Medicare
Fill in the blanks: Medicare part A is an automatic benefit that covers _____________ services, while part B is a supplemental voluntary program that covers ____________ services.
Medicare part A is an automatic benefit that covers inpatient services, while part B is a supplemental voluntary program that covers outpatient services.
Complete the sentence: Medicaid is a _________ assistance program that varies according to each _________.
Medicaid is a federal assistance program that varies according to each state.
Which of the following does not count toward a practitioner’s billable productivity?
A) Documentation
B) Chart review
C) Intervention planning
D) All of the above
D) All of the above
True or false: CPT codes are used only in the field of OT and PT.
False. CPT codes are used throughout the healthcare field to describe the services that are provided.
“ICD code” is an acronym for what?
International Classification of Disease Code
Medicare part A requires a _________ minimum hospital stay in order for a pt to qualify for therapy services at a SNF.
3 day minimum hospital stay
True or false: A patient cannot be considered “dual eligible” for both Medicare and Medicaid.
False. As a secondary payer, Medicaid coverage can extend beyond what is covered by Medicare for those who are dually-eligible.
What is the term for the type of documentation that is completed during a treatment session with a patient?
Point of service documentation
Which of the following should be the driving factor when choosing the correct CPT code for an activity?
a) Pt’s response to the ax
b) Practitioner’s intent behind the ax
c) Whichever code is the least expensive for Medicare to cover
b) Practitioner's intent behind the ax
True or false: ICD codes are unstandardized and vary according to each specific healthcare facility.
False. ICD codes are specific, standardized codes that create a common language within the healthcare field.
Medicare will only pay for services that are _____________ and __________ ____________.
Medicare will only pay for services that are skilled and medically necessary.
True or false: Although policies vary by state, many public school systems can seek reimbursement from their state Medicaid program to supplement payment for services according to an IEP.
True.
Name one potential benefit and one drawback of point of service documentation that OT practitioners should take into consideration.
Possible benefits: documenting closer to the time of provided tx (better chance for accuracy), can be used as an educational session “wrap up summary” with patient, can be included in billable productivity
Possible drawbacks: could take away from valuable tx time, can be harmful to rapport with client, potential for increased typing/spelling mistakes
A COTA working in a pediatric outpatient clinic completes an activity with a child during a treatment session that addresses visual motor integration as well as executive functioning skills. For that one activity, she decides to bill for CPT codes 97530 (Therapeutic activities) and 97129 (Therapeutic interventions that focus on cognitive function). Why is this incorrect?
An activity can only be billed under one CPT code. The practitioner should choose the code that best reflects the intent of the activity, even if other skills were also addressed.
True or false: The treating diagnosis code may not always be the primary diagnosis code.
True, however they should be related. According to AOTA, practitioners should “use the diagnosis that most appropriately describes the condition you are treating”. (Coding Basics Video, 2020)
Give an example of a case in which skilled services can be justified to promote maintenance of function as opposed to progress.
Possible answer: Degenerative diseases of the CNS (i.e. Alzheimer's disease, amyotrophic lateral sclerosis, Parkinson's disease, etc.)
True or false: In CT, Medicaid benefits do not cover behavioral health occupational therapy services.
False. Husky Health, the state Medicaid program of CT, includes coverage for both inpatient and outpatient behavioral health services.
A COTA is having trouble meeting the 95% productivity standards set by the SNF where she works. One particular day, she realizes three of her patients happen to all be available during the same time period and decides to provide group therapy in order to increase her productivity. What is wrong with this choice?
Medicare regulations require that if group therapy is to be provided to patients, it must be planned ahead of time according to a documented plan of care. There are also significant ethical concerns in this situation due to the fact that the practitioner is making the determination based on her own needs, rather than her patients’ needs.
A COTA working in a SNF provides a light meal prep ax for a pt to complete prior to d/c home in order to improve standing dynamic balance and to promote increased functional (I) within the home. What would be the appropriate CPT code to choose for this ax?
a) 97530 Therapeutic activities
b) 97535 Self-care/home management training
c) 97110 Therapeutic procedure
b) 97535 Self-care/home management training
How often does the WHO release updates regarding the ICD codes?
a) Every 5 years
b) Biannually
c) Annually
c) Annually
A COTA is working with a pt who is receiving OT services s/p THR and has an active tx plan addressing post-surgical recovery. In working with the pt, the COTA realizes that the pt also has limited mobility of his L hand, specifically at the MCP joints, and utilizes joint mobilization techniques to improve ROM. Why won’t this treatment be covered by Medicare?
Medicare will only pay for services that are directly related to a documented tx plan that has been approved by a physician. In this case, the OT treatment has been approved to address the THR only.
According to the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits, coverage for OT services is mandated under Medicaid for which population?
Pediatrics. In physical rehabilitation, OT is considered an “optional” benefit and coverage is determined by each state.
Name one strategy that can be used to help improve productivity.
Possible answers: Staying organized, planning ahead, coordinating ahead of time with other disciplines such as PT and speech, keeping ready-made copies of HEP’s and handouts
A COTA is working with a pt in a LTCF who has a STG related to improving ROM of R wrist s/p wrist fx in order to promote (I) with ADLs. It is the week before Christmas and the pt reports that she has very fond memories of making Christmas cookies with her children in the week prior to the holiday. The COTA plans an ax in the rehab kitchen where the pt makes Christmas cookies, rolling out the dough and cutting them into various shapes. Which CPT code is most appropriate for this ax and why?
a) 97530 Therapeutic activities
b) 97535 Self-care/home management training
c) 97110 Therapeutic procedure
a) 97530 Therapeutic activities. The intent is to facilitate functional usage of the wrist joint and to promote increased ROM, not home mgmt training (pt is in LTCF).
Among the 2021 ICD-10 updates, under the Mental Health and Behavioral Disorders section, which of the following categories was expanded?
a) Mental and behavioral disorders due to psychoactive substance use
b) Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
c) Behavioral syndromes associated with physiological disturbances and physical factors
a) Mental and behavioral disorders due to psychoactive substance use