L&A_Final

- Self-Awareness
- Self-Regulation
- Self-Care
- Listening to Others
- Empathizing
- Persuasion and Influence
- Foster Healing and Growth
- Conceptualization
- Sense of Stewardship
- Foresight
- Build Community

- Autocratic (leader makes ALL DECISIONS)
- Democratic (equal voice and vote for everyone)
- Laissez-Faire (hands-off approach)
- Bucreaucratic (adher to rules and policies)
- Strategic (visionary thinking + strategies and motivation are used to support the vision)
- Transformational (change and working the vision towards the future)
- Transactional (rewards and punishments)
- Coaching (leader = mentor, individualized support + feedback)

- Organization's mission and vision
- Day-to-day tasks
- Seeks predictable outcomes and short-term objectives
- Middle management = department or group of services

- Big Picture
- Creates the mission and vision
- Guides and plans for structural change
- External facing process
- Guides and inspires others
- Distributes power
- Focuses on relationships
- Not always in formal designated positions
- Every OT practitioner must be a leader in their own way

Purpose or Mission
Time
Degree of Autonomy
Authority Structure
Physical Presence

- The REASON behind the formation of a team!

- The longevity of a team
- Based off the needs of the organization (temporary or permanent)

- How the team operates!
- Focus = level of accountability and decision making (self managed vs. set leader)

- How a team is connected to the organization's authority structure!

- How a team PHYSICALLY works together!
- i.e.: in-person vs. virtual

- Multidisciplinary
- Interdisciplinary
- Interprofessional
- Transdisciplinary

- Professionals work within their OWN scope of practice
- Formal interactions
- Typical in private or hospital OP

- Shared problem solving with both FORMAL or informal communication
- Meant to create a SINGLE INTEGRATED treatment plan!
- Typical in HH or SNF

- Two or more professionals working TOGETHER to provide care
- Collab = KEY to meet optimal outcomes
- May or may not utilize a shared intervention plan

- Greater blurring of roles = incorporating methods from all disciplines and discuss findings with one other!!
- Typical in EI and School-Based

- Forming
- Norming
- Storming
- Performing
- Adjourning

- Challenge the process
- Model the way
- Encourage the heart
- Inspire a shared vision
- Enable Others to Act

- Seek innovative methods to change, grow, and improve
- Experiment by learning from mistakes + celebrating small wins

- Use personal values to find your voice
- Model aligning actions w/ shared values

- Show appreciation for individual achievement by recognizing contributions
- Create a spirit of community by celebrating values and victories

- Imagine exciting possibilities for the future
- Encourage others to envision the possibilities by appealing to shared aspirations

- Foster collab by building trust + a cooperative environment
- Strengthen the group by distributing power

- Structured hierarchy of COGNITIVE SKILLS
- Guides teaching and learning
- Useful for designing assessments, planning lessons, increasing rigor, simplifying activities, supporting discussions or projects-based learning
- 6 parts!! = Remember, Understand, Apply, Analyze, Evaluate, and Create (RUAAEC)

- 6 parts = Foundational Knowledge, Application, Integration, Human Dimension, Caring, and Learning how to learn
- Foundational Knowledge = Understanding and remembering information
- Application = developing skills, critical thinking, and the ability to apply knowledge
- Integration = connecting ideas across disciplines, experiences, or contexts
- Human Dimensions = learning about oneself and others (self-awareness, teamwork, leadership)
- Caring = developing new feelings, interests or values about the subject
- Learning how to learn = becoming a self-directed, reflective learning

- AOTA Guidelines for supervision and state-by-state supervision requirements

- Qualified professional overseeing a student’s intro clinical experience
- Supervision can be carried out by other qualified, comparable professionals besides OT
- Fieldwork requirements = determined by student’s academic program

- Students may deliver OT services when supervised by qualified OT
- Services = skilled interventions when supervision and regulatory guidelines are followed
- AOTA requires 24 full-time weeks for Level 2s

- Evaluation → under direction of licensed OT; can contribute to administration but NOT interpret data
- Treatment → can provide group and individual treatment
- Discharge → must collaborate with OT during discharge process

