2023 UHC Medicare Basics Certifications

2023 UHC Medicare Basics Certifications eligibility for medicare Answer -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 Answer -acute care hospital -home health -hospice -skill nursing facility medicare B optional program Answer -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 Answer $105 medicare part B PT settings Answer -outpatient hospitals -comprehensive outpatient rehab facility -private practice OTs and PTs -SNF (that aren't covered by A) medicare advantage plans Answer created new options that serves the roll of A and B at least as well but with other options types of medicare advantage plans Answer -HMOs -PPOs -point of service (POS) plans -private fee-for-service plans -medicare special needs plans (SNP) medicare D Answer -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 Answer -costs vary by type of plan -reduced cost for prescription drugs at least ____ drugs per class just be included in medicare D plan Answer 2 medicare part A in SNF qualify Answer -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 Answer full cost paid for first 100 days post-hospital extended care in medicare certified SNF: days 21-100 Answer daily co-insurance of approximately $148 per day medicare part A in SNF: receives daily skilled care Answer -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 Answer -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) Answer all inclusive per diem rate for Part A SNF care and medicaid patients RUGs based on results of: Answer Minimum Data Set (MDS) RUG IV: 7 categories Answer -rehab plus extensive services -rehabilitation -extensive -special care -clinically complex -behavioral and cognitive -reduced physical function MDS Answer basic assessment performed on all residents of SNF regardless of payer under RUG IV, "rehabilitation" category there are subcategories based on: Answer -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 Answer -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 Answer -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 Answer -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 Answer -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 Answer -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 Answer -$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 SNF: Part B: documentation -eval/plan of care: must be certified/signed by the referring physician within _____ Answer 30 days SNF: Part B: documentation Certification is for the duration of the POC or _______ (whichever is less) Answer 90 days SNF: Part B: documentation PT plan of Care must contain: Answer -type of intervention and purpose -frequency -duration -medical diagnosis -Primary diagnosis -Therapy diagnosis -LT treatment goals -dated signature of therapist establishing POC SNF: Part B: documentation