ETHICS
An OT in an outpatient clinic is treating a client who has plateaued. The clinic director encourages the OT to continue documenting “measurable progress” to justify ongoing insurance coverage.
Which actions are MOST appropriate? (Select all that apply)
A. Document the client’s current status accurately, including lack of progress
B. Continue treatment but shift goals to focus on maintenance if justified
C. Discontinue services immediately without consulting the client
D. Discuss concerns with the clinic director and reference ethical obligations
E. Modify documentation wording to reflect subtle improvements
In New Jersey, an occupational therapist whose license has been suspended by the state board may continue practicing if they believe the suspension was issued in error and they have requested an appeal.
True or False?
False.
An occupational therapist requests authorization for additional outpatient OT visits for a client recovering from a rotator cuff repair. The insurance company denies the request, stating the client has “reached maximum improvement.” The client continues to have difficulty with dressing and overhead reaching tasks required for independence.
What is the MOST appropriate next step for the occupational therapist?
A. Discharge the client immediately since further therapy is not covered
B. Submit an appeal with updated functional outcomes and justification for continued skilled need
C. Continue treatment without billing insurance
D. Refer the client to orthopedic surgery for reevaluation before continuing therapy
B. Submit an appeal with updated functional outcomes and justification for continued skilled need
An occupational therapist may base a letter of medical necessity primarily on the client’s personal preference for a specific piece of equipment, as long as the client reports it improves their comfort and satisfaction. True or False?
An occupational therapist notices that a client is becoming fatigued and mildly short of breath during a treatment session. The therapist stops the activity, monitors the client, and adjusts the intervention to prevent further strain.
Which ethical principle is MOST clearly demonstrated?
A. Autonomy
B. Justice
C. Nonmaleficence
D. Veracity
C. Nonmaleficence
In New Jersey, an occupational therapist must renew their licensure every two years. True or False?
True.
An occupational therapist is providing services to a client covered under Medicare Part B in an outpatient setting. Which of the following must be present for occupational therapy services to be reimbursed by Medicare?
A. The client requests continued therapy services
B. The services are considered skilled and medically necessary
C. The therapist provides more than 60 minutes of treatment per session
D. The client has private insurance as a secondary payer
B. The services are considered skilled and medically necessary
An occupational therapist writes the following daily note for a client recovering from a right CVA with left-sided weakness:
"Client participated in upper extremity activities and completed tasks with assistance. Client tolerated session well and is progressing toward goals. Continue OT per plan."
Which of the following BEST explains why this documentation is considered ineffective for skilled occupational therapy services?
A. It fails to include the client’s diagnosis
B. It does not provide specific, objective, or measurable information about occupational performance or skilled interventions
C. It includes too many references to the client’s tolerance of therapy
D. It should not include any mention of the plan of care
B. It does not provide specific, objective, or measurable information about occupational performance or skilled interventions
An OT student discusses a patient’s case in a public elevator without using the patient’s name. Is this ethical?
A. Yes, because no name was used
B. Yes, because it’s for educational purposes
C. No, because others could still identify the patient
D. No, but only if the patient complains
C. No, because others could still identify the patient.
A recent graduate of an accredited occupational therapy program has passed the NBCOT exam and wants to begin working as an occupational therapist in New Jersey as soon as possible. The graduate has accepted a job offer, but their start date is approaching and their state license has not yet been issued.
What is the MOST appropriate action for the graduate to take?
A. Begin treating clients under supervision until the New Jersey license is issued
B. Begin working in a non-clinical role until the license is issued
C. Begin treating clients since the NBCOT exam has been passed
D. Delay submitting the licensure application until after starting work
B. Begin working in a non-clinical role until the license is issued
An occupational therapist is reviewing a new client’s coverage information before beginning outpatient services. The client has coverage through a federal insurance program that primarily serves individuals aged 65 and older, as well as certain younger individuals with qualifying disabilities.
Which type of insurance does this MOST likely describe?
