Mastering OT Policy & Medicare Quiz for CEU Credit

1. Question

Which of the options is an example of everyday advocacy?

Educating a patient or physician on the role of OT
Advocating for an automatic door to the bathrooms
Advocating for intake forms to have inclusive language
Contacting legislators about Telehealth legislation

2. Question

Who is responsible for advocating for OT at the state level? (Select all that apply)

AOTA’s State Affairs Team
AOTA’s Federal Affairs Team
State OT associations
OT practitioners and students in that state

3. Question

True or False: to be an effective advocate you need to make a grand gesture and be comfortable with public speaking.

True
False

4. Question

Which of the options below is not a reason why we advocate?

Professional pride
Eliminate licensing for OT
Jobs & Reimbursement
Patient access to service

5. Question

What is the first key step when advocating?

Establishing a goal
Identifying barriers and supports
Identifying allies

6. Question

What differentiates a profession from a job? (select all that apply)

Long-term commitment
Sense of community
Means to an end
Advanced training

7. Question

Which of the following is true about Medicaid coverage

Every state pays for OT services for adults under Medicaid
The federal government sets most of Medicaid’s policy
Each state has different coverage for OT services
Medicaid never covers services provided by OTAs

8. Question

True/False: Occupational therapy practitioners must engage in additional training and be in a leadership position to be effective advocates

True
False

9. Question

Which of the bellow is not included in a state’s practice act?

CEU requirements
Scope of Practice
Supervision requirements
Medicaid reimbursement

10. Question

What issues do we advocate for at the state level? (Select all that apply)

Supervision laws
Scope of practice
Medicare reimbursement
Licensure Laws

11. Question

Why is telehealth legislation needed?

To permanently expand Medicare coverage of telehealth for OT services
To expand coverage of telehealth services provided by OTAs since Medicare already covers telehealth provided by OTs.
To increase Medicare reimbursement for telehealth services provided by OTPs
To change supervision requirements to allow OTAs to provide telehealth.

12. Question

What is the purpose of the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act? (Select all that apply)

Change Medicare Part B private practice supervision requirements
Provide exemptions for the OTA payment differential in rural and medically underserved areas
Provide exemptions for the OTA payment differential for minority-owned businesses
To increase access to telehealth services under Medicare

13. Question

What is the goal of the Allied Health Workforce Diversity Act?

To expand coverage of OT services under Medicare
To provide funding to increase diversity in OT, PT, SLP, and RT
To create loan forgiveness for individuals from diverse backgrounds
To create funding for OT, SLP, RT, and PT research on the benefits of diversity

14. Question

Which AOTA teams are primarily responsible for advocating for occupational therapy in Congress? (Select all that apply)

AOTA Federal Affairs Team
AOTA Quality Team
American Occupational Therapy Political Action Committee (AOTPAC)
AOTA State Affairs Team

15. Question

What issues do we advocate for at the federal level? (Select all that apply)

Medicare policy
Student loans
Licensure
Higher education requirements

16. Question

When is there an opportunity to advocate for OT during the process of creating Medicare law? (Select all that apply)

Before any legislation is introduced
During the CMS rule-making process
Only after the final rule is published
While legislation is being considered in the House and Senate

17. Question

The House of Representatives serves ____ year terms and the Senate serves ___ year terms.

6, 2
4, 2
2, 6
2, 4

18. Question

How often do we have a new Congress start?

2 years
6 years
4 years
1 year

19. Question

What happens to Medicare legislation after it passes through Congress and is signed into law?

It is always immediately implemented
It typically undergoes a rule-making process
It goes to the state to be interpreted
The President writes a letter telling CMS what to do.

20. Question

What is the 60% rule in Inpatient Rehab Facility?

60% of patients admitted to the IRF must have a certain diagnosis as determined by Medicare
60% of patients must have both OT and PT services
There is no 60% rule in IRF. That is for skilled nursing facilities.
60% of patients must stay at least 24 days

21. Question

Fill in the blank: Acute inpatient stays are reimbursed under ________ and Acute outpatient/observation stays are reimbursed under ________.

