PTICP

Question 1

Compare Part A to Part B

Answer 1

Part A: impatient and post acute care, home health post hospitalization, SNF, hospice

Part B: outpatient PT, prescriptions, long term non skilled care, physician services, labs, diagnostic tests, long term care thats not skilled

Question 2

How do payment systems differ between A and B

Answer 2

A: all PPS, patient based not service based

B: still some volume based payment systems - you get paid based on the number of units you provide

Question 3

when did the discussion of national health care arise?

Answer 3

1916

Question 4

Medicare vs. medicade funding

Answer 4

Medicare: federally run but certain things can vary state to state

Medicaid: state run, EVERYTHING varies state to state

Question 5

how did medicare payment systems begin in infancy

Answer 5

reimbursed based on what it cost them to deliver care and implemented “primary intermediaries” to perform day to day operations of bills

Question 6

after payment for service what happened

Answer 6

costs in hospitals and part B skyrocketed!

Question 7

What does TEFRA do?

Answer 7

apply limits to total hospital costs and began developing PPS for hospitals

Question 8

in general what are the things that PPS payment is based off of

Answer 8

geographical location, pts condition, tx strategies

Question 9

How are pts classified in acute care?

Answer 9

MS-DRG’s: medicare severity diagnosis related groups

expected to require similar amounts of hospital resources

Question 10

Acute care reimbursement

Answer 10

DRG

Question 11

what does DRG incentivize

Answer 11

get people in acute care out the door, decrease LOS

Question 12

72 hour rule

Answer 12

DRG payment includes all OP services delivered 72 hrs prior to hospital admission

Question 13

How does therapy billing fit into acute care

Answer 13

you’re just part of one giant bill

Question 14

What did HCFA impliment

Answer 14

IRF 75% rule (that then got changed to 60%)

Question 15

what two settings did cost shifting initially occur between?

why?

Did this expand to other settings?

Answer 15

acute care and IRF

Acute care had incentive to get people out the door (same pay no matter what) and IRF were incentivized to open.

expanded to all other post acute care settings as well

Question 16

BBA was movement towards PPS in post acute care settings in response to what?

Answer 16

cost shifting and increasing costs on their end

Question 17

What are the two main areas that discharge from acute care were seen into?

Answer 17

home health and SNF

therefore this is where medicare saw their greatest expense

Question 18

what is the big idea of IMPACT

Answer 18

being able to more easily follow a patient across post acute care settings

Question 19

what is the main difference between scoring ofIMPACT and FIM

Answer 19

IMPACT uses average function

FIM uses worst

Question 20

waht are some key groups that are not within the 60% rule?

Answer 20

CV
medically deconditioned
single knee replacement

Question 21

what are the 4 main points of eligibility for IRF

Answer 21

physician following 3x a week

“reasonable and necessary: they can’t have been doing just as well somewhere else

must require >1 therapy type

3 hrs of therapy 5 days a week

Question 22

IRF reimbursement is related to what?

Answer 22

CMS: case mixed group

Question 23

main assessment tool for IRF?

Answer 23

IRF-PAI

Question 24

pts primay reaons for rehab

level of cognitive and funciontal impairment

comorbidieis are all elements of what

Answer 24

determining CMG’s for IRF

Question 25

what is the most commonly used post acute setting

Answer 25

SNF

Question 26

what must the SNF patient have if they are going to be covered by part A?

Answer 26

3 day hospital stay preceding admission

Question 27

reimbursement for SNF is based on what

Answer 27

was RUG

is now PDPM - patient driven payment model : value > volume

Question 28

what does PDPM stand for

Answer 28

patient driven payment model

Question 29

what are the three big ideas behind PDPM

Answer 29

value > volume: NOT LOOKING AT MINUTES

resources are more distributed to medically complex patients

payment accuracy

Question 30

what is NTA very generally

Answer 30

things other than therapy services (feeding tubes, respiratory needs etc)

This is part of the PDPM in nursing homes repayment system

Question 31

what is the relevance of an adjustment factor under PDPM (nursing home)

Answer 31

how much you’re getting paid for services can be variable day to day depending on what the pt looks like

Question 32

Assessment tool in SNF is what?

Answer 32

MDS: minimum data set

Question 33

How many times do you have to use the MDS to assess in SNF?

Answer 33

admission and DC

Question 34

for SNF how many is a group now?

how did payment changes change the way we think about treating as far as groups go?

Answer 34

4-6

incentivized to do groups because you get all the minutes for each member there now (but its still limited to 25% of your visits)

Question 35

how is homecare classified as far as part A and B?

Answer 35

A: for the therapy we’re thinking of

B: something like Fox rehab

Question 36

what is the reimbursement method for HH

Answer 36

PDGM: patient driven groupings model

Question 37

what is the outcome tool for HH

Answer 37

OASIS

OT can’t open cases

Question 38

what reimbursement does LTACH use?

what is this similar to?

Answer 38

Ms - LTC- DRG

Similar to acute care: predetermined rate