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DPT > HCD Final > Flashcards

HCD Final Flashcards

1
Q

Mitigation plan

A

strategies implemented in advance to control risk

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2
Q

Contingency plan

A

strategies that are enforced after an event occurs and used to reduce the related consequences

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3
Q

Latent condition

A

elements of a healthcare system’s inherent design that can either contribute to or prevent medical error

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4
Q

6 types of latent condition

A

providers, procedures, products, peripherals, patients, policy

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5
Q

What type of law involves action that is harmful to society as a whole?

A

criminal

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6
Q

What type of law involves private disputes between persons or organizations?

A

Civil

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7
Q

What type of law is a body of rules and principles that governs the duties and operations of federal or state administrative agencies

A

Administrative

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8
Q

Examples of criminal law in PT

A

medicare fraud, HIPAA violation, sexual misconduct, theft

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9
Q

Examples of civil law in PT

A

malpractice, billing company dispute

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9
Q

Colorado PT board has jurisdiction over:

A

CO licensed PTs and PTAs
Individuals that claim to be PTs
Individuals with expired CO PT licenses

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10
Q

List consequences from PT board from least to most severe

A
  1. Dismissal of complaint
    a. complete dismissal
    b. dismissal with confidential letter of concern
  2. Discipline
  3. admonishment
  4. probation/practice limitation
  5. suspension
  6. revocation/surrender of license
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11
Q

Describe rules with corporate practice of PT

A

Owner cannot tell PT how to practice, must contain a procedure for complaints, PT not required to exclusively refer and not required to take action if they determine it is not in the patient’s best interest

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12
Q

What PTAs not do?

A

Evals/re-evals
Interpret referrals
Modify POC
Determine discharge plan/location
Manipulation (V)
Sharp wound debridement
Supervision of PT aides

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13
Q

A PT may supervise no more than __ persons not licensed as a PT at one time

A

4

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14
Q

General supervision

A

PTA; reachable by telecommunications

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15
Q

Direct supervision

A

PT aides; available in same building

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16
Q

Immediate supervision

A

Students; Immediately available

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17
Q

Quality assurance vs. quality improvement

A

bare minimum vs. improving beyond that

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18
Q

What is the deeming authority by CMS for home health and hospice?

A

The Community Health Accreditation Program (CHAP)

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19
Q

What is the independent, not for profit, voluntary commission for IRFs?

A

Commission on Accreditation of Rehabilitation Facilities (CARF)

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20
Q

What treatments are included for CARF? What facilities can be covered?

A

CVA, brain/spinal cord injury, chronic pain
Rehab services in hospital or outpatient clinics

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21
Q

What is the accreditor of hospitals?

A

JCAHO

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22
Q

Who else does JCAHO accredit?

A

Home care agencies, nursing homes, and long term care facilities

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23
Q

All nursing homes are licensed by:

CO specific?

A

the state through a state agency

DORA

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24
Q

Patient access with provisions

A

Time/visit limit, prohibit certain diagnosis/treatment without referral (spinal manip, needle EMG), may require CE connected to direct access

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25
Q

Limited patient access

A

Access to evaluation only, fitness and wellness, and limited treatment only to certain patient populations or under certain circumstances

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26
Q

What happens to a PTs risk of liability with a physician referral?

A

Does not change

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27
Q

What terms are currently protected?

A

physical therapist, physiotherapist, physical therapy technician, PT, LPT

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28
Q

An insurer offering Part C is most likely to experience what type of selection when there are high numbers of enrollees?

A

favorable selection

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29
Q

Part B Medicare co-insurance for PT is what % of the Medicare Fee Schedule?

A

20%

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30
Q

What is a medical home?

A

Team-based model of patient care focused on coordination

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31
Q

What does telehealth include?

A

Synchronous interactions and store & forward transfers and remote monitoring

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32
Q

Originating site

A

site where the patient is located at the time of service

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33
Q

Originating provider

A

on-site with the patient
Originally designed where patient is at another facility (nursing home, PCP office) and specialist is at a distant site

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34
Q

Distant site

A

site where the provider is located at the time of service

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35
Q

Store & forward transfers/asynchronous telehealth
Examples

A

Specialist physicians most often
Radiologist reviewing imaging
Electronic access to HEP

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36
Q

Synchronous telehealth

A

Face to face

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37
Q

Medicare approved telehealth providers

A

MD/DO
NP
PA
Nurse midwives
Clinical nurse specialists
Certified registered nurse anesthetist
Clinical psychologists and clinical social workers
RD

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38
Q

Bipartisan Budget Act included what in regard to telehealth

A

Requirement that telehealth be included as a basic benefit in the medicare advantage program

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39
Q

How does Medicaid pay for telehealth?

