Term
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Definition
| FI = fiscal intermediary: INS copany that works with mediare to pay claims |
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Term
| What requirements must you have before Medicare pays? |
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Definition
- RX from MD to evaluate pt.
- RX from M to treat pt.
- OTs must be qualified |
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Term
| Where do OTs relay the reasonable and necessary reasons for therapy? |
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Definition
| in there documentation!!! |
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Term
| What do OTs must prove (about the pt.) to get tx reimbursed? |
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Definition
| - the pt. must have "significant, practical improvement in function" |
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Term
True or false:
Does Medicare have a list of preapproved diagnoses? |
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Definition
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Term
| Who is the #1 payer to OTs? |
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Definition
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Term
What type of facilities are covered in Medicare part A? |
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Definition
- in patient hospital - skilled nursing facilities (SNFs) - homehealthcare - hospice |
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Term
| What are general conditions of coverage? |
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Definition
- under the care of a physician - services must be reasonable and necessary - client must have a need for services - qualified professional |
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Term
There are five aspects a client must meet for treatment to be considered "reasonable and necessary". What are they? |
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Definition
1. Expectation of improvement 2. the pt. must improve within a reasonable and predictable time 3. the pt.'s improvement must meet an amount of accepted standards (i.e. 5 degrees of increased ROM) 4. the OT must I.D. what specific services the pt. will receive. (skilled OT? cognitive behavioral training?) 5. OT must I.D. the complexity and sophistication of services. |
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Term
Why is it important to document a pt.'s prior level of function? |
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Definition
| A prior level of function shows how much the patient has improved with therapy |
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Term
| How will an OT define a "decline in function" in an initial evaluation report? |
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Definition
| The OT will write the diagnosis given by the MD and other specifc problems to be evaluated and describe how or why it would impact treatment |
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Term
Medicare requires documentation of objective measures. What is an objective measure? |
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Definition
An objective measure is a functional assessment score or other measureable progress toward goals. (i.e. FIM scores) |
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Term
When are objective measures recorded? |
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Definition
- initial evaluation - comparison of initial evaluation and scores at discharge - Objective measures links the test measurements to function. |
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Term
Will a person who is not expected to improve within a reasonable/predictable amount of time receive Medicare benefits for treatment? |
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Definition
NO, the pt. must have the clear expectation of improvement within a specified amount, frequency, and duration of treatment. (i.e. a person with a severed nerve will regrow 1 cm of nerves per month) |
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Term
What type of specific interventions must be written in the documentation? What types of interventions can be left out? |
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Definition
Included: TENS, ROM, NMES, retrograde massage, cognitive behavioral treatment Excluded: arts and crafts |
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Term
| Why must the evaluation address the necessity of a therapist or an assistant? |
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Definition
If the OT cannot justify the reasons to have a professional to treat the pt., the pt. can improve spontaneously at home. The OT has to emphasize the importance of decline in function if the pt. does not receive help. |
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Term
What aspects must each goal have? |
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Definition
objective, behaviorally stated measureable/ observable outcomes specific time frame specific to patient's needs |
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Term
| Long term goals can also be considered what? |
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Definition
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Term
What type of goals are intermediate steps for long term goals? |
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Definition
| short term goals because they can be attiend within a shorter time frame |
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Term
What are the important 4 components of an evaluation? |
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Definition
1. decline in function 2. objective measures 3. reasonable and necessary skilled services 4. qualified personnel providing services |
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Term
| What is the difference between a Care Plan and a Plan of Care? |
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Definition
Care plans are interdisciplinary whereas a Plan of Care is descipline specific. |
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Term
| Daily Treatment Notes include: |
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Definition
- daily services delivered - date of treatment - CPT codes (with time and units) - name and credentials - payer or state practice act requirements |
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Term
What do Progress Notes include? |
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Definition
Progress notes are similar to the part A of SOAP notes. Even though they contain the objective evidence (which would be an O), progress notes justify the necessity for treatment. Also, the objective measures are paired with comparative statements (not judgemental ones!). |
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Term
Is there a specific time frame for progress notes? |
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Definition
It depends on the facility, progress notes can be written weekly, monthly, and at discharge. |
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Term
| Under Medicare Part B, when must the OT write progress notes? |
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Definition
OTs must write a progress note every 2nd, 4th/ 30 day and discharge summary notes. The OT must provide 1 unit of tx at least once every 2 weeks prior to writing the progress note. |
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Term
| How are Progress Notes and Discharge Summaries similar? |
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Definition
Discharge summaries include the same basic info as progress notes: objective measures paired with comparative statements, justifies the medical necessity of servcies. However, discharge summaries include objective measures from initial and ending evaluations. |
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