PT 705 - skilled nursing facility (SNF)
prospective payment system (PPS). the
basics
What is a prospective payment system commonly referred to as? - answerPPS
What is the payment system used for? - answerto reimburse Skilled Nursing Facilities
(SNF) for the care provided to patients covered under Medicare Part A
What does the payment system provide? - answera daily rate of payment for a set
period of time
Why does the prospective payment system look at the resources used in the past
service period? - answerto determine payment for a future period of service
- level of care
- service provided
What are the reimbursement categories referred to as? - answerresource utilization
groups or RUGs
8 major RUG classification - answer- rehabilitation plus extensive services (REX)
- rehabilitation
- extensive services
- special care high
- special care low
- clinically complex
- behavioral symptoms and cognitive performance
- reduced physical function
5 levels of rehab intensity in the RUG categories - answer- ultra high
- very high
- high
- medium
- low
How are the five levels of rehab intensity determined? - answerby days, minutes, and
number of therapy
According the MDS instructions, what is a "day of therapy"? - answerminimum of 15
minutes of skilled care
prospective payment system (PPS). the
basics
What is a prospective payment system commonly referred to as? - answerPPS
What is the payment system used for? - answerto reimburse Skilled Nursing Facilities
(SNF) for the care provided to patients covered under Medicare Part A
What does the payment system provide? - answera daily rate of payment for a set
period of time
Why does the prospective payment system look at the resources used in the past
service period? - answerto determine payment for a future period of service
- level of care
- service provided
What are the reimbursement categories referred to as? - answerresource utilization
groups or RUGs
8 major RUG classification - answer- rehabilitation plus extensive services (REX)
- rehabilitation
- extensive services
- special care high
- special care low
- clinically complex
- behavioral symptoms and cognitive performance
- reduced physical function
5 levels of rehab intensity in the RUG categories - answer- ultra high
- very high
- high
- medium
- low
How are the five levels of rehab intensity determined? - answerby days, minutes, and
number of therapy
According the MDS instructions, what is a "day of therapy"? - answerminimum of 15
minutes of skilled care