A

Unique state by state

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40
Q

Payment parity

A

requirement that telehealth visits be reimbursed at the same pay rate or amount as if care was delivered in person

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41
Q

Service/coverage parity

A

requires the same services be covered for telehealth as they would be if delievered in person but does NOT guarantee the same rate of payment

42
Q

Colorado Law changes for telehealth

A

Removes previous population restriction of 150,000 or less residents
Bars health plans from requiring an initial physician encounter
Requires health plans to reimburse providers same amount (payment parity)
Providers do no have to demonstrate that a barrier to inperson care exists

43
Q

Pre-Pandemic payment from Medicare for telehealth

A

PT not included
Synchronous only
Patient can’t be at home

44
Q

Which state requires the person providing telehealth care (distant provider) must be in the same state as the patient?

A

Alaska

45
Q

Fraud

A

intentional deception or intentional misrepresentation that a provider makes to gain a benefit for which the provider is not entitled

46
Q

Abuse

A

Payment for items or services when there is no legal entitlement to that payment, and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment

47
Q

Waste

A

Overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the healthcare system

48
Q

False Claims Act

A

Imposes liability on any person who submits a claim to CMS that they know is false

49
Q

Safe Harbor
Example

A

Legal provision in a statute or regulation that provides protection from legal liability when certain conditions are met

IOAS in Physician Self-Referral Law

50
Q

Anti-Kickback Statute

A

It is a criminal offense to knowingly and willfully offer, pay, solicit, or receive bribes or kickbacks to induce or reward referrals

51
Q

Physician Self-Referral

A

Stark Law
Physician referring a patient to a facility in which they have a financial interest - can’t do
For federal payers

52
Q

Why can PT be referred to under physician self-referral (stark law)?

A

included under in-office ancillary services statuteE

53
Q

Exclusion Statute requires exclusion of ____ from participating in federal payers

A

Medicare/Medicaid fraud, patient abuse or neglect, felony conviction relating to controlled substances

(May exclude: misdemeanor health care fraud and controlled substances, suspension/revocation of a license, unlawful kickback, defaulting on health education loan)

54
Q

What does initial consent to treat cover?

A

Treatment (day to day documentation and communications between providers), health operations (QA, outcomes tracking), payment (insurance billing)

55
Q

Are federal government prosecutions for fraud increasing or decreasing?

A

increasing

56
Q

When was ADA created? And expanded/modified?

A

1990
2008

57
Q

Disability

A

Physical or mental impairment that substantially limits one or more major life activities of the individual or
record of such an impairment
or
being regarded as having such an impairment
or
known association/relationship with a person with a disability

58
Q

Amendments made to ADA

A

Expanded definition of major life activities/body functions
Employees may not consider mitigating measures other than ordinary eyeglasses/contact lenses in assessing whether an individual has a disability
Disability can include impairment that is episodic or in remission

59
Q

Covered Entity under ADA

A

Private employer, employment agency, labor organization, joint labor action committee, state/local governments

60
Q

Reasonable accommodation

A

modifications at the job workplace to enable a person with a disability to easily perform a specific job

61
Q

Undue burden

A

ADA
Action necessary to provide a reasonable accommodation that would cause the employer/owner significant difficulty or expense

62
Q

Who does Title I of ADA apply to?

A

All employers with 15 or more employees
Private employers
State and local governments
Employment agencies
Labor unions/organization

63
Q

Who is protected from employment discrimination?

A

Qualified individuals with disabilities
(could the individual perform essential functions with reasonable accommodation?)

64
Q

Physical Agility/Fitness Tests

A

PRE-offer only
Performed by non-medical person
Must be given to all applicants
Can’t include medical aspects (HR, BP)

65
Q

Medical examination under ADA

A

POST-offer only
Must be job-related and consistent with business necessity
Performed/interpreted by healthcare profession
Requires proof that the medical exam is designed to evaluate only essential functions
Required of all entering employees

66
Q

When are medical examinations allowed after employee begins job?

A

Required by other Federal laws
Determining current fitness to perform a particular job (i.e. annual test of firefighters)
Voluntary exams that are part of employee health program
Evidence of a job performance or safety problem

67
Q

Can an employer ask interview questions about the ability to perform specific essential functions and how they would? Ask about previous job duties?

