process final

what is primary payer of occupational therapy services in the United States

medicare

the number of units billed is always determined by the total ______ for all time-based services

time

An OT works with the client in occupational therapy, providing 20 minutes of activities of daily living (ADL) training. How many units can the OT bill Medicare for the therapy provided?

1

A 14-month old child with a developmental delay would most likely receive OT services resulting from which legislation?

IDEA part C

what is at the center of the OT process

client and therapist in collaborative relationship

the following are examples of what part of the OT process:

occup. performance, prevention, health and wellness, QOL, participation, role competence, wellbeing, occupational justice

outcomes

problem statement

[contributing factor] results in/limits [area of occupation affected]

Client requires [assist level] in [performing what occup.] due to [contributing factor] secondary to [diagnosis]

what are COAST goals

Client

Occupation

Assist Level

Specific Condition

Timeline

what are SMART goals

Specific, Measurable, Achievable, Relevant, Time-bound.

maintain approach

Provide supports to preserve capabilities

Performance would decrease w/out intervention

modifiy approach

Revise context or activity demands to support performance

Adaptation changes the environment or task

Compensation uses existing strengths to compensate for limitation to accomplish task

prevent approach

No assumption of disability, but possible risk exists

Avoid possible barriers to performance in the future

Create/Promote Approach

No assumption of disability

Enriched context and activity experiences for all

establish/restore approach

Change client variable to gain/regain a skill

what category of intervention are the following:

Orthotics, prosthetics, PAMS, mechanical modalities

Assistive technology and environmental modification

Wheeled mobility

Self regulation

Prepares muscles to enhance occupational performance

interventions to support occupations

what are the intervention types

Occupations and Activities

Interventions to support occupations

Education and Training

Advocacy

Group Interventions

Virtual interventions

what's the difference between adapting and grading

adapting changes the actual task, grading is making it easier or harder

what is the intro statement in phys dys soap section O

Client participated in [# min] OT session [in what setting] for [occupation based intervention]

phys dys: what section do we document

Pain levels, quotes about concerns, Psychosocial elements like frustration, fear of falling

S

phys dys: what section do we document

Objective measures like ROM, MMT, FIM scores, LOA, transfer ability, use of AT, skilled observation of posture,etc

O

phys dys: what section do we document

problem, progress, potential, benefit/justification to continue

A

phys dys: what section do we document

Specific interventions for next session

Frequency and duration

Rationale for plan/purpose

Short term goal updates if needed

P

GIRP note

Goal

Intervention

Response

Plan

what setting are GIRP notes common in and why

mental health, use language anyone can understand (interprofessional team)

MH: what section do we document

Direct quotes

Client's mood, self reports

Current stressors, symptoms, coping strategies used, etc

S

MH: what section do we document

Observations of client's presentation, affect, appearance, behaviors

O

MH: what section do we document

Problems, Progress, potential, benefit

Responses

Identification of barriers

Clinician's impression and any risks

A

MH: what section do we document

Interventions for next session, homework given, recommended referral, etc

P

what setting would the following problem statement be most appropriate for:

client is unable to [fxnl task/occupation] due to [barrier/contributing factor], which impacts their ability to [broader area of occup. performance/participation]

community based

what do goals target in community based settings

Health management

Routine building

Social participation

Environmental navigation

Life role support

Overcoming access barriers

community: what section would we document the following

Input from client, caregiver, family, staff

Quotes about relevant areas

Any changes in living situation, symptoms, supports, etc

S

community: what section would we document the following

Functional observations in real contexts

Community participation

Any use of adaptive equipment, cognitive supports

Response to coaching or environment

Any quantifiable data

O

community: what section would we document the following

Barriers and strengths to occupational performance

Reflect on environmental, social, cultural, systemic barriers

Progress, justification of OT

A

community: what section would we document the following

Continued skill building, education, community re-entry training, health management training

Frequency and duration of visits

considerations for interprofessional teams

Equipment recs or referrals

P

peds: what section do we document the following

pt quote, caregiver, teacher, etc

Child's affect or arousal level, emotional state

S

peds: what section do we document the following

Start w/ opening statement

What skills addressed/observed

Level of assist (Hand over hand, modI w/ visual schedule, etc.)

