To avoid payment challenges to functional limitation reporting when you file for outpatient Medicare services provided beginning July 1, submit your claims in sequence.
As a reminder, the testing phase of the functional limitation reporting requirement ends June 30, after which outpatient Medicare claims will be returned unpaid if they don't include the required functional limitation reporting.
On each beneficiary's first treatment date on or after July 1, physical therapists must report the appropriate functional G-codes and corresponding modifiers on the claim form (editor's note: see update below). This includes beneficiaries for whom functional reporting occurred during the testing period. Once Medicare receives the claim, its claims processing system will open a therapy reporting episode and start counting to the next 10 treatment dates of service per the progress reporting period, starting with the first claim containing the appropriate current and goal status G-codes and corresponding modifiers submitted on or after July 1. Submitting claims in sequence will facilitate tracking of treatment dates for the different reporting periods.
For more information and resources on functional limitation reporting, please see APTA's Functional Limitation Reporting webpage, which includes links to PTNow's resources on appropriate tests and measures, and APTA's Functional Limitation Discussion Forum.
Update - June 18, 2013: Some of the information reported above is obsolete, in light of recent changes by CMS. Learn more here: CMS Changes July 1 Functional Limitation Reporting Instructions for Current Patients.
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