Medicare Part A, Medicare Part B
Medicare Part B, Medicare Part A
Medicare Part A, Medicare Advantage
Medicare Part B, Private Pay

22. Question

What is the admission assessment for inpatient rehab facilities?

Inpatient Rehab Facility Patient Assessment Instrument (IRF-PAI)
Minimum Data Set
Inpatient Rehab Facility CARE Data Set (IRFCDS)
Diagnostic Related Groups (DRGs)

23. Question

What major role does the American Medical Association play in the US healthcare system?

They develop current procedural terminology (CPT) codes
They develop the international classification of diseases for diagnosis
They lobby Congress on behalf of hospitals and nurses
They help develop vaccines with the CDC

24. Question

What tab should you go to on AOTA’s page to find information on what AOTA is lobbying/ advocating for?

Events
Advocacy
Practice
About

25. Question

Who is responsible for defining and maintaining CPT Codes?

The Centers for Medicare & Medicaid Services
American Medical Association
World Health Organization
American Occupational Therapy Association

26. Question

What tab would you go to on AOTA’s page to find coding and billing information?

Practice
Education
Community
Events

27. Question

Where should you go on AOTA’s website when you want to find information on salary or tips for applying for a job?

Career
Advocacy
Education
Publications

28. Question

Where should you go on AOTA’s page to find open volunteer opportunities?

Community
Practice
About
Events

29. Question

The occupational therapist completed an initial evaluation of the patient after their total knee replacement. They spent 24 minutes completing the assessment and evaluation. The patient then completed a bed transfer, practiced lower-body dressing, and completed grooming and toileting, all while receiving education from the practitioner. This took 35 minutes. How would the therapist bill in this scenario?

1 unit of OT Eval for 24 minutes. 2 units under self-care for 35 minutes.
2 units of OT Eval for 24 minutes. 3 units under self-care for 35 minutes.
1 unit of OT Eval for 59 minutes.
2 units of OT eval for 24 minutes and 2 units under therapeutic exercise.

30. Question

31. Question

What is the role of the Centers for Medicare & Medicaid Innovation (CMMI)/ the Innovation Center?

Develop and test new value-based payment models or alternative payment models
Develop new eligibility criteria for Medicare beneficiaires
Develop protocols for healthcare interoperability
Develop innovative interventions for physicians

32. Question

What modifier does Medicare require when an occupational therapy assistant provides a service to a Medicare Part B beneficiary?

CO
CQ
GO
KX

33. Question

How are outpatient therapy services typically billed under Medicare Part B?

Through CPT codes and units in a fee-for-service model
Through bundled payments based on the patient’s diagnosis
Through a capitated payment system for all therapy services
Through a monthly premium paid by patients

34. Question

What is the name of AOTA’s Member forum where members can post questions and interact with each other?

AOTA’s Members Only
CommunOT
AOTA’s Facebook Page
CommunAOTA

35. Question

What is the fixed amount payment made by the patient in addition to the payment from the insurer?

Copay
Deductible
Premium
Coinsurance

36. Question

Who is responsible for defining and maintaining ICD-10 codes?

Centers for Medicare and Medicaid Services
World Health Organization
American Medical Association
American Occupational Therapy Association

37. Question

Under the Inpatient Prospective Payment System, how is acute care paid for by Medicare?

Through a Diagnosis Related Group based on the patient's admitting diagnosis
Through a Resource Utilization Group based on therapy and diagnosis
Through the number of services provided such as lab tests and medications
Through the Patient Driven Groupings Model

38. Question

What are the 3 components used in selecting the appropriate evaluation code? (select all that apply)

Profile and History
The amount of time spent on the eval
Assessment of occupational performance and identification of deficits
Clinical Decision making

39. Question

Typically, when a document refers to “Section XXXX” it is referring to the ______. When a document refers to “XX FR XXXX” it is referring to the ______________.

Social Security Act, Federal Register
Federal Register, Social Security Act
CMS proposed rule, CMS final rule
Medicare policy, HHS policy

40. Question

What government agency does not fall under the Department of Health and Human Services?

