FFS, POC, CMS, PQRS, FLR—it can be hard to keep track of Medicare’s long list of acronyms. Throw in G-codes, and you might find yourself drowning in alphabet soup. Even more confusing: we use G-codes for both PQRS and FLR, and yet, these two types of G-codes are not interchangeable.
Let’s start with PQRS. Chances are, if you treat Medicare Part B patients, you’re reporting PQRS G-codes to CMS to either avoid a penalty or receive an incentive (sadly, the incentive part ends in 2014). Eligible professionals report PQRS G-codes as QDCs (i.e., quality data codes). The acronym might sound a lot like QVC, but—believe it or not—QDCs are not nearly as fun as televised shopping from the comfort of your couch. But if you use WebPT and our certified PQRS registry, complying with the requirements is as easy as calling that 1-800 number and ordering yourself a new flameless candle. You simply treat and document, and we prompt you to report on your selected measures. Then, our system applies the corresponding G-codes to your documentation, and we submit the necessary data to CMS on your behalf. If you’re still documenting on paper, you’re probably recording G-codes and submitting that data by hand for every eligible note. Talk about time-consuming!
In 2013, Medicare introduced us to another set of G-codes: those associated with the functional limitation reporting (FLR) program. On July 1, 2013, FLR became mandatory for healthcare professionals providing PT, OT, and/or SLP services to Medicare patients in outpatient settings. To complete FLR, these practitioners must submit G-codes and corresponding modifiers to denote a patient’s primary functional limitation as well as the severity of that limitation. If you use WebPT, all of the G-codes and modifiers are already built into the system, and all of your FLR data automatically flows over to the billing report. Plus, our system prompts you to complete the required reporting at the necessary time intervals—which makes it almost impossible not to comply.
Let’s talk about the differences between PQRS and FLR.
- FLR is mandatory; Medicare will automatically deny your claim if you don’t report. This is true for healthcare professionals providing PT, OT, and SLP services.
- PQRS is not mandatory, but CMS will penalize you—in the form of a 2% payment adjustment—if you do not fulfill the requirements for reporting. This also is true for PT, OT, and SLP.
- You must report FLR data on your claims.
- You can complete PQRS using either claims-based or registry-based reporting. (Check out this blog post to learn more about PQRS reporting methods.)
- You must complete FLR at the initial evaluation, for any re-evaluation, every ten visits (or progress note), and upon discharge.
- The CPT code (usually 97001 or 97002) for a particular claim determines whether you’ll complete PQRS.
You cannot use PQRS G-codes and FLR G-codes interchangeably. Yes, they have the same name, but they do not perform the same function. This can get confusing, which makes a good EMR all the more important. If you’re using an EMR solution, you should ensure that the system includes both FLR and PQRS reporting solutions.
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