Private Insurance
True or False?
Small employers can choose to offer health insurance coverage for their employees.
True
How many levels of health care common procedure coding sets are there?
2 levels
level 1: 5 digit AMA CPT
level 2: codes owned by CMS
What are the types of Workers' Compensation Program?
Third party/private insurance
Self insurance
State-run programs
Federal programs
Occupational therapy helps in the recovery of work related injuries but also in the ________ of these injuries.
Prevention
Who's husband works with workers comp and work hardening programs?
Dr. McConnell's husband, PAT!
Describe a co-payment.
Give an example of who may require one.
A set amount paid for each practitioner visit.
Practitioner visit, primary care, or specialist
A client's spouse comes to you with concerns about their shoulder pain. They do not have a referral from a physician. What laws allows this client to receive OT services without a referral from a physician?
Direct access laws
What ways can occupational therapist become involved in safety and health promotion services?
Stress management, time management, interpersonal relations, diet/sleep management, and other health and wellness training
What is it called when a therapist is not reimbursed for a service? Give an example.
An exclusion
Ice packs (cold packs)
More than _____ % of workers comp cost are through employer self insurance and third party private insurance.
80
What does it mean if someone is an out of network HCP (health care practitioner)?
A client may take on extra expenses for services because they are not covered by their health insurance.
The service payment cycle includes:
1. OT services
2. Documentation
3. Coding
4. Billing
5. Reimbursement
What is the most pervasive reason for under reporting work place injuries in vulnerable populations?
Poor promotion of culturally relevant workplace safety programs AND lack of knowledge of ways to access workers comp.
Why should OTs be attentive to private health insurance?
What condition is the leading reason that U.S. employees are unable to work?
musculoskeletal conditions
How do people in the United States acquire private health insurance?
employee sponsored, government based, or workers compensation
What are two reimbursement platforms for occupational therapist or therapy settings under Medicare?
fee for service and a prospective payment system
This term refers to a situation in which individuals are able to maintain continuous participation and successful performance of job duties, realizing benefits through financial or other positive rewards.
Gainful employment
Why is the mental health parity and addiction equality act expansion so important to occupational therapy?
Because those with substance use disorders and addiction treatments are protected and it is within OTs scope of practice.
Why are uninsured rates for children only around 5%?
The children's health insurance program (CHIP)
Explain the different types of health insurance plans / managed care options that many employers offer.
HMO: within network providers
PPO: within network but still pay some cost outside of network
POS: choose between HMO and PPO each time they get medical care
EPO: services are only covered if patient goes to doctors, specialist, or hospitals in the plan's network
Basis of the number of minutes or units of service provided to determine productivity levels.
Client has lost his distal right upper extremity including hand and wrist while working in a meat package plant. What category of wage loss would your client fall under?
Describe the meaning of this category?
Permanent partial disability
Greg suffered from a sever concussion while at work falling off scaffolding and was hospitalized for a week. He missed 7 days of work.
1. What is this covered under?
2. Is this regulated by federal or state legislature?
1. Loss time claims
2. State legislature
Lack of health insurance is the _____ leading cause of death in the United States?
6th