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pg. 1 NAB-NHA Line of Service Exam Review 2025 Actual Exam Test Bank| Complete 300 Real Exam Questions and Correct Detailed Answers (Verified Answers) Graded A+|| Brand New!!
What is PDPMP? – ANSWER - e Patient Driven Payment Model
How does PDPM improve payments to SNF's? – ANSWER - Improves payment accuracy and appropriateness by focusing on the patient, rather than the volume of services provided, Significantly reduces administrative burden on providers, & Improves SNF payments to currently underserved beneficiaries without increasing total Medicare payments
How is RUG-IV different from PDPM? – ANSWER - Under RUG-IV, the number of PT, OT, and SLP therapy treatment minutes are combined for a total number of treatment minutes that is used to classify a given patient into a given therapy RUG
What is CB? – ANSWER - Consolidated Billing
What is MAC? – ANSWER - Medicare Administrative Contractor, where Medicare payments are made through.
What does Medicare Part A cover? – ANSWER - Medicare-certified SNF Skilled care services. 1 / 4
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pg. 2 What is the maximum amount of days Medicare part A covers for SNF services? – ANSWER - Up to 100 days of SNF care per benefit period, but it pays the full amount only for the first 20 days. For each day from the 21st through the 100th, the beneficiary must pay the ''coinsurance''
How long is the Medicare Part A interruption period? – ANSWER - A 3- day period beginning on the first non-covered day after a part A covered
SNF stay and ending at 11:59 PM on the third consecutive non-covered
day.
What is a Prospective Payment Systems? – ANSWER - A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.
What is Medicare Fee-for-Service? – ANSWER - Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered.
What is value-based purchasing? – ANSWER - Linking provider payments to improved performance by health care providers. The SNF VBP Program is a Centers for Medicare & Medicaid Services (CMS) program that awards incentive payments to SNFs based on their performance on a single measure of all-cause hospital readmissions.
What are the SNF financial reporting requirements? – ANSWER - A SNF must prepare annual consolidated financial statements of related entities and have those statements reviewed by a Certified Public Accountant (CPA), unless already audited. 2 / 4
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pg. 3 How often must Medicare-certified institutional providers are required to submit a cost report to a Medicare Administrative Contractor (MAC).– ANSWER - Annually
What must a cost report contain that is being submitted to Medicare? – ANSWER - Provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data.
Why should an administrator get department heads involved in the budget-making process? – ANSWER - To obtain more accurate cost estimates and more control over costs.
Medicare Part A coverage of skilled nursing facility (SNF) care entails out-of-pocket payment by the resident of a daily amount for which days of SNF care in a benefit period? – ANSWER - 21st through 100th
The process by which an individual becomes eligible for Medicaid by incurring medical expenses until personal resources fall below a
specified ceiling is called: – ANSWER - Spend down
Part A Medicare eligibility requirements include the resident: –
ANSWER - Needing skilled nursing care on a daily basis.
Under the Patient Driven Payment Model (PDPM), a nursing home must set an assessment reference date (ARD) within how many days of the beneficiary's admission? – ANSWER - 8 days 3 / 4
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pg. 4 A care recipient residing in a skilled nursing facility has elected hospice care. Shortly thereafter the patient experiences a significant weight decline and develop pressure injuries. The interdisciplinary team suggests an alternating pressure air mattress for comfort. Who will be responsible for the rental charge of this mattress? – ANSWER - The hospice agency
A care recipient with traditional Medicare coverage is receiving skilled therapy after a back surgery in a skilled nursing facility. The recipient needs to go to a follow-up appointment with the surgeon. An ambulance transport is medically necessary and reasonable for the recipient. Under consolidated billing, will the nursing facility have to pay for the ambulance transportation? – ANSWER - No, if the ambulance transportation is a medical necessity, the transport may be excluded.
For care recipients receiving psychotropic medications, it is important for the facility to perform laboratory testing to check on which of the following metabolic side-effects? – ANSWER - Unstable blood sugars
Nursing facilities operating under a Medicare license must promptly refer care recipients with lost or damaged dentures for dental services within how many days? – ANSWER - Referral must be made within 3 days.
What is true regarding Non-Physician Practitioner (NPP) visits to care recipients residing in a skilled nursing facility (SNF)? – ANSWER - NPPs may perform every other required visit, after the initial visit is conducted by the physician.
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