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: ________
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 now receive for his stay?
*WHAT IS THE DIFFERENCE in reimbursement rate for Mr. Wright, per day, from his first daily rate (when first admitted to the nursing facility) to today (as a Medicaid stay)? _______
*WHAT IS THE LOSS/GAIN IN REVENUE OVER 30 DAYS? ________
8. As the Licensed Nursing Home Administrator (LNHA), why is it important for you to understand the reimbursement system? Provide at least 3 DIFFERENT reasons below:
9. Nursing facility care is “need” driven, not “want” driven. Explain what this means.