Management II - Quiz

Who qualifies for Medicare?

- people over 65 - people with disabilities - people with end stage renal disease

When documenting for medical necessity....

...always justify why OT specifically is needed

Reimbursement for OT services requires 3 things, ...

1. a physician's order 2. treatment provided by a qualified OT or supervised OTA 3. reasonable and necessary treatment

What are 4 ways to become more involved in OT policy and practice?

1. as an individual 2. as a group (i.e., OTD c/o 2024) 3. as an organization (i.e., AOTA, MSOTA, etc.) 4. as a community (i.e., school boards, social services, community grants, etc.)

T/F: therapy is required to effect improvement or restoration of function where a patient suffers a transient and easily reversible loss or reduction of function

False - therapy is not required

__________ monitor and pay claims, perform audits and investigations - require diagnostic and procedural codes. (i.e., ICD 10s, CPT codes, & G Codes)

Fiscal Intermediaries

T/F: Private Health Insurance plans accounted for 67.5% of all health care coverage with the majority being employer-sponsored insurance.

True

This type of rehab provides support for people with disabilities (PPD and PTD) through comprehensive services to maximize their ability to participate in productive activities - usually new career options, training to improve job prospects, providing skills for finding employment

Vocational Rehab

This type of health insurance covers direct medical expenses up to maximum medical improvement and covers wage loss when an injury occurs on the job

Worker's Compensation

ex: inpatient hospitalization, SNF, home-health, hospice a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

a. Medicare - Part A

hospital insurance plan a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

a. Medicare - Part A

must be standardized and include a formal report; therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity - direct patient contact/15 minutes = 97129, each additional 15 minutes = 97130 a. cognitive testing assessment b. sensory integrative tech. c. self-care/home management training d. community reintegration

a. cognitive testing assessment

rarely used; procedures may be reasonable and necessary for training patients whose walking abilities have been impaired by neurological, muscular, or skeletal abnormalities or trauma - document: gait cycle, weight-shifting, symmetry of gait, ascend/descend stairs, balance deficits, pain, etc. a. gait training b. massage c. manual therapy d. therapeutic activities

a. gat training

this evaluation code is used when the OT identifies 1-3 performance deficits a. low complexity b. moderate complexity c. high complexity d. re-evaluation

a. low complexity

ability to identify and understand policy based on policy information or knowledge a. policy literacy b. policy acumen c. policy competence d. policy influence

a. policy literacy

- traction, mechanical - vasopneumatic device - paraffin bath - whirlpool - diathermy - e-stim, not for Medicare - e-stim, for Medicare and sometimes United a. supervised modalities (un-timed/service-based) b. constant attendance modalities (time-based)

a. supervised modalities

attempt to reduce impairments and restore function through the application of clinical skills; require one-on-one attendance; time-based (each 15 minutes); must be able to tie their use to a specific goal a. therapeutic procedures b. therapeutic exercise (therex) c. neuro re-education (neuro re-ed) d. aquatic therapy w/ therapeutic exercise

a. therapeutic procedures

this type of coding requires direct one-on-one time spent with the patient, contact is between 8-127 minutes in length, and the therapist can bill multiple units of the same CPT code on the same day per discipline per patient a. time-based codes b. service-based codes

a. time-based codes

Which of the following is NOT true regarding Worker's Compensation? a. up to 95% of claims made are medical only claims and need little to no time off work b. lost time claims occur when the employee cannot carry out essential job functions c. guarantees payment payment for medical expenses without either employer or employee being at fault d. there are two types of programs (a. traditional/self-insured or all costs absorbed by the employer)

a. up to 95% of claims made are medical only claims and need little to no time off work - 75% of claims made are medical - meaning around 25% of claims made possibly end up needing rehab

assessments, fitting, and training; determination of a patient's need, patient's strength and ROM, endurance, skin integrity, balance/sitting, etc. - must be tied to a goal - typically up to 4 visits within a month is sufficient a. wheelchair management b. physical performance test and measurement c. orthotic management d. wound care selective debridement

a. wheelchair management

ex: physician and outpatient services, durable medical equipment a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

