HELLO

 

I HAVE 10 QUESTIONS I NEED HELP WITH, PLEASE YOU MUST  READ THE ATTACHED FILES

TO ANSWER THESE QUESTIONS.

 

THANK YOU.

Questions 1 and 2 are worth 2.5 points. The remaining questions are worth 10 points each.

1. What is the Medicaid case mix rate for Summit Manor Health and Rehabilitation? ____________

2. The poor public image of nursing homes is slowly changing, which also impacts emerging professionals and their misconceptions surrounding the pursuit of nursing home administration as a future career path. There are a variety of reasons for the increasing popularity of nursing home leadership as a career choice. Provide one of those reasons below.

____________________________________________________________________________________________________________________________________________________________

3. In some situations, there can be limited healthcare options for individuals with Medicaid. Explain one of those reasons below:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. If you are caring for someone with dementia, it is important to know their life story. Explain what that means below.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Read the information provided about the resident. Then answer the following questions.

5. Mr. Wright was discharged from the hospital and admitted as a resident at Auburn Health Care in Auburn, KY. He has both Medicare and Medicaid. His stay is currently covered under Medicare Part A as a skilled resident because he is receiving occupational therapy 5 days a week for a total of 500 minutes per week (rehabilitation very high) and also receives tracheostomy care (an extensive service). He has an ADL score of 8.

Fill in the following information for Mr. Wright’s current reimbursement:

RUG Category: _______________________________

RUG IV: ________

Daily Rate:

6. Mr. Wright is no longer receiving any type of therapy but continues to receive tracheostomy care. His ADL score is the same.

Fill in the following information for Mr. Wright’s new reimbursement:

RUG Category: _________________________________

RUG IV: _______

Daily Rate: _______

7. Mr. Wright has exhausted his Medicare Part A benefits and will now have his nursing facility stay paid by Medicaid. What rate, per day, will the facility no

SYNERTX, a national provider of contract rehabilitation services and an industry leader in regulatory
expertise, brings you the 2016 SNF Prospective Payment System (PPS) rates effective October 1, 2015.

Rate
Class

Payment
Amount

Rate
Class

Payment
Amount

RUX $678.22 HB1 $291.90
RUL $664.42 LE2 $360.91
RUC $525.03 LD2 $347.11
RUB $525.03 LC2 $305.70
RUA $446.35 LB2 $290.52
RVX $595.91 LE1 $302.94
RVL $537.95 LD1 $291.90
RVC $444.10 LC1 $258.78
RVB $388.89 LB1 $247.73
RVA $387.51 CE2 $322.26
RHX $533.68 CD2 $305.70
RHL $478.47 CC2 $268.43
RHC $381.86 CB2 $249.12
RHB $345.98 CA2 $211.85
RHA $307.33 CE1 $297.42
RMX $485.00 CD1 $280.86
RML $446.35 CC1 $249.12
RMC $331.80 CB1 $231.17
RMB $312.48 CA1 $198.05
RMA $260.04 BB2 $224.27
RLX $422.14 BA2 $187.01
RLB $317.25 BB1 $214.61
RLA $208.22 BA1 $178.73
ES3 $584.49 PE2 $297.42
ES2 $458.90 PD2 $280.86
ES1 $410.59 PC2 $242.21
HE2 $396.79 PB2 $206.33
HD2 $371.95 PA2 $171.82
HC2 $351.24 PE1 $283.62
HB2 $347.11 PD1 $267.06
HE1 $330.54 PC1 $231.17
HD1 $311.22 PB1 $198.05
HC1 $294.66 PA1 $164.93

SYNERTX makes no expressed or implied warranty on the accuracy of the calculated rates. Your use of these
rates and the information it provides is therefore undertaken at your own risk, and you hereby agree to hold
SYNERTX harmless for any losses or damages that may result from error or omission.

These rates are based on the Federal Register Vol. 80, No. 149 dated August 4, 2015 – Medicare Program;
Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2016; Notice.

The information provided should be verified by your own Accountant or Medicare Administrative Contractor (MAC)
for accuracy.

www.SYNERTX.com

2016 Prospective Payment System (PPS) RUG IV Rates Effective October 1, 2015
These are the RURAL rates effective for zAll Others county in KY. (Wage Factor: 0.7742)

7540 North 19th Avenue
Phoenix, Arizona 85021

(888) 873-4221
fax (888) 543-2289

Commonwealth of Kentucky

Department for Medicaid Services
Prepared by Myers and Stauffer LC, January 26, 2015

