Occupational Therapy Reimbursement and Documentation, Exams of Occupational therapy

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NBCOT Certification Competency and

Practice Management 2024 Exam

Review Questions and Answers 100%

Pass | Graded A+

David Mungai [Date] [Course title]

NBCOT Certification Competency

and Practice Management 2024 Exam

Review Questions and Answers 100%

Pass | Graded A+

Discuss the National Board of Certification of Occupational Therapy (NBCOT) code of conduct. List the first five principles. - Answer>> The Code of conduct is a document established by the National Board of Certification of Occupational Therapy (NBCOT) to define and explain the standards of personal and professional conduct expected by OTs and required for licensing and certification. It is expected that all occupational therapy practitioners behave with moral and ethical standards. There are nine principles in the code of conduct. Here are the first five: 1.) Certificants shall provide accurate, truthful, and timely representations to NBCOT 2.) Certificants who are the subject of a qualifications and compliance review shall cooperate with NBCOT concerning investigations and requests for relevant information. 3.) Certificants shall be accurate, truthful, and complete in any and all communications, direct or indirect, with any client, employer, regulator agency, or other parties as they relate to their professional work, education, professional credentials, research, and contributions to the field of occupational therapy. 4.) Certificants shall comply with state and/or federal laws, regulations, and statutes governing the practice of occupational therapy. 5.) Certificants shall not have been convicted of a serious crime.

well-being of the facility will help prevent near misses and critical events. Discuss precautions for early mobilization in the critically ill and intensive care unit (ICU) patients and what treatment may look like. - Answer>> Early mobilization in the intensive care unit (ICU) is currently an emerging area of research. This is a change in the culture for the ICU, which is used to be one of letting a patient rest in bed and keeping them as relaxed and immobile as possible to facilitate healing and medical stability. The benefits of early mobilization include reduced hospital acquired, improved functional recovery within the hospital, improved mobility at facility discharge, and reduced hospital length of stay. Early mobilizations requires a multidisciplinary team approach with frequent concurrent treatments with PT/OT and respiratory in addition to nursing staff. Precautions will mainly be based on labs being stable as well as stability with respiratory issues. Additionally, having enough people present to assist the patient and to manage lines including the ventilator is key. Most ICU treatment will be bed-based, edge-of-bed, or simple transfers to a chair at the bedside. Edge-of-bed activity can be any of the following:

• trunk control activity (leaning and reaching outside of the base of support and returning to the midline) -seated ADLs (tooth brushing, face washing, combing hair, cleaning glasses)
• vestibular training (change of gaze, weight shifting) -joint compression
• ROM
• lung expansion/deep breathing activity
• cognitive activity
• endurance.

Discuss precautions and contraindications based on the lab work of your patient. - Answer>> Critical thinking and clinical decision making are key components to being a licensed healthcare professional. When working in an acute care setting, lab values become a key part of an intervention to determine the safety of a therapy treatment. A bad value can determine if you will see a patient, or whether you are going to hold therapy. It is important to not only look at the actual lab number, but to notice trends over the last few blood draws. The following are the most critical labs that need to be checked prior to the starts of treatment. HCT

• Female: 37%-48$ -male: 39%-55%
• no exercise: <25%
• Light exercise: 25%-30%
• resistive exercise: >30% HGB(g/mL):
• Female: 12.2-14. -Male: 13.9-18. -No exercise: < -Light exercise: 8-
• Resistive exercise: > WBC per mm
• female: 4,500-11,
• male: 4,500-11, -No exercises: <5,000 with fever
• light exercise: >5,
• resistive exercise: >5,000 as tolerated Platelets per uL -Female: 150,000-400, -male: 150,000-400,

