Question 1

What is the method of reimbursement for skilled home care services?&#10;A) Fee for service&#10;B) Per episode&#10;C) Per case&#10;D) Prospective payment

Accepted Answer

Prospective payment is the system of reimbursement for skill home care services. The other choices are other forms of reimbursement that are not commonly used in home care.

Question 2

Rehab managers responsible for services in hospices should emphasize which of the following concepts?&#10;A) Assuming increasing control of a patient's life&#10;B) Optimizing function at each stage of dying&#10;C) Fragmentation of components of care&#10;D) Inclusion of PT and OT in every plan of care

Accepted Answer

The key is educating other providers of the importance of rehab although the patient's ability to function is deteriorating. Function should be optimized at each stage through a integrated, not fragmented, plan of care that supports patient control of their circumstances. Legally, a hospice must have PT and OT services available, but are not required to have each patient receive those services.

Question 3

What is the expression that describes the premature discharging of a patient because a therapist is uncomfortable with the home situation or the patient is perceived as unpleasant or a threat?&#10;A) Discontinuance&#10;B) Dumping&#10;C) Suspension&#10;D) Break-off

Accepted Answer

This is a description of patient dumping, also known as abandonment. The other options are synonyms for discontinuation

Question 4

What is the current status of home care in the U.S. healthcare system?&#10;A) Home care uses more Medicare dollars than any other setting&#10;B) Utilization of home care services for children is on the decline&#10;C) Home care services have increased because of technology&#10;D) Hospitals prefer patient transfers to skilled nursing facilities.

Accepted Answer

Hospitals and physicians take the most Medicare dollars. In comparison, home care is a much smaller share. All home care services are on the rise because of technology that enables transfer of very sick people to their homes. Return to home is a time honored tradition and an outcome expectation for hospitals.

Question 5

Which applicant would be the preferred hire for a home care job?&#10;A) New graduate physical therapist with interest in home care&#10;B) Outpatient certified orthopedic specialist who seeks additional income&#10;C) Physical therapist with recent acute care work in her ten-year experience&#10;D) Physical therapist with four years of SNF experience only

Accepted Answer

The general opinion is that therapists need at least one year of experience to work in home care. It may be difficult for an OP person to transition to patients with low functional goals. Acute care experience is helpful as home care patient acuity continues to increase. SNF experience is good but home care usually covers a broad age range. A physical therapist with recent acute care work during her ten years of experience is the most experienced candidate and that is generally important as well.

Question 6

What is the system for home care patient data collection?&#10;A) OBRA&#10;B) OASIS&#10;C) OIG&#10;D) OMB

Accepted Answer

OASIS is the software system that drives documentation and outcomes in home care. OBRA is the federal legislation that improved and controls skilled nursing home care. OIG is the office of the Inspector General that prosecutes Medicare fraud. OMB is the Office of Management and Budget that implements the executive orders across the federal government.

Question 7

Which of the following occurrences of fraud is most common in home care?&#10;A) Overcharging&#10;B) Providing unnecessary services&#10;C) Forged signatures&#10;D) Billing for services not provided

Accepted Answer

Because of the lack of direct supervision, providers may submit charges for services that were not provided. This lack of supervision provides opportunity for fraud unless a manager surveys the patient to confirm services provided. Overcharging is billing an insurer or patient for more than the given charges for services. Providing unnecessary services is more of a risk in situations in which the number of patients required to reach productivity goals are not available. This is uncommon in today's healthcare environment and current reimbursement policies. Although incidents of healthcare providers signing documentation of services they did not provide (ex: an aide saw a patient and signed the PT's name) are known, these seem to be rare occurrences.

Deck 16: Management Issues in Home Care Organizations