Long term care Flashcards
1
Q
What does RUG stand for? Why are they used?
A
- Resource Utilization Groups
- used to prospectively determine reimbursement rates for Medicare part A beneficiaries in SNFs
2
Q
How many group classifications are there and what are they based on?
A
66; clinical condition, Services provided (resources used), Functional status
3
Q
What categories are the reimbursement groups based on?
A
- Extensive plus rehab services
- rehab catergories
- Extensive services (trache care, vent/resp, infection isolation)
- Special care high
- Special care low
- Clinically complex
- Behavioral sxs and impaired cognition
- Reduced physical function
4
Q
What documentation requirements do Medicare require after admission to a long term care facility?
A
- Ordered by MD
- clarification order by therapist
- Provided by qualified PT
- Professional therapist must develop POC/plan of Rx
- Physician must agree on the POC
- Services must by medically necessary and appropriate
- A certification order must be written by therapist every 30 days
- additional documentation request (SNF, Outpatient)
5
Q
Details of rehab categories:
A
- Ultra High: 720+ min/wk (atleast 2 disciplines 5x/wk)
- Very High: 500+ min/wk (atleast 1 discipline 5x/wk)
- High: 328+ min/wk (5x/wk by 1 discipline or combo of 2 disciplines)
- Medium: 150+ min/wk (5x/wk by only 1 discipline)
- Low: now longer a reimbursed category
6
Q
What are the documentation requirements for SNFs and how often does documentation have to occur to meet the requirment?
A
- Must be done daily
- MD order
- clarification order by therapist
- a 700 form or initial eval and POC (must be signed by MD
- Daily or weekly notes describing pt. prognosis and update of goals
- A reclarification very 30 days requesting continuation of services.
- A re-clarification order stating continuation of services once initial clarification has expired
- a d/c by the therapist (only if pt will be in LTC)
