There are length of stay rules that govern skilled nursing facilities, which are reimbursed for up to 100 days of care per calendar year (Medpac.gov, online). If the patient requires more than 100 days of care, that patient is deemed by the government to be in need of long-term care (LTC), for which Medicare does not reimburse providers for. The patient costs associated with skilled nursing facilities is often offset by a Medicaid component, and if the patient has any financial responsibility, it is minimal. However, to qualify for the Medicaid component, the patient must be indigent, and if the patient owns any property, the state in which the patient receives the skilled nursing or long-term nursing care in, which made payments for the patient shares, can seize the patient's assets at death, and sell the assets (usually property) to offset its losses.
The resource utilization groups by which the government determines the RUG payment to the skilled nursing facility, are classified by 53 groups of diagnoses that are related to skilled nursing levels of care (Medpac.gov, online). The groups are assigned reimbursement levels (refer to diagram above), and are periodically updated by the group as is determined by the government with regards to inflation in the cost of the RUG (Medpac.gov, online). The RUGs are tracked by the government, because the patients who fall within a certain RUG should have similar charges for utilization of care (Medpac.gov, online).
Again, documentation must support the RUG. For instance, when physical therapy or another ancillary service is utilized by the patient, the number of minutes, or hours that the patient receives in service will impact the...
Prospective Payment System and how that system has impacted the nursing home industry. The writer explores how the system operates and explains its necessary elements. The writer than discusses the impact and significant elements that the system has on the nursing home industry. There were 10 sources used to complete this paper. One of the most pressing concerns facing the nation today is the health care system. The medical community
If the area wage index is greater than 1, the labor share equals 69.7%. The law requires the labor share to equal 62% if the area wage index is less than 1.0. 2) the wage adjusted labor share is added to the non-labor share of the standardized amount. 3) the wage adjusted standardized amount is multiplied by a relative weight for the DRG. The relative weight is specific to each of
Nursing Shortage Issues Surrounding the Nursing Shortage In the early 2000s, national strategies to improve the nursing workforce profile were largely focused on increasing the number of nurses at the bedside through the use of sign-on bonuses and travel nurses. While these strategies tended to provide local short-term solutions, they did little to address long-term issues affecting the nursing shortage. With nursing education programs challenged to increase student enrollment, many colleges were
Healthcare Practices in Nursing Today Over the last 50 years, health care systems all over the world have experienced rapid and significant changes. Some of these changes have been the result of innovative developments in medical science and technology that have greatly benefited patients, prolonging and saving the lives of millions. Some of these changes, however, have had the unfortunate result of limiting patient access to prescribed treatment and diminishing
Health Care Reimbursement and Billing Both Mrs. Zwick and Mr. Davis face significant issues in the presented scenarios. Mrs. Zwick has multiple considerations under Medicare Parts A, B and D, in addition to her hospital-acquired urinary tract infection. Meanwhile, Mr. Davis must address the severe time constraints and costs of COBRA in light of his job termination. These two scenarios underscore current difficulties and complexities of current health care in the
This is important because the cost of hospital acquired infections run high. The cost to care for a patient with a hospital acquired infection is almost three times the amount to care for a patient without a hospital acquired infection (Hassan et al., 2010). Since hospital acquired infections can be attributed to the hospital, Medicare and Medicaid will no longer cover payment of these infections beginning in 2008. Medicare and
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