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NBCOT Exam OTR > Admin > Flashcards

Admin Flashcards

1
Q

standardization

A

Uniformity: Content, administration, scoring.

Includes description of purpose, admin/scoring protocol, and established norms and validity.

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2
Q

What does administration protocol for eval/screen include?

A

instructions, ID’s required materials, provision of exact wording of directions to client.

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3
Q

What does scoring protocol include?

A

Ratings and criteria to determine ratings. Norms for range of ratings specific to population. Norm data= age, gender, diagnostic groupings

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4
Q

Validity

A

Accuracy of assessment to determine if tool measures what it meant to measure.

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5
Q

Face validity

A

how well assessment APPEARS to meet its stated purpose

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6
Q

Content Validity

A

Content in eval is representative of content that could be measured.
(Ex: role checklist = adequate list of roles?)

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7
Q

Criterion Validity

A

COMPARES assessment tool to another with established validity.

Correlation (compares). Higher correlation = better value

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8
Q

Concurrent criterion validity

A

COMPARES results of 2 instruments given at approx. the same time.

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9
Q

Predictive criterion validity

A

COMPARES degree to which an instrument can predict performance on future criterion

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10
Q

Reliability

A

Establishes consistency and stability of evaluation.
Good Reliability = scores same from time-time, place-place, eval-eval.
Correlation or % identifying degree that 2 items agree or relate.

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11
Q

Inter-rater reliability

A

interobserver. Different raters using same tool get same results.

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12
Q

Test-retest reliability

A

same results when administered 2x+ by same administrater

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13
Q

List of assessment tool types

A 
observation
interviews
self-report
checklists
rating scales
Goal Attainment Scales (GAS)
Performance Tests
norm referenced assessments
criterion referenced assessments
specific tools for :     client factors, areas of occupation, performance skills/patterns, contexts.
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14
Q

Observational Skills

A

In diff contexts
structured/unstructured
assess environmental & physical contexts, and physical and sociocultural supports and barriers.

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15
Q

Interview Guidelines

A

Establish purpose and rapport
ask organized/formal questions
observe nonverbal comm
interpret incongruence of non/verbal comm
listen before talking
Answer personal questions directly/honestly
interpret verbal/nonverbal responses- hypothesize about situation
develop plan based on above.
maintain confidentiality at all times.

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16
Q

Developmental considerations in evaluation

A

family/teacher interviews & Home/Class observations
Consider developmental levels for toys and evaluate media
observe a/symmetries, trunk stability, pelvis/hips/shoulders at rest and movement.
Observe transitions: in/out sidelying, quad, prone/sup, sit/stand, kneel, half-kneel, tailor/long/heel/side sit.
assess quality of movement and FMC
Consider positioning, AE, seating, tech needs, visual and auditory aides.
Assess cognition in context of play & occ’s
Assess psychosocial skills- coping, frustration tol, social interactions

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17
Q

Types of OT Intervention

A

Prevention
Primary- create/promote/enhance health
secondary- early detection of problem in at risk population (screening preemies for dev delay)
Tertiary- eliminate/reduce impact of dysfunction on individual

Meeting health needs
change process
management
maintenance

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18
Q

Intervention planning

A 
formulate plan
collaborate with individual
prioritize problems to address
content= LTG, STG, possible referrals
Intervention methods
Duration/frequency. Number/type of sessions
recommendation for referrals
use clinical reasoning
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19
Q

Principles of OT Interventions

A

Interventions:
change agent to remediate or restore
establish performance skills and develop habits
valued = inherently motivating
ID values and interests
practice perf skills and reinforce performance
produces feedback
facilitate mastery or competence
promote participation
assume responsibility for own health/wellness
positive influence on health/well-being
means to adapt to changing needs/conditions
create and maintain ID
positive effect psychological fxn
meaning/purpose influence quality of performance
satisfaction and fulfillment
influence how ppl spend time and make decisions

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20
Q

code of ethics

A

aspirational code of core values to guide ethical actions

enforceable principles and standard of conduct to AOTA members

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21
Q

Beneficence

A

safety and well being of clients

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22
Q

nonmaleficence

A

do no harm

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23
Q

autonomy

A

respect pt right to self-determination, privacy, confidentiality, consent

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24
Q

justice

A

promote fairness and objectivity

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25
Q

veracity

A

comprehensive, accurate, objective information

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26
Q

fidelity

A

treat others with respect, fairness, discretion, integrity

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27
Q

nosocomial infection

A

hospital acquired

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28
Q

ethical distress

A

know correct action to take, but barriers prevent it.