A

Yes & yes

68
Q

When is an employer required to make a reasonable accommodation?

A

Only when disability is known
Not obligated if individual does not request (unless disability effects person’s ability to communicate)

69
Q

Title II of ADA

A

Public service/transportation
Governmental
Applies to all state/local governments

No size exemption

70
Q

Title III of ADA

A

Public Accommodations (FOR the public)

Private entities that own/operate/lease/lease to places of public accommodation, commercial facilities, private entities that offer certain exams and courses related to education and occupational certification

71
Q

Construction requirement under title III ADA

A

New construction or alterations must conform to ADA
Any facility occupied after 1993

72
Q

3 things organizations must do to comply with title III

A

Physical access (readily achievable barrier removal, accessible parking, building access)

Communication access (available in AN alternative format)

Reasonable modification to policies (person with DM can have injection equipment even in places that prohibit sharps)

73
Q

When are elevators required?

A

Any building over 3 stories or is a shopping center/mall, healthcare office, public transport station, airport terminal

74
Q

If a building was built pre-1992 what does ADA require?

A

Readily achievable barrier removal

75
Q

Fair Labor Standards Act (FLSA)

A

Federal law
Establishes minimums that employers must follow

76
Q

Examples of FLSA

A

Time keeping and overtime compensation requirements
Breaks/meal periods
Minimum wage (federal default is $7.25)
Wages due on regular payday
Employee vs independent contractor
Exempt vs. non-exempt

77
Q

Exempt employee

A

Exempt from overtime
Paid on a fixed salary basis
Categories: executive, administrative, professional, creative/computer professional, outside sales

78
Q

Non-exempt employees

A

Overtime eligible
Typically paid an hourly rate

79
Q

Independent contractor

A

Per IRS
Free from control and direction for performance of service under the contract
Controls own work, assumes risk for profit/loss, bid for jobs, impermanent relationship

80
Q

Family and Medical Leave Act (FMLA) covers what?

A

Federal law

Birth and care of newborn of employee, placement with employee for adoption/foster care, care for immediate family member(parent, spouse, child), take medical leave when employee is unable to work due to serious health condition, qualifying military family leave

81
Q

Who is eligible for FMLA?

A

Employees that have worked for their employer for at least 12 months AND
worked at least 1,250 hours AND
work at a location where the company employs 50 or more employees within 75 miles

82
Q

What is the FMLA benefit length?

A

12 workweeks of leave in a 12-month period

83
Q

Unemployment Insurance

A

Insurance for workers who have been terminated from their job at no fault of their own (monetary payments for a given period of time or until they find a new job)

84
Q

Is unemployment insurance a federal or state statute?

A

Both

85
Q

How are premiums determined for unemployment insurance?

A

Based on how often the insurance is used

86
Q

What is an example of a state statute?

A

At will employment

87
Q

What is at will employment?

A

Employer or employee may terminate its job contract for any or no reason

88
Q

Do employers have to show progressive discipline or cause for termination in an at will state?

A

No

89
Q

Who establishes standards for safe employment?

A

OSHA

90
Q

What is the Colorado Paid Family and Medical Leave Insurance (FAMLI)?

A

Law passed in Colorado where workers who earn $2,500 in yearly wages are eligible for paid family & medical leave

91
Q

How long do you have to be working to qualify for FAMILI in CO?

A

180 days

92
Q

What accounts under FAMILI in CO?

A

Care for biological/adopted/fostered child
Care for themselves for serious medical condition
Care for family member with serious health condition
Arrange for a family member’s military deployment
Address the immediate safety needs/impact of domestic violence and/or SA

93
Q

How many weeks of leave/pay are you allowed with FAMILI?

A

12 weeks (more for pregnancy or childbirth)

94
Q

Who has to participate in FAMILI?

A

Every employer regardless of size (fewer than 10 employees = won’t have to pay premium tax)

95
Q

Revenue

A

Gross money earned by a company

96
Q

Net income

A

Total revenues minus total expenses over a period of time

97
Q

Assets

A

Economic resources of the company

98
Q

Liabilities

A

amounts the company owes to other parties (loans, leases)

99
Q

Fixed costs

A

Independent of volume (utilities, salary, gym equipment)

100
Q

Variable costs

A

Costs that fluctuate depending on sales volume (theraband, lotion, hourly wages)

101
Q

ROI

A

Return On Investment, measure of profitability
Net profit/total investment x 100

102
Q

SWOT Analysis

A

Strengths (of business)
Weaknesses (of business)
Opportunities (market)
Threats (market, competition)

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