OT Process- Continuum of care

Question 1

Inpatient settings

Answer 1

Acute care
Inpatient rehabilitation
Subacute rehabilitation
Skilled nursing

Question 2

Community-based settings

Answer 2

Home health
Assisted living
Nursing home/residential

Question 3

Outpatient settings

Answer 3

Comprehensive outpatient facilities (CORFs)
Day treatment
Work site

Question 4

Telemedicine

Answer 4

Telerehabilitation

Question 5

Acute Care

Answer 5

Physical medicine setting
Inpatient hospitalization
Acute illness 2º illness or accident
Various highly skilled professionals
Diagnostic & intervention services
Short LOS stream lined services
Bill by diagnostic related groups (DRG) 
Inpatient prospective payment system (IPPS)

Question 6

DRG’s- Diagnosis Related Groups

Answer 6

Pt. classification scheme relating type of patient to hospital costs incurred; case mix
Used by Centers for Medicare & Medicaid Services (CMS) to reimburse for Medicare recipients http://www.cms.gov/
Considers: age, diagnosis, mortality risk, prognosis, treatment difficulty, need for intervention, & resource intensity
*Will discuss this more

Question 7

IPPS- Inpatient Prospective Payment System

Answer 7

Inpatient Prospective Payment System
each case is categorized into a DRG
DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG
Payment based on:
Basic payment amounts
Wage index accounting for labor costs
Add-ons for low income, medical education, others

Question 8

Rehabilitation

Answer 8

Physical dysfunction rehabilitation
Community, teaching, or free-standing hospitals
Medically stable clients
Tolerate 3 hrs therapy/day
Measurable goals & progress
Neuro, multiple ortho, cardiac, respiratory, CVA, arthritis, cancer
Bill by PPS

Question 9

Long Term Acute Care (LTAC)

Answer 9

Medical needs that do not meet criteria for acute, subacute or inpatient rehab
Requires estimated say of approx. 25 days
Usually involves respiratory care and wound management

Question 10

Subacute

Answer 10

Must meet medical criteria
Can be nursing home based or hospital based
Intervention gap between acute & LTC
Less costly than rehab hospitals & units
Billing prospective payment system (PPS)
Cardiac, orthopedic, neuro, wound care, muscle weakness

Question 11

PPS

Answer 11

Prospective Payment System
reimbursement by Medicare
Per discharge payment is made to inpatient rehabilitation facilities (IRFs) based on a predetermined, fixed amount
Info from patient assessment instrument (IRF-PAI) to classify patient into a group based on clinical characteristics & resource needs

Question 12

Skilled Nursing Facility

Answer 12

SNF may provided long term and short term services
Some residents will be long term for the remainder of their lives; others may discharge home as they improve or social situations change
Hospice services may intervene in this setting

Question 13

RUGs

Answer 13

Payment made to skilled nursing facility based on amount of therapy provided during determined period of time (usually 7 days)
Varies from 720 minutes per day to 30 minutes three times per week
Usually referred to as ultra, very high, high, medium and low