for quiz on 11/18 Flashcards
What was used before we as a profession adopted a code of ethics?
The core values
Focuses on compliants/ files against practitioners. Also works on monitoring and updating code of ethics
The ethics commission
Guides practitioners to take appropriate ethical action
Ethical reasoning
Demonstrate a concern for the safety and well-being of the recipients of their service
Beneficence
Intentionally refrain from actions that cause harm
Nonmaleficence
Respect the rights of the individual to self-determination
Autonomy & confidentiality
Shall provide services in a fair and equitable manner
Social justice
Shall provide comprehensive, accurate, and objective information when representing the profession
Veracity
Shall treat colleagues and other professionals with respect, fairness, discretion, and integrity
Fidelity
The process of assessing and validating qualifications
Credentialing
Legal domain of practice for occupational therapy practitioners
Scope of practice
Recognition that an OT or an OTA has met professional requirements and is authorized to use certification marks
NBCOT certification
Process by which government grants permission to engage in practice
Licensure
A law passed by the state or federal government
Statute
What protects consumers from unqualified or unscrupulous practitioners
The regulation of OT
What are the 4 levels of regulations
Licensure, certification, registration, title control
The act of representing yourself exactly as you are
Title control
A law that is established by an individual state to regulate health care professionals within that state
Practice act
Please note
When filing a complaint with AOTA/NBCOT they can only disciple those registered with the organizations
Supervision with a mentor, continuing ed, payment of a fine, or suspension or revocation of a license
Some possible disciplinary actions
Can an OT aide supervise OT practice
No
Face to face contact between supervisor and supervise
Direct supervision
Non face to face contact between supervisor and supervise
Indirect supervision
Which type of supervision requires daily, direct contact at the site of work?
Close
which type of supervision requires direct contact at least every 2 weeks at the site of work, with interim supervision occurring by other methods such as telephone or written communication
routine
which type of supervision requires at least monthly direct contact with supervision available as needed by other methods
general
which type of supervision requires only as needed basis, and may be less than a month
minimal
the degree, amount, and pattern of supervision required can vary depending on the practitioners: competence service demands state laws/ third party payers case characteristics
conditions of supervision
who determines how much supervision is required in a particular setting?
the OTR/L
Standardized intervention protocol for specific diagnosis
Clinical pathway
Centers for Medicare and Medicaid services
Cms
Code that describes medical reason for condition for services
Diagnosis code
Cms category that determines level of payment
Diagnostic related group (drg)
Method of maintaining control over healthcare costs, includes hmo and ppo
Managed care
Levels of care are classified to be used for reimbursement purposes in snfs
Resource utilization group (rug)
10 digit code for facility/provider (mainly for Medicare)
Npi or national provider information
Method of payment for predefined health care services
Pps or prospective payment system
Companies who are primary reimbursers for healthcare services (bc/bs, hphc, etc)
Third party payers
Established in 1965 as part of the security act.
For people 65 or older, people with permanent kidney failure, black lung disease or on social security for over 2 years
Medicare
OT treatment is covered if:
under MD care
prescribed by physician with certified care plan
Provided by qualified otr or cota under supervision of otr
requires skills of an otr or cota
reasonable and necessary for treatment of a persons illness or injury
must show significant improvement in level of function within reasonable period of time
Medicare coverage for ot services
Inpatient acute care hospitals
snf up to 100 days (first 20 days free IF 3 night stay in hospital)
inpatient rehab facility
long term care hospital
hospice care
home health care (ot, pt, speech)
inpatient psych hospitals (lifetime amount of 190 days)
includes specific time limits, deductibles, and copay of 20% for home health care
Medicare Part A
Hospital outpatient services (subject to $1900/year cap)
snf (after 100 days part A)
home health care (not covered under part A)
private practice OT
Dme (not adaptive) (splinting or repositioning)
outpatient mental health services
mental health partial hospital programs
includes: no specific time limit, but 20% copay applies
Medicare Part B
Medicare health plan offered by a private company that contracts with Medicare to provide you with all your part A and B benfits
also known as part C or MA plan
medicare advantage plans include health maintanance organizations, preferred provider organization, private fee-for-services plans, special needs plans, and Medicare medical savings account plans
Medicare services are covered through the plan and aren’t pad for under original Medicare
Medicare advantage plans
Prescription drug coverage
these plans add drug coverage to original Medicare, some Medicare cost plans, some Medicare private fee-for service plans, and Medicare medical savings account plans
CANNOT HAVE PART C AND PART D COVERAGE AT THE SAME TIME
Medicare Part D
Provides for “free appropriate public education that includes special education and related services to meet their unique needs”
Idea
