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  • Second Call-in Q&A Can Answer Your Questions on Functional Limitation Reporting

    Because of high demand for its first Q&A call-in, APTA will host a second Q&A call for members on Tuesday, July 16, 2:00 pm-3:00 pm (EST) to answer questions about the functional limitation reporting requirements that became effective July 1.

    All providers who bill outpatient therapy services under Medicare Part B must submit functional limitation data (G-codes and appropriate modifiers) for any Medicare beneficiary, or claims will be returned unpaid. Therapists must report functional limitation data on the beneficiaries' current functional status and on the projected goal at scheduled intervals throughout the episode of care, including at the outset of the therapy episode, no less frequently than every 10th visit, and at discharge. Participants in this second Q&A will need access to a computer and the Internet. Space is limited. To secure a spot, please e-mail advocacy@apta.org with "July 16 Call" in the subject line. Based on demand, APTA will host future calls throughout the month of July.

    For more information and resources on functional limitation reporting, please visit APTA's Functional Limitation Reporting webpage.

    GAO Says 115,000+ Medicare Beneficiaries Affected by Manual Medical Review in 2012

    The Government Accountability Office's (GAO) mandated report on the implementation of manual medical review (MMR), part of the therapy cap exceptions process, estimated that the Centers for Medicare and Medicaid Services (CMS) received more than 167,000 reviews, affecting more than 115,000 Medicare patients, over a 3-month period.

    Between October 1, 2012, and December 31, 2012, CMS-contracted Medicare administrative contractors (MACs) reviewed 110,000 preapproval requests and 57,000 claims for services that were not preapproved. These were the 2 types of MMRs being implemented during the last 3 months of 2012. Of the estimated 110,000 preapproval requests reviewed, the MACs affirmed 80,500 (73%) and did not affirm 29,500 (27%). The MMRs of claims without approvals resulted in 19,500 (34%) claims affirmed for payment and 37,000 claims (66%) not affirmed for payment.

    The GAO report, required by the Middle Class Tax Relief and Job Creation Act of 2012, also looked at the implementation process as carried out during those 3 months. (The report did not review the new MMR process that began April 1, 2013.) CMS did not issue complete guidance at the start of the MMR process in 2012, and so the MACs encountered implementation challenges, said GAO, such as a lack of fully automated systems for tracking the reviews of preapproval requests in the time allotted.

    APTA continues to advocate for a less burdensome and more streamlined approach to manual medical review, including advocating for revisions to the new MMR process that began on April 1, 2013, in which outpatient therapy claims exceeding $3,700 are reviewed by recovery audit contractors.

    What Belongs in an Annual PT Exam - Tell Us

    APTA wants member input on standard elements that should be included in an annual physical therapist examination. Per a House of Delegates charge and goals related to the association's strategic plan, a task force is developing templates for such an exam and seeks comments from the APTA membership at large.

    The deadline for sending comments is July 29, 2013, and member input is valuable, so please review the webpage and consider adding your thoughts to those of your colleagues for this important initiative.