Medicare Law and Documentation: An Introductory Guide for Occupational Therapists


The purpose of this module is to ensure that all occupational therapy (OT) clinicians have a working knowledge of the Medicare guidelines as they relate to patient selection, treatment, and documentation. Medicare provides a large percentage of therapy reimbursement, so a thorough understanding of Medicare guidelines will assist you in writing notes that meet intermediary specifications. Because the review process is performed “after the fact,” the documentation is the only witness to whether the treatment was appropriate and necessary.


Hours: 3.00


Certificates provided by accrediting body (3 Match)

Alabama State Board of Occupational Therapy


This course has been approved by the Alabama State Board of Occupational Therapy for 3.00 contact hours, approval number 20-615430.

American Occupational Therapy Association


Relias Learning is an approved provider of continuing education courses by the American Occupational Therapy Association. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. Category 1 & 3. This activity is approved for 3.00 contact hours.

Florida Board of Occupational Therapy


This course has been approved by the Florida Board of Occupational Therapy for 3.00 contact hours, approval number 20-615430.

Course Details

Course Code: REL-SRC-0-MLDIGOT
Hours: 3
Type: Online Course
Content Expiration Date: 7/31/2020
Learning Objectives:
Identify 2 regulatory resources that detail Medicare coverage criteria.
Describe the role of the Medicare Administrative Contractor in managing the Medicare program.
Identify 4 regulatory requirements related to Medicare coverage of skilled therapy services.
Examine 2 types of therapy services provided by occupational therapists.
Examine 3 documentation requirements related to the provision of therapy services.
Identify 2 functional G-code reporting requirements.

Section 1: Introduction
A. About This Course
B. Learning Objectives
Section 2: Medicare Rules and Regulations
A. Medicare Programs
B. Medicare Manuals
C. Coverage Determinations
D. Medicare Coverage Specific Rules
E. Review
F. Summary
Section 3: Covered OT Services
A. Key Terms
B. Covered Therapy Services
C. Reasonable and Necessary
D. What is Reasonable?
E. What is Necessary?
F. Establishing Medical Necessity
G. Rehabilitative Therapy
H. Maintenance Therapy
I. Therapy Delivery Options
J. Review
K. Summary
Section 4: Medicare Therapy Documentation Requirements
A. Evaluations
B. Diagnoses
C. Certification of the Plan of Care
D. Functional Goal Setting at a Glance
E. Progress Notes
F. Treatment Notes
G. Discharge Summaries
H. Tips for Documenting Skills
I. Clear Communication through Documentation
J. Review
K. Summary
Section 5: Functional G-Codes
A. Functional G-Codes
B. G-Code Severity Modifier
C. Reporting Requirements
D. G-Code Reporting Example – Onset of Therapy
E. Review
F. Summary
Section 6: Conclusion
A. Summary
B. Course Contributors
C. Resources
D. References
E. Congratulations!

Instructor: Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM Ambassador/Trainer
Ronald Orth, RN, CMAC, CHC  obtained a nursing degree from Milwaukee Area Technical College in 1985 and a B. A. in Health Care Administration from Concordia University in 1996. Mr. Orth possess over 30 years of nursing experience with over 20 of those in the Skilled Nursing industry. Mr. Orth has extensive experience in teaching Medicare regulations to healthcare providers both in the US and internationally. Mr. Orth is currently the Senior SNF Regulatory Analyst at Relias Learning and is certified in Healthcare Compliance through the Compliance Certification Board (CCB). Disclosure: Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM Ambassador/Trainer has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Expert Reviewer: Rhonda Gaudreau, MA, OTR
Rhonda Gaudreau, MA, OTR. Rhonda holds a Bachelor’s degree from Vassar College and a Master’s degree in Occupational Therapy from New York University, where she also received a Fellowship in Rehabilitation Technology. She was an adjunct faculty member for several years at New York University and Dominican College in New York. Rhonda is co-owner of Theracore Management Group LLC a company that specializes in the management of therapy services and consulting for long term care facilities to enhance their operational and clinical outcomes and to improve their regulatory compliance.  Disclosure: Rhonda Gaudreau, MA, OTR has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: entry, intermediate, and advanced level Occupational Therapists; in the following settings: Post-Acute Care, Rehabilitation Settings.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.
If you require special accommodations to complete this module, please contact Relias Customer Support by calling (800) 381-2321 or emailing