatient Rehabilitation Facility) |
CMG (Case Mix Group) |
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PPS (Prospective Payment Systems) Group -
HHA (Home Health Agency) |
HHRG (Home Health Resource Group) |
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Under Medicare's prospective payment system for long-term care hospitals, all of the following elements are used to group patients into a MS-LTC-DRG EXCEPT:
*Principal diagnosis *Complications and comorbidities *Qualifying diagnosis at acute inpatient hospital prior to admission to LTCH *Sex |
Qualifying diagnosis at acute inpatient hospital prior to admission to LTCH
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In terms of grouping and reimbursement, how are MS-LTC-DRGs and acute care MS-DRGs similar?
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Based on principal diagnosis
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True/False
When a patient has a CT scan done in the hospital while in SNF, Medicare may be billed separately for this procedure. |
False
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Which of the following is NOT one of the components of the payment rate for a RUG?
*Nursing component *Therapy component *Physician component *Non-case mix adjusted component |
Physician component
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A patient with which condition is an appropriate candidate for an LTCH?
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Ventilator-dependent emphysema
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In Medicare's prospective payment system for skilled nursing facilities, what classification is used to adjust for case mix?
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RUGs
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Under Medicare's prospective payment system for skilled nursing facilities, which healthcare service is excluded from the consolidated payment?
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Radiation therapy
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True/False
Even though Medicare-severity long-term care diagnosis related groups (MS-LTC-DRGs) are based on the same general factors as the acute-care MS-DRGs for the IPPS, MS-LTC-DRGs differ from acute-care MS-DRGs because MS-LTC-DRGs have different relative weights and use quintiles for low volumes.
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True
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What tool does the SNF PPS use to annually adjust the base rate for differences in local markets?
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Market Basket Index
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What tool does CMS require that skilled nursing facilities use to collect and to report clinical data on residents?
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Minimum Data Set (MDS)
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To be eligible for SNF, Medicare beneficiaries have to have:
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a 3 day acute care inpatient hospitalization
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True/False
In an LTCH facility, coders should code the diagnosis that the patient was treated for in the acute care hospital. |
False
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On the MDS 3.0, therapists report therapy by mode of delivery which includes all but:
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Retrospective
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In Medicare's prospective payment system for skilled nursing facilities, which data set determines a resident's classification into a resource utilization group?
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MDS
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What converts the MS-LTC-DRG into an unadjusted payment amount?
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Standard federal rate
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True/False
In SNFs, if the ADL index is low, the more dependent the resident is. |
False
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What tool does CMS require that long-term care hospitals use to collect and to report clinical data on patients?
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Long-term care hospital Continuity Assessment and Record Evaluation (CARE) data set
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What cost-sharing applies to a Medicare beneficiary who did NOT have an immediately preceding admission at an acute care hospital AND resides in an LTCH for 90 days?
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*Inpatient deductible for the 90-day benefit period
*Daily coinsurance payment for days 61 through 90 |
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In Medicare's prospective payment system for long-term care hospitals, what classification is used to adjust for case mix?
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MS-LTC-DRGs
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How many RUGS are there?
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66
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Patients with all the following conditions are appropriate candidates of LTCHs EXCEPT:
*Chronic tuberculosis *Sequelae of head trauma *Acute myocardial infarction *Ventilator-dependent emphysema |
Acute myocardial infarction
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The most commonly used of the post acute care systems is the:
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Skilled nursing facility
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CMS' analyst divide admissions to skilled nursing facilities into upper and lower categories. To which of the following categories does the "presumption of coverage" apply?
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*Rehabilitation Plus Extensive
*Rehabilitation |
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In most situations, for a facility to be defined as an LTCH, the lengths of stay of its Medicare patients must be at least how long?
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25 days
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In Home Health Agencies the unit of payment that consolidates services into one payment is called the:
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Episode of Care
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For what variations in resource consumption does Medicare's prospective payment system for home health services account?
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Number of therapy visits by a therapist
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In the HHPPS, what does the abbreviation LUPA stand for?
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Low-utilization payment adjustment
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Under Medicare's prospective payment systems for post-acute care, which component is directly adjusted by the local wage index?
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Labor portion
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In Medicare's prospective payment system for inpatient rehabilitation facilities, what classification is used to adjust for case mix?
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CMGs
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By the 4th day of hospitalization inpatient rehabilitation facilities require:
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Assignment of codes
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If a home health agency provides fewer than five visits in an episode, they can still receive payment under a/an:
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low-utilization payment adjustment
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In IRFs, all of the following reasons are purposes for codes EXCEPT:
*Conducting research *Grouping patients into case mix groups *Determining payment tiers *Documenting patients' functional statuses |
Documenting patients' functional statuses
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In Medicare's prospective payment system for home health services, what classification is used to adjust for case mix?
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HHRGs
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In Medicare's prospective payment system for home health services, what software is used to electronically submit data?
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Home Assistance Validation and Entry (HAVEN)
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True/False
DME is EXCLUDED from the HHPPS.
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True
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What is the term used in a rehabilitation facility to mean "a patient's ability to perform activities of daily living"?
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Functional status
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Within a 60-day episode of care, what home health care services are consolidated into a single payment to home health agencies?
*All therapy (speech, physical, and occupational) *Skilled nursing facilities *Medical social services *All of the above |
All of the above
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All of the following elements are part of the IRF PPS EXCEPT:
*Major diagnostic category *Impairment group code *Rehabilitation impairment category *Patient assessment instrument |
Major diagnostic category
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Which of Medicare's prospective payment systems for post-acute care is a per diem?
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Skilled nursing facility PPS
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True/False
For inpatient rehabilitation facility patients, codes on the IRF PAI should follow the UHDDS and the UB-04 guidelines. |
False
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All of the following dimensions are used to calculate an HHRG EXCEPT:
*Type of clinician providing services *Clinical severity *Functional status *Service utilization |
Type of clinician providing services
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What tool, that drives payment, is used to collect information about Medicare patients in the IRF PPS?
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Inpatient rehabilitation facility patient assessment instrument (IRF PAI)
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In an IRF, on what tool is/are patients' abilities to perform activities of daily living recorded?
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Functional Independence Measure (FIA) Assessment
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To be eligible for an Inpatient Rehabilitation Facility, a patient must:
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Be able to tolerate and benefit from 3 hours of therapy a day
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