Complete Test Bank | Reimbursement Issues Related To – Ch.4

Chapter 4. Reimbursement Issues Related to Documentation

Multiple Choice

1. What do the letters HMO represent?

A. Health maintenance opportunity

B. Health model outcome

C. Health maintenance outcome

D. Health maintenance organization

2. Within which organization is the patient required to select a primary care provider (PCP) from a list the organization provides to direct all medical care the patient receives?

A. POS

B. PCP

C. HMO

D. PPO

3. Under which program is the patient not required to have a primary care provider or receive a referral for access to medical services?

A. MCO

B. PPO

C. HMO

D. PCP

4. At what age can most individuals access Medicare benefits if they meet the requirements?

A. 60

B. 62

C. 65

D. 68

5. Under what circumstances can a person younger than age 65 access Medicare benefits?

A. When the patient has end-stage renal disease and permanent disabilities

B. When the patient has Lou Gehrig’s disease and Parkinson’s disease

C. When the patient has permanent disabilities and diabetes

D. When the patient has multiple sclerosis (MS) and polio

6. What does Medicare Part A cover for individuals who qualify for those services?

A. Outpatient physical therapy services

B. Home health services

C. All types of medical equipment

D. Hospital and skilled nursing facility services

7. How many months before a person turns 65 can he or she enroll for Medicare benefits?

A. 1

B. 2

C. 3

D. 4

8. What is one qualification, besides age, that an individual must meet to be eligible for Medicare benefits?

A. Good health

B. Eligible for Social Security benefits

C. Completely disabled

D. Evaluated by his or her primary care physician

9. Which part of Medicare provides for physician visits and outpatient services (e.g., physical therapy) and requires that a monthly premium be paid by the patient?

A. Part A

B. Part B

C. Part C

D. Part D

10. Even with Medicare, it is important for patients to have additional coverage in a supplemental plan to cover costs outside of those that Medicare covers, commonly referred to as Medigap insurance. Identify an example of such a supplemental plan.

A. HIPAA

B. HBO

C. AARP

D. PCP

11. Identify the program that provides comprehensive medical and social services in a non-institutional setting specifically for older individuals and may not be available in every state.

A. AARP

B. BCBS

C. NMMIP

D. PACE

12. Workers’ compensation insurance is provided by an employer to cover an individual employee who may be injured or become ill on the job. If the employee dies, up to what age can his or her surviving children typically expect to receive benefits?

A. 6

B. 13

C. 18

D. 21

13. To qualify for Medicaid services, the patient must meet specific financial guidelines in addition to other qualifications of which FPL is one. What do the initials FPL represent?

A. Federal policy legislation

B. Federal poverty level

C. Federal police list

D. Fiscal poverty level

14. What is one of the expectations a company employee might have regarding workers’ compensation insurance?

A. The employee may have to pay for some of the medical benefits he or she receives.

B. Workers’ compensation will pay 100% of the employee’s salary while he or she is receiving worker’s compensation benefits.

C. Prior to receiving workers’ compensation benefits, the employee must satisfy a waiting period, usually between 3 and 7 days, before benefits are initiated.

D. Most workers’ compensation laws do not require the employer to pay for vocational rehabilitation services.

15. All states require workers’ compensation laws to provide complete medical coverage, without durational or monetary limitations, with the exception of seven states. Identify two of the states that have separate provisions to this requirement.

A. Arkansas and New Jersey

B. Idaho and Montana

C. Ohio and Colorado

D. Tennessee and New York

16. Which states do not have vocational rehabilitation provisions in their workers’ compensation laws?

A. South Carolina, Montana, and Tennessee

B. Alaska, Ohio, and Minnesota

C. Tennessee, North Dakota, and Georgia

D. North Carolina, Pennsylvania, and Wyoming

17. Identify the group of practitioners who cannot receive reimbursement for patient treatments under Medicare Part B requirements.

A. Students

B. Physicians

C. Physical Therapists

D. Occupational Therapists

18. Under Medicare Part A, a student’s patient treatment may be reimbursed under specific conditions. Identify the condition under which the student must treat the patient for services to be reimbursed.

A. The student must be under direct supervision of the supervising PT or PTA.

B. The student must be within the direct line of site of the supervising PT or PTA.

C. The student must be within the same building as the supervising PT or PTA.

D. The student does not have to have the supervising PT or PTA within the building.

19. Within a skilled nursing facility, students must meet certain requirements for their patient treatments to be billable as skilled therapy minutes. Identify the requirements that must be met for services to be billable.

A. The supervising PT or PTA does not have to be in the facility but must be available by cell phone for any questions that may arise.

B. The student does not have to be supervised by the PT or PTA but needs to communicate the treatment session at the end of the day.

C. The supervising PT or PTA is required to review and co-sign all students’ patient documentation.

D. The student is allowed to determine the appropriate level of service for the patient and communicate this decision in the patient documentation.

20. According to the rules and regulations under Medicare, what activities can a physical therapist aide provide in the clinical setting?

A. Prepare the treatment area prior to the patient’s arrival.

B. Apply ultrasound to the patient’s back once the PT/PTA has prepared the settings.

C. Instruct the patient in the home exercise program once it has been developed by the supervising therapist.

D. Give the patient different weights when those being used are too easy.