WebPT Blog - PQRS
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0 CommentsMay 22, 2013| Charlotte Bohnett
Today's blog post comes from WebPT Senior Writer Charlotte Bohnett, contributing writer Erica Cohen, and WebPT Co-Founder Heidi Jannenga, PT.
Monday and Tuesday we hosted webinars on functional limitation reporting. We got tons of great questions. Here are the most frequently asked ones:
The Basics
What is functional limitation reporting?
Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare part B patients in order to receive reimbursement for your services. Essentially, FLR is a type of reporting focused on the progress of the patient through measurable goals, and supporting documentation is required for reimbursement.
Who created FLR?
CMS developed functional limitation reporting as part of the Middle Class Tax Relief Act of 2012, which mandated the collection of the following information regarding the beneficiaries on the claim form: function and condition, therapy services furnished, and outcomes achieved on patient function. CMS is enforcing noncompliance.
Why functional limitation reporting?
CMS created FLR to collect information regarding beneficiaries’ functions and conditions, the services therapists provide, and the functional outcomes patients achieve. CMS will use all of this information to better understand the beneficiary population that uses therapy services and how their functional limitations change as a result of the therapy they complete. Furthermore, CMS will use the data they collect to reform future payment structures.
Does FLR apply to rehab therapists?
According to the APTA, “All practice settings that provide outpatient therapy services must perform FLR. Specifically, FLR applies to physical therapy, occupational therapy, and speech-language-pathology (SLP) services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and nonphysician practitioners.”How does FLR work?
Therapists will report functional limitations (current status and projected goal for initial examination and at minimum every tenth visit or progress note, and then discharge status and projected goal at discharge) using G-codes and corresponding severity modifiers for all eligible Medicare patients.What are G-codes and severity modifiers?
G-codes are quality data codes therapists will use to describe their patients’ functional limitation—that is, the primary reason they’re seeking therapeutic services. Upon identifying the primary functional limitation, the therapist will select the corresponding G-code and then assign a severity modifier, which indicates the extent of the severity of the functional limitation. Therapists select an appropriate severity modifier based on the score of an outcome measurement tool as well as their skilled clinical knowledge. Lastly, therapists must also include a therapy modifier (GO, GP, and GN) to indicate that they’re providing therapy services under an OT, PT, or SLP plan of care, respectively.For a full list of the FLR G-codes and a severity modifier chart, check out this blog post.
What are the benefits of FLR?
With FLR, rehab therapists finally have an outlet to prove that what they do clinically is relevant and deserves payment. It’s an opportunity for rehab therapy professionals to demonstrate the value of their profession. FLR also allows rehab therapists to incorporate clinical judgement to truly assess the severity of a patient’s functional limitation without relying on patients’ faulty self-assessments, and that leads to better, more effective treatment.
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May 8, 2013| Brooke Andrus
We believe in empowering the entire rehab community to achieve greatness in therapy practice. That’s why we created WebPT, an intuitive, web-based EMR solution exclusively for rehab therapists that offers comprehensive documentation, scheduling, practice management, and billing services.Don’t let the name fool you; WebPT isn’t solely for physical therapists. Rather, it’s for the entire rehab therapy community, and we’ve custom tailored our EMR solution to suit the practice of occupational therapy. Here’s how:
OT-Specific Documentation
WebPT contains a whole separate user profile for occupational therapists. As soon as you select an OT user type, WebPT automatically loads all of our OT-specific items into your clinic’s account.
In addition to OT billing codes and Medicare therapy cap-tracking, WebPT features tons of OT-related tests and tools—like our Activities of Daily Living (ADL) profile; our Disabilities of Arm, Shoulder, and Hand (DASH) test; our upper extremity functional test; our shoulder pain and disability index; plus a host of special tests geared toward hands and joints. And speaking of hands—OTs specializing in hand therapy (like Laura Berger of Maui Hand Therapy) absolutely love our detailed wrist/hand profile. They also love being able to document and bill for custom orthoses, casts, and splints right in WebPT.
Plus, every document you create in our system will have an occupational therapy label—and your clinic’s name and logo—right at the top of the page, so the source and content of your emailed and faxed documents is immediately clear to referring physicians and other recipients. And you can send out those documents directly from the WebPT system. Cool, huh?
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Mar 11, 2013| Erica Cohen
Today's blogs post comes from WebPT Co-Founder and PT Heidi Jannenga, Marketing Manager Mike Manheimer, and Senior Writers Erica Cohen and Charlotte Bohnett.
Last month’s webinar on Medicare was our most highly attended webinar to date. And that’s really not surprising, because wherever Medicare goes, questions follow. But unfortunately, we couldn’t get to them all live. So we thought we’d put together a blog post will all the great questions you asked and our answers. That way, you can access it wherever, whenever you want. Ready to jump in? Here’s your Medicare Q&A.
(P.S. Are you a first timer to thiswebinar or looking for a refresher? Click here to rewatch the webinar.)
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Feb 12, 2013| Charlotte Bohnett
What is PQRS?
Created by Center for Medicare and Medicaid Services (CMS), Physician Quality Reporting System (PQRS) mandates that physical therapists, occupational therapists, and qualified speech-language therapists meet the standards for satisfactory reporting. If you are not PQRS compliant in 2013, CMS will assess penalties of 1.5% of your Medicare payments as fines in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period.
