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OTD 417 Exam 2 Information: Part 1 Questions With Solutions $19.49   Add to cart
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OTD 417 Exam 2 Information: Part 1 Questions With Solutions
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OTD 417 Exam 2 Information: Part 1 Questions With Solutions Coverage based criteria for Medicare - need based service - established plan of care - care of physician - physician certification need based service - reasonable and necessary in terms of type, amount, frequency and duration - ...

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Document information

  • October 19, 2024
  • 17
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • OTD
  • OTD

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OTD 417 Exam 2 Information: Part 1
Questions With Solutions

Coverage based criteria for Medicare - need based service


- established plan of care

- care of physician

- physician certification




need based service - 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 - 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 - no new regulations- clarified existing


- not dependent on potential improvement but need

- homebound coverage, not bed confined

, OTD 417 Exam 2 Information: Part 1
Questions With Solutions
- 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 - 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 - established before treatment begins


- signature and professional identity

- date

- may render billable services on date established

- certified by physician/NPP

, OTD 417 Exam 2 Information: Part 1
Questions With Solutions
- individualized- services directly related

- evaluation and treatment may occur on same day

- appropriate to begin treatment once established

- significant changes




Progress notes - therapist must complete at least every 10th visit


- provide evaluation of goals

- report any changes to POC

- must be developed by therapist (NOT OTA)

- dates for recertification do not effect

- sent to physician for recertification




Services furnished by a therapy assistant - therapist needs to apply patient modifiers to

claims for all OP services

- assistance provided at least 10% of service independently from therapist

- activate a 15% payment reduction




Medicare payment thresholds for 2020 - permitted to exceed with KX modifier

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