PT 8320 - Regulation and Reimbursement in Physical Therapy

• The student will be able to compare and contrast principles of reimbursement in the following health care settings: Outpatient Rehabilitation, Skilled Nursing Facilities, Inpatient Rehabilitation, and Home Health.
• The student will be able to compare and contrast reimbursement relative to each third party payer in each health care setting including but not limited to: Medicare, Medicaid, HMOs, PPOs, and Worker’s Compensation.
• The student will be able to compare and contrast Social Security retirement and disability supports healthcare reimbursement.
• The student will be able to defend adherence to legal practice standards, including all federal, state, and institutional regulations related to patient/client care and fiscal management.
• The student will be able to discriminate ICD-10 and Current Procedural Terminology (more commonly referred to as CPT) coding information for correct coding to ensure fair financial compensation for PT services rendered.
• The student will be able to evaluate plans of care for consistency with legal, ethical, and professional obligations and administrative policies and procedures of the practice environment.
• The student will be able to compare different types of documentation specific to payers and/or health care settings.
• The student will be able to communicate effectively in a culturally competent manner with patient/client, family members, caregivers, other health professionals, and payers based on knowledge of the health care system.
• The student will be able to explain the concept of acceptance of a fiduciary responsibility for all patients/clients through knowledge of the health care system and the regulation of health care services through accrediting bodies like Joint Commission.
• The student will be able to explain the evolution of health care in the United States up to and including the Affordable Care Act and its modifications