Why WebPT?
While it seems like a pain, PQRS is absolutely necessary. Save yourself the headaches—and fines—and let WebPT manage PQRS for you. We’re a Certified PQRS Registry, so with us, staying compliant is easy. Here are the benefits:- Avoid a 1.5% reimbursement penalty in 2015
- Earn a 0.5% incentive payment
- Let WebPT manage PQRS for you with our registry-based reporting method
- Improve measure reporting efficiency through our EMR
- Ensure compliance
- Elevate your clinic’s standard of care while saving yourself time, money, and stress
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Dec 6, 2012| Charlotte Bohnett
On Thursday, we presented an educational PQRS webinar, and it turned out to be one of our most heavily attended webinars in WebPT history. Missed it or want a refresher? Watch the PQRS webinar in its entirety below.
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Nov 20, 2012| Charlotte Bohnett
Today's blog post comes from Senior Copywriters Erica Cohen and Char Bohnett.
‘Tis the season for PQRS. Why the hullabaloo? Because beginning in 2013, not complying with PQRS requirements will result in penalties, which CMS will assess as fines (starting at 1.5% of your fee schedule) in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period. With the impendency and necessity of PQRS reporting, we’ve dedicated this month to blog posts on all things PQRS.Recently, CMS released new information about the PQRS 2013 outcome measures. Compliance guru Tom Ambury will be contributing a blog post with more details in the coming weeks but for now, here’s a brief rundown:
According to the APTA, these are the top 5 measures PTs and OTs used in 2010:
- 131 Pain Assessment Prior to Initiation of Patient Treatment*
- 154 Falls: Risk Assessment*
- 130 Documentation and Verification of Current Medications in the Medical Record*
- 155 Falls: Plan of Care*
- 128 Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-Up*
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Nov 13, 2012| Charlotte Bohnett
Today’s blog comes from WebPT Copywriters Char Bohnett and Erica Cohen.
If you pay attention to our blog posts this month, you may notice a theme. That’s because we always have themes, but this particular month is über important. For us here at WebPT, November is synonymous with PQRS prep. So we thought we’d share our vast PQRS knowledge with you, giving you all the info you need to prepare yourself for 2013.
Today, we’ll cover the two ways you can report your PQRS and how we can help.
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Nov 12, 2012| Charlotte Bohnett
In an effort to improve quality of reporting in the healthcare industry, the Center for Medicare and Medicaid Services (CMS) created the Physician Quality Reporting System (PQRS), which mandates that physical therapists, occupational therapists, and qualified speech-language therapists meet the criteria for satisfactory reporting. Beginning in 2013, not complying with PQRS requirements will result in penalties, which CMS will assess as fines (starting at 1.5% of your fee schedule) in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period.
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Nov 7, 2012| Charlotte Bohnett
Today’s blog post comes from WebPT Senior Copywriters Erica Cohen and Charlotte Bohnett.We do this every year: waiting and wondering what Medicare is going to do. As the news trickles in—and details are still coming—it all seems as expected so far. So what are the big takeaways? Here is WebPT Co-Founder and COO Heidi Jannenga’s take on what these CMS changes mean for you and your clinic.
First of all, CMS increased the therapy cap by $20 to $1,900 (from $1,880 in 2012) for physical therapy and speech therapy combined and $1,900 for occupational therapy. While this may not seem huge, it’s better than the cuts they once considered imposing. With this ruling, the automatic exemption process will also no longer be in effect after December 31, 2012. That means you will need to appeal based on medical necessity for continued treatment over the cap amount; it won’t be as simple as adding the KX modifier to your billing and supporting it with documentation anymore. Additionally, CMS’s ruling includes a 26.5% reduction to medicare payment rates for physicians, physical therapists, and other professionals. However, if Congress acts by the end of the year (as I think they will), we won’t experience this cut, and they will most likely outline some sort of exception process. Ultimately, we’ll know the outcome for both of these issues as soon as congress comes back into session at the beginning of the new year.APTA, CMS, compliance, fee schedule, G code, medicare, policy, PQRS, therapy cap -
Nov 6, 2012| Erica Cohen
Today's blog post comes from WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L.Can you believe it’s already November? That means two things: Thanksgiving and PQRS 2013 (if you treat Medicare patients, of course). I know we’d much rather fill our thoughts—and bellies—with turkey, dressing, and buttery mashed potatoes. But you have to make room somewhere for Physicians Quality Reporting System (PQRS, formerly known as PQRI). You can’t smother it with gravy or tuck it behind excess cans of cranberry jelly because while PQRS might induce thoughts of dread, it is absolutely necessary—and contrary to popular belief, not all that challenging or stressful.
Let’s start off with the basics. 2013 is the first year that PQRS is “mandatory.” I mean you could skip it, blow it off completely, or pretend you didn’t know, but before you do that, you should know that CMS will penalize you in the form of a 1.5% adjustment on your fee schedule in 2015. I don’t know about you, but my clinic couldn’t afford that. Now if you say that Uncle Sam, or the government, might dilly dally on all this, let me say that insurance regulations are tightening and pay for performance methodologies are quickly becoming the name of the game. It’s inevitable. So why fall behind? Get with the program and meet PQRS head on. Plus, this year, compliance will earn you a 0.5% incentive payment on your total allowed charges during the reporting period.
