Medicare Basics Test Questions and Correct Solutions Rated A+

eligibility for medicare - -65+ -paid taxes into SS 10 years (40 quarters) OR spouse who paid into SS for 10 years -Permanent disability x24 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