- Important to ensure safe, effective care, creating clear plan for any delegated client-related or non-client tasks
- OT remains responsible for all actions performed by the supervisee
- Supervision requirements such as frequency and level, vary by state and depend on the worker’s experience and the client’s need
- The role of non-licensed personnel, such as rehab aides, includes tasks such as preparing the treatment area, transporting patient, maintaining and cleaning up clinic spaces, and assisting OTs with patient care

- Controls policies, procedures, and program assessment (employment accountability)
- Directs training and education
- Organizes orientation and job assessment (transition employees into roles, plans communication and supervision)
- Plans hiring and staffing

- Harassment
-Negligent hiring
- Defamation (false statements of fact made by one person that harms another person's reputation)
- Discrimination
- Employee and client safety

- Control your OWN hours of availability (earn more money and flexibility!)
- Maintains your OWN liability insurance
- Pays own work expenses (write off work-related purchases and expenses on taxes)
- Provides own materials in some cases
- Pays own income tax + payroll taxes
- Carries OWN health insurance, dental, and other benefits
- Often NO PTO or sick time

- Conforms to the employer's schedule agreed upon at hiring
- Employer provides everything! (space, equipment, supplies)
- Employer DEDUCTS from employee paycheck and pay ALL taxes (rule of thumb = 30% tax)
- Employer may provide benefits (health insurance, dental, PTO, CUE compensation, etc.)
- Employer has group professional liability and general liability insurance

- Education
- Background
- Experience
- Current abilities
- Attributes
- Plans/Priorities

- Daily Practice Level
- Professional Level
- Systems Level

- PROVIDING evidence-based, occupation-centered interventions
- Documenting the distinct value of OT interventions!
- Ensuring that clients have the supports they need to be successful after discharge!
- Communicating clients' needs
- Explaining how OT can help them achieve their goals

- Goal = promote the profession!
- Practitioner requests a referral for a client they believe would benefit from occupational therapy services.
- Practitioner works with management to revise the occupational therapy evaluation template, so it more closely aligns with the new CPT codes.
- After noticing OT colleagues using non-evidence-based interventions, a practitioner establishes a biweekly journal club to promote best practices.
- After receiving a denial letter from an insurer, a practitioner appeals with objective data that demonstrates how occupational therapy intervention is improving the client’s health and preventing further costs.
- A school-based practitioner develops a lunch program to improve social skills in students with autism spectrum disorder while reducing bullying.
- Practitioner serves on their town’s council on aging, contributing their expertise on matters related to accessibility and aging in place.

- Goal = achieve systems-level change WHERE it is needed!
- Membership in AOTA and state associations to support these organizations’ lobbying efforts.
- Writing to members of congress about an issue affecting the profession.
- Replying to regulatory agencies’ requests for comments about proposed rule changes.
- Meeting with legislators in their offices or at public events.
- Contributing to AOTPAC and state political action committees.

- Professional MEMBERSHIP organizations!
- Typically affiliated w/ AOTA that supports OT/OTA practitioners within a specific state (i.e.: OTAC)
- Advocate for policies + regulations that DIRECTLY affect OT practice
- Includes licensure, reimbursement, and overall service delivery
- Provide professional support through continuing education, resources, and peer networking tailored to state-specific needs.
- Help practitioners understand and comply with licensing and regulatory requirements, ensuring ethical and legal practice.
- Foster community support by offering opportunities for mentorship, collaboration, and sharing best practices.

- Advocacy and legislative monitoring (scope of practice, reimbursement, direct access, licensure changes)
- Continuing education events and conferences
- Networking and mentorship opportunities
- Practice resources, newsletters, and job boards
- Representation in state government and regulatory discussions

- NOT SURE!!!!

- Responsive leadership style
- Leader = clear vision, confidence, commitment, and inspiring personality!
- Core = idealized influence, inspirational motivation, intellectual stimulation, individualized consideration

- Clinical settings = transformational OT leader mentors staff, promotes professional growth, and fosters evidence-based practice
- Educational settings = Leaders inspire students and faculty to innovate CURRICULA, engage in reseahrc, and implement best practice!
- Community and policy = OT leaders influence policy changes, advocate for client needs, and promote occupational justice

- Emphasis on SERVING OTHERS = primary goal of leadership
- Core = serving first, empathy, listening, awareness, persuasion over authority, commitment to growth, building community

