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  • FLR Processing Fixes May Decrease Rejections

    The US Centers for Medicare and Medicaid Services (CMS) has implemented several fixes that should decrease the number of rejections in the processing of functional limitation reporting (FLR) claims. APTA became aware of claims processing errors and delays in payment soon after the FLR system was implemented, and has worked extensively with APTA members and Medicare officials over the last several months to resolve these issues.

    According to CMS, accurately submitted FLR claims should process in the typical 14-day timeframe, and FLR claims with errors should now reject quickly from the system. Providers can then resubmit previously rejected FLR claims once their most recent FLR claims are processing normally. The fixes apply to claims submitted on or after May 6, 2014.

    In correspondence with CMS Administrator Marilyn Tavenner (.pdf), APTA requested that CMS "take immediate action to remedy this situation and ensure that the financial burden caused by the FLR claims processing problems do not hinder patient access to care.” APTA offers multiple resources on FLR reporting at its FLR webpage.


    • Here is the problem with this release from CMS. It's not a public release in terms of a transmittal or information put on the CMS Therapy website. Secondly, what was fixed? Which of the many issues have been corrected? Do we know for sure we can report a subsequent functional limitation with all 3 G-codes when the previous functional limitation is still being reported? Can we now report 5 G-codes on the claim form on the same date of service as CMS said we could do 10 months ago?

      Posted by Rick Gawenda -> =IY`?L on 5/31/2014 3:02 PM

    • Thanks for your questions, Rick. Based on conversations with CMS staff and information from members related to the processing of FLR claims, we believe that the vast majority of FLR claims processing issues have been resolved. Providers who continue to experience issues with the processing of FLR claims submitted on or after May 6th 2014 should complete the FLR complaint form at www.apta.org/flr. Providers should comply with Medicare guidance if an evaluative procedure is billed for a new condition during an ongoing plan of care. Please see our FLR documentation FAQ for more details.

      Posted by APTA Staff on 6/2/2014 9:15 AM

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