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29
Q

ethical dilemma

A

2+ potentially moral ways to solve problem.

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30
Q

Abuse

A

duty to report = beneficence

minimum standard = report to supervisor

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31
Q

Ethical decision making

A
  1. ID issues/dilemmas
  2. Gather relevant info
  3. determine conflicting values/areas of agreement
  4. ID relevant alternative course of action
  5. Determine all possible neg/pos outcomes
  6. Weigh consequences of each
  7. Seek input from others
  8. apply professional judgment
  9. contact agencies assoc. with individual
  10. determine desired/potential outcome of filing complaint.
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32
Q

AOTA

A 
jurisdiction:
professional membership
provides guidelines
NO DIRECT authority
- reports to AOTA ethics commission = extensive, confidential review process.
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33
Q

NBCOT

A

jurisdiction:
National credentialing agency
NO DIRECT authority over UNCREDENTIALED practitioners
* authority to investigate and discipline NBCOT certified practitioners

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34
Q

SRB - State Regulatory Boards

A

Jurisdiction:
Public/state bodies
protect public from potential harm.
Each state has own scope of practice guidelines and required qualifications
Most adopt AOTA code of ethics
AUTHORITY to discipline if public at risk

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35
Q

OT AIDES

A

not OT practitioners

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36
Q

OTA’s

A

can expand role by establishing service competency
primary role = implement tx’s
Can CONTRIBUTE to eval, devel/implement Interv plan, & monitor/document Pt responses
Must be supervised by OT

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37
Q

Types of supervision

A

Close - direct, daily
routine - direct @ least every 2 wks
General - direct, @ least monthly
Minimal - as needed

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38
Q

OT Aide Supervision

A

Can be supervised by COTA
intermittent - 0 Pt contact
Continuous - with client related tasks

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39
Q

Intradisciplinary

A

1 discipline/evaluation/tx
little to no involvement of other disciplines
NOT HOLISTIC

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40
Q

Multidisciplinary

A

Several disciplines assess/perform interventions INDEPENDENT of each other. ( like Franciscan med grp)
some formal communication btw team
resources/responsibilities individually allocated - may cause competition

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41
Q

Interdisciplinary

A

Jacobs Ladder
all disciplines collaborate for decision making
eval’s and interventions still independent
greater understanding of each disciplines role/perspectives

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42
Q

Transdisciplinary

A

Role Blurring.
Trans - man/woman. PT/OT….
Ongoing training, support, cooperation, etc, ensure integrity and quality of care.

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43
Q

Consumer

A

Most important member of care team (Pt.)

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44
Q

OT also collaborates with

A

PCA - personal care assistants

HHA - Home health aides

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45
Q

Role: Biomedical Engineer

A

Develop, design, fabricate CUSTOMIZED equipment and technologies. TECHNICAL EXPERT

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46
Q

Role: Certified Orthotist

A

Design, fabricate, fit ORTHOSES

OT, PT, or individual with specialized training.

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47
Q

Role: Certified Prosthetist

A

Evaluate, design, fabricate, PROSTHESIS

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48
Q

Role: job coach

A

1 to 1 and involvement fades over time

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49
Q

Role: Nurse Practitioner

A

Can refer to OT

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50
Q

Role: Registered Nurse

A

Can be Primary CASE manager

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51
Q

Role: Optometrist

A

Can refer to OT

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52
Q

Role: Physiatrist

A

Dr. of physical medicine and rehab. LEADS rehab team

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53
Q

Role: Primary Care Provider (PCP)

A

GATEKEEPER of services in managed health systems - MD or DO

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54
Q

Role: Psychiatrist

A

Mental Health Physician

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55
Q

Role: Psychologist

A

professional with PHD in psych

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56
Q

Role: Rec therapist

A

Bachelor or graduate degree

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57
Q

Healthcare system overwhelmingly insured by

A

Privately owned companies

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58
Q

Government pays for large portion of private sector services

A

medicare/medicaid

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59
Q

Healthcare system is:

