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  • CMS Changes July 1 Functional Limitation Reporting Instructions for Current Patients

    In response to concerns raised by APTA, providers, and other stakeholders, CMS has changed its functional limitation reporting instructions for claims submitted for each patient's first visit on or after July 1, 2013.

    As a result of the change, therapy providers who have submitted functional limitation data (G-codes) on Medicare Part B patients prior to July 1 will not need to restart functional limitation reporting on the first date of service on or after July 1. Instead, for these patients only, therapists can wait to submit functional limitation data until the next required reporting interval (eg, at the patient's 10th visit or at discharge).

    However, for beneficiaries whose treatment began prior to July 1, but for whom functional limitation reporting information has not been submitted prior to July 1, therapists must submit data on the first claim with a date of service on or after July 1.

    Functional limitation data will be required for all new patients as of July 1.

    CMS notified APTA of this change via e-mail yesterday. For more information on functional limitation reporting, including updated FAQs and a list of measures identified for high-volume conditions, visit APTA's functional limitation reporting resource page.


    • HALLELUJAH!!!!! We were just discussing this this morning and it was developing into a scheduling nightmare! Thank you for the clarification.

      Posted by Angie on 6/18/2013 10:34 AM

    • This is fantastic news! Thank you for the update.

      Posted by James Buchanan -> AJScEL on 6/19/2013 11:59 AM

    • We are trying to determine New York status as to whether or not CMS has dropped the 30 day timeframe to report new G codes, OR if they can just be reported at 10th visit?

      Posted by Stephen W. Bassin,PT,DPT on 6/20/2013 11:46 AM

    • Please clarify if the FLR pertains to Medicare Advantage plans such as Excellus, Humana, United Healthcare or strictly Medicare Part B patients only. Thanks for the update!

      Posted by DBSouthwick on 6/20/2013 4:07 PM

    • Great news! It would have been such a problem for those of us who have been hard at work trying to implement these procedures for the last 6 months.

      Posted by Stella on 6/21/2013 5:00 PM

    • On those patients who have not had G-code data submitted before July who have been receiving PT, do we submit progress data as they've been receiving PT vs. starting new G-code data even though they are not techically starting as new patients on July 1?

      Posted by Bruce Buley on 6/21/2013 5:11 PM

    • Mahalo from South Kona Physical Therapy for this update. We've been working through the FLR on our WebPT program for over a month now and really hated to think of starting over again.

      Posted by Betty Fackler on 6/22/2013 12:33 AM

    • Great news? Halleluja? Why are we providing statistical research unrelated to the primary focus of care we are providing in the first place? This provided CMS at no charge? Reduced reimbursement combined with 2 additional layers of examination and documentation.

      Posted by Gary on 6/24/2013 10:48 PM

    • Anybody know if we need to do this CBOR stuff when Medicare B is secondary?

      Posted by Charles Kibbey on 6/27/2013 11:42 AM

    • This will lead to the next step, managed care payment related to the functional limitation codes only. Every code will receive X amount of $$$, even the APTA playing into it with the new payment plans related to severity. Where do our clinical, patient individualized skills go, if we put patients in a limited amount of groups provided? It is dumbing down our professional, clinical knowledge and uncle Sam is loving it! And we want all PT's to have a doctorate to be recognized????

      Posted by Caren on 6/29/2013 6:13 PM

    • Thank You Gary & Caren for the 6/24 posts; I concur.

      Posted by Devra on 7/6/2013 12:55 AM

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