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.

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  • Common Questions from our G-Code Denials Webinar: Part 2 Image

    articleJul 30, 2014 | 4 min. read

    Common Questions from our G-Code Denials Webinar: Part 2

    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 …

  • When to Report Discharge Codes with Functional Limitation Reporting Image

    articleMar 5, 2014 | 3 min. read

    When to Report Discharge Codes with Functional Limitation Reporting

    Lately, there’s been a bit of confusion surrounding Medicare’s requirements for submitting functional limitation reporting (FLR) discharge codes. Due to a “glitch” in the way Medicare processes claims containing FLR data, some therapists have received claim denials for cases involving tricky discharge reporting scenarios. So, we’ve put together a guide to address some common head-scratching situations. Read on to learn when you need to discharge and when you don’t. Patient Self-Discharges and Returns After 60 or More …

  • articleJul 24, 2013 | 3 min. read

    Help! Medicare Rejected My Claim. Now What?

    So, you submitted a claim lacking functional limitation reporting to Medicare after July 1. Uh oh. By now, you’ve probably received a polite rejection letter telling you that Medicare will not be providing you with reimbursement for your services—and neither will the beneficiary. What’s a PT, OT, or SLP to do? Well, unless you actually completed a full functional limitation assessment during your patient’s evaluative visit and simply forgot to include the corresponding G-codes and severity modifiers, …

  • 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 …

  • articleFeb 5, 2013 | 3 min. read

    Embracing Functional Limitation Reporting

    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 …

  • articleJul 3, 2013 | 5 min. read

    Most Frequently Asked Questions From June’s FLR Webinar

    Last month, WebPT hosted another fantastic functional limitation reporting (FLR) webinar . If you missed it or simply want a refresher, this post is for you. Here were the most frequently asked questions and answers: Q: How do I handle functional limitation reporting after July 1 for a current patient with no FLR data on record? A: If you haven't submitted functional limitation reporting data on a patient prior to July 1, you should submit it (current …

  • articleNov 5, 2013 | 3 min. read

    Founder Letter: PQRS 2014

    Well, it’s November already, and that means two things: Thanksgiving and Physician Quality Reporting System (PQRS). Sure, PQRS doesn’t involve mouthwatering roasted turkey, savory stuffing, or creamy mashed potatoes, but it has become quite the November tradition for us here at WebPT. You see, this is the time of year that the Centers for Medicare & Medicaid Services (CMS) typically confirms the details of next year’s reporting requirements, thus allowing us to update our PQRS solution (claims- …

  • 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 …

  • Back to Basics: Functional Limitation Reporting G-Codes Image

    articleFeb 11, 2013 | 7 min. read

    Back to Basics: Functional Limitation Reporting G-Codes

    We’ve covered the ins and outs of G-codes as well as how it easy it will be to implement them successfully within WebPT —and why an integrated functional limitation reporting solution is the best solution . Today let’s go back to the G-code basics. What’s a G-code? Effective July 1, 2013, CMS will require therapists to complete functional limitation reporting through the use of new G-codes and corresponding severity modifiers for all eligible Medicare patients at the …

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