EXAM 1: All Settings, Medicare Criteria, Laws Flashcards
Acute Care treatment session time, patients per day, length of stay, level
- 15-30 min
- 10-15 pts/day
- few days
- level 2
LTACH treatment session time, patients per day, length of stay, level
- 30-45 min
- 6-8pts/day
- 25+ days
- level 3 (subacute)
IRF treatment session time, patients per day, length of stay
- 45-90 min (of pt only? but 3 hrs total? or of just therapy?)
- 6-8 pts/day
- 2-3 wks
SNF treatment session time, patients per day, length of stay, level
- 30-45 min
- 8 pts/day
- 100 d/spell beginning at admission to a facility ending at 60 says w/o remission or facility
- level 3
Home Health treatment session time, patients per day, length of stay, level
- 45-60 min
- 5-6 pts/day
- stay: as long as homebound
- level 4
OP Therapy treatment session time, patients per day, length of stay, level
- 30-60 min
- 7-20+ pts/day
- N/A
- level 4
Medicare Criteria for LTACH
- pts physician ordered IP hospitalization for condition
- tx is medically complex and only provided in hospital
- require longer length of stay for tx (>25days)
Medicare Criteria for SNF
- needs 7 days of nursing or 5 days of therapy
- after qualified hospital stay (3 nights)
- w/o skilled therapy, condition would worsen
- services provided must be what was treated during stay or arose in SNF for previously treated condition
- can only be provided on an IP basis in SNF
- must be physician ordered therapy
Medicare Criteria for Home Health
- pt is confined to home
- pt must be under physician care and they periodically review POC
- in need of skilled nursing, PT, SLP … OR continuing need for OT
IDEA- A
- everyone is required to recieve education regardless of disabilities
- focus: education goal of EACH child
- lets children get ANY type of special ed service to help them learn
Section 504 of Rehabilitation Act of 1973
- for students w/ disabilities who dont qualify for special ed
- federally funded
- child may just need PT for physical impairment but no other special ed services
Early Intervention (IDEA part C)
- 0-3yo
- have a diagnosed physical or mental condition that has a high probability in resulting in developmental delay
Comprehensive OP Rehab Facility (CORF)
- medicare certified facility
- requires physician, PT, and psycho/social services
- PT/OT/SLP can be provided off site
POPTS
- physician owned interest in PT practice he/she refers
- referring MD, DO, DDS, DPM, Chiro gains financially from the referral
- APTA OPPOSES POPTS
Negative effects of referral for profit in POPTS
- unnecessary referrals to PT
- excessive durations/freq of tx
- excessive procedures administered
- higher charges
- referring physician can have undue influence on PTs clinical judgement
STARK LAW
- prohibits physician from referring MEDICARE pt to any designated health service if that physician holds a financial interest in that organization
- STOPS referral for profit
Anti-Kickback Statute
- prohibits the offer or receipt of any kickback, bribe, or rebate in the form of cash or any kind for referrals by physicians or their recommendations to purchase or lease supplies and services of patients insured under medicare and medicaid
Spontaneous Recovery Statute
- services are not to be considered reasonable and necessary covered therapy services when a pt suffers a transient and easily reversible loss or reduction of function which could reasonably be expected to improve spontaneously as the pt gradually resumes normal activities
Medicare Criteria for Home Health
- pt needs the aid of an assistive device
- the pt requires the assistance of another person to leave the home
- leaving the home requires considerable and taxing effort
- the patient is bed-bound and unable to leave the home
