HCD Final Flashcards
1
Q
Mitigation plan
A
strategies implemented in advance to control risk
2
Q
Contingency plan
A
strategies that are enforced after an event occurs and used to reduce the related consequences
3
Q
Latent condition
A
elements of a healthcare system’s inherent design that can either contribute to or prevent medical error
4
Q
6 types of latent condition
A
providers, procedures, products, peripherals, patients, policy
5
Q
What type of law involves action that is harmful to society as a whole?
A
criminal
6
Q
What type of law involves private disputes between persons or organizations?
A
Civil
7
Q
What type of law is a body of rules and principles that governs the duties and operations of federal or state administrative agencies
A
Administrative
8
Q
Examples of criminal law in PT
A
medicare fraud, HIPAA violation, sexual misconduct, theft
9
Q
Examples of civil law in PT
A
malpractice, billing company dispute
9
Q
Colorado PT board has jurisdiction over:
A
CO licensed PTs and PTAs
Individuals that claim to be PTs
Individuals with expired CO PT licenses
10
Q
List consequences from PT board from least to most severe
A
- Dismissal of complaint
a. complete dismissal
b. dismissal with confidential letter of concern - Discipline
- admonishment
- probation/practice limitation
- suspension
- revocation/surrender of license
11
Q
Describe rules with corporate practice of PT
A
Owner cannot tell PT how to practice, must contain a procedure for complaints, PT not required to exclusively refer and not required to take action if they determine it is not in the patient’s best interest
12
Q
What PTAs not do?
A
Evals/re-evals
Interpret referrals
Modify POC
Determine discharge plan/location
Manipulation (V)
Sharp wound debridement
Supervision of PT aides
13
Q
A PT may supervise no more than __ persons not licensed as a PT at one time
A
4
14
Q
General supervision
A
PTA; reachable by telecommunications
15
Q
Direct supervision
A
PT aides; available in same building
16
Q
Immediate supervision
A
Students; Immediately available
17
Q
Quality assurance vs. quality improvement
A
bare minimum vs. improving beyond that
18
Q
What is the deeming authority by CMS for home health and hospice?
A
The Community Health Accreditation Program (CHAP)
19
Q
What is the independent, not for profit, voluntary commission for IRFs?
A
Commission on Accreditation of Rehabilitation Facilities (CARF)
20
Q
What treatments are included for CARF? What facilities can be covered?
A
CVA, brain/spinal cord injury, chronic pain
Rehab services in hospital or outpatient clinics
21
Q
What is the accreditor of hospitals?
A
JCAHO
22
Q
Who else does JCAHO accredit?
A
Home care agencies, nursing homes, and long term care facilities
23
Q
All nursing homes are licensed by:
CO specific?
A
the state through a state agency
DORA
24
Patient access with provisions
Time/visit limit, prohibit certain diagnosis/treatment without referral (spinal manip, needle EMG), may require CE connected to direct access
25
Limited patient access
Access to evaluation only, fitness and wellness, and limited treatment only to certain patient populations or under certain circumstances
26
What happens to a PTs risk of liability with a physician referral?
Does not change
27
What terms are currently protected?
physical therapist, physiotherapist, physical therapy technician, PT, LPT
28
An insurer offering Part C is most likely to experience what type of selection when there are high numbers of enrollees?
favorable selection
29
Part B Medicare co-insurance for PT is what % of the Medicare Fee Schedule?
20%
30
What is a medical home?
Team-based model of patient care focused on coordination
31
What does telehealth include?
Synchronous interactions and store & forward transfers and remote monitoring
32
Originating site
site where the patient is located at the time of service
33
Originating provider
on-site with the patient
Originally designed where patient is at another facility (nursing home, PCP office) and specialist is at a distant site
34
Distant site
site where the provider is located at the time of service
35
Store & forward transfers/asynchronous telehealth
Examples
Specialist physicians most often
Radiologist reviewing imaging
Electronic access to HEP
36
Synchronous telehealth
Face to face
37
Medicare approved telehealth providers
MD/DO
NP
PA
Nurse midwives
Clinical nurse specialists
Certified registered nurse anesthetist
Clinical psychologists and clinical social workers
RD
38
Bipartisan Budget Act included what in regard to telehealth
Requirement that telehealth be included as a basic benefit in the medicare advantage program
39
How does Medicaid pay for telehealth?
