Miscellaneous Flashcards
(109 cards)
Who does medicare provide medical coverage to?
- individuals > 65 y/o
- disabled
- those with ESRD
What is Medicare’s prospective payment system based on?
Diagnostic-related groups (DRGs)
Places patients into disease categories or groups
(true/false) Medicare A covers all medical expenses of long-term or custodial care.
True
(true/false) Medicaid benefits are the same in all states
False
individual states determine the scope, duration, and amount of services provided
(true/false) preauthorization is needed for medicare and not medicaid.
FALSE (required for medicaid)
What must a person pay for medicare A?
Annual deductible fee
What must a person pay for medicare B?
Monthly premium
(true/false) With medicare, PT provided by a PT aide is reimbersable regardless of supervision
FALSE
Only SPTs
Insurance type that includes commercial insurance, fee-for-service / traditional indemnity plans, or employers who are self-insured
private health insurance
What is a HMO?
Form of managed care that provides a broad spectrum of health services for a preset amount of money
Allow members to seek healthcare outside of the network but at a higher or additional cost to the patient
Has a small copay for members using providers within the network
(true/false) With a HMO, a patient that is seeking additional care (such as PT), must have authorization through their PCP (“gatekeeper”)
true
(true/false) The numer of PT visits when a person is part of an HMO is unlimited
FALSE - limited number of visits
What are the two types of HMOs?
- **Individual practice associations (IPA) **- contract independently with the HMO and work out of their own office
- Prepaid Group plan (PGP) - physicians practice in a central facility
What is a PPO?
Group of providers that offer healthcare services as an entity to their employers - discount their fees to attract patients
Pts are not locked into the PPO providers but receive financial incentives to use services through that network
Preauthorization is needed before services can be provided
Definition:
A flat bundled reimbursement rate that is established based on the diagnosis- predetermined dollar amount:
- per diem / per day
- per visit
- per episode of service
Case-based rate
Definition:
Tax-free savings account that can be used to pay for health-related expenses and reiree health expenses
Health Savings Account
(true/false) Those who have a health savings account must have a high-deductible health plan
–> insurance product that covers catastrophic health occurrences
true
Stage of RA
- joint pain and stiffness
- no visible bone damage on XR
- slight swelling (primarily in fingers and toes)
- fatigue and malaise
stage I
early RA
stage of RA
- cartilage damage, stiffness, and decreased ROM
- persistent symptoms
- joint swelling that is more noticeable in the morning
stage II
moderate RA
stage of RA
- bone damage, cartilage loss, and joint deformity
- progressed pain, stiffness, and loss of mobility
- thickened knuckles
- twisted fingers
- higher risk of CTS
Stage III
severe RA
stage of RA
- bony or fibrous ankylosis
- severe pain, swelling, and stiffness
- loss of mobility
stage IV
end-stage RA
What is the RPE for light exertion?
11-12
What is the RPE for hard exertion?
15-16
What is the RPE for very hard exertion?
17-18
