Unit 2 Compliance

Question 1

What is the purpose of the State Boards of Physical Therapy Practice?

Answer 1

• Disseminates the rules and regulations governing
  the profession of physical therapy
• Oversee the state licensure of physical therapists and physical therapy assistants
• Review complaints brought against physical therapists, physical therapy assistants, and students for violations of the practice act

Question 2

Describe the 3 types of supervision physical therapists are required to provide that may apply to supervision/delegation of patient care to PTAs, PT aides/techs, and/or DPT students:
a. General Supervision:
b. Direct Supervision:
c. Direct Personal Supervision:

Answer 2

a. General Supervision: the PT is not required to be on site for direction and supervision, but must be available at least by telecommunications
b. Direct Supervision: the PT is physically present and immediately available for direction and supervision. PT will have direct contact with the pt/client during each visit
c. Direct Personal Supervision: the PT, or where allowable by law, the PTA is physically present and immediately available to direct and supervise tasks that are related to pt/client management. the direction and supervision is continuous throughout the time theses tasks are performed.

Question 3

If there are conflicts in the regulatory hierarchy which rule should you follow?

Answer 3

• The most restrictive is the one we need to follow
• More restrictive requirements typically trump less restrictive requirements

Question 4

List the documents where the APTA professional standards for PTs can be found:

Answer 4

➢Standards of Practice
➢Code of Ethics
➢Core Values
➢Guide to Physical Therapy Practice
➢Consensus Statement on Clinical Judgement

Question 5

Should PTs wave fees (copays, coinsurance etc.) and deductibles? Why or Why not?

Answer 5

• Pts are obligated to collect copayments and deductibles from patients
• in most cases it is illegal to routinely waive copays for private insurance and Medicare
• Agreeing to wave fees → ↑ the amount of care to the patient and the cost to the insurer which might be considered to be
  fraudulently obtained
• Medicare: if you occasionally waive copayments to those in financial need you will still be within the law

Question 6

What are the 6 things fraud, waste, and abuse lead to in PT practice?

Answer 6

*overutilization of services
*corruption of medical decision making
*harm to the pt
*increased costs for payers
*unfair competition
*reduced reputation of PT practice

Question 7

Define Fraud, Abuse, and Waste:
a. Fraud:
b. Abuse:
c. Waste:

Answer 7

a. Fraud: intentional deception or misrepresentation that a person makes to gain a benefit to which they are not entitled; knowingly billing for services not furnished, altering claims forms to increase payment, falsifying documentation
b. Abuse: payment for items or services that the provider is not entitled to and for which the provider has not intentionally misrepresented facts to obtain payment; billing services that are not medically necessary +/or do not meet professionally recognized standards, unbundling services/billing
c. Waste: incurring unnecessary costs as a result of deficient management
practices, systems, or controls; duplication of services already provided
elsewhere, spending on services that lack evidence of producing better
outcomes compared with less expensive alternatives

Question 8

List the ways you can ensure compliance in a PT practice:

Answer 8

• Conduct internal monitoring and auditing
• Implement compliance and practice standards
• Designate a compliance officer or contact
• Conduct appropriate training and education
• Provide written standards of conduct, policies, and procedures