Centers for Disease Control and Prevention
Centers for Medicare and Medicaid Innovation
Food and Drug Administration
World Health Organization

41. Question

What is the name of the Medicare Home Health Assessment that is part of the initial and comprehensive start of care?

Outcome Assessment and Information Set (OASIS)
Minimum Data Set (MDS)
Functional Independence Measure (FIM)
Home Health CARE Data Set (HH-CDS)

42. Question

True/False: A Health Maintenance Organization (HMO) requires a referral in order for a patient to see a specialist.

True
False

43. Question

What type of Medicare pays for care received in a long-term care hospital (LTCH)?

Medicare Part A
Medicare Part B
Medicare Part D
Medicare Part G

44. Question

What CMS document would you use to look for detailed and comprehensive information on what is included as part of the Medicare benefit (i.e., what services are covered under Home Health or outpatient services)

The Medicare Benefit Manuals
The Federal Register
Medicare.gov
Medicare Learning Network

45. Question

Which website is best to use for general information on Medicare or as a resource for patients?

CMS.gov
AOTA.org
Medicare.gov
The Federal Register

46. Question

What is the minimum number of minutes you have to provide to bill a timed code?

15 miniutes
8 minutes
23 minutes
There is no minimum

47. Question

What is the value-based incentive system in Medicare Part B private practice?

OASIS
Value-Based Purchasing Model
Merit-Based Incentive Payment (MIPS)
Accountable Care Organization (ACO)

48. Question

What is the National Quality Forum?

They develop quality measures that are considered the gold standard of quality measurement
They develop best practices for clinicians and physicians
It is a government agency focused exclusively on quality and new wasy to measure care
They certify hospitals based on the quality of care provided

49. Question

How is occupational therapy paid for by Medicare during an acute inpatient hospital stay?

In units of CPT® Codes and patients owe a 20% co-insurance
Patients pay out-of-pocket because therapy isn't covered under the Inpatient Prospective Payment System
Therapy is covered as part of the Diagnosis Related Group (DRG)
OT is only fully covered when the patient is in the ICU

50. Question

In which scenario is an OT able to initiate and complete the comprehensive start of care in home health?

Only when a nurse is unavailable to perform the assessment
Only if the patient is receiving speech therapy services
Only when the patient’s condition requires both nursing and therapy services
In therapy-only cases without nursing involvement

51. Question

Which of the following are special OTA considerations in private practice? (select all that apply)

Servies provided by an OTA require the use of a “CO” modifier
Services provided by an OTA have a 15% payment reduction
OTAs require general supervision in private practice
OTAs require direct supervision in private practice

52. Question

What type of supervision is required in private practice by Medicare Part B?

General: The OT has to be available in person or via telecommunications
Direct: The OT has to be physically on site with the OTA
Whatever is required by the state
Direct: The OT has to be in the same room as the OTA

53. Question

What type of health insurance plan generally has the best coverage for out-of-network providers?

Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Accountable Care Organization (ACO)
Exclusive Provider Organization (EPO)

54. Question

What type of Medicare pays for service under hospice?

Medicare Part A
Medicare Part B
Hospice care isn’t covered by Medicare
Only Medicaid covers hospice

55. Question

What is another name for the Home Health Prospective Payment System?

The Patient-Driven Groupings Model
The Patient-Driven Payment Model
The Patient-Determined Payment Model
Resource Utilization Groups (RUGs)

56. Question

What does “homebound” mean in the context of home health eligibility criteria?

The patient is unable to leave their home under any circumstances
The patient must be bedridden and unable to move
The patient must have difficulty leaving their home due to medical reasons or extensive effort is required
The patient must not leave their home for any reason, medical or non-medical

57. Question

Preferred Provider Organizations typically have a higher ______ in exchange for _________ flexibility and coverage.

premium, more
savings, less
premium, complete
deductible, full

58. Question

What is the primary role of occupational therapy practitioners in patient rehab facilities?

