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Under the SNF PPS, which one of the following healthcare services is excluded from the consolidated payment?
routine care, ancillary services, and capital costs
What healthcare services are included from the consolidated payment under the SNF PPS?
resource utilization groups (RUGs)
Which classification system is used to case-mix adjust the SNF payment rate?
minimum data set (MDS)
In the SNF PPS, which data set determines a resident's classification into a resource utilization group?
The therapist in the skilled nursing facility is treating multiple patients who are each performing different therapies. How does CMS classify this mode of delivery?
practice of one professional therapist treating multiple patients at the same time while the patients are performing different therapeutic activities.
In the PAC payment systems, which tool does CMS use to adjust its payment rates to account for geographic variations in costs?
Mix of goods and services appropriate to the setting, such as home health services or SNF.
exactly the same
In terms of their composition, how do the groups of the MS-LTC-DRGs compare to the groups of the acute care MS-DRGs?
principal diagnosis, up to 8 additional diagnoses, and up to 6 procedures
Both MS-LTC-DRGs and acute care MS-DRGs are based on what 3 things?
based on the principal diagnosis
In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS-DRGs similar?
constant that converts the MS-LTC-DRG weight into a payment
In the LTCH PPS, what is the standard federal rate?
quality of, access to, and continuity of care; efficient provision of rehab services, and fairness and equity to facilities, beneficiaries, and taxpayers
According to CMS, what are the 3 purposes of the IRF PPS?
stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, fracture of the femur (hip), brain injury, neurological disorder, burn; active, polyarticular rheumatoid arthritis; psoriatic arthritis, and seronegative arthropathy; systemic vascularities with joint inflammation (unresponsive to aggressive, sustained and appropriate outpatient treatment; severe or advanced osteoarthritis involving greater-than-or-equal-to 2 major weight-bearing joints; knee or hip replacement with bilateral replacement, extreme obesity, or age greater-than-or-equal-to 85.
To meet the definition of an IRF, facilities must have an inpatient population with at least a specified percentage of patients with certain conditions. Which conditions are counted in the definition?
standard federal rate
National base payment amount in the PPS for LTCH. This amount is multiplied with the relative weight of the LTC-DRG to calculate the unadjusted payment. SFR is published annually in the Federal Register.
all therapy (PT, OT, S), skilled nursing visits, home health aide visits, medical social services; all medical supplies, including non-routine medical supplies
All of the following services are consolidated into a single payment under the HHPPS.
nursing, therapy, and noncase-mix-adjusted
3 components of the per diem (daily rate) for SNF PPS include:
rehabilitation impairment category, total scores from motor (M) items from functional independence assessment tool, total scores from cognitive (C) items from functional independence assessment tool (used only with selected diagnoses related to stroke and traumatic brain injury), age (used only with selected diagnoses related to stroke, traumatic spinal cord injury, and joint replacement), and comorbid conditions
5 elements part of the IRF PPS:
skilled nursing care, therapy (OT, PT, S), medical social work, home health aide
Services provided by HHA:
sociodemographic, environment, support system, health status, functional status, behavioral status
Name 6 major OASIS domains that are collected:
number of therapy visits by a therapist
For what variations in resource consumption does the HHPPS account?
In which of the PAC payment systems, is the adjusted rate multiplied by the patient's number of Medicare days to determine the reimbursement amount?
What is the term used in a rehabilitation facility to mean "a patient's ability to perform activities of daily living"?
The functional independence assessment tool is comprised of 18 items, and scores are based on a scale of ____ to _____.
identification, admission, payer, medical, medical needs, function modifiers, functional independence assessment, discharge, quality measures
9 types of patient information comprising the IRF PAI:
Computer software for data entry in inpatient rehabilitation facilities (IRF). Captures data for the IRF PAI and supports electronic submission of the IRF PAI. Allows data import and export in the standard record format of the Centers for Medicare and Medicaid Services.
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