Industry Regulations Flashcards

A physical therapist is asked by a supervising physician to perform a procedure outside the PT's scope of practice. The therapist should:

Answer: Decline and explain that performing the procedure would violate the state practice act

A physician's order does not override the legal scope of practice defined by the state PT practice act; the therapist bears personal liability.

Medicare's '8-minute rule' applies to which category of physical therapy billing?

Answer: Timed therapeutic procedure codes that require a minimum of 8 minutes to bill one unit

The 8-minute rule governs how timed CPT codes are billed: at least 8 minutes of direct one-on-one contact is required to bill one unit of a timed service.

Which of the following actions would MOST likely trigger a Medicare audit of a physical therapy clinic?

Answer: Consistently billing at the highest complexity evaluation code for nearly all new patients

Statistically abnormal billing patterns, such as nearly exclusive use of the highest-level codes, are a primary trigger for Medicare fraud audits.

A physical therapy clinic implements a social media policy prohibiting staff from posting patient information online. This policy is PRIMARILY grounded in:

Answer: HIPAA requirements to protect patient PHI from unauthorized disclosure

HIPAA prohibits the disclosure of protected health information without patient authorization, including through social media platforms.

What is the primary purpose of credentialing a physical therapist at a hospital or health system?

Answer: To verify that the therapist's education, licensure, and competencies meet the organization's standards before granting clinical privileges

Credentialing is the formal process of verifying a clinician's qualifications, licensure, and competence before granting privileges to practice at a facility.

Under state professional licensing regulations, which of the following would MOST likely result in suspension or revocation of a physical therapist's license?

Answer: Conviction of a felony involving moral turpitude

Felony convictions, especially those involving moral turpitude, are among the most serious grounds for license suspension or revocation under most state practice acts.

Which of the following BEST describes 'unbundling' as a fraudulent billing practice in physical therapy?

Answer: Billing separately for components of a procedure that should be billed as a single comprehensive code

Unbundling involves separating components of a service that should be reported as one inclusive code to artificially increase reimbursement.