Primary Care Reimbursement: Current Processes and Future Advocacy

Credentials Display

Brenda Koverman, PhD, MBA, MS, OTR/L, FAOTA; Monika I. Robinson, DrOT, OTR/L; Lydia Royeen, PhD, OTR/L

Abstract

Occupational therapy’s (OT) role in primary care is emerging as a viable practice area. Yet, operational efforts that include reimbursement continue to lag and have been identified as a barrier to entry. Current literature reveals confusing and overlapping reimbursement descriptions. Payment for services is critical for the sustainability of this practice area. This paper proposes a taxonomy to assist frontline clinicians, leaders, and provider practice managers to determine the best reimbursement strategy for their specific clinic. Differentiating and defining payment models, reimbursement determinants, and reimbursements methods allows OT leaders a shared language. Implementing the best reimbursement tactic will ensure the fiscal viability of the OT department and the provider practice. Advocacy efforts around reimbursement can strengthen OT's role in primary care and includes( a) increasing knowledge of reimbursement options, (b) engaging with professional organizations, and (c) using outcome measures will ensure a successful and sustained primary care service program. Access to OT services in primary care can only occur when effective and correct reimbursement strategies are used.

Recommended Citation

Koverman, B., Robinson, M. I., & Royeen, L. (2026). Primary Care Reimbursement: Current Processes and Future Advocacy. The Open Journal of Occupational Therapy, 14(3), 1-14. https://doi.org/10.15453/2168-6408.2499