eligibility for medicare - ✔✔ -65+
-paid taxes into SS 10 years (40 quarters)
OR spouse who paid into SS for 10 years
-Permanent disability x24
... [Show More] months
-Presence of end stage renal disease requiring dialysis or transplant
types of setting that medicare part A covers - ✔✔ -acute care hospital
-home health
-hospice
-skill nursing facility
medicare B optional program - ✔✔ -participation in medicare A is prerequisite
-if one does not enroll at time eligible for medicare A, then my enroll at certain times, but at a higher cost
-premiums vary by annual income
standard medicare part B monthly premium - ✔✔ $105
medicare part B PT settings - ✔✔ -outpatient hospitals
-comprehensive outpatient rehab facility
-private practice OTs and PTs
-SNF (that aren't covered by A)
medicare advantage plans - ✔✔ created new options that serves the roll of A and B at least as well but with other options
types of medicare advantage plans - ✔✔ -HMOs
-PPOs
-point of service (POS) plans
-private fee-for-service plans
-medicare special needs plans (SNP)
medicare D - ✔✔ -prescription drug plan
-establishes OP prescription drug benefit
-a stand-alone drug plan that adds prescription drug coverage to the original medicare plan
-beneficiary pays monthly premium and other co-payments
medicare D costs - ✔✔ -costs vary by type of plan
-reduced cost for prescription drugs
at least ____ drugs per class just be included in medicare D plan - ✔✔ 2
medicare part A in SNF qualify - ✔✔ -must be hospitalized at least 3 consecutive days
-be admitted to SNF by a physician within 30 days after D/C from hospital
first 100 days post-hospital extended care in medicare certified SNF: days 1-20 - ✔✔ full cost paid for
first 100 days post-hospital extended care in medicare certified SNF: days 21-100 - ✔✔ daily co-insurance of approximately $148 per day
medicare part A in SNF: receives daily skilled care - ✔✔ -required ongoing SNF or rehab services ordered be a physician and related to the condition for hospitalization or condition that arose during inpatient admission
-daily services
-can be provided only on an inpatient basis in SNF
-must be deemed reasonable, medically necessary, and of appropriate duration
SNF: part A: PT services - ✔✔ -directly related to physician POC
-be at level of complexity that requires judgement, knowledge, and PT skills
-expectations of rehab potential within a reasonable time or must be necessary to establish effective maintenance program
-services must be reasonable and medically necessary fro resident's condition
-5-7 DAYS PER WEEK OF SERVICES
RUGS (resource utilization groups) - ✔✔ all inclusive per diem rate for Part A SNF care and medicaid patients
RUGs based on results of: - ✔✔ Minimum Data Set (MDS)
RUG IV: 7 categories - ✔✔ -rehab plus extensive services
-rehabilitation
-extensive
-special care
-clinically complex
-behavioral and cognitive
-reduced physical function
MDS - ✔✔ basic assessment performed on all residents of SNF regardless of payer
under RUG IV, "rehabilitation" category there are subcategories based on: - ✔✔ -number of therapies
-minutes per day
-days of skilled therapy during 7 day assessment
-4 ADLs (eating, toiling, bed mobility, transferring ability form MDS)
SNF: Part A: RUG levels: Rehab Ultra High - ✔✔ -720 minutes per week
-at least 2 disciplines PT, OT, ST
-one discipline at least 5 days per week
-other discipline at least 3 days per week
SNF: Part A: RUG levels: Rehab Very High - ✔✔ -at least 500 minutes per week
-at least one discipline provides services at least 5 days per week
SNF: Part A: RUG levels: rehab high - ✔✔ -at least 325 minutes per week
-at least one discipline provides services at least 5 days per week
SNF: Part A: RUG levels: rehab medium - ✔✔ -at least 150 minutes per week
-across 3 disciplines provide services 5 days per week, so that the beneficiary receives service from at least on of the discipline at least each day
SNF: Part A: RUG levels: Rehab low - ✔✔ -at least 45 minutes per week
-at least 3 days per week of any combination of therapy + 6 days of 2 restorative nursing programs (2 activities from MDS section p3)
SNF: PT services under part B - ✔✔ -$148 annual deductible and a 20% co-insurance rate on part B benefits
-practice must be enrolled through medicare carrier
-each therapist has to complete an application to be a provider, and get a unique provider ID number
-PT must be provided by licensed PT or PTA under general supervision of PT [Show Less]