Documenting Progress in Home Care

The home is an ideal environment for the practice of occupational therapy. However the tumultuous health care environment of the late 1990s requires practitioners to take special care not only in delivering effective services, but also in documenting the delivery of skilled care. Documentation is the bridge between the delivery of occupational therapy services in the home and the approval for reimbursement of services by third-party payers. This article presents principles for writing reimbursable progress notes for home care that are based on Medicare documents related to occupational therapy. Application of these principles can improve efficiency and excellence in practitioners’ documentation skills.