Chapter 4 - Professional Standards and Responsibilities

Question 1

Physiatrist

Answer 1

Diagnoses and medically treats individuals with musculoskeletal, neurological, cardiovascular, pulmonary, and/or other body systems

Question 2

Biomedical Engineer

Answer 2

• Specializes in the biomedical application of engineering theory and technology
• Serves as a technical expert to recommend commercial products, adapt available devices, or modify existing environments
• Develops, designs, and fabricates customized equipment, devices, and techniques

Question 3

Interdisciplinary

Answer 3

Collaboration of all relevant disciplines, but evaluation and intervention is still independent

Question 4

Transdisciplinary

Answer 4

Expansion of collaboration of all relevant disciplines: roles are blurred

Question 5

Intradisciplinary

Answer 5

No other disciplines involved

Question 6

Multidisciplinary

Answer 6

Multiple disciplines involved, but independent from one another

Question 7

Fieldwork Educator Requirements

Answer 7

OTA: Level I fieldwork for OT students
OT: Level II Fieldwork with 1 year experience in field
OTA: Level II fieldwork for OTA students with 1 year experience in field

Question 8

Early Intervention “at risk”

Answer 8

1 - birth complications
2 - suspected delays in development
3 - Failure to thrive
4 - Maternal substance abuse during pregnancy
5 - Birth to teen mom
6 - Established disability/diagnosis

Question 9

G - codes

Answer 9

• Medicare must report functional data
• Identify primary issue being addressed by therapy
• Used to track patient outcomes

Question 10

Diagnostic/Procedural Codes

Answer 10

Describe a person’s condition or medical reason for requiring services - ICD-9-CM

Describe Specific services provided - HCPCS
(CPT Codes - Physician’s current procedural Terminology)

Question 11

Medicaid Optional

Answer 11

OT, PT, Speech, DME, Transportation, Crisis response services, Dental, Eyeglasses, Psych inpatient for 65, Related services (OT) provided by school to children w/ disabilities, & Independent professionals; psychologists, psych. social workers, and other mental health professionals

Question 12

Medicaid Mandated

Answer 12

Inpatient & Hospital, Outpatient & Physician (Lab work, x-rays), home health, early periodic screening diagnosis and services (EPSDT) for 21 and younger, Services deemed necessary during EPSDT (OT), and SNF receiving medicaid must provide rehab to residents requiring it (OT)

Question 13

Medicare part A

Answer 13

• Pays for inpatient, SNF, home health, rehab facilities, and hospice
• Automatic
• Inpt require minimum of 5 days a week
• Treatment supplies covered in DRG rate in acute care
• Covered service has time limits, deductible, and requires co-insurance by beneficiary
• 20% of home health is paid by patient

Question 14

Medicaid Part B

Answer 14

• Must be purchased
• Pays for hospital outpt physician and other professionals (OT)
• No time limit, but 20% co-payment
• OT must be prescribed by physician
• No diagnostic restrictions for OT
• Typically covers 3 days/week for outpt

Question 15

Medicare eligibility

Answer 15

65 or older, end stage renal disease or kidney failure, long-term disability (ALS, MC) who have received gov’t-funded disability benefits for 24 months, and retired railroad workers

Question 16

Critical/clinical pathway

Answer 16

A standardized recommended intervention protocol for a specific diagnosis.

Question 17

Capitation

Answer 17

Provider is paid prospectively a set fee for each member

Question 18

Beneficiary

Answer 18

Person receiving services

Question 19

Prospective Payment System (PPS)

Answer 19

Worldwide - determines mecicare payment for each inpt stay of a medicare beneficiary based on diagnostic related groups (DRG)

Question 20

Diagnostic Related Groups (DRG)

Answer 20

The descriptive categories established by th CMS that determine the level of payment at a per-case rate

Question 21

Health Maintenance Organization (HMO)

Answer 21

The most common form of managed care - maintains control over services by requiring enrollees to see only doctors within the HMO network and to obtain referrals before seeking specialty or ancillary (secondary) care.

Question 22

Managed care

Answer 22

Maintaining Control over care: PPO, HMO

Question 23

Preferred Provider Organization (PPO)

Answer 23

Similar to HMO, but with more choice - which leads to increased payment

Question 24

Treatment authorization request (TAR)

Answer 24

Medicaid form a PCP must complete to document the need for the requested medically necessary covered services and their supporting rationale.

Question 25

Homebound Criteria for Medicare

Answer 25

• Person is typically not able to leave house - “confined” (considers medical, physical, cog, and psych conditions)
• If person leaves, it requires “considerable and taxing effort”
• They may leave for medical (dialysis) and non-medical (hairdresser) short-term/infrequent appointments
• The need for adult day care does not make receiving home services impossible for a person