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 are the main things you need to know about functional limitation reporting (follow the links to learn more about each item):

  • The functional limitation reporting mandate only applies to patients using Medicare proper as their primary or secondary insurance. It does not include patients with Medicare replacement or Medicare Advantage plans.
  • You must complete functional limitation reporting at the onset of therapy (i.e., initial evaluation), at reevaluation (if appropriate), at minimum every tenth visit (progress note), and at discharge.
  • As you decide which severity modifier to choose, you must consider both the results of the outcome measurement tool(s) you use as well as your clinical judgment. You absolutely should not crosswalk an OMT score directly to a percentage of impairment—this defeats the purpose of functional limitation reporting.
  • If you issue an Advanced Beneficiary Notice of Noncoverage (ABN) to a Medicare patient, you still must complete functional limitation reporting on that patient—even if you know Medicare will deny the claim, leaving the patient responsible for covering the cost of treatment.

 

Well, that pretty much covers the nuts and bolts of FLR. (You can pull your head out of the sand now.) Still have questions? Head over to functionallimitation.org, where you can check out a list of frequently asked questions, watch an FLR webinar, and test your knowledge with a ten-question quiz.

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  • articleJun 27, 2013 | 6 min. read

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    articleMay 22, 2013 | 12 min. read

    Most Frequently Asked Questions From Our Functional Limitation Reporting Webinars

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    articleMay 2, 2013 | 3 min. read

    The Basics of Functional Limitation Reporting

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    articleMar 5, 2014 | 3 min. read

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  • articleMay 23, 2013 | 4 min. read

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    articleJul 30, 2014 | 4 min. read

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    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 …

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