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 (CMS) began requiring that physical therapists, occupational therapists, and speech-language pathologists complete functional limitation reporting on all Medicare patients billed under Part B. The penalty for noncompliance? Automatic claim denial.
To report on patients’ functional limitations, therapists must submit G-codes and corresponding severity modifiers at designated intervals (i.e., current status codes and projected goal status codes at initial examination, at minimum every tenth visit or progress note, and at discharge). At the outset of treatment for a particular episode of care, therapists identify the patient’s primary functional limitation—that is, the main reason the patient sought therapy treatment—and then select the G-code and severity modifier that best represent the category and degree of the limitation. Therapists should base the assigned severity modifier on their clinical knowledge as well as the score of an outcome measurement tool. Finally, therapists choose a therapy modifier—GO, GP, or GN—to designate the type of therapy they are providing: OT, PT, or SLP, respectively.
The Basics of PQRS
PQRS—which stands for Physician Quality Reporting System—is a CMS mandate affecting physical therapists, occupational therapists, and qualified speech-language pathologists. The rule requires eligible clinicians to perform a certain number of applicable outcome measures on a designated percentage of Medicare patients. This percentage differs based on the reporting method the therapist chooses (i.e., claims- or registry-based). Failure to comply with this regulation will result in a financial penalty. In 2013, that penalty amounted to 1.5% of total Medicare reimbursements.
Still have questions about how PQRS and FLR differ? Leave ’em in the comments section below and we’ll do our best to provide an answer.