Question 1

What word describes receiving payment for medically unnecessary services?&#10;A) Abuse&#10;B) Negligence&#10;C) Fraud&#10;D) Malpractice

Accepted Answer

Fraud is knowingly and willfully scheming to defraud a benefit program by false or fraudulent pretenses to obtain money or property from a health benefit program. Abuse is obtaining payment that results in unnecessary costs to Medicare through payment for services that fail to meet professionally recognized standards of care, are billed inappropriately, or that are medically unnecessary. Negligence is failure to perform as another similar person would perform in similar circumstances. Malpractice is illegal or negligent act by a licensed professional.

Question 2

Which of the following characteristics sets outpatient practice apart the most from other practice settings?&#10;A) The relationship with physicians&#10;B) Need for specialization&#10;C) Predictable reimbursement&#10;D) Reduced productivity demands

Accepted Answer

Board certified specialists work in all practice settings. Reimbursement for outpatient services is largely dependent on contract negotiations with insurers annually, which is very unpredictable. Productivity demands are often very high in all practice settings. Physician relationships are key to the success of a practice and challenging to avoid illegal referral relationships in outpatient practices.

Question 3

Where should managers look for information about reimbursement and authorization to provide services to a patient with a workers' compensation claim?&#10;A) The National Board of Workers' Compensation&#10;B) US Department of Labor&#10;C) Office of Equal Opportunity&#10;D) State statutes governing workers' compensation

Accepted Answer

Each state has its own ever changing statutes that govern workers' compensation. There is not centralized system or organization that governs workers' compensation. The US Department of Labor and the Office of Equal Opportunity are possible governmental organizations involved in workers' issues but do not influence workers' compensation.

Question 4

Offering a physician rent-free office space in return for referrals to physical therapy is a violation of which law?&#10;A) Stark Law Phase III&#10;B) Health Insurance Portability and Accountability Act&#10;C) Medicare/Medicaid Patient Protection Act&#10;D) Affordable Care Act

Accepted Answer

This scenario is described as a kickback which is prohibited by Medicare/Medicaid Patient Protection Act. Stark laws deal with self-referral and a key feature of Health Insurance Portability and Accountability Act is patient privacy. The Affordable Care Act deals with broad healthcare policy reform.

Question 5

What does &#34;out of network&#34; mean?&#10;A) The practice is not included in an accountable care organization&#10;B) The medical documentation is not electronic&#10;C) The patient does not have internet services for communication&#10;D) The patient's insurance does not include the provider's services

Accepted Answer

Providers seek to become part of the network of preferred providers selected by insurance companies. If the provider is not on the list of providers in a patient's insurance plan, they are less likely to select that provider because they are penalized for seeking services "out of network". The other options are possible definitions related to networks.

Question 6

Who is currently able to use the term &#34;physical therapy&#34; in their healthcare practices?&#10;A) Only physical therapists&#10;B) Any provider licensed to use physical therapy interventions&#10;C) Anyone submitting a charge using a physical medicine code&#10;D) Only health professionals certified in physical medicine

Accepted Answer

The term is not copyrighted or protected in any way by the physical therapy profession. Unfortunately, the term is used to describe treatments from hot packs to therapeutic exercise. Any provider can submit charges using any of the Common Procedural Terminology codes BUT the submission of such a charge does not mean payment if they are not licensed to perform the services covered by those codes. Therefore, "any provider licensed to use physical therapy intervention" is the most correct choice. Chiropractors, physicians, personal trainers may use the term.

Question 7

Outpatient satisfaction has been found to be most highly related to which of the following factors?&#10;A) Location of the practice&#10;B) Time spent with the physical therapist&#10;C) Interaction with a variety of personnel&#10;D) Waiting time to begin a treatment session

Accepted Answer

All of these factors have been studied. The results are that the interaction with the physical therapist is the factor that most influences patient satisfaction.

Deck 14: Management Issues in Out-Patient Settings