Final Exam Flashcards
What are the different types of Home Care?
Includes home health agencies, home care, personal-care providers, and hospice.
Omnibus Budget Reconciliation Act
Mandated the implementation of a new prospective payment system for skilled nursing facilities, home healthcare agencies, outpatient rehabilitation services, and other outpatient services provided to Medicare beneficiaries.
Prospective Payment System
Changed Medicare and Medicaid home care reimbursement from a cost-based system to a fixed-fee system based on a patient-need classification system.
Outcome and Assessment Information Set (OASIS)
Is a group of data elements that represent core items in a comprehensive assessment for an adult home care patient. The data elements for the basis of measurements used for outcome-based quality improvement.
Uniform Minimum Data Set (UDS)
Is a minimum set of informational items that have uniform definitions and predefined categories.
Community Health Accreditation Program (CHAP)
An accreditation organization whose core standards are related to information management, clinical records, and management information systems.
What are the 4 key processes for data that involve continuous improvement for data quality?
- Application: The purpose for which data are collected
- Collection: The processes by which data elements are accumulated.
- Warehousing: The processes and systems used to archive data and data journals.
- Analysis: The process of translating data into information used for an application.
What are the 4 general categories that govern admittance into a home care facility?
- Medical stability (with the exclusion of hospice patients)
- Desire for home care (or hospice)
- The suitability of the home environment
- Financial resources
How soon after a home health referral must the initial assessment visit take place?
The intake or clinical record documentation must specify a start-of-care date. According to Medicare COP, the initial assessment must be held within either 48 hours of referral or 48 hours of the patient’s return home or on the physician-specified start-of-care date.
In the absence of a physician-specified start-of-care date, the initial assessment visit is conducted within 48 hours of the referral. The physician specified start-of-care date supersedes the 48-hour time frame.
What happens when you elect hospice care?
When patient elect hospice care, they waive their rights to Medicare reimbursement for treatment of their principal (terminal) diagnosis and related conditions outside of care provided by the designated hospice.
What are the 4 general hospice care levels?
- Routine home care
- Continuous home care
- Inpatient respite care
- General inpatient care
Who are the main hospice employees?
- A doctor of medicine
- A doctor of osteopathy
- A registered nurse
- A social worker
- A pastoral counselor or another type of counselor
What does Medicare require of hospice facilities regarding medical record documentation?
- The health record must contain evidence that the interdisciplinary team plans and manages a patient’s care across all settings of care
- The health record must contain evidence that hospice interdisciplinary care continues when a patient is admitted for inpatient hospice care.
- Health record documentation must justify the level of hospice care the patient is receiving. When the status of a patient changes such that he requires continuous home care or inpatient care, clinical notes must document this change, and the care plan must be revised to indicate any new problems or changes in plans.
To be a Medicare-reimbursed home health facility, what conditions must the facility meet?
- the beneficiary is confined to home
- the beneficiary is under the care of a physician, who establishes and approves the plan of care for the individual
- the beneficiary needs intermittent, skilled nursing care, physical therapy, speech therapy services, or continuing occupational therapy.
What does it mean to be homebound?
Not necessarily bedridden, but leaving home must present considerable difficulty and be infrequent and of short duration unless for medical reasons.
What types of documentation should be monitored concurrently?
- Documentation generating charges (especially higher dollar amounts)
- Documentation for any physician charges
- Documentation for ancillary service billing.
Advance Directives
Are instruments patients can use to clarify treatment choices in the event that they lose the ability to do so. Two common types are living wills and durable powers of attorney.
Patient Outcome Measures
Are calculated on a completed episode of care that begins with admission to a Home Health Agency and ends with discharge or transfer to an inpatient facility. This is different from a home health prospective payment episode of 60 days. The patient outcome is defined as a change (or lack of change) in a patient’s condition during an episode of care.
What areas of hospice care should be studied annually?
- Symptom management
- Stress management
- Continuity of care
- Inpatient care
Inpatient Facilities
Provide patients with around-the-clock care.
Partial Stay or Day Treatment Programs
Provide individuals with mental health treatment that is more intense than the services provided on an outpatient basis.
- Typically, partial hospitalization is a four-hour-a-day, Monday through Friday program in which treatment may be provided in the morning, afternoon, or even early treatment,
- Day treatment is typically provided eight hours a day, Monday through Friday, during the work day.
Residential Programs
These programs provide a homelike environment and help residents build self-esteem, develop relationships, and improve life skills. Treatment can include individual psychotherapy, group therapy, vocational/educational counseling and support, and treatment for co-occurring addictions.
What are the 2 Types of Residential Programs?
- Group Residential Communities: Also called “group homes,” these family-like surroundings provide tools through which residents repair self-esteem, build skills, develop relationships, and learn to manage symptoms. They create a stable long term living arrangement.
- Apartment-Based Communities: Residents live in apartments while participating in a program of therapeutic activities, supportive relationships, and treatment. Clinicians may visit resident apartments to gain insight that enhances treatment and recovery.
