Medicare Law and Documentation: An Introductory Guide for Occupational Therapists

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 (1 Match)

American Occupational Therapy Association


Relias LLC 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: Category 1 & 3.

This activity is approved for 3.00 contact hours.

Course Details

Course Code: REL-SRC-0-MLDIGOT
Hours: 3
Type: Online Course
Content Expiration Date: 1/31/2021
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.

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 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 possesses 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 Post-acute Care Curriculum Designer and is certified in Healthcare Compliance through the Compliance Certification Board (CCB). Ron has also successfully completed the Infection Control Officer training through the AHCA and is an AHIMA approved ICD-10-CM trainer. Disclosure: Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM 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: Intermediate level Occupational Therapists; in the following settings: Post-Acute Care, Rehabilitation Settings.
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.