Unique state by state
40
Payment parity
requirement that telehealth visits be reimbursed at the same pay rate or amount as if care was delivered in person
41
Service/coverage parity
requires the same services be covered for telehealth as they would be if delievered in person but does NOT guarantee the same rate of payment
42
Colorado Law changes for telehealth
Removes previous population restriction of 150,000 or less residents
Bars health plans from requiring an initial physician encounter
Requires health plans to reimburse providers same amount (payment parity)
Providers do no have to demonstrate that a barrier to inperson care exists
43
Pre-Pandemic payment from Medicare for telehealth
PT not included
Synchronous only
Patient can't be at home
44
Which state requires the person providing telehealth care (distant provider) must be in the same state as the patient?
Alaska
45
Fraud
intentional deception or intentional misrepresentation that a provider makes to gain a benefit for which the provider is not entitled
46
Abuse
Payment for items or services when there is no legal entitlement to that payment, and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment
47
Waste
Overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the healthcare system
48
False Claims Act
Imposes liability on any person who submits a claim to CMS that they know is false
49
Safe Harbor
Example
Legal provision in a statute or regulation that provides protection from legal liability when certain conditions are met
IOAS in Physician Self-Referral Law
50
Anti-Kickback Statute
It is a criminal offense to knowingly and willfully offer, pay, solicit, or receive bribes or kickbacks to induce or reward referrals
51
Physician Self-Referral
Stark Law
Physician referring a patient to a facility in which they have a financial interest - can't do
For federal payers
52
Why can PT be referred to under physician self-referral (stark law)?
included under in-office ancillary services statuteE
53
Exclusion Statute requires exclusion of ____ from participating in federal payers
Medicare/Medicaid fraud, patient abuse or neglect, felony conviction relating to controlled substances
(May exclude: misdemeanor health care fraud and controlled substances, suspension/revocation of a license, unlawful kickback, defaulting on health education loan)
54
What does initial consent to treat cover?
Treatment (day to day documentation and communications between providers), health operations (QA, outcomes tracking), payment (insurance billing)
55
Are federal government prosecutions for fraud increasing or decreasing?
increasing
56
When was ADA created? And expanded/modified?
1990
2008
57
Disability
Physical or mental impairment that substantially limits one or more major life activities of the individual or
record of such an impairment
or
being regarded as having such an impairment
or
known association/relationship with a person with a disability
58
Amendments made to ADA
Expanded definition of major life activities/body functions
Employees may not consider mitigating measures other than ordinary eyeglasses/contact lenses in assessing whether an individual has a disability
Disability can include impairment that is episodic or in remission
59
Covered Entity under ADA
Private employer, employment agency, labor organization, joint labor action committee, state/local governments
60
Reasonable accommodation
modifications at the job workplace to enable a person with a disability to easily perform a specific job
61
Undue burden
ADA
Action necessary to provide a reasonable accommodation that would cause the employer/owner significant difficulty or expense
62
Who does Title I of ADA apply to?
All employers with 15 or more employees
Private employers
State and local governments
Employment agencies
Labor unions/organization
63
Who is protected from employment discrimination?
Qualified individuals with disabilities
(could the individual perform essential functions with reasonable accommodation?)
64
Physical Agility/Fitness Tests
PRE-offer only
Performed by non-medical person
Must be given to all applicants
Can't include medical aspects (HR, BP)
65
Medical examination under ADA
POST-offer only
Must be job-related and consistent with business necessity
Performed/interpreted by healthcare profession
Requires proof that the medical exam is designed to evaluate only essential functions
Required of all entering employees
66
When are medical examinations allowed after employee begins job?
Required by other Federal laws
Determining current fitness to perform a particular job (i.e. annual test of firefighters)
Voluntary exams that are part of employee health program
Evidence of a job performance or safety problem
67
Can an employer ask interview questions about the ability to perform specific essential functions and how they would? Ask about previous job duties?
