Healthcare Settings, Reimbursement, and Regulatory Compliance Flashcards

Under Medicare's inpatient rehabilitation facility (IRF) intensity rule, a patient generally must be able to tolerate how much therapy?

Answer: 3 hours per day, at least 5 days per week

The IRF "3-hour rule" requires intensive therapy of at least 3 hours per day, 5 days per week, or 15 hours over 7 days.

Which disciplines are counted toward the IRF intensive therapy requirement?

Answer: PT, OT, SLP, and orthotics/prosthetics

CMS counts PT, OT, speech-language pathology, and orthotics/prosthetics toward the intensity requirement; RT is part of the interdisciplinary team but is not counted.

The IRF "60% rule" requires that at least 60% of an IRF's patients:

Answer: Have one of the CMS-specified qualifying medical conditions

At least 60% of an IRF's patients must have one or more of 13 qualifying conditions, such as stroke, spinal cord injury, or brain injury.

Which assessment instrument must be completed for Medicare patients admitted to an inpatient rehabilitation facility?

Answer: IRF-PAI

The Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF-PAI) drives IRF PPS payment and quality reporting.

In acute care hospitals, Medicare inpatient payment under the IPPS is based on:

Answer: Diagnosis-Related Groups

Acute hospitals receive a fixed payment per discharge based on the patient's Diagnosis-Related Group (MS-DRG).

A CTRS is told a patient is in "observation status" for three days at the hospital. What is the main implication for a later skilled nursing facility stay?

Answer: Observation days do not count toward Medicare's 3-day inpatient stay requirement

Observation is outpatient status, so those days don't count toward the qualifying 3-day inpatient stay for Medicare Part A SNF coverage.

Which federal law requires that HIPAA-covered entities disclose only the minimum necessary protected health information for a given purpose?

Answer: HIPAA Privacy Rule

The HIPAA Privacy Rule includes the minimum necessary standard for uses and disclosures of PHI.