Choose the BEST answer for each of the following questions:

1. Capitation is:

A. a plan for the consumer which identifies a group of specific providers.
B. insurance rates which the consumer pays based on an individual's medical history.
C. a payment system where health providers receive a fixed amount over a given period.
D. prospective payment per episode of care.

2. A copayment requires:

A. cost-sharing by the consumer.
B. an employer to pay a portion of the insurance costs for the employee.
C. a provider to lower his or her fees.
D. a managed care plan to calculate deductibles previously paid.

3. Peer review provides a mechanism:

A. to determine salary increases over time.
B. to assess the quality of care provided to a patient.
C. to save money by not hiring outside experts.
D. to initiate and review contracts to determine compliance with state law.

4. A physical therapy aide may NOT provide physical therapy services:

A. without the immediate and continuous supervision of a licensed physical therapist.
B. unless specifically directed to do so by a physical therapist.
C. to patients covered by Medicaid, Medicare and CHAMPUS.
D. a and b above

5. Reimbursement may be denied when documentation fails to show that:

A. services provided are specific and effective for the patient's condition.
B. the patient has been instructed in a home exercise program.
C. the patient has a identified a family member to be involved in his/her care.
D. treatment is provided at least three times per week.

6. Hospice services

A. never involve physical therapists.
B. are often based in the patient's home.
C. are offered only in the first 30 days after acute hospitalization.
D. are not available to patients who have Medicare.

7. Sub-acute care :

A. requires that the patient be able to ambulate on level surfaces.
B. is available only to patients over the age of 65.
C. requires the coordinated services of an interdisciplinary team.
D. is another name for home health care.

8. Multi-skilled workers in acute care settings

A. are cross-trained to provide technical services in health care delivery.
B. usually have college degrees in a specific profession.
C. must be licensed by the state.
D. require the continuous supervision of a physical therapist.

9. A critical pathway

A. provides helpful information for the families of critically ill patients.
B. is only used in the appeal process following initial utilization review.
C. provides the maximum allowable amount for reimbursement for a diagnostic group.
D. is a plan to establish preferred treatment activities in a specific timeline.

10. The APTA Guide for Professional Conduct:

A. provides treatment parameters by diagnostic group.
B. outlines a code of ethics for physical therapists.
C. replaces state law in some states.
D. defines the scope and nature of physical therapy services.