Discuss what it means to treat an observation patient, and explain the two-midnight rule. - Answer>> When a patient is admitted into a hospital, they are given a status. It can be inpatient or observation. As inpatient status means that the patient is formally admitted to the hospital with a doctor's order. If a patient is under observation status, they are considered outpatient status, which means that the physician is keeping them under close supervision to determine if they are sick enough to need inpatient treatment. Even though they are staying overnight in the facility and receiving treatment from staff, things are coded differently and it is not considered an inpatient admission. This becomes problematic should a patient need to discharge to an SNF. Medicare and most insurance will not pay for SNF placement with a hospitalization on observation status. The patient must be inpatient status. The two- midnight rule states that inpatient hospital admission under Medicare that lasts less than two midnights must be treated and billed as outpatient, or observation status. Any "midnight" on observation status does not count toward the three-day qualifying hospital stay for SNF placement. Discuss the therapy reimbursement structures. - Answer>> There are three forms of reimbursement in healthcare: fee for service (FFS), capitation, and bundled/episode-based payments. An FFS reimbursement is a payment that is based on what procedures the practitioner provides. Each individual item that a patient receives is coded with a price attached, and the payment is based on an A la carta price. Capitation is a payment that will cover all services for a medical episode over a specific period of time. If the provider has a deal with an insurance company for 100$ a month, the beneficiary can be seen as many times as they want and receive as many services as they need, but the provider will still only receive 100$ a month. Bundled/episode -based payment is reimbursement based on the expected costs for defined episodes of care. If the expected cost of an orthopedic

procedure is 10,000$ all of the patient's care including hospital stay, surgery, therapy, etc. needs to stay within or less than the 10,000$ because that is all the reimbursement that will be provided. If the facility spends more, they will lose money on that case. Explain National Provider Identifier (NPI) numbers and how they are used. - Answer>> A National Provider Identifier (NPI) number is 10-digit identification number issued to healthcare providers and organizations by the federal government for identification and billing purposes across payment sources. NPIs are issued by National Plan and Provider Enumeration System. If you are a Health Insurance Portability and Accountability Act of 1996-covered practitioner or if you are a healthcare provider/supplier who bills Medicare for your services, you need an NPI number. NPI numbers do not expire nor do they need to be updated. The number will be deactivated if the practitioner dies or closes their practice. NPI numbers are further classified by a taxonomy code. Healthcare Provider Taxonomy Codes are descriptors that categorizes the type, classification, and specialty of the healthcare providers. The taxonomy code for occupational therapy is 225X00000X. This code can be further organized by code categories to designate the area of practice: pediatric, gerontology, mental health etc. Discuss the G-codes and how and why they are used. - Answer>> The Centers for Medicare and Medicaid Services (CMS) uses G-codes to collect information about its beneficiaries' functional limitations. This system was established in 2013 to collect information over the course of therapy services to understand and identify conditions, outcomes and expenditures. There are 42 functional G-codes. Six of the TG-codes sets are used by PT and OT and eight of the G-code sets are for SLP functional limitations. G-codes are documented at evaluation noting current status and goal status. They are required for all

• restriction: at least 20% but less than 40% impaired, limited or restricted. Modifier CK
• restriction: at least 40% but less than 60% impaired, limited or restricted. Modifier CL -restriction: at least 60% but less than 80% impaired, limited or restricted. Modifier CM
• At least 80% but less than 100% impaired, limited, or restricted. Modifier CN
• At least 100% impaired, limited, or restricted. ` Discuss therapy payment denials and the appeal process. - Answer>> It is not uncommon for therapy treatment to be denied by a provider. The most common reasons for denial are the following: Error
• misspelled name, the time is not documented, wrong procedure code, transposing social security or birthday numbers. Lack of progress:
• if the notes are not detailed showing patient progress, claims can be denied. Medical necessity:
• if a case is not made to show explicitly why therapy is indicated, services can be denied. Credentialing or provider issues

