Study Guide For Lisa Unit 2 Quiz

Advocacy

an active and principled process of advancing the cause of something or someone

CMS

Centers for Medicare and Medicaid Services

Managed Care

Shifted the authority of determining the services the patient needs from the providers of care to the payers of care (third party) and is private contract

Reimbursement and TR
Insurance Companies Require what

Physicians Order

Reimbursement and TR is dependent on what

Insurance contracts
Local managed care agreements
Documentation
Active Treatment

What is Active Treatment

Restore, remediate, rehabilitate, reduce, eliminate

Documents must justify reimbursement if they show what?

Protocol
Evidence based

For TR reimbursement each setting is influences by

regulatory standards (CMS-centers for medicare and medicaid services, JC,CARF)

Direct Reimbursement for TR

Time units: billed per time interval
Per diem rate: services are part of daily charge
Still need physician orders no matter what!

What types of activities are sometimes used in TR, but historically not covered?

Rec for rec's sake
Diversion (coloring)
Movie night
Palliative care

What does PPS stand for?

Prospective Payment System

What is PPS

Medicare payments made based on predetermined, fixed amount
Early 1980s payment derived from classification system of that service
- Diagnostic Related Groups (example. Needing a shunt)

CMS has separate _____ for reimbursement to different types of facilities

PPSs

What are the four different parts of Medicare

A:hospital
B:Medical insurance
C:Supplemental
D:Prescriptions

The different parties of Medicare

1st party: The consumer
2nd party:Healthcare organization
Largest federal 3rd party payer

What age can people get medicare

65 years old

What year was people with disabilities added to medicare

1972

What is medicare

is federal health insurance for people 65 or older

Defintion medicaid

is an assistance program for low-income patients' medical expenses

Facts about medicaid

It is state programs
Low income families must qualify
Cost of living, poverty lines varies by state

Categories of healthy people 2030

Health Conditions
Health Behaviors
Populations
Settings and systems
Social determinants of health

Healthy People

The surgeon general's report on health promotion and disease prevention 1979

Affordable Care Act basics

2010 by obama
Provide 32 million people with health insurance
low income in every state, health insurance tax credit, by health coverage, exchange for menu of options

Access to Inpatient Rehabilitation Act/Three Hours Rule Basics

Charge insurance for 3 hours a day
In 2010- no longer TR
2015: Wants to undo and allow TR didn't get pass
Tried again in 2017