Today marks the one-year anniversary of the mandatory implementation of functional limitation reporting (FLR). While it might not be an occasion worthy of streamers, cake, and noisemakers, this anniversary definitely warrants a moment of reflection. Despite the months-long FLR testing period, July 1, 2013, still hit our industry like a punch to the gut.
Assuming you’re a medical professional who provides outpatient therapy services to Medicare patients, you may have experienced this FLR gut punch, too. Since November of last year (when CMS finally got the appropriate edits in place), Medicare has been denying all claims that do not accurately report functional limitation G-codes and corresponding severity and therapy modifiers. Initially, rehab therapists felt frustrated and nervous about this additional reporting burden—and understandably so. But we buckled down, and we reported. We tackled, head-on, something rather complicated—and that’s worth celebrating.
More importantly, we didn’t resist the change, nor did we merely grin and bear it. We faced FLR with our heads held high, and I believe that’s because we as therapists have come to understand the benefits of FLR. After all, this reporting affords us a unique opportunity to demonstrate our expertise and relevancy—in an objective, standardized way—and get paid for it. We were already doing what FLR required; with the new mandate, we simply had to begin documenting it according to Medicare’s standards, using measurements that clearly show our clinical relevance and the amazing outcomes we achieve every day in clinics across the US. FLR also allows—actually, demands—us to incorporate clinical judgment to truly assess the severity of a patient’s functional limitation without relying on patients’ faulty self-assessments, and that ultimately leads to better, more effective treatment. This is different than how we operated previously, basing much of our validation on hearsay and anecdotes. With FLR, we have the opportunity to take advantage of real, objective data. But that also means we have to actually report real, objective data. Otherwise, it’s garbage in, garbage out. And that will not help us take advantage of FLR as a platform to show our worth.
That all said, FLR certainly hasn’t been all sunshine and rainbows. We’ve had to get used to using G-codes, severity modifiers, and therapy modifiers, and we’ve had to stay on top of reporting them at the required intervals. Some of us might have tweaked our workflows or introduced new tools—like WebPT—to help ease the burden of reporting and ensure compliance. Beyond that, there have been some major bumps in the road—unforeseen challenges that we’ve had to overcome. And there are still some we’re battling, like Medicare errors causing perfectly correct FLR reporting claims to be denied. (If that sounds all too familiar, be sure to join us on July 25 for our webinar: Stop the Denials! How to Report G-Codes so You Get Paid.)
Now that you’ve got a full year of FLR reporting under your belt, it’s probably starting to feel more like second nature, and as a result, you’re able to tell your patients’ stories in a way that validates you and your services. And that’s certainly something that deserves a few fireworks—or at least a pat on the back.