b. Medicare - Part B

supplementary medical insurance plan a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

b. Medicare - Part B

- e-stim (manual) - iontophoresis (not covered by Medicare) - contrast baths - ultrasound - hubbard tank a. supervised modalities (un-timed/service-based) b. constant attendance modalities (time-based)

b. constant attendance

Which of the following is NOT one of the OT practitioner's responsibilities regarding health insurance? a. strong knowledge of policies b. disregarding "in-network" vs "out-of-network" policies c. knowing how Medicare influences Private Insurance

b. disregarding "in-network" vs. "out-of-network" policies

includes effleurage, petrissage, and/or tapotement which are designed to restore muscle function, reduce edema, improve joint motion, or for relieve of muscle spasms - use of the hands is considered the most effective method of application - generally not covered greater than 6-8 visits a. gait training b. massage c. manual therapy d. therapeutic activities

b. massage

this evaluation code is used when the OT identifies 3-5 performance deficits a. low complexity b. moderate complexity c. high complexity d. re-evaluation

b. moderate complexity

Must have a separate written report; cannot be billed the same day as an eval or re-eval - includes time required to analyze and interpret data while patient is present - must show why the patient needs the test, specific test performed, provider's interpretation, and how it impact POC a. wheelchair management b. physical performance test and measurement c. orthotic management d. wound care selective debridement

b. physical performance test and measurement

ability to analyze policies and make good, quick decisions a. policy literacy b. policy acumen c. policy competence d. policy influence

b. policy acumen

used to enhance sensory processing, promote adaptive responses to environmental demands - promotes adaptive responses to environmental demands and/or when a deficit in processing input from one of the sensory systems decreases the individual's ability to make adaptive responses a. cognitive testing assessment b. sensory integrative tech. c. self-care/home management training d. community reintegration

b. sensory integrative tech.

this type of coding says that a therapist can only bill one unit of each code daily per discipline per patient, however there can be rare instances where you could bill more than one unit within the same day a. time-based codes b. service-based codes

b. service-based codes

used to develop strength, ROM, and flexibility; performed on dry land with a pt. either actively, active-assisted, or passively participating; may be reasonable and necessary for a documented loss or restriction of joint motion, strength, functional capacity, or mobility a. therapeutic procedures b. therapeutic exercise (therex) c. neuro re-education (neuro re-ed) d. aquatic therapy w/ therapeutic exercise

b. therapeutic exercise

Considered an alternative to Original Medicare; advantage plans are provided by private insurance companies approved by Medicare. They provide all the coverage Original Medicare provides, plus additional services and benefits. a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

c. Medicare - Part C

Most Medicare Advantage plans include prescription drug coverage, often for no additional premium. You'll still be in the Medicare program, but you will receive you benefits through the plan instead of through Original Medicare. a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

c. Medicare - Part C

There are two types of HCPCS ("Healthcare Common Procedural Coding System") codes used in rehabilitation... which of the following is NOT one of them? a. time-based codes b. service-based codes c. condition-based codes

c. condition based codes

this evaluation code is used when the OT identifies 5 or more performance deficits a. low complexity b. moderate complexity c. high complexity d. re-evaluation

c. high complexity

mobilization/manipulation, manual lymphatic drainage, manual traction - joint mobilization may be considered reasonable and necessary if restricted joint is present and documented - can be an adjunct to therex when loss of function impedes therapeutic procedure - must obtain "before and after measurements" a. gait training b. massage c. manual therapy d. therapeutic activities

c. manual therapy

Which of the following about Private Health Insurance policies is NOT true? a. generally pools resources of a community b. costs and risks are shared amongst the group c. most employers offer very limited options for policies d. typically provide coverage with preferred provider organizations (PPOs)

c. most employers offer very limited options for policies - some employers offer multiple options. (smaller employers do not have to offer insurance though)

use when working on movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities a. therapeutic procedures b. therapeutic exercise (therex) c. neuro re-education (neuro re-ed) d. aquatic therapy w/ therapeutic exercise

