Practice Management & Professional Development Flashcards
Occupational therapy aide
Staff member with no formalized OT education who may provide non-skilled support to the occupational therapy process under direction and close supervision of the OT and OTA practitioner
Minimum Data Set (MDS)
A mandated component of the assessment process for all Medicare and Medicaid residents in certified nursing homes used to:
- evaluate each resident’s functional abilities
- support the formulation of an individualized care plan
- determine the Resource Utilization Category (RUG) level for reimbursement
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)
A comprehensive evaluation process that must be completed for Medicare Part A patients who receive services in the inpatient rehabilitation setting, that supports quality of care and reimbursement
This process includes:
- collecting data about the patient’s physical, cognitive, functional, and psychosocial status
Outcome and Assessment Information Set (OASIS)
The screening tool used for clients who receive services under Medicare Part A in the home health setting to establish the Health Resource Group (HHRG) for reimbursement
Medicare homebound eligibility
A guideline outlined in the Medicare Benefit Policy Manual that defines the criteria that must be met in order to qualify for home health care
National Provider Identification (NPI)
A number issued by the Centers for Medicare and Medicaid Services (CMS) that is unique to each healthcare provider
Home Health Resource Group (HHRG)
Categories that use a client’s Outcome and Assessment Information Set (OASIS) score to determine prospective reimbursement under Medicare for home health agencies
Prospective Payment System (PPS)
A reimbursement method in which Medicare compensates the healthcare provider by using a predetermined payment schedule
Managed care
Type of health-care plan that manages care and is typically comprised of a network of providers
Types include:
- health maintenance organizations
- preferred provider organization
- point of service plans
Medicaid
A medical insurance program in the United States that provides health coverage for low income adults and children
Medicare Part D
An optional section of the federal health insurance plan in the United States that provides coverage for prescription medications
Informatics
The process of using technology to generate, organize, store, and communicate health information
Accountable evaluation
Expectation that the results of the evaluation process are:
- reliable, justifiable, and accurate
- acceptable by all stakeholders
- evidence-based and client-centered
- defensible against best practice and professional standards
Utilization review
Process of auditing health records to assess:
- necessity of services
- cost-effectiveness of services
- efficiency of services
- compliance with policies and procedures
Letter of medical necessity
Documentation that justifies the need for DME or mobility devices as reasonable and necessary based on evaluation results and evidence-based practice standards
Appeal letter
A letter written to justify and request payment for services from an insurance company or payor source that denied reimbursement
Current Procedural Terminology (CPT) codes
A medical coding system designed to communicate information about service provision and procedures using a uniform language
Features include:
- published by the American Medical Association
- primarily used in outpatient settings
Medicare Part C
Optional health insurance plans in the United States that are sold by private insurance companies but are approved by Medicare
Medicare Part B
A section of the federal health insurance plan in the United States that is referred to as medical insurance and provides coverage for the following:
- some physicians’ services
- outpatient care
- medical supplied
- preventative care
Medicare Part A
A section of the federal health insurance plan in the United States that is referred to as hospital insurance and covers care provided in the following settings:
- hospital
- SNF
- hospice
- home health
NBCOT® Disciplinary actions
Following an investigative process, actions taken as a consequence for violation of the Code of Conduct, as outlined by the national OT credentialing body, may include one or more of the following sanctions:
- ineligibility for certification
- reprimand
- censure
- probation
- suspension of certification
- revocation of certification
NBCOT® Code of Conduct
Guidelines of the OT national credentialing body outlining expectations of professional responsibilities for present and future occupational therapy certificants
Violation of any of the eight principles will initially result in investigation and action by the national credentialing body
NBCOT® Practice Standards
Guidelines of the OT national credentialing body outlining expectations for quality occupational therapy care, holding OTR® and COTA® certificants accountable for delivering consistent, high quality services
Consist of four sections:
- practice domains
- code of professional conduct
- supervision
- documentation
