PTCIP: all the coding ever Flashcards
What is the Triple Aim of healthcare?
experience
quality
cost
What is the Iron Triangle of healthcare
access
cost
quality
“A state of complete physical, mental, and social well being and not merely the absence of disease.” This is a definition of what and created by Whom?
Health
World Health Orgination
1950s
Term for the attributes of settings where care is delivered? Examples?
Structure
EMR, clinical specialization
Term for whether or not good medical practices are followed? Examples?
Process
Screening for falls
Term for measuring impact of care on health status?
Outcome
What are the three population characteristics that determine use of healthcare?
predisposing characteristics
enabling resources
need
What does conditional direct access mean?
neuromuscular conditions only
patient can come to PT only for 30 days without a script from physician
What is construct validity?
construct: abstract concept invented to represent unobservable behaviors or ideas: no one way I can measure function, ex: LEFS
What is content validity?
includes all characteristics it says it measures, expert panel, etc
What is face validity?
appears to measure what is intended to measure, you look at the measure and think it makes sense
What are three types of construct validity?
convergent
discriminant
know-groups validity
What is convergent validity?
correlates with another thought to measure construct, ex: i compared it to a previous test and showed those results
What is discriminant validity?
does not correlate w a measure assessing distinctively different characteristics: using a mental health component in a PT study
What is know-groups validity?
Produces different scores for different groups known to be different.
Ex: surgical vs. non-surgical patients, acute vs. chronic
What is criterion validity?
comparing to a gold standard
What are the 3 vestibular reflexes?
VOR: vestibulo-ocular
VSR: vestibulospinal
VCR: vestibulocollic
What is angular (rotational) VOR responsible for ?
compensates for rotation
nystagmus
What mediates the VOR?
Mediated by SCCs (semicircular canals)
What is the normal response of nystagmus? How would you name it?
postrorotary nystagmus
direction of nystagmus will be opposite to direction of rotation
ex: turn head l, you will have r nystagmus
Does the vestibular system habituate during constant movement?
What compliments this?
Yes, the optokinetic reflex.
Optokinetic reflex generated by cerebral cortex
Which sensory organ mediates the ocular tilt reflex, compensates for head tilt, and creates a counter-rolling response? How does this benefit you?
utricle
allows you to tilt head, but still see target in front of you
What happens in Barany Testing? What is it measuring?
Rotation: 10 turns in 20 seconds
Postrotary nystagmus
What is the Anti-kick Back Statute?
Protects patients and federal health-care programs from fraud and abuse by eliminating the corrupting influence of money.
Prohibits exchange or remuneration for services payable by the federal gov’t and prohibits behaviors that induce reward, or generate business.
What law prohibits physicians from referring patients to certain designated health services to facilities in which they or a their close family member has a financial relationship?
Stark Law
What does the False Claims Act do? Who created it?
Created by President Lincoln.
Identifies punishment for individuals that submit claims that are knowingly false.
What law is required by the Office of the Inspector General that is designed to help protect and detect potential violations; includes a code of conduct, and provides a method for employees to report behavior in question and a process of investigation and correction?
Corporate Compliance Plan
In PA specifically, what law defines the scope of PT practice, id’s standards of profession conduct and defines actions that result in further investigation and judgement of professional misconduct?
PA State Practice Act
What does the Medicare rate reduction do?
Medicare will pay for the most expensive procedure, but then each subsequent unit will be reimbursed less.``
What is a KX modifier?
needed after $2040 of services are provided to indicate that services continue to be medically necessary and remain skilled. pt and speech combined, ot separate
What is cost-based reimbursement called?
fee for service
What are three types of prospective payment systems?
diagnostic related groups (drg)
resource utilization groups (rug)
ambulatory payment classifications (apc)
What type of prospective payment system is used in acute care facilities
diagnostic related groups (drg)
very specific patient groups
What type of prospective payment system is used in home health care?
HHRG, will get a lump sum determined by an OASIS form
What type of prospective payment system is used in a SNF?
resource utilization group (rug)
What type of payment system is used in outpatient?
fee for service/ohpps
What is capitation?
a payment arrangement for health care service providers such as physicians or nurse practitioners
What is an example of a capitation model?
Accountable Care Organizations
What is an accountable care organization?
“provider-led organization whose mission is to manage the full continuum of care and be accountable for overall costs and quality of care for a defined population”
What type of payment system is used in an inpatient rehab facility?
irf-pai
What type of payment system is used in LTCH (long term care facilities)?
diagnosis related group (drg)
