Unit 2- WK5- Payment Across the Health Care Continuum Flashcards
How are visits to the emergency department billed to Medicare Part B ?
Fee for service, CPT codes, physician fee schedule
How are ICU, CCU, PCU and Acute Care financed ?
Inpatient Prospective payment system ( IPPS)
In acute care a patient’s primary diagnosis determines assignment to a ____________.
MS-DRG
Medicare pays for _______ days of hospital care per “spell of illness”, plus an additional lifetime reserve of ______ days.
90, 60
Define a single spell of illness
From hospital admittance to discharge from facility and gone 60 days without readmittance.
What are the 2023 Hosptial deductible, coinsurance for 61st-90th day, and daily coinsurance for lifetime reserve days, for Medicare Part A beneficiaries
1600
400
800
Explain the Hospital Value Based Purchasing Program
incentive payments for providing quality care, following best clinical practices, enhancing patient experience
Explain the hospital readmissions reduction program:
charges hospital fees for excessive readmission. 2% reduction in payout
Explain the Hospital Acquired Condition Reduction program
charges hospitals for injuries or complications occurring in the hospital 1%/
How can PTs have an impact on Acute Care Hospital Quality of Care ?
Reducing readmissions
discharge recs
enhancement of care transitions
minimize patient harm events
improve patient satisfaction; clear expectations
How is an LTACH paid and how are patient classified into payment groups ?
long term hospital prospective payment system; one time lump sum based on MS-LTC-DRGs
A Medicare beneficiary sspent 10 days in an Acute Care Hospital before being transferred to an LTACH. What is the maximum number of days that this beneficiary will be FULLY covered by Medicare at the LTACH ?
80 days
How is an inpatient rehab facility paid and how are patients classified into payment groups ?
IRF prospective payment system
IRF-PAI to classify patients
A Medicare beneficiary spent 5 days in an Acute Care Hospital before being transferred to an Inpatient Rehab Facility. What is the maximum number of days that this beneficiary will be fully covered by Medicare at the LTACH ?
85 days
What happens on day 61-90 for Medicare beneficiaries staying in an inpatient rehab facility ?
They must pay a coinsurance
What is the Medicare 60% compliance rule for IRF?
60% of facilities population must meet one or more specific pathological conditions
What is the IRF-PAI used for?
payment determination and quality measure at discharge
What happens if an LTACH or IRF fails to submit their quality report annually ?
2% point reduction in annual payment.
What system is used to pay a SNF ?
SNF-PPS
What is the minimum data set used for in a SNF? (MDS)
What determines classification thus reimbursement. Only for Medicare Part A.
The payment classification system in SNFs is called:
patient driven payment model
How is Medicare’s payment to the facility adjusted starting on day 21 of a SNF stay ?
2% decrease each week after day 20
How many nights must a patient have had a hospital stay to qualify for admittance to a SNF
3 nights
Medicare Part A will cover up to _______ days per spell of illness, as long as a patient _________
100 days, shows progress
Medicare Part A will fully cover days ________
1-20
Starting on day 21, the beneficiary must pay the ____________
daily copay until day 100
$200
Define this mode of treatment: Individual
1 patient at a time
