SNF-PPS & PDPM (Test 2)
SNF-PPS - answer Skilled Nursing Facility Prospective Payment System
PDPM - answer Patient Driven Payment Model
SNF - answer Skilled Nursing Facility
SNF definition - answer A facility certified by Medicare to provide 24-hr skilled nursing
care and rehab services in addition to other medical services
SNF Service-
Skilled Care - answer Level of care, such as injections, catheterizations, and dressing
changes, which are provided by trained medical professionals, such as: physicians,
nurses, and physical therapists
SNF Service-
Skilled Nursing Care - answer Daily nursing and rehab care that can be performed only
by (or under) the supervision of skilled medical personnel
SNF Service-
Rehabilitation Services - answerServices designed to improve or restore a person's
functioning; includes physical therapy, occupational therapy, or speech therapy... or
some combination of these therapeutic services
Nursing Home - answerFacility licensed by the state to offer residents personal care as
well as skilled nursing care 24 hrs/day.
Provides nursing care, personal care, room and board, supervision. medication,
therapies, and rehab.
Shared rooms and communal dining are common.
A SNF is a type of... - answerNursing Home
SNFs provide short-term skilled nursing care and rehab services to: what kind of
beneficiaries? - answerMedicare beneficiaries after an acute-care hospitalization
SNF things (1 of ?) - answerSNFs can be: freestanding hospitals, hospital-based units,
or swing beds in an acute-care hospital
About 90% of SNF admissions are in freestanding facilities
, SNF services are covered under Medicare Part A
Medicare beneficiaries... - answer-are eligible for SNF services immediately after an
acute care IP hospitalization of at least 3 days
-have 100 days of SNF covered services per benefit period (per year)
-have cost sharing payments for SNF services
SNF-PPS definition - answer-mandated by the Balanced Budget Act
-went into effect in 1998
-payment covers the cost of skilled nursing care, rehab services, ancillary services,
capital costs, and other goods & services
-high-cost, low-probability services are excluded from the daily rate & are paid
seperately
SNF-PPS:
Mandates consolidated billing - answer-requires the SNF to pay for outside services
provided to the resident from outside vendors (ex. laboratories, imaging centers,
pharmacies)
-the outside vendors would submit their bills to the SNF, not to Medicare
-emergency services, IP services, and other extensive procedures (ex. radiation
therapy) are not consolidated
-operational costs assoc. w/ defined, approved educational activities are also excluded
from the base rate and consolidated billing
The SNF-PPS case mix model that was used from 1998-2019 was... - answerResource
Utilization Groups Version IV
(RUG-IV)
How were patients classified into RUGs? - answerData is used from the MDS (Minimum
Data Set), which reflects health characteristics and resource utilization
3 types of data classifications in RUGs:
#1 Therapy - answer1- Therapy (occupational, physical, or speech) and certain other
services such as respiratory therapy or feeding
--mode of therapy [individual, concurrent (one therapist treating multiple pt's who are
performing different therapeutic activities) or group therapy]
SNF-PPS - answer Skilled Nursing Facility Prospective Payment System
PDPM - answer Patient Driven Payment Model
SNF - answer Skilled Nursing Facility
SNF definition - answer A facility certified by Medicare to provide 24-hr skilled nursing
care and rehab services in addition to other medical services
SNF Service-
Skilled Care - answer Level of care, such as injections, catheterizations, and dressing
changes, which are provided by trained medical professionals, such as: physicians,
nurses, and physical therapists
SNF Service-
Skilled Nursing Care - answer Daily nursing and rehab care that can be performed only
by (or under) the supervision of skilled medical personnel
SNF Service-
Rehabilitation Services - answerServices designed to improve or restore a person's
functioning; includes physical therapy, occupational therapy, or speech therapy... or
some combination of these therapeutic services
Nursing Home - answerFacility licensed by the state to offer residents personal care as
well as skilled nursing care 24 hrs/day.
Provides nursing care, personal care, room and board, supervision. medication,
therapies, and rehab.
Shared rooms and communal dining are common.
A SNF is a type of... - answerNursing Home
SNFs provide short-term skilled nursing care and rehab services to: what kind of
beneficiaries? - answerMedicare beneficiaries after an acute-care hospitalization
SNF things (1 of ?) - answerSNFs can be: freestanding hospitals, hospital-based units,
or swing beds in an acute-care hospital
About 90% of SNF admissions are in freestanding facilities
, SNF services are covered under Medicare Part A
Medicare beneficiaries... - answer-are eligible for SNF services immediately after an
acute care IP hospitalization of at least 3 days
-have 100 days of SNF covered services per benefit period (per year)
-have cost sharing payments for SNF services
SNF-PPS definition - answer-mandated by the Balanced Budget Act
-went into effect in 1998
-payment covers the cost of skilled nursing care, rehab services, ancillary services,
capital costs, and other goods & services
-high-cost, low-probability services are excluded from the daily rate & are paid
seperately
SNF-PPS:
Mandates consolidated billing - answer-requires the SNF to pay for outside services
provided to the resident from outside vendors (ex. laboratories, imaging centers,
pharmacies)
-the outside vendors would submit their bills to the SNF, not to Medicare
-emergency services, IP services, and other extensive procedures (ex. radiation
therapy) are not consolidated
-operational costs assoc. w/ defined, approved educational activities are also excluded
from the base rate and consolidated billing
The SNF-PPS case mix model that was used from 1998-2019 was... - answerResource
Utilization Groups Version IV
(RUG-IV)
How were patients classified into RUGs? - answerData is used from the MDS (Minimum
Data Set), which reflects health characteristics and resource utilization
3 types of data classifications in RUGs:
#1 Therapy - answer1- Therapy (occupational, physical, or speech) and certain other
services such as respiratory therapy or feeding
--mode of therapy [individual, concurrent (one therapist treating multiple pt's who are
performing different therapeutic activities) or group therapy]
