Today I want to talk about the Change of Therapy (COT) Other Medicare Required Assessment (OMRA). There are a couple of major points that should be kept in mind when considering whether COT OMRA needs to be completed. For one, how do we manage our therapy case load to prevent continually needing to complete an off schedule assessment for our PPS or our Medicare Part A patients? Always remember the COT OMRA is generated because there needs to be a change in the level of payment. This is due to the level of therapy intensity that is being provided. So, if you have a PPS Assessment and it generates a nursing RUG classification, a nursing RUG score is being paid for a particular PPS Assessment. If Therapy is involved, you are monitoring your COT Assessment Reference Dates, and the change in therapy intensity decreases, you do not need to complete a COT OMRA (if you are being paid at nursing RUG level). Many times it is forgotten that this is both clinically related as well as payment related.