Deck 13: Surviving and Thriving in High-Demand Settings

Question 1

Productivity requirements have a positive contribution to sustaining businesses and assuring that communities receive quality healthcare.

Answer 1

True

Question 2

The Centers for Medicare and Medicaid Services (CMS) have some of the most stringent guidelines on what is considered billable service and are often applied to patients with private insurances.

Answer 2

True

Question 3

The legal case Jimmo v. Sibelius determined that Medicare never covers services focused on the maintenance of an individual's condition or prevention of decline.

Answer 3

False

Question 4

A primary and acceptable strategy for improving productivity is to place many patients in 100% concurrent therapy.

Question 5

The number of units of care billed or the percentage of time spent in billable activity during a predetermined period, often based on an 8-hour day, best defines:

A) Value.
B) Productivity.
C) Metrics.
D) Output.

Question 6

A state and federal program that can be used to pay for health care for people with low income is best named:

A) Medicare Part A.
B) Medicare Part B.
C) CHIPS.
D) Medicaid.

Question 7

Codes that are published by the American Medical Association and are used to describe specific medical procedures performed by healthcare practitioners on patients are best called:

A) AMA codes.
B) HCPC codes.
C) CPT codes.
D) Billing codes.

Question 8

The Patient-Driven Groupings Model (PDGM) is a model of payment that affects occupational therapy intervention and payment in what setting?

A) Acute care
B) Home health
C) Skilled nursing facilities
D) Inpatient rehabilitation

Question 9

The Patient-Driven Payment Model is a model of payment that affects occupational therapy intervention and payment in which setting?

A) Acute care
B) Home health
C) Skilled nursing facilities
D) Inpatient rehabilitation

Question 10

Criteria for services that are considered medically necessary and reasonable include each of the following except:

A) The practitioner's skills were needed for the treatment of the illness or dysfunction.
B) Objective assessments can be used to measure progress and improvement.
C) A statement of medical necessity is completed by the occupational therapist.
D) Improvement can be expected in a reasonable and predictable duration.

Question 11

Which of the following include examples of healthcare fraud?

A) Billing for services not rendered
B) Documenting services not rendered
C) Billing for a more complex procedure than was actually performed
D) All of the above

Question 12

All of the following might be considered a compromise of professional autonomy except:

A) Asking the practitioner to provide services focused on the maintenance of an individual's condition or prevention of decline if the individual has Medicare.
B) Asking the practitioner to increase the duration of services to a patient even if therapeutic services are not needed anymore.
C) Asking the therapist to initiate services for a client even if the services are not medically necessary or the interventions are not skilled.
D) Asking the therapist to decrease the duration of a client's services even though the therapist thinks the client needs a longer duration of services.

Question 13

The productivity expectation of a skilled nursing facility is 85%. Based on an 8-hour day (excluding breaks), the duration of billable services (in minutes) would be:

A) 400 minutes
B) 415 minutes
C) 420 minutes
D) 408 minutes

Question 14

Services covered through Medicare can be described as:

A) Skilled and medically necessary.
B) Skilled and billable.
C) Billable and nonbillable.
D) Subject to productivity expectations.

Question 15

An example of nonbillable service is a:

A) Therapist performing therapeutic activities (CPT 97530) with a client.
B) Therapist performing exercises that the caregivers have been trained to do with a client.
C) Therapist educating a client regarding the use of an adaptive device to improve function.
D) Therapist establishing short-term and long-term goals for a client.

Question 16

Which of the following have been identified as contributing to moral distress by occupational therapy practitioners?

A) Diminished client care due to poor communication among team members at work
B) Decreased quality of patient care secondary to pressure from administration or insurers
C) Diminished quality of patient care (that leads to suffering) due to lack of provider continuity
D) All of the above

Question 17

A group for therapy purposes can consist of:

A) two to three people in a group.
B) two to four people in a group.
C) two to five people in a group.
D) two to six people in a group.

Question 18

Concurrent therapy can consist of:

A) seeing two clients performing different activities or interventions at the same time.
B) seeing two clients performing the same activity or intervention at the same time.
C) seeing a group of three clients performing the same activity.
D) co-treating two clients with the physical therapist.

Question 19

Which of the following is true regarding the requirements for demonstrating improvement in occupational therapy services in order to obtain Medicare coverage for services?

A) Clients must always demonstrate sustained improvement.
B) Improvement is never a consideration in whether occupational therapy services are covered by Medicare.
C) Even though clients cannot attain full medical recovery, they may still need skilled services to maintain current capabilities or prevent further deterioration of condition.
D) Sustained improvement must be demonstrated in the first 10 days of occupational therapy services.

Question 20

Which of the following is most commonly considered a nonbillable service?

A) Re-evaluations
B) Documentation
C) Group therapy
D) Patient and family education