OTD 417 Exam 2 Information: Part 1 Questions with Correct Answers

What is included in documentation of initial evaluation? Correct Answer - Assessment - Plan of care - goals - evaluation codes re-evaluation documentation Correct Answer - not a routine service - require re-certification by physician - assessment of change in functional or medical status - update initial profile to reflect change - revised POC - new clinical findings - significant changes to condition - failure to respond to intervention Coverage based criteria for Medicare Correct Answer - need based service - established plan of care - care of physician - physician certification need based service Correct Answer - reasonable and necessary in terms of type, amount, frequency and duration - level of complexity and sophistication only safely and effectively performed by or under supervision of qualified therapist Medical necessity Correct Answer - reasonable to achieve desired level of relief/functional improvement - necessary to reduce risk of deterioration or suffering if left untreated - requires skills of licensed therapist Jimmo vs. Sebelius Correct Answer - no new regulations- clarified existing - not dependent on potential improvement but need - homebound coverage, not bed confined - skilled services to maintain, prevent or slow deterioration - reimbursement for establishment of maintenance - does not apply to IRF's or comprehensive outpatient rehabilitation facilities What Medicare will not pay for/common claim denials Correct Answer - non-skilled - extending to educate - missing certification - too many units - no minutes - activities to promote wellness - missing/incomplete POC - missing/incomplete progress notes