Submission outside a specified time frame Needs a modifier: If PT and OT are providing two completely separate and distinct services during the same treatment period but both are billing the same code (therapeutic exercise, therapeutic activity), a modifier is needed. If the biller does not use a modifier, the claim will likely be denied. If a claim is denied, most facilities have a billing department that used a form letter to appeal the process. The biller is responsible for identifying why the claim was denied and then must contact the payer to determine if that is actually why the claim is denied. Then they must follow the detailed instructions for correcting, rebilling, and resubmitting the claim that they are provided. This may include having a therapist make addendums to the notes in order to correct an error. Discuss payment and coverage for occupational therapy services by commercial insurance. - Answer>> Many insurance plans cover occupational therapy, but every plan is different. Most cover occupational therapy in an acute care hospital setting, but they may have exclusions in other areas, such as outpatient and school-based therapies. Many insurance plans will allow for short- term occupational therapy if it meets certain criteria or diagnosis standards and is deemed medically necessary. In some cases, the benefits are defined by the total number of sessions covered per year, and some companies will have the beneficiary pay higher deductibles in order to include therapy services. Explain resource utilization groups (RUGs) in the skilled nursing setting. - Answer>> Resource utilization group (RUGs) are a classification system used to determine reimbursement levels for patients in SNFs. In an SNF, data from the MDS are used to determine the RUG category. A resident is assigned to one of the

determine how the facility is meeting as many as 1500 standards set by CARF. They have three levels of accreditation:

• Three-year accreditation: the provider is meeting or exceeding CARF standards
• One-year accreditation: There are some deficiencies, although the program shows capability and commitment in correcting the issues.
• Provisional accreditation: the provider is still working at the 1- year level longer than 1 year and has not yet met CARF standards. It may face nonaccreditation status.
• Hospitals and facilities need accreditation because it is required in order to get paid from federally Medicare and Medicaid programs. Define the following therapy reimbursement terms: medical necessity, beneficiary, benefit period, dual eligibility and spend down. - Answer>> Therapy services are impacted dramatically by documenting, billing and payer regulations. The following terms are important definitions in the billing process. Medical necessity: treatment, services, or supplies, needed to prevent, diagnose or treat an illness, injury or condition and the symptoms related to it. Beneficiary: the person eligible for the benefits in a healthcare program or insurance policy. Benefit period: The length of time during which a benefit is paid. It begins the day that you are admitted to a hospital or skilled nursing facility (SNF) and ends when you have not received care

in an inpatient hospital or skilled care in an SNF for 60 consecutive days. Dual eligibility: A person qualifies for Medicare and Medicaid benefits simultaneously. Spend down: In order to qualify for Medicaid, some people need to spend down their excess and surplus income on medical bills before medical benefits can be approved. Medicaid rules vary from state to state. In general, a single/widowed individual can retain 2,000$ in assets, and married couples who are still living together can retain 3,000$ in assets. Discuss the differences between Medicare and Medicaid and how they may impact services. - Answer>> Medicare is a federally funded program that provides health coverage despite income if you are 65 and older or have a documented and severe disability. Medicaid is a federal-state program that varies state to state that provides health coverage to anyone that has a significantly low income. You can apply for Medicaid is you have mounting medical expenses that you cannot afford or if you are you are pregnant, under age 18 or over age 65, blind, or disabled. Not all nursing homes, assisted living facilities, or clinics will accept Medicaid payments , or they may have a cap on the number of patients with Medicaid that they will take at any given time because the reimbursement rate is lower than most other payers. Discuss payment and coverage for occupational therapy services by Medicare. - Answer>> In 2018, Congress eliminated therapy caps. Therapy caps were limited to how much Medicare would pay for therapy services in a single calendar year. Medicare Parts A and B both cover occupational therapy services. Medicare Part A is also known as hospital insurance. It helps cover inpatient medical care, including hospitals, SNFs, and occasionally home healthcare. Medicare Part B helps cover medically necessary and

CPT Code 97112: Neuromuscular reeducation CPT Code: 97530: Therapeutic activity CPT Code 97535: Self-care/ home management/ ADLs CPT Code 97140: Manual Therapy Discuss the role of the Accreditation Council for Occupational Therapy Education (ACOTE) - Answer>> The American Occupational Therapy Association's Accreditation Council for Occupational Therapy Education (ACOTE) is an organization that is the accrediting agency for occupational therapy education in the United States. it monitors more than 400 schools for OT and OTA programs in the United States. It is recognized by the Department of Education and the Council for Higher Education Accreditation. It is the job of ACOTE to designate the minimum standards that schools will have and to ensure the development of quality-level degree requirement for the OT will move to the doctoral level by July 2027. Discuss the role of the American Occupational Therapy Association (AOTA) - Answer>> The American Occupational Therapy Association (AOTA) is a national organization for occupational therapy practitioners that was established in 1917. The goals is to represent the interests and concerns of occupational therapy students and practitioners as well as improve and influence the practice of the profession. As an OT, membership is not mandatory; however, AOTA provides networking, discounted continuing education, conference opportunities, professional support, special interest information, discounts on supplies and education, as well as advocacy and information about the field. Students in occupational therapy school are encouraged to join, and there are special forums and meetings during the conference in April just for students and new

