OT_Specific_Settings__Reimbursement.pptx

Reimbursement

1. Documentation and Reimbursement for Specific Settings and Situations School-Based Occupational Therapy Practice

2. Overview • Contexts and best practices in service delivery • Funding source requirements guide documentation • Ensures accurate reimbursement • Majority of pediatric OT occurs in public schools • IDEA Part B governs documentation in schools

3. School-Based Practice • Children 3–21 yrs receive services under IDEA Part B • Documentation guided by state Dept. of Education & local boards • IEP = legal written document • Key IEP sections: present levels, goals, services, accommodations • OT follows professional standards in planning and intervention

4. Supporting Documentation • Forms beyond IEP include: – Evaluation report templates – Score reporting charts – Data collection & attendance logs – Group activity schedules • OT staff may create formats if district has none • Logs must classify all OT service contacts

5. Screenings • Not covered under most medical funding • Common in school-based OT • Purpose: identify strengths/weaknesses, need for eval • Documentation: referral, reason, occupational profile, context factors • Strategies shared collaboratively, then documented • Parent notification/approval may be required

6. Evaluations • Required for special education eligibility or service need • Mandated timelines; requires parental consent • Record review, interviews, contextual analysis • Standardized & nonstandardized tools, classroom observation • Outcomes answer: – Does student need skilled OT? – How do findings affect educational participation?

7. IEP Goals & Objectives • Goals are objective, measurable, annual • Address academic, functional, developmental needs • Best practice: interprofessional goals • Goal writing steps: 1. Gather info & baseline 2. Define desired performance 3. Identify conditions 4. Establish criteria • SMART format: Specific, Measurable, Achievable, Relevant, Time-bound • Postsecondary goals after age 16 (transition planning)

8. Progress Reports & Reevaluation • Progress reported at same schedule as report cards • IEP reviewed at least annually • Reevaluation every 3 years (triennial) • May occur sooner if needed/requested • OT collaborates with team and collects progress data

9. Discharge Reports • Prepared when recommending service change • Similar to progress report, but more detailed • Reasons: goals achieved, no further need, lack of benefit, school transfer • Formal proposal to IEP team with parent notification • Team discusses before decision • Suggestions for ongoing success included