Reimbursement - Snf

Front 1

When was PPS introduced and put into effect?

Back 1

Introduced July 1998, went into effect Dec 1, 1998

Front 2

How are RUGs determined? How many are there?

Back 2

Using Minimum Data Set resident assessment instrument
53 RUGs (now 66)

Front 3

3 variables to describe nsg home residents?

Back 3

Clinical Characteristics (first letter)
Self performance on ADLs (third letter)
Counts of services received (second letter)

Front 4

7 categories a resident may be classified into?

Back 4

1. Rehabilitation
2. Extensive services
3. Special Care
4. Clinically complex
5. Impaired cognition
6. Behavioral problems
7. Reduced physical function

Front 5

How are the groups initially divided for Rehab and Extensive services group?

Back 5

First broke into groups by total min/wk of thearpy, days therapy/wk, # of therapy types
Then by ADLs

Front 6

How are Rehabilitation residents divided when figuring out what RUG category they fit in.. after put into an ADL group

Back 6

Based on minutes of rehab, days/wk and # of therapy services receiving OT, PT, ST
(RU, RV, RH, RM, RL)

Front 7

After a pt in the Rehabilitation group has been put into an intesnity level, what are they further divided into?

Back 7

ADL's
A, B, or C

Front 8

2 sections of the MDS we are concerned with?

Back 8

P - record minutes
T - Project minutes

Front 9

What is the MDS Schedule assessment days and what days does it pay

Back 9

5th: 1-14
14th: 15-30
30th: 31-60
60th: 61-90
90th: 91-100

Front 10

What are grace days? Why do we have them?

Back 10

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

Front 11

When do you record minutes for the MDS during a schedule period?

Back 11

The last 7 days

Front 12

How do you record minutes for the MDS?

Back 12

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

Front 13

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

Back 13

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

Front 14

Explain the stipulations of Group therapy and the MDS./

Back 14

Less than or equal to 4 pts/PT or PTA
No more that 25% of minutes can be group

Front 15

When can section T be used to project minutes?

Back 15

Only in the first few days of pt's stay

Front 16

Can services outside the building be included on the MDS?

Back 16

They may be considered... but are you really gonna take someone out of the building with PPS?

Front 17

Do family services count toward minutes on the MDS?

Back 17

Yessir as long as the patient is hangin out

Front 18

How many bills does Medicare accept from SNF each day?

Back 18

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

Front 19

Name some services that are not covered under "consolidated billing"

Back 19

Physician fees
PA and NP fees
Some homedialysis if they want to continue it when they enter the facility

Front 20

When is SNF negated from responsibility ... ie. they don't have to accept a pt back after they leave?

Back 20

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

Front 21

Difference btw concurrent and group therapy

Back 21

Concurrent: 2 or more pts receiving very different tx's
Group: 4 or less pts receiving similiar tx's

Front 22

What's the deal with Physician Certification?

Back 22

Doc must agree to POC - must sign it in reasonable amt of time... before facility bills Medicare

Front 23

When must the IE be?

Back 23

During the B's stay... even tho it doesn't count on the MDS

Front 24

What does it mean to be "Skilled?"

Back 24

Professoinal req'd: licensed PT
Supervision: PTA supervised by PT
Pertain to active POC containing complexity and sophistication and potential for pt resoration

Front 25

Routine vs. skilled

Back 25

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

Front 26

How often does rehab need to be if it is "skilled'

Back 26

5 days, 7 days if offer those services t/o whole week

Front 27

What is "Routine Restorative Services"?

Back 27

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.

Front 28

When would you bill Part B in a SNF

Back 28

Didn't get 3 day qualifying stay
Vaccinations and shit
B only pays coinsurance and deductible
Still req's doc certification/recert

Front 29

How are pt's ranked for ADLs?

Back 29

4-18 with 18 req'ing most assistance

Front 30

What is the OMRA?

Back 30

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

Front 31

How does a pt require for "rehab extensive"?

Back 31

Need therapy
ADL > 7
Another extensive qualifier (trach, vent, parenteral, suctioning)
All RUGs with an "X"

Front 32

Qualifiers for Ultra High category?

Back 32

720 mins therapy
2 types of therapy
1 therapy at least 5x/wk

Front 33

How does a pt qualifty for "Very High" category?

Back 33

500 mins/week
1 therapy at least 5x/wk

Front 34

How does a pt qualify for "High" category?

Back 34

325 mins/wk
1 therapy 5x/wk

Front 35

How does a pt qualify for "Medium" category?

Back 35

150 mins/wk
5 days, can be combined across 3 therapies

Front 36

How does a pt qualify for "low" category?

Back 36

45 min/wk
1 therapy service plus resotrative nursing
3 days or more/wk combined therapy

Front 37

What if you get 458 mins? What category?

Back 37

Rehab High - need 500 to go into Very High

Front 38

How are non rehab and extensive service pts divided in groups?

Back 38

Based on nursing rehab and depression signs

Front 39

Coninsurance for SNF

Back 39

$0 for first 20 days
$141.50 for 21-100
>100 days its all on the pt

Front 40

Medicare part B:
Deductive
Co-insurance
Premium
Cap

Back 40

$135
20% coinsurance
25% premium
$1870 cap for therapy services combine OT/PT

Front 41

Deductible for part A do get into a SNF?

Back 41

$1132