c. neuro re-education

Which of the following regarding modalities is NOT true? a. some modalities require constant attendance and others require supervised attendance b. modalities should never be used as a stand alone treatment c. no more than 4 modalities should be used during each visit d. apply to one or more areas treated per day

c. no more than 4 modalities should be used during each visit - no more than 2 modalities should be used during each visit

includes: assessing the patient, determining the type of orthotic, designing, selecting, or fabricating, fitting and training - L codes may be more appropriate (refer to LCD) a. wheelchair management b. physical performance test and measurement c. orthotic management d. wound care selective debridement

c. orthotic management

the ability to understand and apply policies and procedures in a consistent and effective manner a. policy literacy b. policy acumen c. policy competence d. policy influence

c. policy competence

ADLs; compensatory training, meal preparation, safety procedures, and instruction in use of adaptive equipment - bathing, grooming, dressing, personal hygiene, basic household cleaning - not for use for teaching a HEP - assist/verbal cuing for balance and mobility during the performance of a task must be documented a. cognitive testing assessment b. sensory integrative tech. c. self-care/home management training d. community reintegration

c. self-care/home management training

To determine medical necessity, OT treatment should be considered with factors such as ________, _________, and _________ type to provide the most effective and efficient means to achieve the patient's goals.

condition, progress, and treatment type

prescription drug coverage a. Medicare - Part A b. Medicare - Part B c. Medicare - Part C d. Medicare - Part D

d. Medicare - Part D

procedures may be reasonable and necessary for the loss or restriction of joint motion, strength, mobility, or function due to pain, injury, or illness by using buoyancy and resistance of water; this code is generally not an "indefinite" code - pt. should be instructed in a home program during visits a. therapeutic procedures b. therapeutic exercise (therex) c. neuro re-education (neuro re-ed) d. aquatic therapy w/ therapeutic exercise

d. aquatic therapy w/ therapeutic exercise

services solely for specific employment opportunities, work skills, or work settings are not included under Med. B - training in: shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, etc. a. cognitive testing assessment b. sensory integrative tech. c. self-care/home management training d. community reintegration

d. community reintegration

Which of the following is NOT one of the OT practitioner's responsibilities regarding health insurance? a. ensure equitable care is delivered and are equitably reimbursed for therapy b. correct intervention at the correct time in the correct dosage c. succinct, clear documentation according to policy d. having strong knowledge of billing and coding rules is the responsibility of the supervisor

d. having strong knowledge of billing and coding rules is the responsibility of the supervisor - it is the OT's responsibility

the conscious endeavor to take influence on the policy process with a view to changing the policy outcome (i.e., "having a seat at the table") a. policy literacy b. policy acumen c. policy competence d. policy influence

d. policy influence

this evaluation code is used the the OT provides an update to the initial occupational profile to reflect changes in condition or environment that affects future interventions or goals a. low complexity b. moderate complexity c. high complexity d. re-evaluation

d. re-evaluation

this is the use of dynamic activities to improve functional performance; i.e., bending, lifting, carrying, pushing, pulling, crawling, climbing, etc. - they require the skills of the therapist to design the activities to address a specific functional need of the patient and to instruct the patient in performance of these activities a. gait training b. massage c. manual therapy d. therapeutic activities

d. therapeutic activities

removal of devitalized tissue from wounds; selective debridement without anesthesia, with or without topical applications, wound assessment and instructions for ongoing care, may include use of a whirlpool - per session, total wounds surface area less than or equal to 20 sq. cm. (97598 is used for a surface area greater than 20 sq. cm.) a. wheelchair management b. physical performance test and measurement c. orthotic management d. wound care selective debridement

d. wound care selective debridement

Which of the following is NOT included in the payment process? a. provision of OT services b. documentation of services c. coding of services d. billing of claims e. reimbursement for services f. all of the above are included

f. all of the above are included

T/F: documentation should establish through subjective measurements that the patient is making progress toward goals

false - objective measurements

this is the "financial remuneration for services provided"

reimbursement

T/F: therapy departments and practices must develop expertise in multiple payer requirements for issues like network enrollment, coding, billing, and appeals

true