Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
Balance Budget Act
|
1997
Designed to hold down escalating medicare costs Priced Based System- rates set in advance |
|
|
RUG- what does it stand for
|
resource utilization group
|
|
|
Qualifiers for SNF med A stay
|
3 day hospital stay
total of 100 days in benefit (spell of illness) Get skilled Nursing or rehab |
|
|
Deferred Therapy
|
Medicall Predictable readmit- Must have an order from the doctor when leaving the hospital. Only exception for going outside of the 30 day window.
|
|
|
" Daily" in a NH is defined as
|
5 days for therapy
7 for nursing |
|
|
MDS
|
minimum data set
assessment tool to identify resident problems and faciliate care management through an individualized care plan -determines reimbursement |
|
|
Purpose of MDS
|
Reimbursemnt
monitor QOC Consumer info reports |
|
|
When are MDS assessments required
|
Day 5, 14, 30, 60 and 90 of the stay
|
|
|
Who determines the RUG category
|
the information entered into the computer..and the computer decides
|
|
|
how many rug groups are there
|
66- determined using predetermined items coded on the MDS assessment
|
|
|
CMS
|
center for medicaid services- determine the RUG category payment rates
|
|
|
What categories determine the RUG
|
1.Number of therapy (in days and min) needed during a7 day period
2. Severity of condition 3. ADL score |
|
|
what is the min amt of minutes must you have for therapy to be considered 1 day
|
atleast 15 minutes or more
|
|
|
how many modes of therapy are there
|
3
individual group concurrent |
|
|
How many people must be in a group for it to be considered group therapy- part A
|
4 residents
Must be performing similar activities and be supervisied by the OT/OTA who are not seeing any other residents |
|
|
What is the group requirements for Med part B
|
2 or more residents
may or may no be performing the same activitiy |
|
|
Concurrent - Part A
|
two residents treated at same time
not performing same or similar acitivities must be in line of site of treating therapist |
|
|
What day is the start and end date
|
start: Day of Eval
end: most recent therapy regimen-last day they were provided therapy |
|
|
what is billable when using a rehab aid or tech?
|
not when providing services but you can bill if set up for treatment
|
|
|
What areas does the MDS look at to determine the score
|
Bed Mobility
Transfers Ambulation in Room Ambulation in Corridor Locomotion on Unit Locomotion off Unit Dressing Eating Toilet Use Personal Hygiene Bathing |
|
|
Column 1 levels
|
Independent
Supervision Limited Assistance Extensive Assistance Total Dependence Activty occured only once or twice Activity did not occur |
|
|
Rehab Category- Ultra High
|
720 min therapy over 7 days
atleast 2 disciplines, one at least 5 days/wk, the other atleast 3 days/wk |
|
|
Rehab category- Very high
|
500 min over 7 days
atleast 1 discipline 5 days a wk |
|
|
Rehab category- high
|
325 min over 7 days
atleast 1 discipline, 5 days/wk |
|
|
Rehab category- Medium
|
150 min over 7 days
5 days across 3 disciplines |
|
|
Rehab category- Low
|
45 min over 3 days
nursing 6days/week |
|
|
OMRA-
|
Other medicare required assessment
|
|
|
4 types of OMRA
|
Start of Therapy OMRA (SOT)
End of Therapy OMRA (EOT) Both Start and End of Therapy OMRA (BOT) Change of Therapy OMRA (COT) |
