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OTS 134: Navigating Medicaid Billing for School-Based OTPs

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Welcome to the show notes for Episode 134 of the OT Schoolhouse Podcast.

Have you ever felt overwhelmed by Medicaid billing and unsure of how to navigate the funding process?

In this episode of the OT Schoolhouse Podcast, Elizabeth & Jason will dive into the world of Medicaid billing. You'll have a basic understanding of Medicaid billing and be equipped with the knowledge and confidence to navigate this vital aspect of our profession and have the knowledge to be able to advocate for more support from your supervisors.

Listen now to learn the following objectives:

  • Learners will understand the process of Medicaid billing in schools.

  • Learners will identify how to advocate for support with their supervisors.

  • Learners will identify the importance of completing random moment time studies.

Guest(s) Bio

Elizabeth Duncan, OTR/L is a school-based occupational therapist in Louisiana and started coordinating to help her peers understand Medicaid. She is now the Education Program Consultant of Health Communities for the Louisiana Department of Education.

Jason Coker, Certified Internal Auditor, has extensive experience providing monitoring and agreed-upon procedures (AUP) services to the Louisiana Department of Health (LDH), focusing primarily on time study administration and cost report review for the Louisiana School-Based Medicaid Claiming program.

Leveraging his internal audit experience and training, he manages P&N’s involvement in this program, providing support through quarterly random moment participant sampling, desk review of claims and cost reports, and monitoring of the records supporting the claims for a selected sample. Jason provided critical input in the development of the State Plan and Time Study methodology for CMS approval.

Through his work with LDH, Jason has developed a deep knowledge of numerous Medicaid programs, their requirements, and the various reimbursement methodologies used by CMS, and has experience in the design, development, and implementation of monitoring and compliance initiatives.


“We're skilled service providers, and we're also trained to document, so we are providing medically necessary services...when we're evaluating our students and we are treating them based on our plan of care."

-Elizabeth Duncan, OTR/L

"Advocate for your profession, advocate for your services and advocate for your state if they have not already expanded."

-Elizabeth Duncan, OTR/L

"Medicaid does not require documentation. The service that you're providing requires you to document that service."

— Jason Coker, Certified Internal Auditor

"School districts are not allowed to use federal funding to draw down federal funding. It's called double dipping."

— Jason Coker, Certified Internal Auditor

"Medicaid does not require documentation. The service that you're providing requires you to document that service."

— Jason Coker, Certified Internal Auditor

"I think that's important, just from within your own district to make sure that you're doing these right. Make sure you're filling out those random moment time studies because people do see them."

— Jayson Davies, MA, OTR/L


Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners!

Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now!

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