Chapter 10
consolidated billing
The SNF PPS also assigns billing responsibility to the SNF for the entire package of care that residents receive during a stay. This concept is called ______.
quality of care
requires a facility to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care
monthly
In many states, MDS data are required to be submitted to the state agency ______, in either paper or electronic form.
restorative rehabilitation
In some facilities, a distinction is made for nursing assistants who strictly provide restorative therapy. They are called ______ aides or ______ aides.
True
The care plan is viewed as the focal point for communicating significant care findings, resident preferences, and goals for the individual long-term care resident. True or False?
7
The care plan must be completed within ______ days after the comprehensive assessment and should be an interdisciplinary process that involves not only the professional disciplines involved in the resident's care but also the attending physician and the resident or the resident's legal representative.
true
True or False? Long-term care typically describes care of the frail, institutionalized elderly, or those who are permanent residents of a nursing facility.
true
True or False? Most ancillary services provided in long-term care facilities are through independent contractors.
LCTCH (long term acute care hospitals)
__________ facilities are licensed as hospitals and have their own prospective payment system under Medicare.
care plan
The ______ is viewed as the focal point for communicating significant care findings, resident preferences, and goals for the individual long-term care resident.
resource utilization groups (RUGS)
______ reimbursement methodology is a specific case-mix payment system used in a growing number of states for long-term care Medicaid reimbursement.
permanent residents skilled care
______ requiring ______ can receive services from one or more licensed professionals on a frequent, and often daily, basis.
quality of life
requires a facility to care for its residents in a manner and in an environment that promotes maintaining or enhancing each resident's quality of life
skilled nursing facility (SNF)
A ______ meets the requirements for reimbursement under Medicare.
14
According to federal regulations, a comprehensive assessment must be completed, within ______ days of admission or after any significant change in condition, for each resident admitted to a certified bed, and on at least an annual basis thereafter.
quality indicator survey (QIS)
In the _______, the resident record is used as a means of validating positive and negative care outcomes both in the annual survey and in complaint investigations.
special care unit (SCU)
The ______ often is a distinct service within a long term care facility.
registered nurses
______ are the primary coordinators of daily care within the long-term care facility.
MDS
In the Medicare- and/or Medicaid-certified facility, data and information flow centers on the ______, which is not only a vehicle for a clinical assessment process but also is a mandated data set linked to regulatory compliance.
short term
A ______ patient in a long term care facility is one whose length of stay is less than 100 days and the intent is to ultimately discharge the patient to a more independent level of care.
nursing facility
A __________ is a facility that is qualified for reimbursement under Medicare.
100
A short-term patient in a long-term care facility typically has a length of stay of fewer than ________ days.
licensure survey
A survey conducted by the state agency to determine compliance of long-term care facilities with state licensure laws.
quality indicator suvey (QIS)
In the federal survey process known as the ______, the resident record is used as a means of validating positive and negative care outcomes both in the annual survey and in complaint investigations.
social services
______ staff members are advocates for many residents who no longer are able to protect their rights to decision-making, fair treatment, dignity, respect, and so on, or who cannot realize what their rights are.
minimum data set (MDS) care area assessment (CAA) utilization guidelines
The RAI consists of three basic components: the ______; the ______ process, formerly resident assessment protocols (RAPs); and ______ as specified in the Resident Assessment Instrument Manual.
comprehensive resident
The ______ assessment is the primary vehicle for evaluating care outcomes in the federal long-term care survey process.
care area assessment (CAA) summary
The ______ form is used to document the location within the resident's record where the assessment information may be found.
long term care
______ typically describes the care of frail, institutionalized elderly people and those who are permanent residents of a nursing facility.
ICD-10-CM
_______ diagnosis codes must be used for submitting Medicaid, Medicare Part A SNF, and Medicare Part B claims
nursing facility (NF)
As stated in federal regulations, the term ______ is defined as a facility that is qualified for reimbursement under the Medicaid program.
minimum data set (MDS)
The ______ is a core set of screening, clinical, and functional status elements that constitute a standardized means of assessing all residents in Medicare and/or Medicaid certified facilities.
minimum data set (MDS)
The ______ is a vehicle for a clinical assessment process and also a mandated data set linked to regulatory compliance.
The Joint Commission
In addition to long-term care accreditation standards, ______ offers disease-specific care certification programs. For example, a long-term care facility with a special care unit for the care of Alzheimer's-type dementia residents could elect to seek certification for this unit with or without seeking accreditation for the entire facility.
prospective payment system (PPS)
Beginning in 1998, Medicare payments to SNFs changed from a cost-based reimbursement to a ______
15
In long-term care facilities, standard surveys are unannounced and conducted at least every ______ months.