- Person-Centered Care = Ensures the clients' needs and goals drive intervention planning
- Team Development = encourages mentoring, coaching, and support for colleagues to strengthen professional skills
- Organizational Culture = Promotes ethical practice, collaboration, and shared decision-making within OT departments or organizations
- Advocacy and Leadership = Supports OT leaders in influencing policy, improving practice standards, and fostering community engagemen

- Clear and Concise Communication
- Active Listening
- Constructive Feedback
- Collaborative Goal Setting
- Adapt Communication Style (adjust tone, level of detail, and communication method)
- Encourage Open Dialogue
- Follow-up and Support
- Positive Reinforcement

- Process of identifying the target population, defining their perceived and actual needs, and examining RESOURCES and LIMITATIONS
- Formal = Surveys, Focus Groups, Interviews
- Informal = Casual Discussions, Observations
- Data Review = How have the needs of the target population been met in other regions?

- The mission and long-term vision of the business
- Vision = allows for goals to be set and create a ROADMAP to get the business where they want to be!
- Conclude a SWOT (Strengths, Weaknesses, Opportunities, Threats) Analysis = anticipate specific supports and barriers

- Aspirational statement of where the organization WANTS to be in the future!
- Rooted in the belief that the idea will meet a unique need in the community
- Fuels motivation, commitment, and the application of specialized skills
- Guide development of the program proposal and be clearly stated at the OUTSET

- Organization's core value, underlying purpose, basis for its existence, focus and actions
- Practical actions the organization takes to reach the vision!
- Should be first drafted in writing then refined with feedback from mentors and supporters

- Examines both organization's INTERNAL PERFORMANCE and EXTERNAL ENVIRONMENT
- Identifies Strengths, Weaknesses, Opportunities, and Threats
- Should be repeated 6-12 months and include ALL staff
- Develop and reassess organizational goals to build on strengths and opportunities, and address weaknesses and threats to business success.

- Reputation
- Professional knowledge, skills, years of experience, etc.
- Unique and effective services
- Optimal facilities, equipment, or technology compared to competitors
- “One stop shop” for multidisciplinary services

- Gaps in professional skills or credentials
- Insurance payer mix is too narrow
- Limited features of location
- Need for new equipment, technology or funds
- The need to streamline office procedures to optimize spending and resources

- Closure of other clinic(s), increasing patient flow
- Increased revenue
- Availability of grants for programs
- Community events that staff can attend to increase visibility
- Growth of surrounding community

- Reductions in insurance or other reimbursement sources
- The closing of a large installation that previously hired many people and provided good insurance benefits
- New competitors providing similar services

- Fixed Expenses
- Variable Expenses
- Start-up Expenses

- Expenses that do NOT change over a period of time!
- Rent, Property tax, Insurance, Salaries, etc.

- Expenses that VARY with productivity (most business, some costs go up)
- Utilities, Consumable supplies

- The FIRST budget considerations or expenses first needed for the business
- Business Registration, Licensing Fees, Professional Liability Insurance, Equipment, Furniture, Office or clinic space deposits, etc.

- The estimation of income based on service rates, payer rates, excepted client volume, and the reimbursement timelines
- Important to maintain a cash reserve to cover expenses during slower payment cycles
- Types = Profit, Non-Profit, and Non-Revenue/Grant Funded

- Focus = community benefit, education, research, or serving UNDERSERVED POPULATIONS
- Hospitals, Rehab Centers, Community Agencies, etc.
- Extra revenue is reinvested into programs, staff development, or expanded services!
- May rely on mix of reimbursement and government funding

- Generate profit for both OWNERS and shareholders
- Private practice, contract agencies, therapyehab companies, corporate healthcare organizations
- Revenue is genereated through INSURANCE REIMBURSEMENT, private pay, contracts, or grants

- Specific program OR service within any orgainzation
- Does NOT generate any income
- Purpose = May be community outreach, education, advocacy, or research
- Both For-Profit or Non-Profit programs can create a program like so!

- Process of identifying unmet needs in a TARGET market + creating, communicating, and delivering value to MEET those needs profitably
- Analyzing market size and potential, determining which segments an organization can effectively serve, and designing and promoting products or services tailored to those specific needs and desires.

