APTA members' willingness to share their experiences of claims processing errors and payment delays related to functional limitation reporting (FLR) enriched the information that APTA staff provided to representatives of the Centers for Medicare and Medicaid Services (CMS) during a recent meeting. During that same meeting CMS provided information on how claims on "1500" forms are processed that APTA believes may help physical therapists (PTs) avoid split claims in the future.
Over the past 2 months, APTA received numerous complaints from members about FLR, which in turn helped association staff pinpoint specific systems problems in claims processing. The systems issues were brought to CMS as part of a discussion around changes that could be made to the program.
As part of that discussion CMS explained that its current system can accommodate no more than 13 line items on a 1500 claim form. Given this information, APTA believes that PTs may experience more efficient processing and find their claims less likely to be split if they submit claims with no more than 12 line items.
The FLR program was implemented in October 2013 after being delayed from its original July 1 launch. System difficulties were prevalent enough that APTA developed an FLR webpage that provides guidance to PTs experiencing problems with the system. That resource includes a complaint form (members only) that allows members to share examples of their problems. APTA encourages members to continue to provide feedback on FLR processing so that the association can continue its collaborative work with CMS to correct system issues.
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