A

Market Driven

most practices mandated by state/fed laws

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60
Q

CMS

A

Center for medicare/Medicaid services
division of HHS
develops rules/regs
participating facilities monitored for compliance
SNF’s strongly influenced by CMS regulations

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61
Q

CMS Centers

A

Center for Beneficiary Choices - medicare choice/medigap
Center for Medicare mgt - fee/4/service medicare
Center for Medicaid - state admin programs s/a
Medicaid and SCHIP
Center for program integrity - oversight
Center for Medicare/aid - develops. tests new service
delivery and payment models. Control program
costs

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62
Q

OSHA

A

sets/enforces standards related to safety

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63
Q

Beneficiary

A

Person receiving services

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64
Q

Capitation

A

payment system
provider paid PROSPECTIVELY (monthly). Paid set fee whether or not care has been provided.
PMPM - per member per month
healthier enrollees = more $ retained for Dr’s

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65
Q

Co-insurance

A

Co-pay. %

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66
Q

Clinical/Critical pathway

A

Standardized recommended intervention protocol for specific diagnoses

67
Q

deductible

A

Typically annual.

amt patient pays b4 benefits begin to pay.

68
Q

DRG

A

Diagnostic Related Group

descriptive categories that determine level of payment at per case rate

69
Q

Fee for Service

A

Payer 80%, patient 20%

70
Q

Health Insurance Mktplace

A

ACA

allows consumers to compare cost of insurance plans in their area (aka healthcare exchange)

71
Q

HMO

A

Health Maintenance Organization
MOST COMMON
controls services by requiring enrollees to see only Dr.’s within network and get referrals before specialty/ancillary care.

72
Q

Managed Care

A

HMO’s and PPO’s

73
Q

PPO

A

Preferred Provider Organization
similar to HMO
higher monthly premium = greater access to provider choices in/out of network

74
Q

Procedure Codes

A

describe specific services by healthcare professionals

75
Q

PPS

A

Prospective Payment System

nationwide payment schedule determines medicare payment for each inpatient stay of medicare beneficiary based on DRG

76
Q

Third Party Payer

A

Primary reimbursers in US (incl HMO/PPO)

77
Q

TAR - Treatment Authorized Request

A

Medicaid form to document need for requested medically necessary covered services

78
Q

UCR Usual and Customary Rate

A

Average cost of procedure in geographic area = max amount insurance will cover

79
Q

Private Insurance/Managed Care Plans

A

LARGEST source of INSURANCE payments in US

80
Q

intermediaries

A

private insurers that contract with medicare to handle day to day operations

81
Q

ACA fed regulations for private insurance coverage

A
  • provide essential benefits including rehab
  • can’t refuse coverage d/t pre-existing conditions
  • can’t raise premiums d/t gender, occupation, pre-existing conditions, or claim history
  • young adults covered on parent plans until 26y/o
  • no caps on annual and lifetime coverage
82
Q

Medicare

A

Largest SINGLE PAYER for OT services
65y/o+
end stage renal/permanent kidney failure - any age
ppl with LT disability - ALS, MS, who have received disability benefits for more than 24 months
Retired Railroad Workers

83
Q

Medicare Part A

A

inpatient hospital, SNF, home health, rehab, hospice
automatic when meet criteria & receives SS benefits
Acute care services receive DRG pmnts - includes OT and tx supplies
annual deductible and home health paid by pt. 20%

84
Q

Medicare Part B

A

Supplemental- purchased by beneficiary
no specific time limits - 20% co-pay
hospital outpatient Dr.’s, services by Independent practitioners

85
Q

Medicare part B criteria to cover OT

A 
Rx from Dr or Dr approved
performed by qualified OT or OTA
services = reasonable/necessary
no diagnostic restrictions
MUST result in IMPROVEMENT
increase level of functioning in reasonable amt of time
86
Q

Medicare Part B - OT

A

covers outpatient 3days/wk

87
Q

Medicare Part A - OT

A

covers inpatient OT minimum of 5days/wk

88
Q

Medicare does not cover

A

Most chronic illnesses, LTC, or medical expenses incurred with illness.

