KEY LONG TERM CARE MANAGEMENT AND
SAMPLE QUESTIONS WITH EXPLANATIONS
◉ 3 months of significant loss and severe loss. Answer: significant
loss : 7.5% severe loss: > 7.5%
◉ 1 month significant loss and severe loss. Answer: significant loss :
5% severe loss: > 5%
◉ 6 month significant loss and severe loss. Answer: significant loss :
10% severe loss: > 10%
◉ Upcoding. Answer: Billing for higher reimbursement than services
actually provided or should've been
Important to bill at the highest reasonable level of care actually
needed and provided
DHHS OIG estimates that NF overbilled CMS $1milli in a recent yr
◉ Abuse. Answer: The willful infliction of injury, unreasonable
confinement, intimidation, or punishment with resulting physical
harm, pain or mental anguish. Also includes the deprivation by an
individual, including a caretaker, of goods, or services that are
,necessary to attain or maintain physical, mental, and psychosocial
well-being.
◉ Adverse Event. Answer: Untoward, undesirable, and usually
unanticipated event that causes death and or serious injury, or the
risk thereof.
◉ Composite Distinct Part. Answer: A distinct part consisting of two
or more noncontiguous components that are not located within the
same campus.
◉ Distinct Part. Answer: Physically distinguishable from the larger
institution or intuitional complex that houses it.
◉ Food Conservation. Answer: Of nutritive value, flavor, appearance,
appeal, and proper temp
◉ Proper Food Temperatures. Answer:
◉ Resident has right to.... Answer: A) Choose Activities, schedules,
and health care consistent w/ his or her interests, assessments, and
plans of care
B) Interact w/members of the community both in and out the facility
,C) make choices about aspects of his or her life in the facility that are
significant to the resident
Participation in Resident and Family Groups
A) Resident has the right to organize and participate in resident
groups in the facility
B) Resident's family also has a right to meet in the facility w/families
of other residents
C) F will provide resident or family group w/ private space
D) Staff or visitors may attend meetings at the group's invitation
E) F will provide a designated staff person responsible for providing
assistance and responding to written requests that result from
group meeting
◉ Quality Assurance committee consists of.... Answer: QA and
assurance committee consists of
A) The DON
B) Physician designated by the facility
C) Three other members of the facility's staff will be maintained
◉ QA meeting guidelines. Answer: The committee:
A) meets at least quarterly to identify issues w/respect to which
quality assessment and assurance activities are necessary
B) Develops and implements appropriate plans of action to correct
identified quality deficiencies
, ◉ Food Management. Answer: Store, prepare, distribute, and serve
under sanitary conditions
Proper disposal of garbage and refuse will be done
◉ Frequency of meals. Answer: A) Each resident receives and the
facility provides at least 3 meals a day at reg times
B) no more than 14 hours btwn dinner and breakfast (except when
snack is provided, 16 hours may pass btwn dinner and lunch)
◉ Comfortable and Safe. Answer: Will provide range of 71 to 81
degrees F
◉ Emergency Power Supply. Answer: Will supply emergency lighting
for:
1) all entrances and exits
2) Equipment to maintain fire detection, alarm and extinguishing
system
3) Life support systems
◉ Physical Building Policies. Answer: -Bedroom limited to 4 ppl
-Direct access to exit from room
-Privacy for each resident