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Which type of organization covers hospitals for people with mental illness, infirmaries associated with prisons or reformatories or state medical school hospitals and clinics
State government
What is the insurance type for inpatient hospital short term skilled nursing facility coverage; funded by payroll taxes
Medicare Part A
What are the 3 work settings accounted for the majority of OT practice?
Hospitals, Schools, and Long Term Care/Skilled Nursing
In addition to receiving a referral or a request to provide OT services, OT practitioners should also know what?
Which emerging service model is associated with technology development, includes the "application of evaluative, consultative, preventative, and therapeutic services)
Telehealth
Which managed care plan individuals have lower copays and health care services are reimbursed at a higher rate if they remain inside the predetermined networkas opposed to seeking care outside the network
PPO
Supplemental insurance that covers doctor's visits, OT, other rehabilitation services, home health, and necessary medical equipment; individual pays a monthly premium
Medicare Part B
Name one way that cost containment of OT services may be implemented?
Who provide extensive, specific guidelines for documentation of services covered under Medicare, which can be found in the Medicare Benefit Policy Manual
CMS (The Centers of Medicare and Medicaid Services)
What influence occupational therapy services, such as which populations served, where the services are provided and how those services are reimbursed
LEGISLATIVE
Which types of organizations covers care delivered through charity hospitals, community hospitals, wellness centers, Surgical centers
Nonprofit Organizations
Insurance coverage for military personnel, veterans and their families
TRICARE
Which two generations are particularly important when considering OT service delivery?
Baby Boomers and Millennials
Which three organizations provide essential information for coding?
1 WHO
2 AMA
3 CMS
Which law had the intent to provide health care coverage for the uninsured?
ACA
Which type of insurance (private or federally funded) represents the majority of the insurance coverage used by the US population?
Private health insurance
What type of insurance serves population of children whose families do not qualify for Medicaid services
CHIP
Name 4 emerging niche areas for occupational therapist according tot he Healthy People Initiative.
Children and youth; Education, Health and Wellness, Mental Health, Productive aging, Rehab/Disability and Participation and Work and Industry
Modifiers, which give payers specific information that permits payment of services that may otherwise not be paid.
What are the four types of managed care?
1.Exclusive provider organization
2. HMO Health Maintenance Organization
3. PPO Preferred Provider Organizations
4. POS (Point of Service)
What term describes "when multiple health workers from different professional backgrounds work together with patients, families, careers, and communities, to deliver the highest quality of care"
Interprofessional Collaborative Practice
What type of insurance is for individuals with low incomes, pregnant women, people with disabilities, those who need long term care AND how is it funded?
Medicaid and it is a federal and state funded program
Name the three areas that are considered priorities identified by the AOTA emerging niches and the Healthy People's 2020 initiative
1Access to care
2Mental health and substance abuse
3Prevention and wellness
In Oct 2019, what did CMS transition to PDPM. What does the PDPM stand for?
Patient-Driven Payment Model