exam 1 weeks 1-2

Question 1

3 main documents of OT

Answer 1

ICD, ICF, OTP4

Question 2

What does ICF and ICD stand for

Answer 2

(ICD) - international classification of diseases
(ICF) - international classification of functioning, disability, and health

Question 3

4 guiding principles of ot

Answer 3

CLIENT CENTERED
OCCUPATION CENTERED
EVIDENCE BASED
CULTURALLY RELEVANT

Question 4

typical OT

Answer 4

38 yr old female from central north usa, works in hospital 72k a year

Question 5

secondary work settings for OT

Answer 5

1/4 of practitioners work in secondary setting; most common one is SNF

Question 6

environmental factors

Answer 6

natural environment, products and technology, support and relationships, attitudes, services systems and policies

Question 7

ot practitioners licensed

Answer 7

OTA : 17%, ot : 83%

Question 8

OT demographics

Answer 8

mostly white 84%, female 91%, age group- 30 yr and 39 yrd old

Question 9

OTA primary work setting

Answer 9

SNF, 40% of al OTA’s work in urban areas

Question 10

OT primary setting

Answer 10

hospitals, 46% work in urban, 39% in suburban, 15% in rural

Question 11

geographic density of OT

Answer 11

more OT’s live in north central states, fewest live in Mountain states

Question 12

trends in salary for OT practice area

Answer 12

Academia and Home Health have the highest median salary

Question 13

HHS

Answer 13

-department of health and human services)- protect health of americans, provide essential health services

Question 14

Milestones in Early 1800s

Answer 14

Hospitals were physician-owned by those who practiced
within them

Question 15

milestones in early 1900s

Answer 15

Ownership changed from physicians to church groups,
larger facilities, and the government
* 1973 – first Patient Bill of Rights was established
* 1985 – Emergency Medical Treatment and Active Labor
Act (EMTALA) was enacted

Question 16

current hospitals systems are

Answer 16

not for profit, for profit, gov’t facilites

Question 17

Characteristic of Not-for-profit

Answer 17

traditional model, often initally founded for charitable cause, may have religious group involved
tax exempt

Question 18

For Profit characteristics

Answer 18

new from 1980s
owned buy shareholders
may focus on certain areas of care that are more profitable
-

Question 19

gov’t hospital agencies

Answer 19

owned by federal, state or local gov’t
- provide care for patients who may have limited access elsewhere
impacted by politics, funding debates

Question 20

main type of hospital in USA

Answer 20

not for profit 58%

Question 21

role of congress in health care

Answer 21

write and pass legislation

Question 22

president role in healthcare

Answer 22

carry out laws that are passed, oversees HHS and CMS, power to issue executive orders

Question 23

state and local govt role in healthcare

Answer 23

states administers medicaid programs, local health departments

Question 24

civic- faith based groups

Answer 24

free clinics, civic groups like lions club, shriners

Question 25

insurance 1940s-1960s

Answer 25

blue cross 1929, 1939 blue shield, retrospective payment, consumers could pick provider easily, IMPACT ON OT- hospital based OT are paid by private insurance

Question 26

historical 1964-1972

Answer 26

social security act
- health insurance federalized, medicare provided for 65 and older
- medicaid established for low income people

Question 27

part A medicare in 1965

Answer 27

hospital insurance

Question 28

medicare part b in 1965

Answer 28

medical insurance

Question 29

medicaid 1965-1972

Answer 29

medicaid expanded to include families, pregnant women, individuals with disabilites , and individuals needing long term care

Question 30

medicare 1972

Answer 30

MEDICARE EXPANDED TO INCLUDE PEOPLE YOUNGER THAN 65 WITH LONG TERM DISABLITIES and end stage renal disease

Question 31

medicare-medicaid impact on OT

Answer 31

ot included in original medicare law, medicare largest payer of OT, mediciad largest payer OT school based. expansion in 72 increased number of clients

Question 32

health maintenance act of 1973

Answer 32

beginning of managed care, includes health maintanence organizations, HMOs adn PPO- preferred provider organizations

Question 33

1975 Education of the Handicapped ACT

Answer 33

free and appropraite education for all children

Question 34

1980 and 1982 medicare expansion

Answer 34

expand into home health services, expand into hospice

Question 35

shift in 1983 of payment

Answer 35

shift from retrospective payment to prospective payment DRG (diagnostic related group)

Question 36

1986-1992 EI, IDEA, Fee schedule

Answer 36

1986- handicapped infant and toddle act- ot established EI
1991- IDEA - individuals with disabilities education act, replace education for all children act– requires education in least restrictive environment

Question 37

1992 fee schedule

Answer 37

medicare physician fee schedule- determines fee for services for pArt B
-OT utilize the fee schedule and CPT codes for Part B payment

Question 38

1997 BBA

Answer 38

balanced budget act , OT 1500, PT/SLP 1500,
in 2023- cap of $2,230 for OT and $2,230 for PT/SLP

Question 38

1997 chip

Answer 38

children’s health insurnce program – covers some OT services

Question 39

2010 ACA

Answer 39

Patient Protection adn Affordable Care Act- health care reform to reduce cost and provide affordable act

insurance marketplace created for uninsured

increase in federal funding to expand to include qualifications and to single childless adults

Question 40

ACA impact on OT

Answer 40

rehab and habilitation 10 essential benefits, coverage of prexisiting conditions

Question 41

ACA coverage

Answer 41

health plans can no longer limit or deny benefits to children under 19 due to pre-exisitng conditions
– gurantees right to appeal

Question 42

distribution of coverage trends

Answer 42

mainly employer coverage, then medicaid, then medicare

Question 43

Private health insrance

Answer 43

– fee for service
HMO
– HMO with Point of Service (POS)
– HMO PPO (preferred provider organization
– CDHP
– HSA
– HDHP

Question 44

FEE FOR SERVICE

Answer 44

retroactive payment

Question 45

managed care

Answer 45

moves towards prospective payment – HMP, PPO, POS

Question 46

GOVT Insurance types

Answer 46

federal , fed/state, state

Question 47

federal insurance

Answer 47

medicare (65 older, SSDI, end stage renal disease/ ALS

Question 48

fed/state insurance

Answer 48

medicaid,
CHIP
IDEA

Question 49

state programs insurance

Answer 49

workers compensation

Question 50

medicare part A now

Answer 50

all medicare people are coverd, no monthly premium, pay deductibles,

Question 51

medicare part B now

Answer 51

covers outpatient services –
paid for by monthly premiums,
20% copay,

Question 52

payment for OT services under Medicare part B

Answer 52

medicare physician fee schedule
CPT CODES can be untimed or timed, example evaluation codes are untimed
timed codes think 8 minute rule

ICD-11 CODES

Question 53

8 minute rule

Answer 53

8 to 22 mins 1 unit
23-37 2 units
38 to 52 3 units
53-67 4 units

Question 54

medicare part C

Answer 54

private part of medicare
medicare advantage (benfits of a, b and d )
not a medicare supplement

Question 55

Medicaid

Answer 55

funding shared between federal and state
primarily for low-income individuals and families, older adults, children, individuals with documented disabilities

Question 56

CHIP

Answer 56

states administer programs, covers 1/3 of all us children

Question 57

costs of OT services

Answer 57

for patients with insurance - copay often from 10-50 dollars
private pay insurance
– evaluation costs 150-200, treatment session 50-400 an hour

Question 58

value based care

Answer 58

ACO model
IMPACT – improving medicare post-acute act 2014

Question 59

JCAHO

Answer 59

provides certification for programs

Question 60

CARF

Answer 60

independent, nonprofit accreditor health and human services providers