question

Who determines how long-term care facilities are reimbursed under the Medicaid program?

answer

The individual state agency through state legislation

question

Developed by an interdisciplinary team, the _____ includes measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs.

answer

Care Plan

question

The ______ (is/are) a core set of screening and assessment elements, including common definitions and coding categories forming the foundation of the comprehensive resident assessment of residents in a long-term care facilities, such as skilled nursing facilities (SNF)

answer

minimum data set

question

Which of the following provide(s) structure for assessing social , medical, and psychological problems by providing a systemized method of reviewing key components of the minimum data set and directing caregivers to evaluate causes, interrelationships, and particular strengths that affect development of the care plan?

answer

Care area assessment process

question

When a care area is triggered, the long-term care interdisciplinary team documents the outcome of the assessment process for that particular care area and _____

answer

their decision regarding care planning for a particular problem or need

question

Medicare Part A coverage is limited in that a long-term care resident must first qualify with a minimum of a ____ hospital stay

answer

3 day

question

The duration of skilled nursing facility Medicare Part A coverage is limited to the need for daily skilled care up to a maximum of ____ days per spell of illness.

answer

100

question

The resource utilization group (RUG) that applies to a given resident is based on ____

answer

the minimum data set

question

The phrase "private pay" in the long term care setting denotes payment by ____

answer

the individual or family

question

In long-term care, CPT codes are used most commonly to bill for:

answer

Medicare Part B Services

question

Which of the following is a facility in which the majority of patients are regarded as permanent residents?

answer

Nursing Facility

question

Which of the following would initiate a complaint investigation in response to a hotline call concerning alleged abuse or neglect?

answer

The state licensing agency

question

According to federal regulations, the care plan should be completed within ______ of the comprehensive assessment.

answer

7 days

question

An agreement between the HMO and CMS to provide services to Medicare beneficiaries under which the health plan receives a monthly payment for enrolled Medicare members and must then provide all services needed is called a(n) ______

answer

Risk Contract

question

CMS provides free software for entering and transmitting MDS assessment data. This software is called ____

answer

RAVEN

question

Ability to bathe, dress, groom, transfer and ambulate, toilet, eat, use speech, languages, etc.

answer

Activities of daily living

question

Clinically relevant information about an individual that identifies specific problems and forms the basis for individual care planning

answer

care area triggers

question

A periodic, resident-centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation in the Medicare and Medicaid programs

answer

standard survey

question

A person-centered philosophy that creates a more home-like environment for residents of a nursing facility

answer

culture change movement

question

Residents who need constant oversight and supervision in activities of daily living

answer

Permanent residents receiving non skilled care

question

Designed to care for residents diagnosed with conditions such as Alzheimer's

answer

Permanent residents, special care

question

Residents receive frequent skilled care from a licensed professional

answer

Permanent residents, skilled care

question

Residents length of stay is less than 100 days

answer

Short-term patients

question

Short stay to provide relief to primary caregivers of the frail elderly

answer

Respite care

question

Physical presence in the long-term care facility is limited

answer

Licensed Physicians

question

Coordinate long term daily care and hold supervisory positions

answer

Registered Nurses

question

Predominant licensed caregivers in the long term care setting

answer

Licensed practical nurses

question

Provide daily care needs to long term care residents

answer

Nursing Assistants

question

In some states, can assume responsibilities to lessen the load of the licensed nursing professionals

answer

Certified medication technicians

question

Make arrangements for adaptive equipment, clothing, and financial assistance

answer

Social Services

question

Responsible for assessing the therapeutic recreational needs and preferences of each resident and developing and individualized program

answer

Activities Staff

question

Often independent contractors rather than employees

answer

Occupational therapists

question

True or False: Standard surveys of long-term care facilities are unannounced and conducted at least every fifteen months

answer

True

question

True or False: Contracted providers, such as physical therapists, bill Medicare directly for their services to residents in a skilled nursing facility

answer

False

question

True or False: Long term care patients are commonly called residents

answer

True

question

True or False: Most LTC facilities are accredited by the Joint Commission

answer

False

question

True or False: Substantial noncompliance and substandard quality of care findings at a long term care facility can result in fines up to $10,000 per day

answer

True

question

True or False: A care area may be triggered by data entered on the minimum data set (MDS) and, if so, the interdisciplinary team must document the outcome of their assessment process for that care area

answer

True

question

True or False: When federal and state laws conflict, the facility is required to follow federal law

answer

False

question

True or False: In long-term care facilities such as nursing facilities, records are generally audited for completeness only at the resident's death or discharge

answer

False

question

True or False: Resource Utilization Groups (RUGs) compromise a case-mix methodology based solely on diagnosis and procedure codes submitted on Medicare bills.

