Working in the Medicare RAI System

Working in the Medicare RAI System 

This course is a primer for understanding what Medicare Part A is, the case mix model, what admission requirements must be met to be eligible, how therapy and clinical services are tied, the importance of ADLs, what RUGS are and how they drive reimbursement for the agency. It is recommended all learners start with this course.


Hours: 0.50


Certificates provided by accrediting body (3 Match)

Association of Nutrition and Foodservice Professionals


This program is approved for 0.50 hours by the Dietary Managers Association. Approval code 150681.

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 3. This activity is approved for 0.50 contact hours.

Alabama State Board of Occupational Therapy


This course has been approved by the Alabama State Board of Occupational Therapy for 0.50 contact hours, approval number 20-532355.

Course Details

Course Code: REL-RED-L2A
Hours: 0.5
Type: Online Course
Content Expiration Date: 10/31/2020
Learning Objectives:
List two major categories of care under the Medicare RAI system
List 4 admission criteria for patients using skilled care in the Medicare reimbursement framework
Describe one reason behind including resident voice in the RAI assessment system
Discuss the RAI care pathway and the significance of assessments in delivery of care
Describe the purpose of the interdisciplinary team and their role within the team
Describe the RUGS model of payment for Medicare covered services in the RAI system
Explain how the accuracy of observation and subsequent coding impact reimbursement
List 2 red flags surveyors look for when reviewing cases

The Basics of the Medicare RAI System Eligibility for Coverage The RAI Care Pathway How the RAI System Impacts Payment for Care Fiscal Responsibility and Good Patient Care

Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, 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.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
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.
If you require special accommodations to complete this module, please contact Relias Customer Support here.