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Practice Management > Documentation/Billing/Coding > Flashcards

Documentation/Billing/Coding Flashcards

1
Q

Purpose of Documentation

A

-legal record
-communication
-clinical problem solving
-reimbursement
-confidentiality
-Fraud and abuse

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2
Q

Minimum Documentation Items

A

-referrals
-evals and exam
-plan of care
-each treatment session
-re-evals
-PT and PTA interactions
-discharge summary

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3
Q

7 Essentials of Evaluation

A
  1. Hx and physical exam
  2. Skilled services
  3. Pt Response
  4. Plan for future care
  5. Rationale and need for skilled services
  6. Complexity
  7. Pertinent Characteristics of pt
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4
Q

Documentation Guidelines

A

-every visit
-approved abbreviations
-document no shows
-done within 24hrs
-3rd person
-cross out with pen

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5
Q

10 Payer Complaints

A

-poor legibility
-incomplete documentation
-abbreviation issues
-no documentation for day of service
-not skilled
-not necessary
-does not demonstrate progress
-interventions not timed

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6
Q

Red Flags of Documentation

A

-ranges of level of assistance min-max
-pt agitated or confused
->3 modalities after 4th visit
-poorly written goals
-testing too often

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7
Q

Discharge Planning

A

-where to go
-what support is needed
-referrals
-follow up care

Consider:
-prior level of function
-current function and needs
-rehab ability
-safe for home or community

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8
Q

Long Term Acute Care Discharge Rec

A

-high medical needs
-not safe to go home
-might need ventilator
-variable prognosis

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9
Q

Skilled Nursing Facility Discharge Rec

A

-moderate medical needs
-mod to good prognosis
-<3 hours a day of rehab
-not safe to go home
-Mod-high multidisciplinary needs

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10
Q

Inpatient Rehab Facility Discharge Rec

A

-high prior functional level
-mod to stable medical needs
-good prognosis
-3 hours of rehab a day
-High multidisciplinary needs

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11
Q

Outpatient Discharge Rec

A

-high prior function
-stable medical needs
-Good prognosis
-good current function
-safe to go home
-single multidisciplinary needs

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12
Q

Home Health Discharge Rec

A

-stable medical needs
-good functional prognosis
-limited current function <150 feet
-safe to go home
-nursing or PT required
-possibly homebound

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13
Q

Nursing Home Discharge Rec

A

-low pre functional level
-stable medical needs
-limited prognosis
-limited skilled therapy needs

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14
Q

ICD-10 Codes

A

-internaional classificaion of dissease
-international code system for diagnoses
-7 digits
-used in all healthcare

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15
Q

CPT Code

A

-Current Procedural Terminology
-PT bill for time and skills (97000)
-can be timed or untimed
-indicate care given by PT

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16
Q

8 Minute Rule

A

1 Unit: 15min: 8-22min
2 Units: 30min: 23-37
3 Units: 45min: 38-52
4 Units: 60min: 53-67

17
Q

Timed Codes

A

-require direct patient care
-15 min incements

Ex:
-therex
-neuro re-ed
-gait training
-manual

18
Q

Untimed Codes

A

-does not require direct
-time does not matter

Ex:
-modalities
-group
-estim

19
Q

Modifiers 59/X

A

-can bill for certain pairs of codes during one visit

20
Q

Value-Based Payment System

A

-payment based on outcomes

21
Q

Prospective Payment System

A

-lump sum payment
-predetermined
-patient classified system

22
Q

Fee for Service

A

-payment based on dollar amount
-Volume= greater reward

23
Q

Medicare

A

-65+ or < with disability

Part A:
-Acute Care
-Inpatient rehab
-SNF
-Home Health
-Hospice Care

Part B:
-optional
-must pay a premium
-Outpatient, physician, DME, home health, SNF

24
Q

Medicare and Students

A

Part A:
Hopital: general supervision
SNF: line of sight

Part B:
-will not pay for services by students
-students shouldn’t document directly on chart

25
Q

Medicare and Co-Treatments

A

-cannot be more than 2 disciplines

Part A:
-each therapist can bill for whole time

Part B:
-each therapist cannot bill for entire

26
Q

Medicare and Group Therapy

A

Part A:
-Acute: split time and charge, can do multiple pts
-IRF and SNF: doing similar activities, 2-6 pts, 25% of total treatment

Part B:
-if more than one, must be group
-must be skilled
-must be similar level of function

27
Q

Medicaid

A

-public health for low income, children, pregnancy
-can have aid and care

28
Q

Medicaid and Students

A

-may participate
-must be supervised
-considered auxiliary personnel

29
Q

Medicaid and Co-treatment

A

-must be prescribed
-primary therapist must be there
-only primary therapist can bill
-must be medically needed

30
Q

Medicaid and Group Therapy

A

-must be prescribed
-pts don’t have to do the same activities
-therapist mus be in the room at all times

Practice Management (7 decks)

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