November 16th quiz Flashcards
(30 cards)
What does part A cover
- hospital visits
- home health
- inpatient rehab
- SNF
- Hospice
Admission to SNF requires?
3 day hospital stay w/in 30 days
Minutes and care levels per week
-ultra high 720
-very high 500
-high 325
-medium 150
low 45
What does part B cover?
Outpatient services
-labs, DM, HH, preventative, PT
What does part C cover?
Medicare advantage, approved private insurance
What does part D cover?
DRUGS!
When are progress reports due?
- once on or before 10th trtmnt, no later than 30 days
- monthly note due every 30 days
- PT must write note
Co treatments
- benefit pt, not convenience
- Part A - can each bill separately
- Part B- split time
SNF Part B
- applies if pt does not have qualifying hospital stay
- room and board paid by pt
Hospice
- terminal illness and 6 months or less to live
- give up curative treatments
- covers Pt
- 2 90 day periods, then unlimited 60 day
5 requirements for home health coverage
- home bound
- skilled care on part time basis
- under care of doctor
- face to face encounter with doctor
- HHA must be medicare approved
Homebound
- you cannot leave home and would require substantial effort
- medically inadvisable to leave home without help
Therapy cap part B
- 1965 PT and Speech
- up to 3700 w/o review by medicare
What is the most common error in fraud is?
insufficient documention
Fraud examples
- systematic intentional deception
- upcoding,
Documentation red flags (failure to)
- include certifications on POC
- comply with 8 min rule
- provide adequate PTA supervision
- legible signatures
- physician sign docs
When to use G codes
- initial eval
- every 10 visits
- discharge
- start or end different functional limitation
How to choose primary functional limitation
- clinically relevant to pt
- yield quickest/greatest progress
- greatest priority for patient
G code categories
-mobility
-changing and maintaining body position
-carrying, moving, handling objects
-self care
other
When functional reporting is required for a claim…
two g codes are required
- except when therapy under more than one therapy
- except one time visit only
Frailty
- attribute of aged people who are at increased risk of adverse health outcomes
- diminished ability to respond to stress
- accumulation of deficits
- diminished reserve
Prevalence of frailty
- 5-15% of community older adults
- 30-44% are prefrail
What are the causes of frailty
- genetics 2%
- diseases and injuries
- lifestyle (biggest)
- aging (small)
Frailty consequences
- decreased mobility
- IADL/ADL dependence
- hospitalization
- mortality
- nursing home
- disability