O

peds: what section do we document the following

Identify problems during session

3 Ps and B

A

peds: what section do we document the following

Plan for next session

Recommendations

P

T/F: in peds goal writing always include a baseline, but it can not be 0

true

what are the LTG/STG timeframes for school based

LTG: 1 yr

STG: 3, 6, 9 months

___________ is used to determine progress towards outcomes and decide whether to continue, modify, transition or discontinue services

reassessment

Medicare

federal program, adults 65+, younger people who are disabled, and those w/ end stage renal disease, ALS

Medicare pt A

hospital!

OT inpatient hospital, inpatient rehab, SNF, hospice, some home health

Covered w/ other therapies/integrated, prospective payment systems (DRG, PDPM, PDGM)

Medicare pt B

medical coverage!

Outpatient OT, PHP, IOP, some home health, community based, private practice

Must use CPT codes, fee-for-service model

Medicaid

state and federal joint program for low income individuals/families, pregnant women, certain parents/caregivers, adults w/ disabilities

_________ is a critical payer for children and vulnerable individuals

Medicaid

PDPM

patient driven payment model

SNF and inpatient

shifted focus in SNF from minutes/quantity to treatment of pts, and motivated SNFs to take more complex pts

(P = SNF)

PDGM

patient driven groupings model

home health

Puts patients into case mix group categories based on diagnosis, comorbidities, etc.

CHIP

Children's Health Insurance Program

state and federally funded program for kids of families w/ income too high for Medicaid but too low to afford private insurance

Children under 19, income limit depend on state

IDEA

for school based services and early intervention

Often supplemented by Medicaid

VA

eligible veterans who served in active duty and have been discharged

Priority based on service related disabilities, income, availability of VA resources

Tricare

active duty service members, reserve, retirees and dependents

Different plan types have different coverage

8-22 min =

1 unit

(15 min)

23-37 min =

2 units

(30 min)

38-52 min =

3 units

(45 min)

53-67 min =

4 units

(60 min)

timed codes

constant, direct one on one w/ pt

Ex: ther-ex, neuro re-ed, self care

untimed codes

always one unit

Evals, group therapy, paraffin bath

ICD-10 code

provide the reason for the visit, usually diagnosis

CPT code

describe the procedure or service given

GG code

show functional progress, good for goals, consistent language

HCPS code

for services/equipment outside of CPT codes w/ Medicare/Medicaid pts

what's something specific to document in telehealth

any adaptations made to use telehealth and any tech issues

case centered/clinical consultant roles typically target

a specific client

educational consultant roles typically target

group or population

programmatic/administrative consultant roles typically target

a system or organization

____________ are communication styles that support building the relationship with the client

therapeutic modes

what document is used to determine the need for continuation of services

progress note

what provides objective evidence to justify discharge decisions

outcome measures

what type of service does an OT provide when coaching caregivers or team members to support client's needs

consultative OT services

An OT conducts an eval consisting of 30 min standardized assessment 15 min client/caregiver interview and 15 min observation of client grooming task, how many units can be billed?

1 unit

Goal writing often used in mental health and community based settings often uses what format?

SMART

an OT conducts a 20 minute session involving feeding and eating, how many units can be billed?

1 unit

what are benefits to telehealth

Reduces delays to care and supports home-based function

what is the funding source for a child receiving OT services at their local elementary school

IDEA

what type of OT role works independently with flexible project based arrangements

contract

an OT is working with a 2yo with developmental delays, what intervention approach should be used?

establish/restore (want to establish skills)

what is the value based system that guides reimbursement processes for home health services

PDGM

what is a unique challenge to delivering OT via telehealth

Client disengagement due to technological issues