To assist with pre-admission screenings and determine eligibility
To provide direct medical care and medication management
To conduct research studies on patient outcomes
To maximize the patient’s functional abilities, promote independence, and ensure safe discharge

59. Question

In order to be eligible for admission to an inpatient rehab facility, a patient must meet which of the following requirements?

Spent three midnights in the hospital
Require specialized surgical procedures
Tolerate a minimum of three hours of therapy per day
Have a history of frequent hospitalizations

60. Question

What characteristics/care needs make a patient potentially eligible for admission to a Long-Term Care Hospital? (Select all that apply)

Requires 24-hour oversight by nurses and physicians
Are stable enough to leave the hospital
Spent at least three days in the ICU
Have a complicated course of recovery requiring an extended stay
Is able to tolerate three hours of therapy a day

61. Question

Under what conditions can OT be considered a qualifying discipline for services?

When the patient has acute medical conditions requiring constant care
Always: OT can be the only discipline at the start of care
When the patient has acute medical conditions requiring constant care
When OT services are provided alongside another discipline

62. Question

When is it appropriate to utilize the re-evaluation CPT Code?

When the patient has had a change in functional or medical status that requires a revised plan of care.
When the patient is due for their reassessment on the 10th visit.
When the patient experiences a new symptom that is related to the original diagnosis.
Anytime the patient’s goals need to be updated.

63. Question

What does Medicare use as part of their equation when deciding how much to pay for services under the Medicare Physician Fee Schedule?

Relative Value Units
Timed Codes
CPT Codes
8-minute rule

64. Question

How does an OT practitioner select the correct CPT Code?

Make a guess based on the name of the code
OTPs can only bill self-care codes and therapeutic exercise codes
Carefully consider the definition of each CPT code and pick whichever one best matches the intervention
Pick whatever one your boss tells you to bill. It doesn’t really matter

65. Question

If the therapist provides 10 minutes of self-care and 8 minutes of therapeutic exercise for a total of 18 minutes of therapy, how many units can be billed and will be reimbursed under the Substantial Portion Methodology?

1 of self-care and 1 of therapeutic exercise, and both are reimbursed
1 unit of self-care and 1 of therapeutic exercise, but only one code is reimbursed
1 unit of self-care and only that code will be reimbursed
1 unit of therapeutic activity and only that code will be reimbursed

66. Question

True or False: Evaluation codes are scored based on the lowest scored complexity level out of the 3 components.

True
False

67. Question

What is the primary purpose of inpatient rehab facilities?

To provide short-term acute care services
To offer long-term care for chronic conditions
To serve as an intensive rehabilitation service for complex patients
To provide hospice care for terminally ill patients

68. Question

True or False: PDGM’s Functional Impairment Score is determined by Section GG Scores?

False
True

69. Question

True or False: Long-Term Care Hospitals use a shortened version of Section GG.

True
False

70. Question

Who is eligible for Medicaid?

Children, families, and some adults who are below a certain income level
Anyone can register for Medicaid
Adults over the age of 65 only
Adults over the age of 65, individuals with end-stage renal disease, ALS, or individuals with a disability

71. Question

What may terminate coverage for hospice care?

Going to the hospital
Leaving the house daily
Caregiver training
Getting durable medical equipment (DME)

72. Question

Why did the Centers for Medicare & Medicaid Services (CMS) aim to phase out fee-for-service plans?

They were not profitable for providers.
They did not provide adequate coverage for patients.
They incentivized over-utilization of services.
They were too complicated for consumers to understand.

73. Question

True or False, Medicare Part B has a hard cap on therapy services in a calendar year.

True
False

74. Question

True or False: Untimed codes follow the 8-minute rule.

True
False

75. Question

What is often the primary goal of occupational therapy services in the acute care setting?

To maximize therapy revenue through direct reimbursement
To reduce hospital length of stay and improve discharge safety
To provide long-term rehabilitation services
To focus on preventive care for chronic conditions

76. Question

True or False: When looking for information on Medicare final rules, it is important to look in the comments section as well as the main text of the final rule.

