I heard that some private insurance carriers are now requiring functional limitation reporting. Is this true?

Some non-Medicare insurers do require functional limitation reporting (e.g., Texas Workers' Compensation). Check out this blog post to see a list of the ones we know about right now. Keep in mind, however, that this list is ever-changing—so if you’re unsure of whether a particular plan requires FLR, be sure to inquire directly with the carrier.

If I did not submit G-codes on a claim that was supposed to contain them, is there a way to correct the error?

If you completed an outcome measurement tool and documented appropriately during the patient's last visit but simply forgot to attach the corresponding G-codes to the claim, you can create an addendum containing the missing codes and resubmit. However, as explained in this blog post, adding an addendum could create a red flag for Medicare, so you have to be sure your documentation is complete, correct, and totally defensible. If you forgot to complete a full functional limitation assessment during the visit in question, there is not much you can do to reverse the denial. Simply complete FLR on the patient's next visit to ensure you don't receive another one. For more information on how to handle an FLR claim denial, check out this article.

Can I report G-codes at every visit just to be safe?

In order to accurately report functional limitation data, you should perform an outcome measurement test and use that information, along with your clinical judgment, to gauge your patient's current status and projected goal status. Reporting FLR on every visit isn't so much "against the rules" as it is unrealistic—and unnecessary. It's our recommendation to follow the FLR guidelines and stick to reporting FLR only on initial examinations, re-examinations, progress notes, and discharge notes.

Does the severity modifier need to change between reporting intervals for claims to be paid? In other words, does the data need to indicate improvement?

No. Payment of the claim is only dependent on submitting the correct data. It has nothing to do with whether the data shows that the patient is improving. Furthermore, because the range of impairment that severity each modifier covers is 20%, it is not out of the ordinary for a patient to have the same severity modifier for multiple progress notes.

Can I submit a discharge G-code when a patient unexpectedly stops attending therapy based on information from his or her last session?

No. You should only submit G-codes on billable claims. If the patient self-discharges, you wouldn’t submit a claim after the fact because you did not see or treat the patient. Instead, complete a quick discharge note (discharge summary) that includes functional limitation reporting information. Even though you won’t actually submit a claim to Medicare, you will at least have a clear picture of the patient’s status at the time of discharge so that if the patient returns, you'll know exactly where he or she left off.

Has WebPT addressed all of these tricky functional limitation reporting scenarios within the application?

WebPT is set to release an update to our functional limitation reporting feature at the beginning of August. This update will address all of the reporting scenarios covered during the webinar.

I’m receiving denials even though I’m reporting G-codes correctly. Are other therapists having this problem?

Unfortunately, yes. In many cases, therapists are receiving denials for G-codes even though they are reporting everything correctly. In such cases, you should first contact your local MAC and then, if you’re an APTA Member, submit a complaint form at apta.org/FLR/ComplaintForm/.

In case you missed it--you can read Part 1 here!

Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans - Regular BannerSuppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans - Small Banner
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