Question

When a claim is submitted to Medicare for OT Services which type of Intervention will most likely result in Medicare rejecting this claim and therefore not paying for the OT services which were provided?

A) Maintaining ROM for a spastic hemiplegic arm of a pt who had a stroke several years ago

B) Providing intervention for a rotator cuff tear for 5 predetermined sessions

C) Treating a post-surgical hip replacement in a female pt with schizophrenia

D) Providing E-stim to a pt's lower back extensors to improve postural alignment

Answer 1

Medicare is likely to reject a claim for OT services if E-stim is used to improve postural alignment, as it is not considered medically necessary.

Step-by-step explanation:

The type of intervention that will most likely result in Medicare rejecting a claim for OT services is providing E-stim to a patient's lower back extensors to improve postural alignment.

Medicare generally does not cover E-stim for postural alignment, as it is not considered a medically necessary intervention for this purpose. Medicare will only cover services that are deemed medically necessary and supported by evidence-based practice.

Therefore, it is important to choose interventions that are within the scope of Medicare coverage guidelines when submitting a claim for OT services to ensure reimbursement.