Home Health Care - Regulations And Reimbursement

Front 1

Subrogation

Back 1

If someone else is responsible for your healthcare costs you can elect to have your insurance pick it up first

Front 2

Medicare covers what kind of costs for SNFs?

Back 2

Routine, axillary and capital costs

Front 3

The resident assessment instrument used for RUG classifications?

Back 3

the Minimum Data Set (MDS)

Front 4

3 variables used to describe nursing home residents?

Back 4

1) Clinical characteristics
2) Self performance on ADLs
3) Counts of services received

Front 5

Scale for ranking ADLs?

Back 5

4-18; the higher the number the more assistance the pt requires to complete the ADL

Front 6

What is considered "extensive" in the MDS?

Back 6

ADL of at least 7

Front 7

Conditions for "Ultra High?"

Back 7

1) Need 720min/wk
2) Need minimum of 2 therapy services

Front 8

Conditions for "Very High?"

Back 8

1) Need 500min/wk
2) 1 Therapy service

Front 9

Conditions for "High?"

Back 9

1) Need 325min/wk
2) 1 Therapy service

Front 10

Conditions for " Medium?"

Back 10

1) Need 150min/wk
2) 5 days of combined therapy across 3 different services

Front 11

Conditions for "Low?"

Back 11

1) 45min/wk
2) 1 therapy + nursing service OR 3 days or more of combined services

Front 12

Explain how pts in rehab services would be classified into a certain RUG

Back 12

1) pt would be split into ADL subgroups
2) Next divided based on nursing rehab services and depression signs?
3) Divided in groups from minutes of rehab
4) Level of intensity

Front 13

Grouping pts by level of intensity are based on?

Back 13

1) Total minutes of therapy/wk
2) Days of therapy/wk
3) Number of types of therapy

Front 14

Describe section P of the MDS?

Back 14

Number of days & minutes of therapy completed by the patient in 7 days

Front 15

What is section T?

Back 15

It's used to project minutes

Front 16

Schedule assessments must be done by the these days:

Back 16

5th day
14th
30th
60th
90th

Front 17

PTAs require what kind of supervision?

Back 17

General supervision:
1) No initial eval
2) Periodic supervision

Front 18

What are not included as time on the MDS?

Back 18

1) Initial evaluation
2) Documentation time
3) Group Tx over 25% of min/wk or with more than 4pts per PT or PTA

Front 19

Services not required to be consolidated by medicare?

Back 19

1) Physicians, PAs and NPs

Front 20

How must part B be billed to medicare?

Back 20

By using HCPCS (Healthcare Common Procedure Coding System) codes

Front 21

Concurrent therapy?

Back 21

AKA "Dove Tailing." Example: 1 pt on e-stim while PT is working with another pt

Front 22

Group therapy?

Back 22

Working with a common goal with more than one patient

Front 23

When must a physician certify the POC?

Back 23

Before Medicare is billed

Front 24

Example of routine service vs skilled?

Back 24

Routine is used when the PT can't justify treating the patient with the current POC b/c the pt isn't seeing immediate results BUT the POC can still be carried out as routine through the department. It's just not considered skilled; the PT cost center will still get some money.

Front 25

How is part B billed for SNF?

Back 25

Fee Schedule

Front 26

HHRG

Back 26

Home Health Resource Group

Front 27

LUPA

Back 27

Low Utilization Payment Adjustment - For when the HHA doesn't deliver 5 or more visits

Front 28

OASIS

Back 28

Outcome and Assessment Information Set

Front 29

SCIC

Back 29

Sudden Change in Condition

Front 30

RAC

Back 30

Recovery Audit Contractors - to detect and correct past improper payments

Front 31

PEP

Back 31

Partial Episode Payment - when a pt is d/c then readmitted within the original 60 day episode

Front 32

RAP

Back 32

Request for Anticipated Payment - our bill after the SOC is completed and the HHRG is calculated

Front 33

To receive 100% medicare coverage for HC benefits these 6 conditions must be met:

Back 33

1) Eligible Medicare Beneficiary
2) Physician signs off on Rx and POC
3) Must be homebound
4) Tx must be in place of residence
5) Must be a certified HHCA
6) Pt must need skilled nursing services on an intermittent basis OR OT or PT

Front 34

Define homebound

Back 34

A taxing effort to leave the home

Front 35

Top 2 sources of payment to HHCA?

Back 35

1) Medicare
2) Medicaid

Front 36

Case Mix Index?

Back 36

A scale the measures the relative difference in resource intensity among different groups in the clinical model.

Front 37

3 components of the Case Mix Index?

Back 37

1) Clinical Severity
2) Function
3) Service domains

Front 38

CoPs?

Back 38

Conditions of Participation - The safety and quality standards that an HHA

Front 39

Factors of Oasis

Back 39

Transfers
Hospitalizations
Ambulation
Wound status
Emergent Care
Dyspnea
Bathing
Urinary incontinence
Meds
Discharge to community
Infections
Pain with activity

Front 40

Repercussion for not reporting OASIS data?

Back 40

2% decrease in payments

Front 41

Referrals must contain:

Back 41

1) Physicians orders
2) Diagnosis
3) Pay source
4) Continuity of Care signed IF referred from SNF, hospital or rehab

Front 42

Payor qualifications for medicaid?

Back 42

Same as Medicare but does not have to be homebound. Can even have custodial care with medicaid.

Front 43

Payor qualifications for commercial?

Back 43

Variable, about the same as medicare but usually slightly more restrictive

Front 44

Building the HHRG is based on?

Back 44

national standardized 60 day episode payment adjusted for case mix and wage index.

Front 45

Scoring thresholds for the case mix index?

Back 45

1) 0-13 visits
2)14-19 visits
3) 20+

Front 46

Standardized patient assessment tool?

Back 46

The CARE instrument

Front 47

HHCAHPS?

Back 47

Home Healthcare Consumer Assessment of Healthcare Providers and Systems - survey to patients where the rate their experiences

Front 48

VBP initiative?

Back 48

Value Based Purchasing initiatives - Uses OASIS-C and CAHPS to create $ incentives