1.
Case Study 1 (Use with questions 1 - 5)
Mrs. Smith is admitted to the SNF s/p L hip fracture. She is being treated by PT 6 times per week, OT 5 times per week. Her last MDS assessment was an RU. She receives 60 min OT and 58 min PT treatment on Monday. On Tuesday, she is put on hold for therapy treatment by her physician for a DVT. She is not seen by any discipline on Tuesday, Wednesday or Thursday. On Friday, her physician orders that therapy services continue. She participates in therapy on Friday.
For Mrs. Smith, which OMRA would we complete?
Correct Answer
B. EOT - R OMRA
Explanation
The correct answer is EOT - R OMRA. EOT stands for End of Therapy, and R stands for Resumption. In this case, Mrs. Smith's therapy was put on hold due to a DVT on Tuesday, Wednesday, and Thursday. However, on Friday, her physician ordered that therapy services continue, and she participated in therapy. Therefore, an EOT - R OMRA would be completed to document the resumption of therapy services after the hold.
2.
Does a new eval need to be initiated?
Correct Answer
B. No
Explanation
No, a new eval does not need to be initiated.
3.
Should she receive a full treatment on Friday?
Correct Answer
A. Yes
Explanation
The person in question should receive a full treatment on Friday.
4.
Can this treatment be performed by an assistant?
Correct Answer
A. Yes
Explanation
This treatment can be performed by an assistant.
5.
Which RUG category should her scheduled minutes be targeted toward?
Correct Answer
E. RU
Explanation
The correct answer is RU. The question is asking which RUG category the scheduled minutes should be targeted toward. The answer RU refers to the Resource Utilization category, which indicates that the scheduled minutes should be focused on maximizing the efficient use of resources.
6.
Case Study 2 (Use with questions 6 - 9)
Mr. Jones is admitted to the SNF s/p CABG. He is being treated by PT and OT 5 times a week for strengthening, ADLs, gait training and functional mobility. His last MDS assessment was an RU. OT completes a planned discharge on Tuesday. He becomes ill and is diagnosed with pneumonia. He starts antibiotics, and refuses physical therapy on Wednesday, Thursday, Friday and Saturday. On Sunday, he agrees to participate in therapy. Physical therapy resumes treatment.
For Mr. Jones, what assessment(s) would we complete?
Correct Answer
A. EOT with SOT OMRA
7.
Should he receive a full treatment on Sunday?
Correct Answer
A. Yes
Explanation
The given correct answer is "Yes" because it implies that the person in question should receive a full treatment on Sunday.
8.
Does a new eval need to be completed?
Correct Answer
A. Yes
Explanation
Based on the given options, the answer "Yes" indicates that a new eval needs to be completed.
9.
Which RUG category should his scheduled minutes be targeted toward?
Correct Answer
F. Whatever is most clinically appropriate
Explanation
The correct answer is "Whatever is most clinically appropriate." This means that the scheduled minutes should be targeted towards the category that is most suitable for the patient's clinical needs. It implies that the decision should be based on the patient's specific condition and requirements, rather than a predetermined category.
10.
Case Study 3 (Use with questions 10 - 15)
Mrs. Appleby is on OT and PT caseload. She is being seen six times per week by both disciplines. Her last ARD was Wednesday, 10/5 (Day 58) for 720 minutes, RU.
The following is a record of her treatments for Wednesday, 10/5 through Thursday 10/13:
10/5
10/6
10/7
10/8
10/9
10/10
10/11
10/12
10/13
PT planned
75
70
70
60
0
60
60
55
75
PT actual
90
65
55
60
0
60
45
50
105
OT planned
75
70
70
0
30
60
60
55
75
OT actual
85
60
60
0
30
60
50
45
100
Does a COT OMRA need to be completed?
Correct Answer
A. Yes
Explanation
Based on the given information, a COT OMRA (Change of Therapy Other Medicare Required Assessment) needs to be completed. This is because there is a significant difference between the planned and actual minutes of therapy provided for both PT and OT on 10/11 and 10/13. The planned minutes for PT on 10/11 were 60, but the actual minutes were 45. Similarly, the planned minutes for OT on 10/13 were 55, but the actual minutes were 100. These discrepancies indicate a change in therapy that requires a COT OMRA to be completed.
11.
What are the total minutes for the COT 7 day observation period?
Correct Answer
C. 640
Explanation
The total minutes for the COT 7 day observation period is 640.
12.
If completed, what is the ARD date for the COT OMRA?
Correct Answer
A. 10/12
Explanation
The ARD date for the COT OMRA is 10/12.
13.
If completed, what would be the RUG level?
Correct Answer
B. RV
Explanation
The correct answer is RV.
14.
If completed, what date would the new RUG level payment start?
Correct Answer
B. 10/6
Explanation
The new RUG level payment would start on October 6th.
15.
If a COT OMRA were completed, when should the minutes have been adjusted?
Correct Answer
F. A or B
Explanation
The correct answer is A or B. The question is asking about the adjustment of minutes after completing a COT OMRA. Without further context or information, it is not possible to determine the exact date for adjusting the minutes. It could be either on 10/7 or 10/8, depending on the specific circumstances or guidelines related to the COT OMRA.
16.
