PTICP Flashcards
Compare Part A to Part B
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
How do payment systems differ between A and B
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
when did the discussion of national health care arise?
1916
Medicare vs. medicade funding
Medicare: federally run but certain things can vary state to state
Medicaid: state run, EVERYTHING varies state to state
how did medicare payment systems begin in infancy
reimbursed based on what it cost them to deliver care and implemented “primary intermediaries” to perform day to day operations of bills
after payment for service what happened
costs in hospitals and part B skyrocketed!
What does TEFRA do?
apply limits to total hospital costs and began developing PPS for hospitals
in general what are the things that PPS payment is based off of
geographical location, pts condition, tx strategies
How are pts classified in acute care?
MS-DRG’s: medicare severity diagnosis related groups
expected to require similar amounts of hospital resources
Acute care reimbursement
DRG
what does DRG incentivize
get people in acute care out the door, decrease LOS
72 hour rule
DRG payment includes all OP services delivered 72 hrs prior to hospital admission
How does therapy billing fit into acute care
you’re just part of one giant bill
What did HCFA impliment
IRF 75% rule (that then got changed to 60%)
what two settings did cost shifting initially occur between?
why?
Did this expand to other settings?
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
BBA was movement towards PPS in post acute care settings in response to what?
cost shifting and increasing costs on their end
What are the two main areas that discharge from acute care were seen into?
home health and SNF
therefore this is where medicare saw their greatest expense
what is the big idea of IMPACT
being able to more easily follow a patient across post acute care settings
what is the main difference between scoring ofIMPACT and FIM
IMPACT uses average function
FIM uses worst
waht are some key groups that are not within the 60% rule?
CV
medically deconditioned
single knee replacement
what are the 4 main points of eligibility for IRF
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
IRF reimbursement is related to what?
CMS: case mixed group
main assessment tool for IRF?
IRF-PAI
pts primay reaons for rehab
level of cognitive and funciontal impairment
comorbidieis are all elements of what
determining CMG’s for IRF
