Deck 8: Documentation of Occupational Therapy Services

Question 1

What is the most compelling reason for the therapist to fill out all sections of the Medicare 700 form?

A) Because it makes the therapist appear thorough
B) Because failure to complete a section on the form could result in a technical denial
C) Because supervisors want all the sections completed so they will pass an audit
D) Because filling in all sections makes the need for therapy seem more justified

Answer 1

B
It is important to fill in all spaces on the Medicare 700 form.Failure to complete a section on the form could result in a technical denial.

Question 2

What is the best reason to explain why leaving client charts out in plain view,where others can read the information,is wrong?

A) This is a violation of privacy standards mandated by the Health Insurance Portability and Accountability Act (HIPAA).
B) Food or beverages could be spilled on the charts.
C) They might be accidentally thrown away.
D) The client might see it.

Answer 2

A
Federal laws protect the consumer against breaches of confidentiality.Medical records or portions of the medical record should never be left unattended in public view.Protected health information (PHI)should be disclosed only to the minimum number of health professionals necessary to carry out the intended purpose.Clients have the right to access their medical records.

Question 3

Which of the following is an example of a long-term goal (also called discharge goal)?

A) The client will be able to dress self with a simple pullover shirt with no fasteners.
B) The client will be able to button and unbutton an article of clothing.
C) The client will be able to tie a pair of shoes.
D) The client will be able to dress independently.
E) The client will be able to put on and remove slacks.

Answer 3

D
The long-term goal is called the discharge goal in some settings.It is the overall functional goal of the intervention plan.It is broader than the short-term goal(s).Being able to dress independently entails the other goals listed above and is more comprehensive.

Question 4

Pick the best answer to explain what is wrong with using the following statement as the objective part of a note: "The client has decreased grip strength of the right hand,which limits his ability to open a jar."

A) It should be in the subjective portion of the note.
B) It does not state what interventions are planned.
C) It is not an objective measurement.
D) It is an interpretation of an objective measurement, rather than an objective measurement.

Question 5

Which statement is most true regarding documentation of skilled services?

A) Documentation of skilled services does not necessarily reflect the therapeutic rationale underlying the task performed.
B) Terminology reflecting skilled services includes words such as observe, help, and maintain.
C) Skilled services can be performed safely and/or effectively only by a qualified therapist or under the supervision of a qualified therapist.
D) Progress reports do not have to describe the type of skilled interventions that were provided.