Long Term Care Facility-SNF

Question 1

what is a SNF?

Answer 1

a healthcare institution that provides comprehensive nursing care and rehabilitation services to patients who need medical, nursing, or rehabilitative care but do not require hospitalization

Question 2

what care is provided in a SNF?

Answer 2

24-hour care by RNs and licensed practical nurses - administering medications, managing intravenous therapies, wound care, and monitoring vital signs

PT/OT/SLP

physicians and other healthcare providers regularly visit to monitor patient progress, adjust treatment plans, and address any medical issues

Question 3

what is the PT’s role in management?

Answer 3

clinical management

administration

interprofessional collaboration

d/c planning

continuing education

Question 4

what is involved in clinical management?

Answer 4

assess and treat pts

Question 5

what is involved in administration?

Answer 5

compliance and documentation

Question 6

what is involved in interprofessional collaboration?

Answer 6

team meetings/case rounds
and family/caregiver education

Question 7

what is involved in d/c planning?

Answer 7

build relationships with referral sources

Question 8

what is involved in continuing education?

Answer 8

pursuing specializations

Question 9

who is involved in the interprofessional team?

Answer 9

Administrator

Director of Nursing Services (DNS)

Social Worker

Nurse Practitioner (NP)

Registered Nurse (RN)

Licensed Practical Nurse (LPN)

Certified Nursing Assistant (CNA)

Registered Dietician

Physical Therapy

Occupational Therapy

Speech-Language Pathologist

Question 10

what are examples of managerial roles in SNFs?

Answer 10

traditional director of PT services (rarely seen bc discipline specific managers has decreased0

interprofessional director

area manager for rehabilitation services

the director of rehab

manager of contract therapy services

Question 11

what is the role of the area manager for rehab services?

Answer 11

responsible for several staffs and patient care in multiple facilities of a national chain of SNFs

regional managers may have similar duties as area managers but for more buildings

Question 12

what is the role of the director of rehab?

Answer 12

the larger the organization, the more likely it will be that unit supervisors will manage the day-to-day operations of these units

they may have some flexibility in shifting staff among units, as staffing needs demand

Question 13

what is the role of the manager of contract therapy services

Answer 13

negotiate contracts for assignment of physical therapists

Question 14

what are the biggest hurdles for PTs in SNFs?

Answer 14

lack of staffing and resources

burnout

ineffective maintenance programs or transition programs from skilled care

over utilization

productivity standard issues

billing and coding issues

lack of appreciation of the unique skills of a PT or PTA

expectation for performance of tasks just because they have always been done by therapy such as wheelchair cleaning or inventory

Question 15

what is revenue management?

Answer 15

making sure revenue exceeds expenses

budgeting revenue properly to account for staffing, new equipment, fixing equipment, etc

Question 16

what gives the SNF operators the tools to address financial challenges, monitor revenue streams, and identify any areas of potential improvement?

Answer 16

revenue cycle management

Question 17

t/f: RCM strengthens the financial stability of healthcare organizations by avoiding unnecessary costs, optimizing revenue collection, and minimizing claim deals, allowing SNFs to get through economic uncertainties

Answer 17

true

Question 18

what is the payment system for SNFs?

Answer 18

the patient-driven payment model

Question 19

what is the goal of the patient-driven payment model?

Answer 19

to improve payment accuracy by attending to each individuals circumstances and to classify them into payment groups in regard to specific data-driven patient characteristics

Question 20

what is the patient-driven payment model?

Answer 20

reimbursement is based on resident activity, rather than volume of services provided

Question 21

what are the concerns with the patient-driven payment model that the APTA addresses?

Answer 21

the level of therapy does not change because the payment model has changed

the amount of therapy a patient receives should be determined by the different health care professionals (interprofessional collaboration)

the amount should also be based on the patient’s needs and how they present.

Question 22

in order to make the adjustment to this payment system, PT’s were advised to do what?

Answer 22

conduct workflow analysis, identify opportunities for interprofessional collaboration, proactively address changes in plans of care, follow clinical practice guidelines, assess their knowledge of different regulatory aspects and their understanding of Medicare Part A, Medicare Part B, Medicare Advantage, and 3rd party payer rules

Question 23

what is required for Medicare part A coverage of SNF?

Answer 23

admitted to hospital for 3 days (counting day of admission but not d/c day)

transferred to SNF within 30 days of d/c (if more then you need another 3 day hospital stay)

requires skilled nursing services or rehab on a daily basis

Question 24

what is the cost to the pt for SNF day 1-20?

Answer 24

$0 (possible co-pay if on Medicare Advantage plan)

Question 25

what is the cost to the pt for SNF day 21-100?

Answer 25

$204

Question 26

what is the cost to the pt for SNF day 100+?

Answer 26

all costs

Question 27

what are the rules for Medicaid coverage of SNF?

Answer 27

must be in a medicaid-certified facility

available when other payment options are unavailable and the person has qualities for Medicaid

no limit to the number of days covered

Question 28

t/f: there is a limit to the number of days in SNF converted by Medicaid

Answer 28

false, the limit does not exist (iykyk)

Question 29

will private insurance typically cover the cost of short term care?

Answer 29

yes

Question 30

will private insurance typically cover the cost of long term care?

Answer 30

no

Question 31

what are the requirements to receive benefits from long term care insurance?

Answer 31

2+ ADLs must be limited or cognitive impairment

elimination period- must self pay for services for a predetermined number of days

Question 32

what is the coverage of long term care insurance?

Answer 32

will cover a predetermined daily limit until overall limit reached

will pay a set amount each day of admission

depends on plan