N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide of 171 amount of rehabilitative care that may occur in a nursing home. Medicare does not pay for any long- term or custodial care in a nursing home. Part B reimburses for physician care and outpatient services based on a fixed schedule of payments. Medicaid Title IX of the Social Security Act, which was termedMedicaid, is a federal programand provides funds for healthcare for those dependent on public assistance for low-income people and chronically ill children. Costs for Medicaid are shared between the federal government and each state. Very low income individuals who are eligible for Medicare may be covered by Medicaid in some cases and this is referred to as dual eligible. Each state is responsible for administering Medicaid and determines the eligibility and the extent of Medicaid coverage provided. Supplemental Security Income (SSI) Supplemental Security Income (SSI) is a federal income supplement program funded by general tax revenues (not Social Security taxes designed to help the aged, blind, and disabled people, who have little or no income). It provides cash to meet basic needs for food, clothing, and shelter, and pays benefits to disabled adults and children who have limited income and resources. Supplemental Security Income benefits are also payable to people 65 and older without disabilities who meet the financial limits and who have worked long enough. They may also be able to receive Social Security disability or retirement benefits, as well as SSI. Prospective Payment This is a fixed reimbursement amount for all care required for a particular procedure, an illness, or an acuity category. This reimbursement amount is determined in advance of the provision of service. The predetermined amount is paid without regard to actual services rendered or the costs of those services in individual situations. Thus, the same payment is made whether the person is healthy and has an uncomplicated hospital stay or whether the person is in poor health and has complications that increase the cost of care or the length of the hospital stay. Prospective payment is designed to provide an incentive for providers to control costs. Diagnosis-Related Groups (DRGs) The first major change in the method of payment for healthcare services began October 1, 1983, when the federal government stopped using a fee for service reimbursement for Medicare and introduced a PPS using diagnosis-related groups (DRGs) to determine the payment for each Medicare client admitted to the hospital. This change was designed to stop the spiraling costs of Medicare and to correct inadequacies that made the costs of care in one facility very different than those in another facility. The method of determining the rates to be paid in the Medicare PPS (the creation of DRGs) resulted from computerized analysis of costs that had been billed for hospitalized individuals in the past and a determination of an average length of stay. This analysis led to the formation of categories of medical diagnoses that require similar treatment and for which costs are similar. Each category has a name and a number. A decision was made to increase the payment for care when another illness or condition is present. This second condition is termed comorbidity. ©2017 Achieve Test Prep Page 99