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.

WebPT + Billing Software - Regular BannerWebPT + Billing Software - Small Banner
  • 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 …

  • The Complete PT Billing FAQ Image

    articleMay 24, 2016 | 25 min. read

    The Complete PT Billing FAQ

    Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. (And be sure to check out this separate PT billing FAQ we recently put together.) Questions …

  • 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 …

  • articleNov 6, 2013 | 2 min. read

    Functional Limitation Reporting in a Nutshell

    Hopefully, you’ve been working your functional limitation reporting (FLR) magic for months now, so you’ve got it down pat. If not, you’re probably running into more than your fair share of claim denials. Don’t worry; we’re here to help. Here are some FLR basics in a convenient chestnut shell. (It is almost that time of the year , after all). What is FLR? Beginning July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) require that …

  • 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 …

  • Common Questions from our G-Code Denials Webinar: Part 1 Image

    articleJul 29, 2014 | 6 min. read

    Common Questions from our G-Code Denials Webinar: Part 1

    Today’s blog post comes from WebPT writers Brooke Andrus and Erica Cohen. If a patient has more than one functional limitation associated with a single diagnosis, should I report G-codes and severity modifiers for all of them? No. Medicare will only accept functional limitation reporting (FLR) data for one primary functional limitation per case. Therefore, if the patient has multiple functional limitations associated with a single diagnosis, you'll need to determine which one represents the patient's primary …

  • 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 …

  • webinarMay 21, 2013

    Get Ready for Functional Limitation Reporting

    Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare patients in order to receive reimbursement for your services. We know you want to get paid. That’s why it’s crucial you have functional limitation reporting down pat. With that in mind, WebPT will host a special webinar on May 20 to help you get fully prepared for FLR. In this 60-minute session, hosts Heidi Jannenga and Mike Manheimer will explain …

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