3651697
Descripción
Fichas por Diana Fitts, actualizado hace más de 1 año
|
Creado por Diana Fitts
hace alrededor de 9 años
|
|
| Pregunta | Respuesta |
| medicare established | -1965 -part of social security act |
| medicare qualifications | -65 years old -2 years disabled -end stage renal failure |
| PPS | -prospective payment system -payment for services provided to a Medicare patient is fixed with adjustments made annually. Payment is based on assigned DRGs |
| MDS | -minimum data set -a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive assessment for all residents in a Medicare and/or Medicaid-certified long-term care facility. The MDS contains items that measure physical, psychological and psychosocial functioning. The items in the MDS give a multidimensional view of the patient's functional capacities and helps staff to identify health problems. |
| IRF-PAI | -inpatient rehab facility patient assessment instrument -assessment data collected on all Medicare Part A fee-for-service patients who receive services under Part A from an inpatient rehabilitation facility (IRF) at admission and upon discharge. IRF-PAI items address the physical, cognitive, functional, and psychosocial status of the IRF patients. The data collected for IRF-PAI is used for quality of care purposes and items were developed primarily for IRF prospective payment system (PPS) |
| RUGs | -resource utilization groups -any of 44 classifications patients are assigned to that determine reimbursement -determined by number of days and number of disciplines involved |
| acute hospitals under medicare | -reimbursed under DRGs |
| inpatient rehab facilities | -reimbursed under IRF PPS, data collection for reimbursement under IRF-PAI, 60% compliance threshold, 4 tier reimbursement rates based on acuity and cormobidity |
| SNF under medicare | -reimbursed through SNF PPS, data collection through MDS, 44 tiers of payment through RUGs |
| medicare advantage programs | -similar to Medicare, but managed by private HMO companies |
| HMO | -health maintenance organization -provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. |
| ARD | -assessment reference date -the specific end point of look-back periods in the MDS assessment process. |
| custodial care | -not covered by medicare, non-skilled personal care like ADLs |
| rules for therapy | 1) medical necessity 2) skilled service 3) reasonable and necessary |
| inpatient psych under medicare | -reimbursement based on DRG |
| medicare part A | -hospital insurance -pays for skilled care -requires 3 night stay -7 days/week nursing -5 days/week therapy -covers inpatient stays -no monthly costs to beneficiaries |
| DRG | -diagnostic related groups -group of patients classified for measuring a medical facility’s delivery of care. Based on primary and secondary diagnosis, primary and secondary procedures, age, and length of hospitalization. |
| HDHP | -high deductible health plan -form of catastrophic coverage -higher deductible than other plans |
| ACOs | -accountable care organizations -made up of hospitals, physicians, specialists, and others, such as home health care. The ACO contracts to manage the quality and cost of care for a minimum of 5,000 Medicare beneficiaries for 3 years. The hope is that ACOs will save Medicare money by managing care better. |
| medicare part B | -medical insurance -covers doctor’s services and outpatient care -billed by CPT (current procedural terminology) codes -$3700 threshold -people pay a set fee per month and 20% of costs after a yearly deductible. -therapy cap covering rehab services. Services can’t go beyond this or people must pay out of pocket. -voluntary program -covers some medical equipment (DME- durable medical equipment) |
| medicare part D | -prescription insurance -paid for by monthly premiums |
| medicaid | -for low income individuals -insures older adults, children and parents of dependent children, pregnant women, and people with disabilities who meet the eligibility requirements. -majority of recipients are children and Medicaid covers ¼ of all children in the US. - 2/3 of Medicaid spending goes to older adults and the disabled -pays for 2/3 of all nursing home residents in the US -provides support to 4 in 10 children with special needs -jointly financed by federal and state governments -means tested program, as people qualify if their assets and income levels are below standards set by the program -OT is an optional service under Medicaid |
¿Quieres crear tus propias Fichas gratiscon GoConqr? Más información.