89
Q

Medicare - SNFs

A

Covered if skilled nursing/skilled rehab required on a daily basis
RUG reimbursement
Reimbursement incl: eval, caregiver training, design of maintenance plan, re-eval
Does NOT pay to carry out maintenance plan
Caregiver competency with maint plan must be documented by OT before D/C

90
Q

Medicare - OT Home Care

A

Homebound status
requires intermittent skilled RN, PT, ST before OT can begin
DME excluded from payment

91
Q

HHRG - Home health resource group

A

determines episode pay rate

episode = 60 day period. 1st billable visit - 60th day.

92
Q

OASIS

A

initial home health medicare assessment
Outcome Assessment and Info Set
complete to verify eligibility for medicare HH benefits/ plan for rn, med, social, rehab, d/c needs.
Initial assessment MUST be completed within 48hrs of referral
OT conducts follow-up, transfers, d/c evaluations

93
Q

Medicare - OT in hospice

A 
terminally ill ( less than 6mo to live)
maintain functional skills, adl performance, and or control symptoms
94
Q

Medicare - OT in Outpt

A

by/with medicare provider OR as part of Comprehensive Rehab Facility Services (CORF)

95
Q

Medicare - OT in Independent practice

A

payments according to fee schedule

Resource Based Relative Value Scale (RBRVS)

96
Q

Medicare - OT in Dr. Office

A

OT employed by Dr
services related to condition Dr is treating
service fees included on Dr b ill to M/Care

97
Q

Medicare - OT PHP - Partial hospitalization Services

A

In hospital affiliated or community mental health psychiatric day program
-otherwise requires inpatient psych care
-covered under general M/Care guidelines
-tx incorporates Independent multidisciplinary intervention plan to attain MEASURABLE, TIME-LIMITED, MEDICALLY NECESSARY functional goals related to reason for admission.
does NOT COVER = social, diversional, recreational, or vocational rehab under PHP Services.

98
Q

Medicare DME, Prosthesis, Orthosis Coverage

A

DME - if necessary and used in home. Rx required

Self-Help items - not reimbursable (grab bars, raised toilet seats, etc)

99
Q

Medicaid

A

State/Fed funding 50/50
Qualifiers: low income and / or disability
Mandated Services: inpatient and hospital services
outpatient and dr. home health EPSDT - early periodic screening diagnosis and treatment services (incl OT). and SNFs providing skilled rehab

100
Q

Optional Medicaid Services

A 
OT, PT, SLP
DME
Targeted Case Management
Rx Meds
Dental/glasses
crisis services
transportation
psych inpatient below 21y/o or above 65y/o
overlap services with IDEA
101
Q

Medicaid must provide

A

same minimum benefits provided in insurance exchanges

102
Q

Workers comp

A

Job related illness/injury
joint state/employer funding
state - WC committee board determining regulations and benefits
cash and medical benefits
primary focus - rehab and disease management for return to work

103
Q

OT documentation purpose

A 
record
justification
information resource
increase communication btw professionals
data
EMR (EHR) = digital format
104
Q

Documentation Standards

A

legibility spelling/grammar
concise/complete objective
current/accurate standard abbrev’s
uniform terminology person 1st lang
name, ID# on ea pg. complete data
type of document ID’d confident, compliant
full signature at end (therapist)

105
Q

Documentation Content

A

ID/background Info
Referral source, reason, chief OT complaint
Hx
precautions, risk factors, meds, contraindications
eval and re-eval
intervention plan
problem list, goals and potential for functional improvement.
GOALS - SMART Specific Measurable Attainable Relevant Time-limited
LTG’s
Activities/interventions
type, amt, frequency/duration, of tx needed
explanation of tx plan
statement of reason for missed tx
AE/instructions
HEP - compliance
D/C plan

106
Q

Documentation formats

A 
POMR    problem oriented medical record
based on list of problems
SOAP
consultation reports
critical incident reports
107
Q

Dx codes`

A

describe conditions or MEDICAL reason for required services

108
Q

CPT - Procedure codes

A

services provided by HC professionals. HCFA or HCPCS used.

109
Q

Outpt OT under medicare part B

A

Must report functional data using G codes

110
Q

G-codes

A

ID primary issue (goal) being addressed. All codes usable to track pt outcomes over time.

