Industry Regulations Flashcards
7 cards from real PCE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Industry Regulations flashcards as text
An Advance Beneficiary Notice (ABN) is used in Medicare billing primarily to:
Answer: Notify a patient that Medicare may not cover a service so they can decide whether to proceed
An ABN informs a Medicare beneficiary that a specific service may not be covered, allowing them to choose whether to receive it and accept financial responsibility.
The False Claims Act imposes civil liability on those who:
Answer: Knowingly submit false or fraudulent claims for payment to the federal government
The False Claims Act targets knowing and intentional submission of fraudulent claims to federal healthcare programs such as Medicare and Medicaid.
Regarding supervision requirements for physical therapist assistants (PTAs), which statement is MOST accurate?
Answer: Supervision requirements vary by state law but generally require the PT to be available and to periodically assess the patient
PTA supervision is primarily governed by state practice acts, but the supervising PT retains responsibility for patient care regardless of delegation.
A physiotherapy clinic manager notices the schedule shows a therapist is double-booked and billing simultaneously for two patients in separate rooms. This practice is BEST described as:
Answer: Concurrent billing fraud if both patients are billed as if receiving one-on-one care
Billing for individual one-on-one time while the therapist is simultaneously treating another patient constitutes fraudulent billing under Medicare.
Which regulatory body is responsible for investigating complaints of unprofessional conduct against licensed physical therapists in a US state?
Answer: The state physical therapy licensing board
State licensing boards have the authority to investigate complaints, impose sanctions, and revoke licensure for unprofessional conduct.
Under OSHA's General Duty Clause, employers in physical therapy settings are required to:
Answer: Provide a workplace free from recognized hazards likely to cause serious harm
The General Duty Clause requires employers to maintain a safe workplace by addressing all recognized hazards, even those not covered by a specific OSHA standard.
A physical therapist learns that a new state law expands direct access to PT services. What is the therapist's MOST important obligation before treating patients without referral?
Answer: Understand the specific conditions, limitations, and documentation requirements of the new law
Therapists must understand the legal scope, restrictions, and documentation requirements of direct access laws in their state before acting under them.