Today's blog post comes from WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L.

By now, I’m sure you’ve heard about functional limitation reporting—also known as claims-based outcome reporting (CBOR) and G-code reporting. Regardless of what your clinic calls it, functional limitation reporting is coming quickly. In fact, as of July 1, 2013, CMS is making it mandatory. That means they won’t pay you for your services if you don’t properly report functional limitations via specific G-codes on the claim form for each eligible Medicare patient. Now, if you’re a WebPT Member, we got you covered. In mid-spring, we’re integrating functional limitation reporting (G-codes and corresponding severity modifiers) into your documentation workflow, which will make it a breeze to stay compliant—and thus, get paid.

Last month we covered functional limitation reporting basics in several blog posts, a webinar, and an article on Physiospot, but in the midst of all this—and especially at CSM 2013—I’ve realized that in addition to understanding functional limitation reporting inside and out, we need to understand its importance beyond getting paid. While overall the transition to functional limitation reporting is a good thing, it may actually fall short in terms of bringing our profession closer to achieving evidence-based practice on the whole. Why, you ask?

The Good

Functional limitation reporting will allow us to gain tremendous insight into our patients’ and our peers’ patients’ functional outcomes. Just think of what all that data could show based on treatment type and patient demographics, and that goes for us as individual providers and for us as an industry. This is our chance to prove unequivocally that rehab therapy works—and to see which techniques work best. We’re clearly moving towards a pay-for-performance reimbursement structure, and this is an ideal way to demonstrate our patients’ progress with our care. Additionally, this reporting requirement will make us better therapists by insisting that we treat function and not just objective measures. 

The Opportunities

Because this requirement is more heavily focused on the subjective—what the patient thinks and feels—questions remain as to whether it may actually weaken our evidenced-based practice efforts. As an industry, we’ve fully researched and vetted many functional outcome measurement tools as reliable and valid tests. However, they are still based on the subjective complaints of the patient vs. objective measures taken by the therapist. Ultimately, it appears Medicare’s stance is that what the patient thinks and feels is what really matters—which in my opinion is accurate. But it doesn’t appear that Medicare really cares what method or treatment procedures we use to achieve patient improvement—just do it and do it as quickly as possible. This does not promote nor advocate for true evidence-based practice. It’s just by any means necessary.

Go Forward

In the end, though, we can’t let Medicare’s apathetic vibe influence our behavior and practice. While we need to understand and acknowledge the opportunities, it shouldn’t be what we focus on. Let’s hone in on the good. During CSM 2013, in the Autonomy presentation, an attendee stood up and said: “Functional Limitation Reporting is good. It might be more paperwork [which with WebPT, it won’t], but it’ll prove our worth.” That’s the attitude I’m embracing, and I think we all should. We encourage our patients to think positive—no matter how difficult the process or how murky the waters ahead might be. We need to encourage ourselves to do the same.

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  • articleJun 27, 2013 | 6 min. read

    Functional Limitation Reporting and You: What You Need to Know

    Wow, can July 1 really be right around the corner? Seems like yesterday we were only finding out about the requirement to document and report functional limitation G-codes and severity/complexity modifiers, and I think it really was only yesterday that CMS figured out how they would work. Let me start by making sure you understand that functional limitation reporting (FLR) and PQRS are separate and distinct programs and that each program has its own set of codes …

  • articleJan 3, 2013 | 2 min. read

    Now That I Know G-Codes Ain’t No Thang, How Do I Implement ‘Em?

    Last month, we discussed CMS’s new G-codes in a cleverly titled post, “ Ain’t Nothin’ But a G-Code, Baby. ” As the name implies, this new functional limitation reporting mandate is not nearly as daunting as you may think. In fact, if you use WebPT, it’s going to be as easy as pie—cherry pie, or maybe apple. Regardless, I digress. Here, we’ll discuss how with just a few clicks, and some clinical judgment, you can easily implement …

  • articleNov 6, 2013 | 2 min. read

    Functional Limitation Reporting in a Nutshell

    Hopefully, you’ve been working your functional limitation reporting (FLR) magic for months now, so you’ve got it down pat. If not, you’re probably running into more than your fair share of claim denials. Don’t worry; we’re here to help. Here are some FLR basics in a convenient chestnut shell. (It is almost that time of the year , after all). What is FLR? Beginning July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) require that …

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    articleDec 12, 2016 | 4 min. read

    Functional Limitation Reporting Refresher

    The rehab therapy industry is abuzz with PQRS talk right now. In case you missed it: PQRS as it exists today is dunzo . In 2017, it’ll be replaced with the Merit-Based Incentive Payment System , or MIPS. Unfortunately, though—and yes, it is unfortunate —PTs, OTs, and SLPs are not required to complete MIPS reporting until 2019. (And the jury is still out as to whether they’ll be able to voluntarily participate before then.) All outpatient rehab …

  • articleMay 23, 2013 | 4 min. read

    Gaming the System and Other FLR No-Nos

    We all know that functional limitation reporting (FLR)  means (a little) more work for (basically) the same reward. And that can be a hard pill to swallow for many therapists who are already stretched thin as a result of increasing caseloads and increasingly stringent documentation requirements. Even so, taking the easy road—the low road—and gaming the system—and thus, this profession—is not the answer. It never is. This—just like everything else you do for your patients, your practice, …

  • articleMar 11, 2013 | 17 min. read

    February Medicare Webinar Q&A

    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 …

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    articleNov 28, 2012 | 5 min. read

    Functional Outcome Measures

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , based off this month’s “Compliance Chat” blog post . By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny …

  • The Ultimate Functional Limitation Reporting Survival Guide Image

    articleJul 1, 2013 | 3 min. read

    The Ultimate Functional Limitation Reporting Survival Guide

    Oops! You had your head in the proverbial sand regarding all of this functional limitation reporting mumbo jumbo, and now you need a crash-course—stat! Luckily for you, we’ve put together a quick study guide to help you cram for the big change. Think of it as your FLR CliffsNotes—a condensed summary of this new Centers for Medicare & Medicaid Services (CMS) requirement and what you need to do to stay compliant. So, let’s get to it. Here …

  • articleNov 7, 2013 | 2 min. read

    FLR and PQRS: How Are They Different?

    Functional limitation reporting (FLR) and PQRS both fall under the ever-widening umbrella of Medicare regulations, and they both involve outcome measures and data codes. Still, they are completely separate requirements, each with its own set of rules. Confusing, we know. To help you sort out the differences, we’ve put together a short breakdown of each one as well as a detailed compare/contrast chart: The Basics of FLR On July 1, 2013, Centers for Medicare & Medicaid Services …

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