Centers for Medicare and Medicaid Services


  • American Physical Therapy Association- is an individual membership professional organization representing more than 77,000 member physical therapists (PTs), physical therapist assistants (PTAs), and students of physical therapy.
  • Case Index Score- The case index score for Medicaid determines a skilled nursing facilities medicaid reimbursement rate for that quarter.  The better the case mix score, the better the rate. 
  • Case Mix- A formulative method used in some states to determine patients' needs for health care resources within a nursing facility. The assessment is based in part on functional ability to perform activities of daily living (ADLs), medical and psychiatric diagnosis. 
  • CMS- Centers for Medicare and Medicaid Services Contract Therapy services within a facility are provided and managed by a second party. 
  • CPT Codes- Current Procedural Terminology Codes are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services.  They are used by insurers to determine the amount of reimbursement that a practitioner will recieve from an insurer. 
  • FIM Scores- Stands for Functional Independence Measures. Scores range from 1-7 where 7 is categorized as "complete independence," and 1 is categorized as "total assist" where a patient completed less than 25% of a task. 
  • Inhouse Therapy- services within a facility are provided and managed by the facility itself. 
  • Leading Age- Not for profit healthcare organization
  • Length of Stay- is a term commonly used to measure the duration of a single episode of hospitalization or rehabilitation. Inpatient days are calculated by subtracting day of admission from day of discharge.  
  • MDS 3.0- Minimum Data Set (MDS), a core set of screening and assessment elements that is part of a Resident Assessment Instrument (RAI). The RAI provides a comprehensive and standardized assessment of each long-term care facility resident's functional capabilities and helps staff to identify health problems. This assessment is performed on every resident in a Medicare and/or Medicaid-certified long-term care facility. 
  • MDS nurse- A registered nurse in a skilled nursing facility who is responsible for facilitating the federally mandated Minimum Data Set assessments for patients. 
  • Medicaid- Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills. 
  • Medicare- Medicare is health insurance for the following people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD)  
  • Medicare A- Medicare Part A is Hospital insurance that helps cover inpatient care in hospitals, and helps cover skilled nursing facility, hospice, and home health care. 
  • Medicare B-  Medicare Part B is Medical insurance that helps cover doctors' services, hospital outpatient care, and home health care.  It also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse
  • Medicare Part B Therapy Caps- Therapy caps are determined on a calendar year basis.  Physical Therapy and Speech Language Pathology services are combined, and limited to $1,870 in 2011, and Occupational Therapy Services are limited to $1,870 as well. 
  • OHCA- Ohio Health Care Association long term care industry
  • Provider of Rehabilitation Services- A contract company, healthcare facility, or outpatient clinic that provides speech, physical, and occupation therapy services. 
  • RUGS IV- Implemented in 2010, RUGS IV is the fourth version of Medicare's Resource Utilization Group under the prospective payment system. 
  • RUGS Utilization- Resource Utilization Groups used in the Medicare skilled nursing facilities Prospective Payment Systems. 
  • Skilled Nursing Facility- a health-care institution that meets federal criteria for Medicaid and Medicare reimbursement for nursing care including especially the supervision of the care of every patient by a physician, the employment full-time of at least one registered nurse, the maintenance of records concerning the care and condition of every patient, the availability of nursing care 24 hours a day, the presence of facilities for storing and dispensing drugs, the implementation of a utilization review plan, and overall financial planning including an annual operating budget and a 3-year capital expenditures program.
  • Skilled Stay- To be eligible for a Medicare skilled nursing stay, patients must have Medicare Part A benefits and have been hospitalized for three (3) consecutive days within the last thirty (30) days. 
  • SNF- Skilled Nursing Facility 
  • Three day hospital stay- Medicare requires a 3-day hospital stay for a patient to qualify for paid admission into a SNF.