Service Delivery and Professional Practice
Paying for care and supervision
Know the settings: acute inpatient (DRG-based), inpatient rehabilitation facility (13 admission criteria, 3-hour rule, IRF-PAI), skilled nursing (PDPM, and the distinction between skilled and maintenance therapy), home health (homebound status, physician-certified plan of care), and outpatient (therapy threshold and medical necessity review). Medicaid and commercial plans vary. Supervision levels - direct, close, general - are set by state practice acts, payer rules, and OT judgment; the more restrictive requirement applies and state law overrides a guideline.
Documentation that survives review
Skilled, individualized, measurable. Tie deficits to function, state cues and assist levels, quantify progress, and justify continued care. Goals should be specific, measurable, occupation-based, and time-bound.
Ethics and professional behavior
Beneficence, nonmaleficence, autonomy, justice, veracity, fidelity. Informed consent, HIPAA, mandatory reporting of abuse, incident reporting, and honest billing. Advocacy includes naming barriers and speaking up when productivity demands threaten safe care.
Trap: choosing "call the state board" or "refuse to treat" when the correct first step is raising the concern with the OT or supervisor through the proper internal channel.
Worked example: Your employer asks you to bill four units when you provided three. Correct response: decline to document inaccurately, raise it with your supervisor, and follow the organization's compliance process - accurate documentation is an obligation, not a preference.