- The STEPS taken to identify a SPECIFIC target audience to provide expertise, services, or build a successful payer or referral relationship
- 3 primary target markets = Clients and POTENTIAL clients, Payers, and Referral sources or influencers

- Product
- Price
- Place
- Promotion
- People/Partners
- Process
- Physical Evidence

- Quality/competence
- Features (staff or facilities)
- Mix of what’s available
- Client support
- Availability of services (days, times clinic is open)

- More limited due to 3rd party payment
- Offer out of pocket-only services (classes, camps, baby and me, etc.)
- Free screening/consultation
- Other free, value-added services
- Diverse payment methods
- What TPPs clinic is enrolled with

- Convenience of location
- Ease of access
- How products can be obtained
- Additional locations
- Community that contains target audience
- Not duplicating the competition

- Marketing communication outlets
- Personal promotion
- Sales promotion
- Public relations efforts
- Branding
- Direct marketing
- Who are we promoting to?
- What are we promoting?
- Where are ads being placed and when?

- Are there any skill gaps needing to be addressed?
- “Brag” on staff, skills, state of the art facilities, etc.
- Partnerships with special initiatives

- The flow of activities
- Mechanism that takes place when there is an interaction between the patient/client/family and the facility
- Relates to the mission/philosophy
- How clients are related to from entrance to exit

- How customers are reassured
- How long the company has been in business for
- Impressive facilities
- Comfortable, accommodating, clean reception area
- Online presence, website, etc.

- PPS or Prospective Payment Services (fixed payments determined by patient classification groups)

- Fee for Service!

- Putting planned strategies into action to attract clients, referral sources, and community partners while maintaining ethical and professional standards.
Implementation begins by:
- Aligning marketing activities with the business’s mission and vision, ensuring services clearly address identified community needs.
- The business then launches targeted outreach efforts to its defined market, such as physicians, schools, hospitals, caregivers, employers, or consumers, ideally using both in-person and digital strategies

- Promoting an occupational therapy business involves clearly defining its unique value, building strong referral relationships, and maintaining a professional presence in the community and online.
- Effective promotion includes community outreach and education, advocacy and engagement within the profession, and delivering high-quality client-centered services that support retention and word-of-mouth referrals.
- Using consistent branding and tracking outcomes helps strengthen credibility and support sustainable growth

- Individual = one on one direct service, uses timed CPT codes, requires skilled OT, often done in OP + IP + HH
- Group = 2 or more patients treated at the same time, uses 97150 CPT code, requires skilled OT, often used in rehab groups + wellness groups
- Concurrent = 2 patients with one therapist working on different activities at the same time, uses individual timed CPT codes, requires skilled OT, often used in SNF + IP rehab

- Often used in the SNF setting!
- Applies to Medicare Part A
- Payment = based on resident's CONDITION rather than volume of therapy provided
- Reimbursement = determined by primary diagnosis, functional status, and presence of comorbidities
- Documentation must support medical necessity and skilled OT services
- Classifies residents into FIVE case mix adjusted components (aka each discipline has their OWN rate!)

- Often used in the HH setting!
- Applies to Medicare-certified HH agencies
- Reimbursement = patient CHARACTERISTICS (not diagnosis) and clinical COMPLEXITY (not # of minutes provided)
- OT services = MUST be medically necessary and applied to functional deficits
- Assessment data influences reimbursement
- Determined on a 30-day period of care and grouped based on admission source, timing, clinical grouping (primary diagnosis), functional impairment, and comorbidity adjustment

- 8-minute rule (must be 8 minutes long to bill; 1 unit is 15 minutes +-7, 2 units is 30 minutes +-7, 3 units is 45 minutes +-7, etc.)
- Time-based billing = based on amount of time spent in DIRECT one-on-one (minutes must be documented clearly, interventions = skills and function-based, multiple time-based codes may be billed in one session IF medically necessart and properly documented)
- Service-based codes = billed ONCE per session or per occurrence REGARDLESS of time spent (common codes = eval codes (low, medium, or high complexity) and AT assessment, documentation must support the service provided and medically necessary)

- Level 1 = CPT codes that are used for billing and documentation of PROCEDURES!!! (procedures = the services that OTs provide), other healthcare providers (PTs, SLPs, dentists, etc.) utilize CPT codes for billing and documentation of services!
- Level 2 = Codes used to identify products, supplies, and services not included in CPT codes (DME, prosthetics, orthotics, supplies) when used outside a physician’s office