graduates. Each year in April for National Occupational Therapy Month, a conference is held in a different state. These conferences are a way to complete all the required continuing education for the year in one event as well as provide a place to network, job search, stay abreast of new and emerging practices, and research and present research or therapy techniques. Discuss the requirements for supervision of a student or technician. - Answer>> Supervision of a student will vary based on the setting and comfort level of the OTR; however; there are guidelines specifically set by Medicare to dictate supervision guidelines. The OTR will determine the appropriate manner of supervision of therapy students consistent with state and local laws. For patients that have Medicare Part A and are in a hospital, SNF or inpatient rehabilitation setting, the OTR will determine the appropriate manner of supervision while maintaining state and local laws. Patients that are on the Medicare Part B must be treated by a student within the line of sight of the OTR and the OTR must remain in the same room. An occupational therapy aide/ technician is a support personnel that is unlicensed and assists under the supervision of a licensed OT. Supervision laws will vary on state-to-state basis and will also be based on the comfort level of the OTR whose license the tech is working under. In most cases, techs are allowed to provide servicers in the same room as the OTR and are also allowed to go and get a patient and bring him or her to the therapist for treatment. Discuss the role delineation between an OTR and OTA - Answer>> OTRs spend 3-4 years completing a master's level education program. They are responsible for the evaluation of patient's setting the treatment plan of care, setting goals, writing progress notes, and completing the discharge. Occupational therapy assistants (OTAs) spend 2 years completing an associate's degree. They are responsible for following the POC established by the OTR and implementing the treatment plan.

therapist into more managerial roles such as a manager, supervisor, and even administrator. The variations of each position and productivity standards will vary based on the setting, and the following is a list of the most general responsibilities. Administrator:

• responsible for overseeing daily operations
• may need special certifications based on the state and organization (assisted living administrator license)
• ensuring federal and state compliance is being met
• will often be involved in community committees and boards in order to help promote and maintain the reputation of the facility or organization -delegate many tasks for daily operation Manager:
• mentor and supervisor for therapists in their department (PT,OT and SLP)
• scheduling -payroll -compliance with Medicare and insurance standards
• often acts as a buffer between therapists and administration -interviews therapy staff for recruiting/hiring/firing staff. Discuss the NBCOT standards of practice - Answer>> The NBCOT Professional Practice Standards for OTR is a document established by NBCOT to define and explain what occupational therapy practitioners should and should not do when providing services to a patient. These are the minimum requirements that a therapist is accountable for when providing services. There is a set of practice standards for registered occupational therapists (OTRs) and occupational therapy assistants (OTAs). The standards of practice have four categories. 1.) practice domains:

• Acquire information regarding factors that influence occupational performance throughout the occupational therapy process
• formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process.
• select interventions for managing a client-centered plan throughout the occupational therapy process.
• manage and direct occupational therapy services to promote quality in practice. 2.) code of professional conduct 3.) supervision
• Direct and indirect supervision based on state rules and regulations 4.) documentation
• rules and regulations about what is required and needed when documenting care. According to AOTA guidelines, describe what must always be present in all documentation. - Answer>> Within the areas of evaluation, intervention, and outcome documentation, the following always need to be present in all documentation:
• client's full name and record number
• date and type of occupational therapy contact ( evaluation, reevaluation, treatment, or discharge
• identification of agency and department name ( for example, Memorial Hospital, inpatient therapy services) -OT signature with professional credentials
• Cosign space on documentation written by students and occupational therapy assistants
• Acceptable terminology defined within boundaries of the setting. Most facilities have an issued document with their approved abbreviations.