OTD 417 Exam 2 Information: Part 1
UPDATED ACTUAL Questions and
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
Plan of care - CORRECT ANSWER - - established before treatment begins
- signature and professional identity
- date
- may render billable services on date established
- certified by physician/NPP
- individualized- services directly related
UPDATED ACTUAL Questions and
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
Plan of care - CORRECT ANSWER - - established before treatment begins
- signature and professional identity
- date
- may render billable services on date established
- certified by physician/NPP
- individualized- services directly related