Case Study 4 (Use with questions 16 - 20)
Mr. Lyons is receiving PT and OT services five times per week. His last ARD was 10/10 (14 day) for an RV. Below are his planned and actual minutes:
10/10
10/11
10/12
10/13
10/14
10/15
10/16
10/17
10/18
PT planned
75
75
75
75
75
0
0
60
75
PT actual
45
75
75
75
75
0
0
60
60
OT planned
60
75
75
75
75
0
0
60
75
OT actual
60
75
75
75
75
0
0
60
60
Does a COT OMRA need to be completed?
Correct Answer
A. Yes
Explanation
Based on the information provided, a COT OMRA (Change of Therapy Other Medicare-Required Assessment) needs to be completed. A COT OMRA is required when there is a significant change in the patient's therapy minutes compared to the planned minutes. In this case, there is a difference in the planned and actual minutes for both PT and OT on 10/18. The planned PT minutes were 75, but the actual minutes were 60. Similarly, the planned OT minutes were 75, but the actual minutes were 60. This change in therapy minutes indicates a significant change and therefore a COT OMRA is required.
17.
What is the rationale for the above answer?
Correct Answer
B. RTM increased enough to escalate the RUG category
Explanation
The rationale for the above answer is that an increase in RTM (Return to Manufacturer) is enough to escalate the RUG (Resource Utilization Group) category. This suggests that when more products are returned to the manufacturer, it indicates a higher level of resource utilization and therefore warrants a higher RUG category.
18.
If completed, what would be the ARD date?
Correct Answer
C. 10/17
Explanation
The ARD date would be 10/17 because it is the only date given that falls within the range of the other dates.
19.
If completed, what would be the RUG level?
Correct Answer
B. RU
Explanation
The correct answer is "RU" because it is the highest level of completion in the given options. The question is asking about the RUG level after completion, and "RU" represents the highest level of completion.
20.
What date does the new RUG level payment start?
Correct Answer
B. 10/11
Explanation
The new RUG level payment starts on 10/11.
21.
Case Study 5 (Use with questions 21 - 24)
Mrs. Ronan is receiving PT, OT and ST services five times per week. ST turned in a 5 day discontinuation notice during the rehab meeting. Their last date of treatment is 10/27. The last ARD was 10/19 for an RU. Mrs. Ronan’s planned minutes are as follows:
10/20
10/21
10/22
10/23
10/24
10/25
10/26
10/27
10/28
10/29
PT
50
50
0
0
50
50
50
50
50
0
OT
50
50
0
0
50
50
50
50
50
0
ST
45
45
0
0
45
45
45
45
45
0
10/30
10/31
11/1
11/2
11/3
11/4
11/5
PT
0
50
50
50
50
50
0
OT
0
50
50
50
50
50
0
ST
0
45
45
45
45
45
0
What is the next COT observation period for this resident?
Correct Answer
B. 10/20 - 10/26
Explanation
The next COT observation period for this resident is 10/20 - 10/26. This is because the COT observation period starts on the day after the last ARD (10/19) and continues for 7 days.
22.
And the one after that?
Correct Answer
B. 10/27 - 11/2
Explanation
The correct answer is "10/27 - 11/2" because it represents a date range that starts on October 27th and ends on November 2nd. This is the only option that includes consecutive dates within the given range of 10/26 - 11/1.
23.
Is it necessary to complete a COT OMRA?
Correct Answer
C. Maybe
Explanation
The answer "Maybe" suggests that it is not necessary to complete a COT OMRA in all cases. The completion of a COT OMRA may depend on various factors such as the specific circumstances, requirements, or preferences of the individual or organization involved. Therefore, it cannot be stated definitively that it is always necessary to complete a COT OMRA.
24.
Can the planned minutes be adjusted so as not to have to do a COT OMRA?
Correct Answer
A. Yes
Explanation
The given answer states that the planned minutes can be adjusted to avoid doing a COT OMRA. This implies that there is flexibility in the scheduling or allocation of time, allowing for changes to be made in order to avoid the need for a COT OMRA.
25.
Case Study 6 (Use with questions 25 - 27)
Therapist Sally has a 60 minute group planned for Friday at 11 am with Mrs. Smith, Mr. Jones, Mrs. Appleby and Mr. Lyons (all of which are skilled under Medicare A). At 11 am Sally begins the group with everyone except Mrs. Smith, who is sick and unable to come to the gym. Sally and the other residents continue and end the group session at noon.
Does this meet the new group definition for Medicare A?
Correct Answer
A. Yes
Explanation
The given scenario meets the new group definition for Medicare A because Therapist Sally conducted a group session with multiple residents, including Mrs. Appleby and Mr. Lyons, for 60 minutes. Even though Mrs. Smith was unable to attend due to illness, the group session still took place as planned. Therefore, the correct answer is "Yes".
26.
What is the rationale behind your answer?
Correct Answer
B. The group session was planned for 4 residents
Explanation
The correct answer is "The group session was planned for 4 residents" because it is the only option that directly relates to the given information. The fact that the group session was planned for 4 residents suggests that there was an expectation for 4 residents to attend. The other options, stating that the session consisted of 3 or 2 residents, do not provide any rationale or explanation for why the group session was planned for 4 residents.
27.
How many minutes of group therapy are billed for each resident?
Correct Answer
B. Mr. Jones, Mrs. Appleby and Mr. Lyons each get 15 minutes of group therapy
Explanation
Based on the information given, it is stated that Mr. Jones, Mrs. Appleby, and Mr. Lyons each receive 15 minutes of group therapy. Therefore, the correct answer is that each of these three individuals receives 15 minutes of group therapy.