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  • UnitedHealthcare Announces FLR Requirements Starting August 1

    UnitedHealthcare announced in its May bulletin that the Medicare outpatient therapy functional reporting requirement would apply to UnitedHealthcare Medicare Advantage plans beginning August 1 (the announcement can be found on page 46 of the bulletin).

    G-codes and severity/complexity modifiers will be required on contracted physical therapist claims with dates of service on or after August 1, 2014. Claims that do not include the appropriate G-code and modifiers will be rejected.

    APTA offers a functional limitation reporting webpage that provides resources to help members meet this reporting requirement.


    • Interesting they pay less than medicare - way less, but they want more work. Same group that likes to use pt questionnaires to set arbitrary visit lengths. Funny how insurance companies agree with anything Medicare does to limit care or cut costs, yet they don't agree with their fee schedule.

      Posted by dano napoli on 5/29/2014 4:05 PM

    • Why isn't APTA vocally, and publicly, opposing this? Any PT who actually treats patients in real life knows that these functional codes are ridiculous. Most patients cannot be accurately categorized and modifiers with 20% increments are absolutely worthless. I am ashamed of what APTA has become.

      Posted by Rob Jordan on 5/29/2014 9:17 PM

    • Looks like UnitedHealthcare will be another pay or that I'll be dropping. More work, less pay. ( and it's payment, NOT reimbursement)!

      Posted by George Young on 5/30/2014 12:19 AM

    • I agree with Rob Jordan! The APTA are just sitting back and letting these insurance companies dictate, this profession is so over regulated and documentation is burdensome. What we have lost sight of is "treating" the patient.......

      Posted by Jayne S on 5/30/2014 8:32 PM

    • This is a total shame as the Senior plans near us are a very low flat rate with the patient's paying about 65% of the actual reimbursement and that flat rate has not increased for years. Now it will be additional admin costs to us & I wonder how accurate the adjudication of claims will be. We already have tons of unpaid Medicare claims due to FLR!

      Posted by Cathy Gates on 5/30/2014 9:08 PM

    • As always private sector follows the government regulation no matter how ridiculous the reason, but we all know that it is about a way to get out of paying for services provided. Functional reporting in theory is a good idea, it builds accountability for all parties. However, so many patients do not understand the standardized pain forms or they do not care to be truthful about their condition. In most cases patient don't want to accept there pain therefore they under report their severity, therefore all our hard work to have them improve appears worthless at the Re-eval. This is a tough struggle to deal with extra paper pushing and less truly attended time to teach our patients about posture , body mechanics, and activity modifications to help patients heal. UHC is a joke, all those plans are impossible to accept in network because no clinic can survive on there pay rates and run an ethical business unless they are seeing more than 1 patient at a time which I deem scandalous and not skilled care.

      Posted by James trout on 5/31/2014 12:44 AM

    • I agree, less pay, more work and no direct access to PT. Maybe the patients need to become more informed about their insurance companies and how their care will be so limited. There will be more and more providers is this small rural county that will drop UHC and maybe Medicare!!

      Posted by Mary Hogan -> AJUa@ on 5/31/2014 9:20 AM

    • APTA is not working for therapist's at this point. The amount of paperwork required to actually see and continue to treat a patient is mounting. The reimbursement puts us in the "hole". I am still paying staff and overhead, yet my therapist's have to do more for way less. There will be a mass exodus of highly trained experienced PT's. we can see it coming.

      Posted by Gillian Borden on 5/31/2014 10:31 AM

    • Payors like UHC want good documentation instead of good care. So, as with Medicare, we will continue to provide good care and fabricate the paperwork in order to get paid. We refuse to play their games.

      Posted by Edward W. on 6/1/2014 11:53 AM

    • This is one more example of the payers adopting any system that has the potential to allow them to reduce payment. Medicare Advantage plans should be eliminated as they are a money maker for the insurance companies, allowing them to receive subsidies but not requiring them to pay at the Medicare rate. By the way, UHC's CEO is the highest paid insurance company CEO-clocking in at over $46 million a year (2012 data).

      Posted by Marsha Lawrence on 6/4/2014 11:46 AM

    • In response to Rob Jordan. If we aren't actively engaged in our profession and working with our association, then we will continue to receive cuts. Would an increase in membership increase APTA's productivity and influence? Let's answer that this way: Without members, there is no APTA. Without members providing their expertise and their voices, everything that APTA produces and provides goes away. In addition, membership dues are the most significant element of revenue powering the association's initiatives, representing approximately 41 cents of every dollar received. As a not-for-profit association, APTA uses member dues to support initiatives supporting membership and the profession. It's reasonable to assume that an association that's doing dynamic things for the profession with the support of only 30% of the available market could increase its potential and results with greater support.

      Posted by Rachel Thiel on 6/4/2014 8:53 PM

    • I agree with everyone above. I plan to not participate as an in-network provider if UHC institutes this requirement for payment. Their payments are below costs now. We all have to start standing up for our profession.

      Posted by Sharlynn Landers, PT on 7/5/2014 9:09 PM

    • Could any one of you guys help me in the below scenario.. i have an claim of Physical Therapy in which Medicare is Secondary to Cigna....Do i need to bill the G codes for that..???? I am pretty much clear when medicare is primary or any medicare advantage plan requires G- codes....?? Does medicare Being secondary claims requires G codes.???? PLEASE HELP ME OUT.....

      Posted by rohit patil on 12/20/2017 12:03 AM

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