111
Q

Words that reflect 0 progress

A 
chronic
status quo
maintain
plateau
slow progress
stable
112
Q

words that 0 reflect improvement

A 
same as
uncooperative/noncompliant
dislikes therapy
confused/disoriented
can't follow directions
unmotivated
generalized weakness
113
Q

Federal Legislation

A

Establishes practice guidelines and reimbursement standards

114
Q

ACA

A

10 legislative titles

increase accessibility, fairness, quality, efficiency, accountability, and affordability

115
Q

HIPAA

A

HC continuity, privacy and security
written consent - good effort made
exempt if delays timely care
language barriers - consent can be implied
permission to discuss with family 18y/+
any info disclosed must be minimum needed for purpose
Pt right to access records
30-60days to respond. can charge reasonable copy
$
Pt can request info be amended
Can be refused w/ written rationale
Can be approved, but no removal of original doc
No 100% guarantee of confidentiality
research guidelines align with IRB
does not override stricter state laws

116
Q

Medicare Title 18 - PL 89-97

A

SSI

117
Q

Rehab Act 1973

A

Prohibits discrimination d/t disability w federally funded agencies

118
Q

Fair Housing Act

A

Prohibits discrimination based on sex, color, religion, etc
new apartments must meet accessibility standards
requires tenants to make exceptions to policies for individuals with disabilities (s/a allowing seeing eye dog)

119
Q

OBRA Omnibus Budget Reconciliation Act 1981

A

Prohibit discrimination in federally funded programs

Medicaid financing for community based services if less expensive than institutional care

120
Q

ADA 1990

A

prohibits discrimination against qualified persons with disabilities in transportation, employment, telecom, accommodations, and public services
Criteria for disability = physical/mental impairment limiting 1+ major life activity.
Record of increased impairment
regarded as impaired
NOT - substance abuse, mania’s, or sexual behavior disorders

121
Q

ADA Title I

A

Employment
reasonable accommodations - 15+ employees
unless causes undue hardship
US government, Indian tribes, and tax exempt clubs = exempt

122
Q

ADA Title II

A

Public Services

no discriminating ppl w disabilities from participation in services, programs, or activities of PUBLIC entities

123
Q

ADA Title III

A

Public Accommodations and Services by Public Entities

(schools, hospitals, theatres, stores..) Cant limit participation or benefit from goods/services

124
Q

ADA Title IV

A

Telecommunication 1996
all TV’s include closed captions
phone co’s include TRS (telecom relay services) 24/7

125
Q

TWIAA Ticket to Work & Work Incentives Improvement Program

A

allows pt to maintain Medicare/Medicaid benefits

126
Q

CAPTA Child abuse & prev tx act

A

mandated reporter

mental/physical injury, neglect, maltreatment, or sexual abuse of 18 and under.

127
Q

Early Intervention and Education Acts

A

Free and Appropriate Education (FAPE)
3-21y/o
schools provide OT
schools - prim early intervention service
mainstreaming
OT = PRIMARY EI SERVICE/PRIMARY DEVLOPMENTAL SERVICE
$ for family support services

128
Q

Reauthorization and amendment of IDEA

A

IEP- address childs unique needs to allow full access to general education curriculum/classes
- include consideration of AT and behavioral interventions
- team planning open to all personnel at request of parent or school
Education to prepare student for Independent living and employment
mandates IFSP

129
Q

Transition planning

A

begins at 14y/o or younger

updated annually

130
Q

Transition Services

A

begin at 16y/o or younger

131
Q

IDEA improvement Act

A

evaluations to include functional performance, developmental performance in addition to academic
RtI - services provided as needs become apparent
Pilots multi-year IEP
allows for flexible attendance of taem members, incl video/conference calls
specialist screenings without IDEA eval
Discipline = case by case. Must continue services and assessments

132
Q

IDEAIA & KCFSA

A

requires state procedures for abuse referrals

133
Q

NCLB

no child left behind

A

general education
standards based
OT= pupil services personnel - can recommend testing alternatives and accommodations