answer

False

question

True or False: When the state agency receives notification of a complaint about a long-term care facility, the result is an investigation of the facility

answer

True

question

True or False: The medical program for the indigent is called Medicare

answer

False

question

Which of the following is a list of organizations that have deeming authority for home health care with regard to Medicare certification and the Condition of Participation?

answer

The Accreditation for Commission for Health Care (ACHC) The community Health Accreditation program (CHAP) and the Joint Commission

question

Medical-surgical nursing, intravenous therapy, and restorative nursing care are ____

answer

skilled nursing services

question

_______ is a data set that is a requirement under Medicare for home health

answer

OASIS-C

question

______ is the basis for home health reimbursement under Medicare

answer

HHRGs

question

Under Medicare, approximately how often must a physician certify that home care is needed?

answer

every 60 days

question

One of the criteria for receiving Medicare payment for home care is that the patient being served must be _____

answer

homebound

question

_______ is a charitable organization that provides food services for those unable to leave the home:

answer

meals on wheels

question

A wheelchair or hospital bed is an example of ______

answer

durable medical equipment

question

In-home respite care______

answer

Allows the primary caregiver to have some free time

question

Labor costs and transportation costs associated with home care visits are examples of _______

answer

variable costs

question

Software available from CMS which can be used for data entry, editing, and validation of OASIS data is called

answer

HAVEN

question

The federal agency within the DHHS responsible for administering Medicare programs related to home health is the _______

answer

Centers for Medicare and Medicaid Services (CMS)

question

The rule used as a basis of comparison for measuring quantitative or qualitative value is

answer

standard

question

A _______ is a record organized in sections according to patient care departments and/or disciplines

answer

Source-oriented record

question

Physical therapy, occupational therapy, speech-language pathology, medical social services and respiratory therapy are all examples of various _____ that may provide services to home health patients.

answer

disciplines

question

True or False: Home health care is a service provided to recovering, disabled, or chronically ill patients who receive their treatment in their homes.

answer

True

question

Medicare will only pay for home health care services for persons who are homebound.

answer

True

question

True or False: A home care agency that opts to be surveyed for Medicare certification by the Joint Commission would be deemed to be in compliance with the Conditions of Participation upon accreditation by the Joint Commission

answer

True

question

True or False: The Community Health Accreditation Program (CHAP) us responsible for the development of the OASIS data set and manages data collection using OASIS for home care providers nation wide.

answer

False

question

True or False: The Accreditation Commission for Health Care (ACHC) has deeming authority for Medicare in home health, hospice, and DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies)

answer

True

question

True or False: The home care patient's physician must review, update and recently (if necessary) the plan of care at least every 6 months, a time frame referred to as the certification period.

answer

False

question

True or False: The Outcome and Assessment Information Set (OASIS) is a data set that is used by Medicare for both payment and quality improvement purposes

answer

True

question

True or False: An upcode occurs when the provision of care to a patient results in unusually high costs to the home care agency

answer

False

question

True or False: A home health care agency's payer mix is the ratio of various insurers and third party payers, such as government programs and commercial insurers

answer

True

question

True or False: Home Health Resource Groups (HHRGs) are based on assessment data in three areas --- Clinical, Functional, and Service Utilization

answer

True

question

True or False: A physician must have a face to face encounter with the home health patient within 7 days prior to the start of home health care, or within 3 days after the start of care

answer

False

question

True or False: Medicare-certified home health agencies are required to use OASIS-C for evaluating children and maternity patients

answer

False

question

An associate or member of a particular business

answer

Affiliate

question

A formal way of checking financial and other records

answer

Audit

question

Lack of payment for services rendered due to failure to meet requirements or some other reason

answer

Denial

question

Any happening that is not consistent with routine operations

answer

Incident

question

Data set required of home health care agencies

answer

OASIS

question

End result or consequence; the patient's health and functional status after a period of treatment

answer

outcome

question

Assist patients who suffer from strokes or adverse effects of feeding tubes or endotracheal tubes; teach proper swallowing techniques and so on

answer

Speech-language pathologists

question

Assist the patient to become independent with person care duties such as dressing, bathing and other normal activities of daily living.

answer

Occupational therapists

question

Establish a home exercise and maintenance program for the patient, assisting with exercise routines and ambulating devices

answer

Physical therapists

question

Help patients and family members cope with a patient's disease process through placement and involvement with community services; help find appropriate resources and make suggestions for long-range planning

answer

Medical social services

question

Teach techniques to increase efficiency in the lungs, such as pursed-lip breathing, and safety precautions when using oxygen equipment in the home.