- 06: independent → patientesident safely completes the activity by themselves with no assistance from a helper
- 05 setup or cleanup assistance → helper sets up or cleans up; patientesident completes activity. The helper assists only prior to or following the activity
- 04 supervision or touching assistance → helper provides verbal cues and/or touching/steadying and/or CGA as the patientesident completes the activity.
(Assistance may be provided throughout the activity or intermittently, CGA, SBA, and supervision must)
- 03 partial/moderate assistance → helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort (Min to mod comparison, Start to need physical assistance → 1- 50%)
- 02 substantial/maximal assistance → helper does more than half the effort (The helper lifts or holds the trunk or limbs and provides more than half the effort, Max to total comparison)
- 01 dependent → helper does ALL the effort. The patientesident does none of the effort to complete the activity. OR the assistance of 2 or more helpers is required for the patientesident to complete the activity (All effort is done by another person, 2+ people AUTOMATICALLY dependent)

- 07 resident refused
- 09 non applicable → resident did not perform this activity prior to current injury, exacerbation, or injury (For example → was not doing prior to the facility and will not be doing.)
- 10 not attempted → due to environmental limitations
- 88 not attempted → due to medical condition and safety concerns

- Often the first information reviewed by payers and play a key role in determining reimbursement
- Accurate coding of both medical and treatment diagnoses is essential to establish the medical necessity of OT services and justify why the billed interventions were required

- identifies the disease or condition prompting referral to OT and is reported using ICD-10 code
- Includes a primary diagnosis and relevant comorbidities
- Uses International Classification of Diseases (ICD), 10 edition
- Diagnoses diseases and medical conditions
- We use whatever codes the physician has provided as the “admitting diagnosis” or “referral daignossi” in OP settings

- the client’s FUNCTIONAL limitations or performance deficits that affect participation in desired occupations and the focus of OT intervention
- OT use clinical judgment to select the most specific and relevant ICD-10-CM treatment diagnosis codes that reflect the conditions being addressed in therapy
- Sub-condition that the therapist addresses with the intervention (Examples: Parkinson’s disease G20 is the medical diagnosis → Associated treatment diagnosis → other lack of coordination R27.8)

- Improper, unethical, or illegal billing practices!
- Result in incorrect payment from payers (Medicare, Medicaid, Private Insurance)

- Intentional false statement or representation of services
- False billing (solicitations and referrals) = results in UNWARRANTED payment!
- Examples: billing for services not provided, falsifying documentation to justify a service

- Directly or indirectly contributes to UNNECESSARY cost inflation
- Ignorance = not an excuse!
- Common sources of abuse = up-coding (using higher reimbursement codes than warranted), un-bundling (treated bundled treatment as separate conditions), lack of medical necessity or unskilled treatment

- Systematic, data-driven approach to improving service delivery, client outcomes, efficiency, and compliance (QI)
- Key domains of client outcomes, client and family-centered care, quality documentation and compliance, efficiency and workflow, staff competence and participation

- Improve client experience
- Demonstrate organizational outcomes → you can't prove what you don’t measure
- Bill ethically; we must show that we are achieving promised results
- Build evidence
- Reimbursement increasingly tied to outcomes
- Quality is an assessment of effectiveness
- Value is of growing importance

- person’s entire medical history across multiple providers/facilities
- Can include person’s medical history, current, and previous social context, lab values, therapy notes
- Electronic record storage reduces duplication of services, helps ensure accurate reporting between providers, and gives clinicians the opportunity to maximize reimbursement and preventeduce denial claims

- Poor documentation
- Process errors and technicalities
- Reviewer errors

- Redetermination by Medicare Administrative Contractor (MAC) - 120 days
- Reconsideration by Qualified Independent Contractor (QIC) - 180 days
- Decision by Office of Medicare Hearings and Appeals (OMHA) - 60 days
- Review by Medicare Appeals Council - 60 days
- Judicial Review in Federal Court - 60 days

- occurs when a practitioner knows the ethically appropriate action but is unable to act due to internal or external constraints, or there is pressure to do something unethical or illegal.