Facility

Final

Medicaid

Rate

% of Rate for

Bed Reserve

Days

Arbor Place of Clinton $168.20 50%

Auburn Health Care $159.31 50%

Baptist Convalescent Center, Inc. $189.26 50%

Baptist Health La Grange $189.36 50%

Barbourville Health & Rehabilitation Center $197.89 75%

Barren County Health Care Center $163.51 75%

Beaver Dam Nursing & Rehab Ctr, Inc. $179.00 75%

Belle Meade Home NF $166.89 50%

Berea Health Care Center $188.77 50%

Bluegrass Care & Rehabilitation Center $207.98 50%

Bourbon Heights, Inc. $175.62 75%

Bowling Green Nursing & Rehabilitation Center $182.83 50%

Boyd Nursing & Rehab Center $201.42 75%

Bracken Co Nursing & Rehabilitation Center $186.00 50%

Bradford Heights Health & Rehab Center, Inc $198.48 50%

Bradford Square Care and Rehabilitation Center $167.42 75%

Brandenburg Nursing and Rehabilitation Center $172.79 50%

Breckinridge Memorial Hospital, HB $161.66 50%

Breckinridge Place $186.04 50%

Bridge Point Care and Rehabilitation Center $212.65 75%

Brighton Cornerstone Health Care $155.67 50%

Brownsboro Hills Nursing Home $196.60 50%

Cal Turner Rehab and Specialty Care $168.10 75%

Calvert City Convalescent Center, Inc. $162.98 50%

Cambridge Place Group, LLC $203.14 50%

Campbellsville Nursing and Rehabilitation Center $185.78 50%

Carmel Home $185.62 75%

Carmel Manor $203.62 75%

Carter Nursing & Rehabilitation Center $209.09 75%

Cedar Ridge Health Campus $163.88 50%

Cedars of Lebanon Nursing Center $158.46 50%

Charleston Health Care Center $169.93 50%

Christian Care Center of Kuttawa $167.03 50%

Christian Care Center of Lancaster $165.36 75%

Christian Health Center – West, Inc. $180.28 50%

Christian Health Center of Bowling Green $168.10 75%

Christian Health Center of Corbin $168.66 50%

Christian Health Center of Hopkinsville $192.95 50%

Christian Health Center of Louisville $191.89 50%

Christian Heights Nursing and Rehabilitation Center $200.70 50%

January 1, 2015 Rates

Prepared by Myers and Stauffer LC, 01/26/2015 Medicaid Rate 1 of 7

Commonwealth of Kentucky

Department for Medicaid Services
Prepared by Myers and Stauffer LC, January 26, 2015

Facility

Final

Medicaid

Rate

% of Rate for

Bed Reserve

Days

January 1, 2015 Rates

Christopher East Healthcare Center $183.48 50%

Clark Regional Medical Center $182.

Compliments of ADL Data Systems, Inc.

ADL = 2 — 16 RUG-IV ADL Score End Splits
LE2
LE1

15—16
15—16

Depression
No Depression

LD2
LD1

11—14
11—14

Depression
No Depression

LC2
LC1

6 —10
6 —10

Depression
No Depression

LB2
LB1

2—5
2—5

Depression
No Depression

RUG-IV ADL Score End Splits

BB2

BB1

2 — 5

2 — 5

≥ 2 restorative
nursing

< 2 restorative
nursing

ES3
ES2
ES1
B

BA2

BA1

0 — 1

0 — 1

≥ 2 Restorative
nursing

< 2 restorative
nursing

RUG-IV ADL Score End Splits

G0110 (1)
Self Performance

G0110 (2)
Staff Support

ADL
Score

G0110 (1)
Self

G0110 (2)
Staff Support

ADL
Score

Eating

____ ______

____ ______

0
1
2
3
4

any number =
any number =
-, 0, 1, or 2 =
-, 0, 1, or 2 =
3 =

-, 0, 1, 2, 7 or 8 AND -, 0, 1, 8 = 0
-, 0, 1, 2, 7 or 8 AND 2 or 3 = 2
3 or 4 AND -, 0 or 1 = 2
3 AND 2 or 3 = 3
4 AND 2 or 3 = 4

-, 0, 1, 7, or 8 AND
2 AND
3 AND
4 AND
3 or 4 AND

Bed Mobility (G0110A) =

Transfer (G0110B) =

Toilet Use (G0110I) =

Eating (G0110H) =

K0700A is 51% or more of total calories OR
K0700A is 26% to 50% of total calories AND
K0700B is 501 cc or more per day fluids enteral intake in the
last 7 days

• Pressure relieving chair/bed++
• Turning/Repositioning
• Nutrition or hydration intervention
• Ulcer Care
• Application of Dressing (Not to feet)
• Application of Ointment (Not to feet)
++ Count as one service if both are provided

• Surgical Wound Care
• Application of Dressing (Not to feet)
• Application of Ointment (Not to feet)

• Urinary toileting program and/or bowel
toileting program ++
• Passive and/or active ROM ++
• Splint or brace assistance
• Bed mobility and/or walking training++
• Transfer training
• Dressing and/or grooming training
• Eating and/or swallowing training
• Amputation/prostheses care
• Communication training
++ Count as one service even if both
provided

15 — 16
15 — 16
11 — 14
11 — 14
6 — 10
6 — 10
2 — 5
2 — 5
0 — 1
0 — 1

RUG-IV Late Loss ADL Calculations (Ent