Yes & yes
68
When is an employer required to make a reasonable accommodation?
Only when disability is known
Not obligated if individual does not request (unless disability effects person's ability to communicate)
69
Title II of ADA
Public service/transportation
Governmental
Applies to all state/local governments
No size exemption
70
Title III of ADA
Public Accommodations (FOR the public)
Private entities that own/operate/lease/lease to places of public accommodation, commercial facilities, private entities that offer certain exams and courses related to education and occupational certification
71
Construction requirement under title III ADA
New construction or alterations must conform to ADA
Any facility occupied after 1993
72
3 things organizations must do to comply with title III
Physical access (readily achievable barrier removal, accessible parking, building access)
Communication access (available in AN alternative format)
Reasonable modification to policies (person with DM can have injection equipment even in places that prohibit sharps)
73
When are elevators required?
Any building over 3 stories or is a shopping center/mall, healthcare office, public transport station, airport terminal
74
If a building was built pre-1992 what does ADA require?
Readily achievable barrier removal
75
Fair Labor Standards Act (FLSA)
Federal law
Establishes minimums that employers must follow
76
Examples of FLSA
Time keeping and overtime compensation requirements
Breaks/meal periods
Minimum wage (federal default is $7.25)
Wages due on regular payday
Employee vs independent contractor
Exempt vs. non-exempt
77
Exempt employee
Exempt from overtime
Paid on a fixed salary basis
Categories: executive, administrative, professional, creative/computer professional, outside sales
78
Non-exempt employees
Overtime eligible
Typically paid an hourly rate
79
Independent contractor
Per IRS
Free from control and direction for performance of service under the contract
Controls own work, assumes risk for profit/loss, bid for jobs, impermanent relationship
80
Family and Medical Leave Act (FMLA) covers what?
Federal law
Birth and care of newborn of employee, placement with employee for adoption/foster care, care for immediate family member(parent, spouse, child), take medical leave when employee is unable to work due to serious health condition, qualifying military family leave
81
Who is eligible for FMLA?
Employees that have worked for their employer for at least 12 months AND
worked at least 1,250 hours AND
work at a location where the company employs 50 or more employees within 75 miles
82
What is the FMLA benefit length?
12 workweeks of leave in a 12-month period
83
Unemployment Insurance
Insurance for workers who have been terminated from their job at no fault of their own (monetary payments for a given period of time or until they find a new job)
84
Is unemployment insurance a federal or state statute?
Both
85
How are premiums determined for unemployment insurance?
Based on how often the insurance is used
86
What is an example of a state statute?
At will employment
87
What is at will employment?
Employer or employee may terminate its job contract for any or no reason
88
Do employers have to show progressive discipline or cause for termination in an at will state?
No
89
Who establishes standards for safe employment?
OSHA
90
What is the Colorado Paid Family and Medical Leave Insurance (FAMLI)?
Law passed in Colorado where workers who earn $2,500 in yearly wages are eligible for paid family & medical leave
91
How long do you have to be working to qualify for FAMILI in CO?
180 days
92
What accounts under FAMILI in CO?
Care for biological/adopted/fostered child
Care for themselves for serious medical condition
Care for family member with serious health condition
Arrange for a family member's military deployment
Address the immediate safety needs/impact of domestic violence and/or SA
93
How many weeks of leave/pay are you allowed with FAMILI?
12 weeks (more for pregnancy or childbirth)
94
Who has to participate in FAMILI?
Every employer regardless of size (fewer than 10 employees = won't have to pay premium tax)
95
Revenue
Gross money earned by a company
96
Net income
Total revenues minus total expenses over a period of time
97
Assets
Economic resources of the company
98
Liabilities
amounts the company owes to other parties (loans, leases)
99
Fixed costs
Independent of volume (utilities, salary, gym equipment)
100
Variable costs
Costs that fluctuate depending on sales volume (theraband, lotion, hourly wages)
101
ROI
Return On Investment, measure of profitability
Net profit/total investment x 100
102
SWOT Analysis
Strengths (of business)
Weaknesses (of business)
Opportunities (market)
Threats (market, competition)
