Managed Care Exam
What kind of coverage’s are available? - Medicare A, B, C; Medical; Private Insurance
(HMO, PPO, Kaiser); Military
What do you need to get insurance covered speech therapy - A referral from a
physician and a qualifying medical diagnosis (unless you have private insurance)
Qualifications for Medicare - 65+ or disabled AND actively drawing from social security
What does Med a Cover - Rehab, acute care, and stay at nursing home, home
healthcare, and medicine
Med A Qualifications - 3 day qualifying stay at an acute care facility AND an appropriate
medical diagnosis (CVA, TBI, MS, etc.)
How much rehab can you get with Med A - 90/100 days of rehab? Depends on how
good you are at documenting, severity, onset date, prior level of functioning
Rug Levels - Resource Utilization Group Scale:
RU: Resource Ultra High
RV: Resource Very High
RH: Resource High
RM: Resource Medium
RL: Resource Low
Minutes for Rug Levels - RU: 720
RV: 500
RH: 325
RM: 150
RL: 45
Minimum Data Sheet (MDS) - Gives background and demographic info on the pt as well
as their communication level. The nurse fills it out- we need to make sure what they say
about their communication matches our notes
G Codes - Used for Medicare. Diagnosis for billing with severity level. Filled out with
current severity and goals for severity at the same time of the oval and then every 30
days or at the time of discharge
G Code severity modifiers - 0-10 = mild
10-20
20-60
What kind of coverage’s are available? - Medicare A, B, C; Medical; Private Insurance
(HMO, PPO, Kaiser); Military
What do you need to get insurance covered speech therapy - A referral from a
physician and a qualifying medical diagnosis (unless you have private insurance)
Qualifications for Medicare - 65+ or disabled AND actively drawing from social security
What does Med a Cover - Rehab, acute care, and stay at nursing home, home
healthcare, and medicine
Med A Qualifications - 3 day qualifying stay at an acute care facility AND an appropriate
medical diagnosis (CVA, TBI, MS, etc.)
How much rehab can you get with Med A - 90/100 days of rehab? Depends on how
good you are at documenting, severity, onset date, prior level of functioning
Rug Levels - Resource Utilization Group Scale:
RU: Resource Ultra High
RV: Resource Very High
RH: Resource High
RM: Resource Medium
RL: Resource Low
Minutes for Rug Levels - RU: 720
RV: 500
RH: 325
RM: 150
RL: 45
Minimum Data Sheet (MDS) - Gives background and demographic info on the pt as well
as their communication level. The nurse fills it out- we need to make sure what they say
about their communication matches our notes
G Codes - Used for Medicare. Diagnosis for billing with severity level. Filled out with
current severity and goals for severity at the same time of the oval and then every 30
days or at the time of discharge
G Code severity modifiers - 0-10 = mild
10-20
20-60