True
False

77. Question

True or False: Editing the AOTA Form Letters to share your story will make the letters less impactful.

True
False

78. Question

How does the MPPR policy affect reimbursement for subsequent “always therapy” CPT codes billed on the same patient during the same day?

Reimbursement is increased for subsequent CPT codes.
Reimbursement remains unchanged for subsequent CPT codes.
Reimbursement is reduced for subsequent CPT codes.
Reimbursement is completely denied for subsequent CPT codes.

79. Question

On the take action page, what address should you use when sending letters? (select the most correct answer)

The address where you currently live
The address where you are registered to vote
An address in the district of the person you want to contact
Your school/jobs address

80. Question

What is a key term to add to your Google search when looking for documents directly from Medicare vs. blog posts/ CEUs?

“CMS”
“HHS”
“Medicare”
“AOTA”

81. Question

When is therapy covered under hospice care?

It isn’t covered
When therapy is required for symptom control and to maintain basic function
For caregiver training only
To complete a home evaluation and then discharge

82. Question

Which type of care model has been historically the primary payment model and incentivized a more reactive care approach?

Value-based care
Capitated payment model
Bundled payment model
Volume-based care

83. Question

What are the main ways someone can obtain a health insurance plan? (select all that apply)

Through their employer
Through the state or federal Marketplace
Through the federal or state government
Through a friend
Through their car insurance

84. Question

What determines payment for OT and PT under the SNF Prospective Payment System?

Mostly M1800 Scores
Select Section GG questions
The number of minutes provided by each discipline
All Section GG questions

85. Question

What is another name for the SNF Prospective Payment System as of 2019?

The Patient-Driven Payment Model
The Patient-Driven Groupings Model
The Patient-Determined Payment Model
Resource Utilization Groups (RUG)

86. Question

What does CMS stand for?

Centers for Medicare and Medicaid Services
Center for Medical Services
Center or Maternal & Mother Services
Center for Medicare Services

87. Question

What is Medicare Part A?

State-based insurance that provides health care coverage for low-income children and families
State-based insurance that provides health care coverage for low-income children and families
Federal-based insurance that is available to military families
Federal-based insurance for adults over 65 that covers inpatient hospital services and post-acute care

88. Question

What is Medicare Part C?

Medicare supplemental insurance
Medicare replacement also called Medicare Advantage
Covers prescription drugs only
Covers dental and eye care

89. Question

What is the name of the SNF admission assessment required by Medicare?

Minimum Data Set (MDS)
Outcomes and Assessment Information Set (OASIS)
Skilled Nursing Facility – Patient Assessment Information (SNF-PAI)
Section GG

90. Question

Which of the following is true about a timed code?

You can only bill one unit of each timed code regardless of time spent under that code
Occupational therapy evaluation codes are examples of timed codes
You can’t bill an untimed and timed code in the same session
You can bill multiple units under one timed code depending on the time spent

91. Question

What is the primary coverage criteria for Skilled Nursing Facilities under Medicare?

3 midnights in the hospital as inpatient status and daily skilled care
3 midnights in the hospital as an outpatient status and intermittent skilled care
3 midnights in the hospital as an inpatient
3 hours of therapy 5 days a week

92. Question

What is typically required for a Medicare patient to be admitted to the hospital as an inpatient?

Requires 24-hour oversight by nursing and physicians
Medical complexity that requires two midnights in the hospital
Has a certain diagnosis as determined by Medicare
Requires intensive therapy

93. Question

Where can you easily find AOTA’s Take Action Page? (select all that apply)

www.aota.org/takeaction
AOTA’s Advocacy Tab
Facebook only
CommunOT

94. Question

Who is eligible for Medicare?

Adults over the age of 65, individuals with end-stage renal disease, ALS, and individuals with a disability
Adults over the age of 65 only
Children and families who are below the federal poverty level
Anyone can register for Medicare

95. Question

Who is responsible for most Medicaid policy?

The federal government
Mostly the federal government with some input from state governments
Only the Centers for Medicare & Medicaid Services
Mostly the state governments with some input from the federal government

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