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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.

    WHPA: To Grow Worldwide, Professional Regulation Needs to Be Responsive

    As health care professional regulation's prominence increases worldwide, regulatory models will need to develop in ways that are sensitive to regional differences and changes in the overall health care landscape. That was the challenge presented to physical therapists (PTs), physicians, nurses, dentists, and pharmacists at a recent international conference sponsored by the World Health Professions Alliance.

    While attendees to the May 17–18 conference in Geneva, Switzerland, stressed the importance of diverse approaches to individual regulatory frameworks, the WHPA members also agreed that the shared goals of professional regulation should be "person-centered, involving patient care, patient rights, and patient safety," and should "take into account social and economic welfare and professional practice," according to a WHPA press release.

    "It is clear that there is no single model for a good regulatory system," said Marilyn Moffatt PT, DPT, PhD, GCS, FAPTA, president of the World Confederation for Physical Therapy (WCPT), "but all should ensure that physical therapists and other health professionals provide safe and competent services. Regulatory bodies also need to understand the day-to-day realities of the health professions they are seeking to regulate."

    The WHPA conference on regulation was held immediately preceding the World Health Organization's (WHO) World Health Assembly in Geneva. APTA is a member of WCPT.

    VA Will Use More Private Care to Reduce Delays

    In an effort to respond to criticism that the US Department of Veterans Affairs (VA) has subjected veterans to excessive and potentially deadly waits for care, the VA has announced that it will increase veteran access to private hospitals and clinics.

    As reported in the Los Angeles Times,Huffington Post,Washington Post, and other media outlets, the May 24 announcement from VA Secretary Eric Shinseki stated that VA centers are enhancing capacity wherever possible, and that in areas where expansion isn't an option, the agency will increase use of non-VA care.

    In 2013, about 10% of the department's spending—$4.8 billion—was for non-VA care. The recent announcement did not include cost estimates for the increase in use.

    Critics of the VA say that delays in care have become excessive, that the delays themselves were covered up, and that in some cases patients died while waiting for care. An initial review has not revealed an instance in which a delay resulted in a patient's death, according to the VA.