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.

PQRS G-Codes

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!

FLR G-codes

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.

The Differences

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.

Have more questions about G-codes (or what to buy on QVC)? Comment in the section below; we love it when you do.

Triumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success - Regular BannerTriumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success - Small Banner
  • 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 …

  • The Scoop on PQRS Image

    articleNov 18, 2013 | 5 min. read

    The Scoop on PQRS

    What is PQRS? The Centers for Medicare and Medicaid Services (CMS) developed Physician Quality Reporting System (PQRS), which mandates that eligible professionals meet standards for satisfactory reporting. If you are not PQRS-compliant in 2014, CMS will assess penalties. However, we do not yet know what the penalty amount is or how CMS will assess it. There also is a chance that CMS will provide incentive payments for successfully completing PQRS, as they did in 2013. Again, we …

  • 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- …

  • Founder Letter: 6 Predictions for 2016  Image

    articleDec 3, 2015 | 10 min. read

    Founder Letter: 6 Predictions for 2016

    According to Merriam-Webster , a prediction is “a statement about what will happen or might happen in the future.” I don’t know about you, but when I think about what’s in store for our industry, I’m not satisfied with applying that definition to my hopes for the future. Why? Because I’m about more than just making statements; I’m about taking action. So, how do we take steps to improve our bottom lines, the quality of our care, …

  • articleFeb 8, 2011 | 3 min. read

    PQRI and PQRS Explained for PTs

    In our effort to simplify the clinical environment while maintaining quality and compliance, we decided to dedicate this month the exciting topic of Medicare Regulations. This topic can to be either terrifying or boring for PTs, but it is something that must be considered and is equally important in patient care. This article aims to clear up some of the most common questions regarding the program formally known as PQRI. For your convenience I have translated the …

  • How to Complete Functional Limitation Reporting in WebPT Image

    articleFeb 19, 2014 | 4 min. read

    How to Complete Functional Limitation Reporting in WebPT

    As of July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) requires that therapists complete functional limitation reporting (FLR)—through the use of  G-codes and severity modifiers —on all eligible Medicare Part B patients at the initial evaluation, re-evaluation if applicable, every progress note (minimum of every ten visits), and discharge in order to receive reimbursement for their services. Today, several other private insurance companies also require FLR data as a condition of reimbursement. Good thing …

  • articleNov 21, 2013 | 4 min. read

    How an EMR Helps You Stay Medicare Compliant

    Confidence and compliance are two words rehab therapists rarely put in the same sentence. Sure, they know that therapy cap requirements, functional limitation reporting , PQRS , the 8-minute rule , and MPPR are all Medicare regulations. But beyond that, memories get a bit fuzzy—and that’s understandable. It’s a lot to keep straight, let alone accurately follow. Yet, Medicare requires compliance; otherwise, they’ll deny payment or dole out fines. They don’t care that you’re busy treating patients, …

  • articleNov 4, 2013 | 3 min. read

    What PQRS Could Look Like in 2014

    On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) in the Federal Register. According to this summary , most of the policies were open for comment until September 6, 2013 and, pending final decisions (which hopefully will occur this month), will take effect on January 1, 2014. The 605-page document contains proposals for policy changes on everything from reimbursements to the …

  • Last Legs: The Compliance Vulnerabilities of Dead or Dying Software Image

    articleOct 24, 2016 | 5 min. read

    Last Legs: The Compliance Vulnerabilities of Dead or Dying Software

    Rusty mechanical equipment. Creaky carnival rides. Wobbly chairs. People are naturally skeptical of things that are dilapidated, rundown, or slipshod—and with good reason. After all, that which is ramshackle usually isn’t reliable. Now, imagine it’s the physical therapy software you use everyday to run your rehab therapy practice that’s gone derelict. Take PTOS EMR, for example , because if you didn’t know, this therapy office software is going out of business, and it has ceased all updates …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.