answer

Respiratory therapists

question

The ____ provides care to the hospice patient in the patient's place of residence (such as giving medications, dressing changes, reporting changes in patient's condition) when hospice staff are not there

answer

Primary caregiver

question

Mr. Jones has elected the hospice benefit. Upon election of the hospice benefit, Mr. Jones ________

answer

waives standard Medicare coverage for services related to the terminal diagnosis

question

A hospice patient is admitted to a hospital for pain and symptom management. The hospice will be reimbursed for ______

answer

general inpatient care

question

In a hospice situation, the _____ period ordinarily lasts about one year

answer

bereavement

question

Clinical measures taken to reduce the intensity of disease symptoms, rather than providing a cure for the disease are called

answer

Palliative care

question

Which of the following statements is true concerning Medicare regulations regarding volunteers in hospice?

answer

Volunteer hours must equal at least five percent of the patient care hours of paid employees and contract staff

question

Hospice care focuses on the needs of _____

answer

both patient and the family

question

______ deals with the number of admissions, discharges, transfers and number of patients under the care of a hospice on a given day

answer

Census data

question

Where is the majority of hospice care provided?

answer

Patient's place of residence

question

An individual is considered to be terminally ill if he or she has a life expectancy of _____ or less based on the physician's clinical judgment regarding the normal course of the individual's illness.

answer

6 months

question

The National Hospice and Palliative Care Organizations (NHCPCO) _________

answer

has staff available to answer questions or concerns regarding interpretation of NHPCO standards

question

When a Medicare patient revokes the election of hospice care, ________

answer

the patient returns to standard Medicare coverage

question

The Palliative Performance Scale ______

answer

assesses the patient's physical, functional, and mental status

question

In hospice, coding additional ______ helps build a diagnosis database that can be used to evaluate not only the quality of care give, but also the components of various diagnosis groups.

answer

Signs and symptoms

question

When coding, which would be more useful to hospice staff for internal evaluation of the quality of care provided to the terminally ill?

answer

Urinary tract infection

question

The days of care reimbursed by Medicare at an inpatient rate (either general inpatient or respite) ______

answer

can be no more than 20 percent of the total days of hospice care

question

Upon the death of the patient, the health information department may get numerous requests from insurance companies or attorneys to settle a claim or probate the patient's estate. No information should be released without proper authorization from _____

answer

the legal representative of the estate

question

Hospice routinely provide ________ services as part of the hospice benefit

answer

social work

question

Under Medicare, hospice payment rates are adjusted based on _______

answer

the geographic location of the patient

question

Medicare reimburses hospice care on a _______ basis

answer

per diem

question

A patient is at his or her place of residence and is receiving non-problematic care

answer

Routine home care

question

A patient receives predominantly nursing care for a minimum of 8 out of 24 hours at his or her place of residence during a period of crisis

answer

Continuous care

question

A patient receives care un a approved facility in a short-term basis (not more than 5 days at a time)

answer

Respite care

question

A patient receives care in an approved facility for pain control or acute or chronic symptom management

answer

General inpatient care

question

True or False: Hospice care focuses exclusively on the needs of the patient as the unit of care

answer

False

question

True or False: Under Medicare regulations, both the attending physician and the hospice medical director must certify that the patient is terminally ill

answer

True

question

True or False: Hospice provide curative therapy rather than symptom management

answer

False

question

True or False: No more than 50 percent of hospice care can be provided in the patient's place of residence

answer

False

question

True or False: The primary caregiver is the person designated to provide care for the hospice patient when hospice staff is not available

answer

True

question

True or False: When a hospice patient is admitted to the hospital for pain and symptom management, the hospital is reimbursed by Medicare for the DRG and the hospice receives a reduced per diem payment for each day of the patient's stay

answer

False

question

True or False: The Affordable Care Act requires that hospice physician or nurse Practioner have a face-to-face encounter with a hospice patient not more than 15 days prior to the start of the hospice patient's second benefit period

answer

False

question

True or False: Volunteers may be paid at a lower hourly rate than other hospice employees

answer

False

question

True or False: Medicare regulations permit certification of terminal illness with a life expectancy that is unknown and/or unspecified

answer

False

question

True or False: A hospice program is licensed b the state in which its located

answer

True

question

True or False: There is no voluntary accreditation organization with deeming authority for hospice programs and facilities

answer

False

question

True or False: In addition to clinical staff, the interdisciplinary team includes a pastoral and other counselor who offers spiritual support and comfort

answer

True

question

True or False: Hospice benefit periods are categorized as an initial 60-day period, a subsequent 60-day period, then a final 90 day period

answer

False

question

True or False: By definition, the patient's primary caregiver is also the patient's legal representative

answer

False

question

True or False: Hospice services require little out of pocket expense and paper work on the part of the patient and/or family

answer

True

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