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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  • 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 …

  • 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 …

  • articleJun 27, 2013 | 6 min. read

    Functional Limitation Reporting and You: What You Need to Know

    Wow, can July 1 really be right around the corner? Seems like yesterday we were only finding out about the requirement to document and report functional limitation G-codes and severity/complexity modifiers, and I think it really was only yesterday that CMS figured out how they would work. Let me start by making sure you understand that functional limitation reporting (FLR) and PQRS are separate and distinct programs and that each program has its own set of codes …

  • The Basics of Functional Limitation Reporting Image

    articleMay 2, 2013 | 3 min. read

    The Basics of Functional Limitation Reporting

    Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on Medicare part B patients in order to receive reimbursement for your services. While WebPT can monumentally help with this task through our soon-to-be-released integrated functional limitation reporting feature, it’s important that you still understand FLR thoroughly, especially because clinical judgment does play a large role in its completion. So, with that in mind, let’s tackle the basics of FLR. Why functional limitation …

  • Ain’t Nothin’ But a G-Code, Baby. What You Need to Know About the New G-Codes. Image

    articleAug 20, 2017 | 6 min. read

    Ain’t Nothin’ But a G-Code, Baby. What You Need to Know About the New G-Codes.

    Like the ’90s hip-hop-themed title of this blog post implies, Functional Limitation Reporting G-codes may be new, but they’re nothing to fret over. Essentially, effective July 1, 2013, CMS began requiring therapists to report new G-codes in an effort to further emphasize function and functional progress in therapy treatment. But the good news is that you should already be assessing—and documenting—functional progress as part of your short- and long-term goal setting at the initial evaluation, tenth visit …

  • 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 …

  • Most Frequently Asked Questions From Our Functional Limitation Reporting Webinars Image

    articleMay 22, 2013 | 12 min. read

    Most Frequently Asked Questions From Our Functional Limitation Reporting Webinars

    Today's blog post comes from WebPT Senior Writer Charlotte Bohnett, contributing writer Erica Cohen, and WebPT Co-Founder Heidi Jannenga, PT. Monday and Tuesday we hosted webinars on functional limitation reporting. We got tons of great questions. Here are the most frequently asked ones: The Basics What is functional limitation reporting? Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare part B patients in order to receive reimbursement for your …

  • 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 …

  • 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 …

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