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.
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
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
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