A. Medicaid
B. Medicare
C. Private commercial insurance
D. Workers’ compensation insurance
B. Medicare
An occupational therapist documents a treatment session with a client recovering from a traumatic brain injury. The therapist writes: “Client completed grooming tasks with assistance and tolerated session well.”
Which of the following revisions BEST reflects skilled documentation?
A. “Client did well during session and enjoyed grooming activities.”
B. “Client required assistance with grooming and participated fully in session.”
C. “Client completed grooming tasks with minimal verbal cues to sequence steps due to impaired executive functioning; therapist provided graded cueing and skilled facilitation to promote independence.”
D. “Client was present for grooming activities and completed tasks with help from therapist.”
C. “Client completed grooming tasks with minimal verbal cues to sequence steps due to impaired executive functioning; therapist provided graded cueing and skilled facilitation to promote independence.”
The American Occupational Therapy Association Code of Ethics supports respecting client autonomy, which includes allowing clients to refuse recommended occupational therapy interventions even if the practitioner believes the intervention would be beneficial.
True
Choose the correct answer related to renewal requirements for The National Board for Certification in Occupational Therapy (NBCOT) renewal.
A. CEUs are required; at least 10.
B. CEUs are not required.
C. PDUs are required, at least 10.
D. PDUs are required, at least 36.
D. PDU's are required, at least 36.
An occupational therapist provides 25 minutes of therapeutic exercise and 15 minutes of self-care training during an outpatient treatment session for a client recovering from a stroke. The therapist needs to document and bill for the skilled therapy services provided.
Which coding system is MOST appropriate for reporting these occupational therapy services?
A. HCPCS Level II codes
B. ICD-10 codes
C. CPT codes
D. DRG codes
C. CPT codes
An occupational therapy practitioner writes the following in a home health note:
Client refused to do dressing practice and seemed frustrated during the session. Caregiver states "he is not trying hard enough."
What is the MAIN issue with this documentation?
A. It includes the caregiver in the note
B. It uses subjective language without specific, observable details
C. It does not include patient goals
D. It does not include the client’s diagnosis/ICD 10 code
B. It uses subjective language without specific, observable details
An occupational therapist working in a pediatric outpatient clinic is treating a child with developmental delays. During a session, the parent asks the therapist not to document concerns about the child’s possible need for a referral to a developmental specialist because they are worried it may affect school placement and future testing.
The therapist believes the referral is important for early intervention and appropriate support services.
Question:
Identify the ethical dilemma in this situation. In your answer, identity at least 2 ethical principles involved and describe how the occupational therapist should respond in an ethical manner while considering both the child’s needs and the parent’s wishes.
Beneficence: The therapist has a duty to promote the child’s well-being by recommending appropriate evaluation and early intervention services.
Nonmaleficence: Failing to document or act on concerns could delay needed services and potentially harm the child’s developmental outcomes.
Veracity: The therapist must maintain honest and accurate documentation of clinical observations.
Autonomy (parental authority): The parent has the legal right to be involved in decisions about their child’s care, but this does not override professional obligations to advocate for the child’s health needs.
A student has just graduated from an accredited occupational therapy program and wants to obtain a license to practice in New Jersey. Which of the following must the individual complete before being eligible for licensure?
A. Complete 30 CEUs in occupational therapy practice
B. Pass the National Board for Certification in Occupational Therapy examination
C. Work under supervision for 6 months in New Jersey
D. Obtain certification in a specialty area of practice
B. Pass the National Board for Certification in Occupational Therapy examination
An occupational therapist is reviewing a client’s insurance coverage prior to initiating services. The client will be admitted to a hospital for an acute medical condition requiring inpatient care and rehabilitation services during their stay.
Which type of Medicare plan is MOST directly responsible for covering inpatient hospital-based care?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
A. Medicare Part A
Identify one term commonly used in therapy notes that is a red flag for unskilled/ineffective documentation.
Tolerated, Supervised, Observed, Supported, Encouraged, Continue with POC.