- The “right” choice feels clear.
- Barriers to prevent taking action (e.g., policies, productivity demands, hierarchy).
- Often accompanied by frustration, guilt, anger or burnout.
- When not addressed, negative feelings can accumulate over time.

- occurs when there are two or more competing ethical principles, and any available choice violates at least one ethical value.

- Choice is between morally conflicting options
- There is no clear “right” choice.
- Ethical principles are in conflict.
- Decision-making requires ethical reasoning and prioritization.

- Services that are reasonable, necessary, and appropriate to evaluate or treat a client's condition
- Requires the skills of an OT to improve, maintain, or prevent deteriortation of functional performance

- Goals = too vague
- Poor linkage b/w impairment and function
- Copy n paste documentation
- Language that is not individualized to the client
- Billing skilled therapy when only supervision or monitoring takes place

- Financial fraud and abuse
- Privacy violations or HIPAA violations
- Lack of informed consent
- Abuse and neglect
- Negligence
- Malpractice

- Centers for Medicare and Medicaid Services
- Tracks multiple performance measures (public performance measures and private performance measures)

- More movement towards PERFORMANCE-BASED PAYMENT (medicare part A w/ PDPM and PDGM)
- Usage of Merit-Based Incentive Payment Systems (MIPS)

- Medicare Part B
- Currently voluntary
- Bonuses for top performers
- Penalties for bottom performers
- Measure results in four categories: Quality, Promoting interoperability, Improvement activities, cost

- The process of ending services WITHOUT adequate notice or transition planning for clients with ongoing needs, potentially causing harm
- Legal definitions VARY by state

- Legal & Ethical Responsibility: Practitioners must follow state laws and organizational policies and consider ethical obligations when terminating care.
- Appropriate Termination: When services end for valid reasons (e.g., job change, relocation, conflict of interest), practitioners must ensure a timely, planned transition of care.
Key Ethical Actions: Provide sufficient notice to the client and employer; Collaborate with the client in transition planning; Complete all required documentation and billing; Offer appropriate referrals and community resources; Communicate client needs to future providers to support continuity of care.
- Ethical Tension: Barriers such as finances, staffing shortages, transportation, or geography may limit continued services and create ethical distress.
- Mitigating Harm: Early, transparent communication and empowering clients to participate in planning reduce emotional harm and perceptions of abandonment.
- Temporary Services: Even in short-term roles (e.g., students, research), practitioners must consider the risk of abandonment and provide advance notice and transition support.
- Professional Boundaries: Practitioners are not ethically required to provide care indefinitely but are responsible for minimizing harm during transitions.

- 2G: Do not abandon clients; facilitate appropriate transitions.
- 4K: Refer to other providers when indicated.

Centers of Medicare and Medicaid Services (CMS)
- A federal agency within the U.S. Department of Health and Human Services that administers Medicare, Medicaid, and other public health insurance programs.
- CMS establishes rules for coverage, reimbursement, documentation, billing, and compliance, significantly influencing occupational therapy service delivery across practice settings.
Commission of Accreditation of Rehabilitation Facilities (CARF)
- An international, nonprofit accrediting organization that focuses on rehabilitation and human service programs
- In evaluated programs based on quality, outcomes, person-centered care, CQI, and is commonly used by outpatient rehabilitation clinics and community-based services providers
State of Regulatory Boards (SRB)
- State-level agencies responsible for licensure and regulation of OT and OTA
- Define scope of practice, enforce practice acts, investigate complaints, and ensure practitioners comply with state laws and professional standards to protect public safety
Joint Commission
- An independent, nonprofit organization that accredits and certifies health care organizations and programs in the United States. Its role is to promote safe, high-quality care by establishing performance standards, conducting surveys, and monitoring compliance related to patient safety, quality improvement, and organizational performance.
School Boards
- Locale or state governing bodies that oversee public education systems
- In relation to OT, they establish policies and procedures for school-based services, ensure compliance with federal laws (section 504 and IDEA) and guide service delivery within education environments
Accreditation Council of OT Education (ACOTE)
- The accrediting body of the American Occupational Therapy Association responsible for accrediting occupational therapy and occupational therapy assistant educational programs in the United States. ACOTE establishes educational standards to ensure graduates are prepared for entry-level practice and eligibility for the NBCOT certification exam.