RAVEN
CMS provides free software, called ______, for entering and transmitting MDS assessment data.
resident
In long-term care settings, the patient often is referred to as a(n) __________.
social services
Department providing medically related social services to residents
civil money penalties
Federal enforcement regulations outline remedies, including ______ of up to $10,000 per day, for findings of substantial noncompliance and substandard quality of care.
120
Federal long-term care regulations require that a facility with more than ______ beds employ a fulltime social worker or a person with qualifications outlined in the federal requirements.
individualization
From the perspective of a long-term care survey, ______ of care information is the single most important content characteristic of a care plan in the long-term care setting.
True
If a long-term care facility does not participate in the Medicare or Medicaid program, federal regulations do not apply, and the facility is subject only to the state licensure requirements. True or False?
skilled nursing facility sub acute
In ______ or______ units, frequency of physician involvement is generally greater and can range to several visits a week to once a month.
150
In the larger long-term care facilities, those with more than ______ beds, a registered dietitian may be a fulltime employee of the facility, particularly if the resident population predominantly requires skilled care and has more complex nutritional care needs.
resident
In the long term care setting the term patient is often replaced with ______.
nursing facility (NF) skilled nursing facility (SNF)
Long term care does not include types of institutionalized care settings that are not subject to the federal long term care regulations or the state licensure regulations for a ______ or a ______ .
False
Long-term care facilities are required to have accreditation from the Joint Commission. True or False?
information
Management of _______ is an area of growing significance in the long-term care setting, not only form a reimbursement perspective but also from a regulatory compliance and risk management perspective.
3 30 100
Medicare Part A coverage is limited in that a resident first must be eligible for Medicare Part A coverage and qualify with a ______-day hospital stay within the previous ______ days prior to admission to a Medicare-certified bed and require the services of a skilled professional on a daily basis. If these criteria are met, the duration of the SNF coverage is limited to the need for daily skilled care up to a maximum of _______ days per period of illness.
resource utilization groups (RUGs)
Medicare Part A payment rates now utilize a case-mix adjusted per diem rate. The per diem payments for each qualified admission are based on______, a case-mix methodology driven from the MDS.
comprehensive resident assessment
The ______ is the primary vehicle for evaluating care outcomes in the federal long-term care survey process.
True
Pharmaceutical services are not available directly within a long-term care facility and are provided mainly by a supplier that is remote to the facility. True or False?
therapeutic recreation
Poviding stimulating activities or ______ services is extremely important in the long-term care setting.
True
Proper documentation can be crucial in defending a provider against a wrongful claim for failure to provide quality care and services. True or False?
certified medication technician
Requirements for this position typically include a minimum of nursing assistant training with an additional course in medication administration.
False
The Omnibus Budget Reconciliation Act (OBRA) regulations have allowed facilities to define their own schedules of assessments that will be performed for a nursing facility resident. True or False?
record review
The ______ portion of the long-term care federal survey procedures instructs surveyors to evaluate the care and outcome of care provided to residents as portrayed through direct observation of the staff and assessed through improvement/decline as noted on the MDS.
care area assessment (CAA)
The ______ process provides structure for assessing social, medical, and psychological problems by providing a systematic method for reviewing key components of the MDS and directing caregivers to evaluate causes, interrelationships, and particular strengths that affect the development of the care plan.
social services
The ______ staff takes on many responsibilities that affect the care and well-being of the residents, such as making arrangements for adaptive equipment, clothing, and financial assistance; coordinating discharge planning; coordinating and initiating referrals and appointments with outside services; providing counseling to residents, family members, and facility staff as related to the care needs of individual residents; and providing any other services that promote the psychosocial well-being of the residents.
30 90 60
The minimum visit requirement for physician visits in the SNF and sub acute units is once every ______ days for the first ______ days and then every ______ days thereafter.
CAA resources
offer a list of resources to consult in performing the assessment of a triggered care area.