134
Q

Age Discrimination Employment Act

A

Prohibit age 40+ discrimination or mandatory retirement

Can work AND receive SSI

135
Q

Omnibus Reconciliation Act 1990

A

Nursing homes receive M Care/Aid
Resident Rights - autonomy, QOC, QOL
RN completes MD resident assessment yearly
** Psychosocial, activity pursuit patterns, physical condition, cognition all to be considered. Enhanced OT ROLE
Eval and Tx follow RAP (resident assessment protocol) guidelines
Individual care plans within specific time frame
RESTRAINT REDUCTION

136
Q

Medical Model

A

Individual with disability = decreased functional capacity
tx addresses disorder/dysfunction
FOR address pathology - Biomechanical and Neurodevelopmental

137
Q

Education Model

A

Individual with disability = lacks knowledge/skills
Focus on learning and behavior changes
deficits/goals promote learning & performance
obtain skills, knowledge, competency to meet environmental demands
OT FOR - role acquisition, cognitive remediation

138
Q

Community Model

A

Individual lacks skills, resources, supplies for community participation
ID & Develop skills needed for environment
external supports
OT FOR - life-style performance, Occupational Adaptation

139
Q

Telehealth Model

A

All model features

uses teletechnology

140
Q

Acute Care Hospital

A

Eval - quick accurate screen
stabilize, motivate, improve function through purposeful activities
generalist or specialist

141
Q

Subacute Intermediate Care Facilities

A

Pt progressed to stable, not ready for Outpt.

Eval more in depth

142
Q

LTAC - long term acute care hospital

A

chronic/catastrophic illness/disabilities
extensive medical care… life support/ventilator
2+ dx w complications
palliative
prevent deformities & decubiti

143
Q

Rehab hospital

A

medically stable

Extensive OT eval.

144
Q

Long Term Hospital

A

months to years
Extensive eval
maintain QOL
D/C to least restrictive environment

145
Q

SNF

A

requires skilled care
stable/0 acute symptoms
1mo - life
extensive eval and or palliative care and maintenance of QOL

146
Q

Forensic settings

A

jail - less than 1 yr city/county

prison - greater than 1 yr state/fed

147
Q

Outpt ambulatory care

A

req OT to improve fxn, without hospital or inpatient necessary.

148
Q

EI Programs

A

<3 y/o at risk kids
birth complications, dev delays
failure to thrive maternal substance abuse
kid born to teen mom disability or dx
33% dev delay in 1 area or 25% in 2
IFSP
6mo reviews by all professionals
Strength oriented evals and doc in family friendly terms
Play/ADLs
Transition plan EI to Pre-k

149
Q

Schools

A

facil participation in education and fxnl performance
referrals from: prev agency, teacher, school
IEP annual review
education model
AT & Transition service provisions
OT role incl = psychosocial needs and prevention of school violence, behavioral intervention plans including RtI and positive behavioral supports.

150
Q

Prevocational programs

A

develop prerequisite skills to get work.

151
Q

vocational programs

A

develop specific vocational skills. Already has prerequisite skills. develop strength/endurance

152
Q

Residential Program Continuum

A

24 hr support quarter way houses
half-way houses
group homes
supportive apartments with check-in supervision

153
Q

Partial hospitalization/Day hospital programs

A

Stable med/psychiatric conditions
symptoms still require active tx
up to 5days/wk
1wk-6mo

154
Q

Clubhouse Programs

A

enter/exit at will
OT = generalist
adults/elders with or hx of mental illness

155
Q

MBO Management by Objective

A

management based on core goals

measurable objectives and time frame

156
Q

4 steps in Program Development

A

needs assessment
program planning
program implementation
program evaluation

157
Q

Capital Expense

A

$500.00+ fixed amounts separated from other expenses

158
Q

Direct Expense

A

Service Provision. salaries/benefits, office supplies, tx equipment (ADL materials)

159
Q

Indirect Expense

A

Costs shared by whole setting: utilities, housekeeping, marketing

160
Q

Fixed expenses

A

Expenses that remain the same: rent

161
Q

Variable expenses

A

change in proportion of services provided. more splinting req more splinting materials
splinting materials = variable expense

162
Q

Break even analysis

A

cost-volume-profit analysis

volume of services to equal cost & profits to equal 0

163
Q

Accounts Payable

A

debts within budget

164
Q

Accounts Receivable

A

Assets within budget

NBCOT Exam OTR (3 decks)

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