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  • APTA Member Input Brought to CMS Meeting on FLR; CMS Provides Information on Claims Processing

    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.


    • Thank you for addressing this situation. We started billing Medicare electronically as of 3/24/14 because of this issue. They were splitting our claims and calculating the MPPR wrong. They would pay one code from each of the paper claims at the higher rate instead of just one line from the date of service. So now they are wanting refunds to make up for their mistake. We are a very small clinic and I am the only one that handles claims rather it is billing or payments so this is a great big head ache for me. We had roughly 15 claims last month that I had to refund a couple dollars here and there. I even received one just yesterday where they paid the MPPR wrong for date of service 11/06/13. Not only are they splitting the claims and creating more work for me but they are not processing the two pages to get her so if the FLR codes are not on the first page then you 97001 or 97002 are being denied for payment. I have asked them several different times over the course of the 4 months and the only answer they could give me that made and since was to start billing electronically. One customer service rep told me that i should bill the 97001 or 97002 and the FLR codes first let them process then bill the 2nd half of the claim so that they could see that they were from the same date of service and the 2nd page wouldn't process before the first. Any way this has been a hugh head ache and I am thankful that you are addressing this.

      Posted by Luke Klaja -> ?FR_C on 3/26/2014 12:56 PM

    • The problem of split claims is an inherent problem when submitting the 1500 form or uploading a print image of a 1500 claim form to your clearinghouse. Many billing software packages will allow you to submit claims on the 1500 form or the 837 form. Simply switching to the 837 format should eliminate the problem of split claims immediately because the it doesn't have the line limit that the 1500 form does. Our office switched to the 837 format and we have not had any split claims since that time.

      Posted by Robert Runge on 3/28/2014 11:05 PM

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