APTA has posted a new chart to help members understand the differences between the Physician Quality Reporting System (PQRS) program and a congressionally mandated
functional limitation reporting program that begins January 1, 2013. The chart can be found on APTA's Functional Limitation Reporting Under Medicare webpage.
The Middle Class Tax Relief Act of 2012 mandated that the Centers for Medicare and Medicaid Services (CMS) begin functional limitation data collection on January
1, 2013, for Medicare beneficiaries. The new functional limitation reporting will be done through nonpayable G-codes that are similar in their appearance to PQRS quality data codes. The functional limitation reporting will be visit-driven and must be completed on evaluation, every 10th visit, and at discharge. All practice settings that provide outpatient therapy services must include this information on the claim form. Specifically, the policy will apply to physical therapy, occupational therapy, and speech-language-pathology services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and nonphysician practitioners.
Simultaneously, attention is increasing on PQRS as the program changes from an incentive-based program to a penalty program, with the 2013 year being pivotal to the program's changeover, informing both the 2013 bonus and the 2015 penalty. PQRS, the quality reporting program for Medicare Part B, was implemented in 2007. Physical therapists are eligible professionals in this reporting program and can report a variety of measures, including pain assessment on initial evaluation and a measure related to the use of a functional assessment tool. Reporting under the PQRS program is tied to CPT codes. Therapists reporting under this program submit quality data codes for the selected measures with CPT code 97001 and sometimes with 97002.