Post-Acute Inpatient

Question 1

Criteria for IRF

Answer 1

Reasonable and necessary care and significant rehab potential
Require the coordinated care of at least two therapy disciplines (PT, OT, SLP)
Required to participate in minimum of 3+ hours therapy per day, at least 5 days per week

Question 2

PPS Payment

Answer 2

Based on FIM scores, other demographic and diagnostic data to determine which case-mix group (CMG) the patient will be assigned to.
This provides a set payment that the patient will receive for the entire admission in IRF.
Payment is based on an average length of stay for that particular CMG.
If patient is moved to another health care facility, the payment is prorated.
VERY important to understand why getting someone better and discharged to community is important

Question 3

What is payment in IRF based on?

Answer 3

Payment is based on data gathered: diagnoses, comorbidities, and demographic data and FIM scores&raquo_space; Case Mix Group (CMG)
Each CMG is associated with a specific payment amount for the entire length of stay.
Payment is based on an expected or average length of stay for that particular CMG.

Question 4

Average length of stay in SNF?

Answer 4

26.4 days

Question 5

Payment to SNF for Medicare Advantage?

Answer 5

Medicare Advantage plans typically pay a flat fee per day. Typically case managers to determine level of care, including amount of therapy based on diagnosis

Question 6

Medicare payment to SNF?

Answer 6

Calculated per diem, determined by the amount of rehab services provided.
Categorizing the resident into “resource utilizing group” (RUG) for payment purposes

Question 7

When are minimum data sets required?

Answer 7

Day 1, 14, 30, 60, 90 and if there is a significant change in status

Question 8

Ultra High Rehab:

Answer 8

720 min/ week + 1 discipline 5 days/ week + 1 discipline 3 days/ week

Question 9

Very High Rehab

Answer 9

500 min/week + 1 discipline 5 days/ week

Question 10

High Rehab

Answer 10

325 min/ week + 1 discipline 5 days/ week

Question 11

Medium Rehab

Answer 11

150 min/ week + 5 days any combination of 3 rehab disciplines

Question 12

Low Rehab

Answer 12

45 min/ week + 3 days any combination of rehab disciplines + restorative nursing 6 days/ week

Question 13

What does Long Term Care include?

Answer 13

includes assisted living, adult day care, home care or sitter services (non-skilled care under Medicare Part A

Question 14

Services provided at LTC?

Answer 14

administration of medication, provide ongoing restorative, recreational, social activities

Question 15

Leading cause of LTC admission?

Answer 15

decreased cognition, incontinence, increased falls, decreased functional status

Question 16

Payment of LTC?

Answer 16

out of pocket, by private insurance, or by Medicaid if residents qualify based on their income

Question 17

Average LOS of LTC?

Answer 17

341 days

Question 18

Characteristics of frailty: (3 or more considers patient as frail)

Answer 18

Unintentional weight loss (10# or more in a yer)
General feeling of exhaustion (self-report)
Weakness
Slow walking speed
Low levels of physical activity

Question 19

Modified Physical

Performance Test

Answer 19

test for frailty

Question 20

Domains of Modified Physical Performance Test

Answer 20

Book Lift
Put on and take off coat
Pick up a penny
Chair rise
Turn 360
50 foot walk
One flight of stairs (10 stairs)
Four flights of stairs
Progressive Rhomberg

Question 21

Modified Physical Performance Test

Not frail

Answer 21

32-36

Question 22

Modified Physical Performance Test

mild frailty

Answer 22

25-32

Question 23

Modified Physical Performance Test

moderate frailty

Answer 23

17-24

Question 24

Modified Physical Performance Test

no longer independent within community

Answer 24

<17

Question 25

What is a predictor of stair climbing ability, balance and general functional decline?

Answer 25

self efficacy

Question 26

When is gait training considered a skilled intervention by CMS?

Answer 26

When a therapist needs to give specific instructions, verbally or manually, to improve the gait pattern
A gait assessment needs to be made to determine the impairments causing any abnormalities
Recommendations need to be made for assistive devices.

Question 27

When can it be presumed that a patient has lost 75% of their reserve strength?

Answer 27

If a resident cannot walk without using his arms to support the body because of leg weakness

Question 28

Homebound Status

Answer 28

Required by Medicare A and B for treatment
Leaving home would be extremely difficult
Occasional excursions outside the house allowed

Question 29

OASIS

Answer 29

Outcome and Assessment Information Set
Home health assessment instrument, used to justify care and determine episode rate of reimbursement
PT, Skilled Nursing, and SLP qualified to collect data at start of care (SOC)

Question 30

Components of OASIS

Answer 30

Consent and emergency plan/advanced directives
Emergency Planning
Medication Reconciliation
Health Risk Screening
Home Safety Assessment
Functional Assessment and Musculoskeletal Assessment
Goal Setting
Physician Verbal Order

Question 31

OASIS-C2

Answer 31

Effective January 2017

3 new standardized items (M1028, M1060, and GG0170c)