PTP Billing and Coding, Practice Settings Questions and Answers
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Module
PTS
Institution
PTS
PTP Billing and Coding, Practice Settings Questions and Answers
Acute Hospital
Medicare DRG (Diagnostic Related Group) or per diem (a prenegotiated, per-day, flat fee)
Inpatient Rehab Hospital
PPS (Prospective Payment System) or per diem payment methodology by private or managed care paye...
PTP Billing and Coding, Practice
Settings Questions and Answers
Acute Hospital - answer Medicare DRG (Diagnostic Related Group) or per diem (a
prenegotiated, per-day, flat fee)
Inpatient Rehab Hospital - answer PPS (Prospective Payment System) or per diem
payment methodology by private or managed care payers
Skilled Nursing Facilities (SNFs) - answer Medicare Prospective Payment System
Home Care - answer CMS (formerly HCFA), There is a 60-day national episode
payment based on information obtained through a patient assessment tool known as
OASIS.
Outpatient Care - answer Third Party (Medicare, medicaid, public school systems,
worker's comp)
First Party (pt. pays bill then submit own claim to insurance)
OASIS - answer A nurse or therapist from the HHA uses the Outcome and
Assessment Information Set (OASIS) instrument to assess the patient's condition. (All
HHAs have been using OASIS since July 19, 1999.) OASIS items describing the
patient's condition, as well as the expected therapy needs (physical, speech-language
pathology, or occupational) are used to determine the case-mix adjustment to the
standard payment rate.
HCPCS - answer The Healthcare Common Procedure Coding System is a set of
health care procedure codes based on the American Medical Association's Current
Procedural Terminology (CPT).
Coders today use HCPCS codes to represent medical procedures to Medicare,
Medicaid, and several other third-party payers. The code set is divided into three levels.
Level one is identical to CPT, though technically those codes, when used to bill
Medicare or Medicaid, are HCPCS codes.
IDEA - answer Individuals with Disabilities Education Act
Physical therapy (PT) is one of the related services under Part B of the Individuals with
Disabilities Education Act (IDEA) and is provided to support the Individualized
Education Program (IEP) for students ages 3-21, who have a disability that interferes
with their educational performance
At least 1% but less than 20% impaired, limited, or restricted - answer CI
At least 20% but less than 40% impaired, limited, or restricted - answer CJ
At least 40% but less than 60% impaired, limited, or restricted - answer CK
At least 60% but less than 80% impaired, limited, or restricted - answer CL
At least 80% but less than 100% impaired, limited, or restricted - answer CM
100% impaired, limited, or restricted - answer CN
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