QUIZ: 2022 Medicare Part A Coverage Guidelines

1. Question

Medicare Part A coverage in the SNF covers a resident’s expenses including room and board, therapy services and nursing services.

True
False

2. Question

If a resident is “cut” from Medicare Part A before using all 100 days, they can “restart” Part A if done so within 30 days of the recent skilled episode.

True
False

3. Question

The Medicare Benefit Policy Manuals contain all Medicare regulation. In what Chapter can the rules for Part A in the SNF be found?

Chapter 5
Chapter 8
Chapter 15
Chapter 22

4. Question

Medicare Part A requires the following – Check all correct answers:

A physician order prior to starting therapy
Services are for a condition which patient received hospital services for OR for a condition that arose in the SNF that was treated in the hospital
The resident was on a therapy program in the hospital prior to coming to the SNF
Daily services needed, as defined as 7 days per week for nursing and at least 5 days per week for therapy
All services delivered are reasonable and necessary, consistent with the severity of illness and patient’s medical needs and must be reasonable in terms of duration and quantity.
60 minutes minimum of therapy per day

5. Question

Medicare payment is based on providing SKILLED SERVICES…or services that require the SKILL of the NURSE or THERAPIST.

True
False

6. Question

The following statements are True:

Diagnosis or prognosis is NOT a factor in deciding if a service is SKILLED
Potential for recovery is NOT a deciding factor
The key is if the SKILL of the nurse or therapist was needed—if the service could have been provided by non-skilled personnel (aide, family) it is not skilled

Yes
No

7. Question

In order to meet the coverage criteria for SNF Part A, skilled services need to be provided on a daily basis. For nursing services, daily is defined as 7 days per week. For therapy, daily is defined as 6 days per week.

True
False

8. Question

Services provided by a skilled therapist or nurse are considered skilled, regardless of the activity that is provided.

True
False

9. Question

The following are all categories of skilled care examples except:

Daily routine care
Management and Evaluation of the Care Plan
Observation and Assessment of resident's condition
Teaching and Training

10. Question

The only way to prove skilled services are reasonable and necessary is through documentation.

True
False

11. Question

Medicare Part A transitioned away from the RUG-IV reimbursement system to the Patient Driven Payment Model in October 2019 because:

This was required due to the Paperwork Reduction Act
There are too many people receiving Medicare benefits
CMS has had longstanding concerns about SNF practice patterns of maximizing therapy to attain revenue vs providing therapy based on resident need
Regulation requires the the reimbursement system changes every 20 years

12. Question

By placing therapy days and minutes in Section O of the MDS, the therapist is attesting that those services, including the MODE of therapy, meet Medicare criteria and are skilled, reasonable and necessary and supported in the documentation.

True
False

13. Question

PDPM practices will bring about new negative practice patterns that will eventually arise as False Claims Act lawsuits, just as the RUG system generated multiple False Claims Act lawsuits. Examples of negative practice patterns in the RUG system included: Placing all residents in Ultra High, Achieving exactly 720 minutes in the lookback period for Ultra High, Having the Rehab Manager set the therapy schedule for all disciplines, etc.

What are PDPM potential negative practice patterns that may come into scrutiny with a chance for loss of Part A payment?

(Check all that apply)

Providing limited therapy minutes per day (ie: under 30 minutes) and/or providing excessive amounts of non-individual therapy
Providing therapy less than 5 calendar days per week (with the exception of an occasional missed visit due to illness, refusal)
Providing Group and/or Concurrent Therapy to all residents, without supporting documentation of why these modes are more beneficial to the resident than Individual Therapy
Selecting ICD-10 Codes for Section I020B based on highest paying code component and not for primary reason for Part A coverage

14. Question

When the Department of Justice and the Federal Government bring about a False Claims Act lawsuit for Medicare Part A, it is the SNF that is charged. SNF employees and contract staff cannot be included in the lawsuit.

True
False

15. Question

Which of the following regarding skilled therapy are true? Check all that apply.

Diagnosis or prognosis is NOT a factor in determining if therapy is skilled
Therapy is skilled ONLY if the resident makes progress
Therapy can be considered skilled to maintain a resident status
Therapy can be considered skilled to prevent or slow resident decline
If the therapy services can be provided by an aide or family member it is not considered skilled

Quiz Summary

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