day nine: billing stuff

Question 1

three areas that determine overall complexity:

Answer 1

occupational profile
deficits in performance areas
amount of clinical reasoning involved

Question 2

what insurance requires total time governing how many units you can bill?

Answer 2

Medicare

Question 3

how does Medicare keep track of units

Answer 3

report what was done in minutes and units. the units are determined based on the total time in therapy

Question 4

8 minute rule

Answer 4

you round up or down dependent on the eight minutes

Question 5

Medicare will reimburse the intervention that

Answer 5

required the most skill or where more time was devoted

Question 6

timed codes:

Answer 6

timed codes are billed using Medicare’s 8 minute rule.

Question 7

unlimited codes:

Answer 7

codes billed one unit per date of service regardless of the number of anatomical body areas treated to time spent.

Question 8

what codes do we currently use for outpatient?

Answer 8

CPT

Question 9

what series are CPT codes for outpatient reported in

Answer 9

9000 series

Question 10

Part A is

Answer 10

skilled nursing facilities PPS

Question 11

Part B is

Answer 11

Outpatient PPS

Question 12

OASIS is used for

Answer 12

Home health PPS

Question 13

inpatient acute hospital payment is based on

Answer 13

diagnosis

Question 14

CMC

Answer 14

center for medicare and Medicaid services

Question 15

MAC:

Answer 15

medicare administrative contractor

Question 16

CPT:

Answer 16

common procedural terminology

Question 17

HCPC:

Answer 17

Health Care Common Procedural Coding System

Question 18

PPS:

Answer 18

Prospective Payment Systems

Question 19

new codes promote OT and a

Answer 19

distinct value

Question 20

CPT identifies four components of a the evaluation process:

Answer 20

1. occupational profile
2. assessment of op
3. clinical decision making
4. development of plan of care

Question 21

the therapist determines _______ in the evaluation process:

Answer 21

how complex or broad the occupational therapy profile and medical nd therapy history must be

Question 22

low complexity:

Answer 22

brief problems focused

Question 23

moderate complexity

Answer 23

expanded

- review of history related ot presenting problems

Question 24

high complexity

Answer 24

extensive additional review of history