Professional Practice Final Exam Study

What type of patients are admitted to hospitals?

acutely ill (Medical, surgical, trauma)

What is the admission criteria/reimbursement for a hospital?

1.) pre-admission approval

2.) Medicare A, Medicaid, private sector (employer-sponsored, Affordable Care Act exchanges, other private policies)

What type of patients are admitted to IP rehab?

patients who need continued intensive rehab

What is the admission criteria for IP rehab?

1.) pre-admission screen

2.) certain criteria relative to personnel, intensity, and coordination of services

What reimburses IP rehab?

Med A, Medicaid, Private sector

what type of patients are admitted to SNF?

1.) patients who need continued rehab but not at the intensity of inpatient rehab

2.) intended for short term stay

What is the admission requirement/reimbursement for a SNF?

1.) 18 years of age

2.) Medicare has certain technical and level of care scenarios

3.) Reimbursement: Med A, Medicaid, Private sector

What type of patients qualify for LTAC?

1.) complex medical problems that need long term skilled care

-multi-system organ failure, respiratory failure, wound care complications, chemotherapy, pre/post op transplant

what is the admission criteria/reimbursement for LTAC?

1.) under medicare guidelines, patients must be in need of hospitalization for >25 days

2.) Reimbursement: Med A, medicaid, and private sector

what type of patients qualify for long term/nursing care?

1.) those who can no longer care for themselves independently and lack the support structure to remain in their homes

2.) those who have extensive medical needs

3.) may have intermittent rehab needs

What are the admission criteria/reimbursements for long term/nursing care?

1.) 18 years old

2.) physical exam

3.) statement of finances

4.) Medicaid, private long term care policies, private pay

what type of patients qualify for assisted living?

1.) fills the gap between independent living and nursing home

2.) physical or cognitive issues

What are the different types of assisted living facilities?

1.) Community Based Residential Facilities

2.) Adult Family Home

3.) Adult Day Care

4.) Residential Care Apartment Complexes

5.) Independent Living Centers/Senior Apartments

What is a community based residential facility?

a place where 5 or more adults reside who:

1.) are not related to the operator or administrator

2.) do not require care above intermediate nursing level

3.) receive care, treatment or services that are above the levels of the room and board, but includes no more than 3 hours of nursing care per week per resident

What are the different levels of community based residential facilities?

1.) ambulatory, semi-ambulatory, non-ambulatory

2.) Class A - mentally and physically capable of responding to an emergency without assistance

3.) Class C - not mentally and physically capable of responding to an emergency without assistance

what are services provided at community based residential facilities?

1.) 24 hour health monitoring

2.) assistance with medications

3.) assistance with personal care

4.) recreational activities

What is an adult family home?

a place where 3 or 4 adults reside who:

1.) are not related to the operator

2.) above the level of the room and board

3.) may include up to 7 hours of nursing care per resident

What is an adult care center?

planned program of activities designed to promote well being through social and/or health related activities

What are the 3 levels of care for adult day care?

1.) social care

2.) Healthcare

3.) Alzheimer's care

What is a Residential Care Apartment Complexes?

a place where 5 or more adults reside, that provide room and board, and no more than 28 hours a week of services: supportive services, personal assistance, and nursing services

What is the reimbursement for assisted living?

1.) mostly private pay

2.) Medicare does not reimburse

3.) Medicaid will pay for some or all the costs for assisted living for qualified individuals

What are the reimbursement for home care?

Med A/B, Medicaid, Private Sector

What type of patients qualify for outpatient services?

provided for patients in need of rehab who are community dwelling

What is the reimbursement for OP services?

Medicare B, Medicaid , Private Sector