15
The standard survey is unannounced and is conducted at least every ______ months.
heavy care
The term ______ is used to describe the care needs of permanent residents requiring skilled care because of the intensity of their dependence on the staff for mobility, toileting, bathing, eating, and performing ADLs.
substantial compliance substandard quality of care
The two general survey outcomes for a standard survey are ______ and ______.
resident assessment instrument (RAI)
This assessment system provides a comprehensive, accurate, standardized, and reproducible assessment of each long-term care facility resident's functional capabilities and identifies medical problems
false
True or False? If a long-term care facility does not participate in the Medicare and Medicaid program, federal regulations still apply.
false
True or False? Long-term care facilities are required to seek Joint Commission accreditation.
special care units (SCU)
Units designed to care specifically for Alzheimer's patients, patients using ventilators, or those with special needs are called ______.
licensed physicians
Visits from ______ can range from once a month to once a year, depending on the level of care the resident requires.
doctors of medicine and osteopathy
What type of caregiver is responsible for the overall medical supervision in the long-term care hospital?
advanced practice clinicians
______ , such as nurse practitioners, clinical nurse specialists, and physician assistants, work with physicians to care for their patients who reside in long-term care facilities.
long term care hospitals (LTCH)
______ are licensed as hospitals and have their own prospective payment system (PPS) under Medicare.
licensed practical nurses
______ are the most predominant caregivers among the licensed professionals in the long-term care nursing facility setting. Their responsibilities range from administering medications, tube feedings, and treatments to being in charge of a nursing division and serving in a supervisory capacity within the nursing department.
qualitative
______ audits generally require more training, because they entail a more in-depth look at the actual content of the medical record.
quantitative
______ audits include review of whether medical record forms are complete, timely, and signed by the authors of the forms.
standardized
______ care plans that do not reflect individualization of care routines based on specific resident preferences, strengths, and care priorities are not regarded as individualized or resident-specific.
CPT
______ codes are used for billing Medicare Part B services for rehabilitation (PT, OT, speech) and for physician visits to residents in a nursing facility.
nursing assistants
______ comprise the bulk of the nursing department in a long-term care nursing facility. They are nonlicensed staff members who have completed a basic training course for providing daily care needs to geriatric patients, including basic skills in bathing, transfer training, lifting, range of motion, and related supportive services that would be provided under the general supervision of a licensed nurse.
MDS
______ has become the universal data set for the long-term care industry.
CMS
______ hosts a "Nursing Home Compare" website that provides information about nursing homes in the form of quality measures.
respite care
______ involves a short stay for the purpose of providing relief to primary caregivers.
documentation
______ is linked with regulatory compliance and is vital in the evaluation of how a facility has contributed to and/or has affected the quality of care and quality of life of individual residents.
documentation
______ is vital in evaluating how a facility has contributed to and/or affected the quality of care and quality of life of individual residents.
substantial compliance
______ means that any deficiencies the surveyors find are deemed to be of minimal potential for harm to the residents.
substandard quality of care
______ means that surveyors find one or more deficiencies that constitute either immediate jeopardy to resident health or safety; a pattern of widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm but less than immediate jeopardy, with no actual harm.
risk contract
a contract between an HMO and CMS to provide services to Medicare beneficiaries, under which the health plan receives a monthly payment for enrolled Medicare members
standard survey
a periodic, resident-centered inspection that gathers information about the quality of service provided in a facility to determine compliance with the requirements of participation in the federal Medicare and Medicaid programs.
culture change movement
a person-centered philosophy that creates a more homelike environment for residents of a nursing facility. Culture change involves providing individuals with privacy and the ability to make choices similar to what they would experience were they living in their own homes.
skilled nursing facility (SNF)
an institution that provides skilled nursing care or rehabilitation services and a registered or licensed practical nurse is on active duty at all times
nursing facility (NF)
an institution that provides skilled nursing care, rehabilitation services, or health-related care to individuals who, because of their condition, require services above the level of room and board.
sub acute care
care in these distinct units consists of skilled care for treatment of a specific condition, and often placement is temporary because the goal is to discharge the patient home or to a lower level of care.
OBRA assessments
performed for a nursing facility resident at admission, quarterly, annually, whenever the resident experiences a significant change in status, whenever the facility identifies a significant error in a prior assessment, and when discharged.
registered nurse
primary coordinators of daily care within the long term facility
case mix reimbursement
in the context of long-term care, a methodology designed to provide a mechanism for facilities to be paid in a manner reflecting the types of residents served and the types of services provided. The system also is designed to provide greater access to nursing facility beds for heavier care residents and to improve the quality of care for all nursing facility residents. Payment is based on a specific methodology that considers direct-care costs, care-related costs, administrative and operating costs, and property.
care area triggers (CATs)
specific resident responses for one or a combination of MDS elements which identify residents who have or are at risk for developing specific functional problems and require further assessment
permanent residents receiving nonskilled care
these residents are distinguished by their need for general oversidght and supervision in performing ADL's; however, their needs generally can be met without the direct care or services of a licensed professional on a 24 hour basis.
permanent residents receiving nonskilled care
these residents require more care because of physical or cognitive impairment but their daily care needs do not require continual intervention by a licensed nurse or other skilled health care professional
nursing assistant
they comprise the bulk of the nursing department in a long term care nursing facility
