US healthcare system

Question 1

What is tertiary care?

Answer 1

highly specialized, technologically based medical services

• heart/liver/lung transplants
• other major surgical procedures
• highly specialized physicians in hospital setting

Question 2

What is secondary care?

Answer 2

specialized care - fits between primary and tertiary care

Question 3

A patient staying in an LTAC usually stays a minimum of how many days?

Answer 3

25

Question 4

What two ways can hospice be ensured reimbursement?

Answer 4

1) certificate of terminal illness with <6mo to live via physician
2) medicare eligibility

Question 5

What voluntary accrediting agency accredits hospitals, SNFs, home health agencies, rehab facilities, and ambulatory clinics?

Answer 5

JCAHO (joint commission)

Question 6

How often must an organization get re-accredited?

Answer 6

every 3 years

Question 7

What part of Medicare coverage covers DME?

Answer 7

part B

Question 8

What does part A of Medicare cover?

Answer 8

it’s hospital insurance

• limited number of hospital days
• SNF up to 100 days
• home health agencies
• hospice

does NOT cover long term care

Question 9

What part of medicare covers a stay at a SNF for 40 days?

Answer 9

part A

Question 10

What part of medicare covers outpatient PT? What do you need to document for it to be covered?

Answer 10

part B covers outpatient PT

- must document necessity of treatment, skilled treatment for it to be reimbursed

Question 11

What part of the documentation at the end of an eval do you need for reimbursement for outpatient PT services?

Answer 11

physician cert

Question 12

What is the difference between an HMO and PPO?

Answer 12

both are managed health care systems but…

• HMO = locked in to a certain provider system
• PPO = financial incentives to stay with preferred providers, but pt is able to choose

Question 13

T/F: If you want to have an HSA, you need to have a high-deductible insurance plan.

Answer 13

true

Question 14

What does medicare part D cover?

Answer 14

prescription drugs

Question 15

A reeval/summary must be completed how frequently for medicare patients? What does this include?

Answer 15

complete every 30 days:

• restatement of initial problem
• length of time pt has been treated
• progress/regression since last summary
• rationale for continued care
• revision of goals and outcomes, POC
• document change in objective, measureable, and functional terms

Question 16

What does Title VII of the Civil Rights Act prevent?

Answer 16

prohibits employment discrimination based on race, color, sex, religion, national origin, sexual harassment

Question 17

What is a utilization review?

Answer 17

written plan to determine:

• appropriate use of resources
• medical necessity of services provided
• cost efficiency

Question 18

Is a PTA able to adjust a treatment procedure?

Answer 18

yes, in accordance with changes in patient status within the scopre of the established POC
- they cannot develop, change, or evaluate the POC

Question 19

T/F: A PTA is able to supervise a PT aide.

Answer 19

true

Question 20

T/F: PTA may be alone with a patient and not with PT supervision in the building.

Answer 20

true, PT just needs to be available somehow for emergencies

Question 21

Can a PT aide put a patient on ice?

Answer 21

yes