Exam 2

Question 1

Deductible and Copay for Medicare Part A Beneficiaries

• Inpatient hospital deductible
• Daily Coinsurance for Days 61-90
• Daily Coinsurance for lifetime reserve days
• SNF coinsurance for days 21-100

Answer 1

• $1, 600
• $400
• $800
• $200

Question 2

Consumer-Driven Health Plans

Answer 2

Insurance provided through employer
- Health saving account: helps put money aside pre tax
- Health reimbursement arrangement:
- Flexible spending account: account where you put into for out of pocket expenses

FSA: you don’t pay taxes on money but limit of $2750 and employer can set roll over

Question 3

What are the objectives of Pay for Performance programs? How is the provider reimbursed for services rendered?

Answer 3

-improve the QUALITY, EFFICIENCY, and OVERALL VALUE of health care by linking payment to value of care

-based on a metric of desired outcome: meet or exceed agreed-upon quality or performance get financially rewarded

Question 4

How do reimbursement changes (PPS, MCOs) impact PT practice?

Answer 4

-discounted fee schedule
-increase documentation skill to prove that its medically necessary
-limitation on the number of visits and type of services covered
-limits visits by pts who cannot afford co-pays/coins for each visit
-changes in service delivery: necessitated increase efficiency and cost-effectiveness of services
-increase non-billable time to advocate for more visits and documentation requirements

Question 5

How are IRF pts classified into groups

Answer 5

Case Mixed group
IRF PPS

Question 6

LTACH pa