Lecture 1 Flashcards
Function of documentation
Support intervention
Communication
Measure of quality/effectiveness/discharge Legal documentation
Who controls Documentation?
Federal and state law Accreditation standards Company/institution AOTA and state licensure Payers
ASBOT
Makes you
AOTA
Ideas
NBCOT
Testing
ACOTE
Have to
Documentation Process:
Referral, Evaluation, Int plan, Intervention, Reeval, d/c
USE THE WORD FUNCTION TO MAKE IT OT
Be aware of
Tone, slang, First person language, Gender specific pronouns
Issues with technology
Must follow HIPAA
Do not use personal email When using text follow
Situation Background Assessment Recommendation
Types of insurance
Indemnity insurance
HMO/MCO
Medicare
Cash
Indemnity insurance
Private pay insurance. Paid by individual, employer, not govt
HMO or MCO
health maintenance, managed care
Medicare
Funded by state or federal govt
Cost of policy
Premium
Amount you have to pay out of pocket before insurance kicks in
Deductible
Portion you pay for service despite deductible
Copay
Usually provided by employers: Usually paid partially by employer Can be purchased independently
EX: Blue cross, tricare, united health care
Indemnity programs
Focused on prevention and health maintenance
Usually less expensive than indemnity plans
Has a “gatekeeper” that has to refer you: Primary Doc or OBGYN Works within a network
Rarely allows you to go out of network
Must have authorization prior to treatment
May have limit on visits or treatment dollars
HMO and MCO
Falls under Social Security Act Covers those over 65
SSI disability
End stage renal disease
Medicare
Hospitals, SNF, Home health, Hospice. No charge if you work 40 quarters and pay into it.
Part A
Outpatient services, long term nursing, adaptive equipment, rehabilitation. Pt pays a premium.
Part B
supplemental (patient pays) usually comes from other sources to pick up added cost
Part D
Prospective pay system was based on diagnosis related groups
This lead to quicker D/C from inpatient facilities
PPS
Passed to decrease the cost of Medical
Instituted a $1500 cap for OT and $1500 for PT/SLP for outpatients. This was changed in 2000, and the cap is now at $2230
BBA of 1997
BBA applies to
PT private practice, Offices of physicians, Part B SNFs, Home health, Rehab agencies
Developed to provide for the poor and uninsured
Federal program, state managed
Federal matches, state sets up and runs it. Varies from state to state
Medicaid
OT regulations
NBCOT, State licensure, ALOTA/AOTA
Commission on accreditation of rehab facilities
CARF
national commision for quality assurance
Healthcare organizations NCQA
World health organization. ICF (internal classification of function, disability, and health) Basis for ICD-10 (international classification for diseases and health problems)
WHO
Current procedural terminology
CPT
The efficiency and acceptability of the performance
Adequacy
Implies a minimum of effort, usually relates to difficulty
Can assess level of independence
Efficiency
Functional status index, no difficulty, mild, moderate, severe difficulty
FSI
Focus on academic
School
SBAR
Situation Background Assessment Recommendation