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Functional Limitation Reporting – Claims Based Outcomes Reporting

Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, April 24, 2014 Posted in: Outpatient Rehab

Mediware was privileged to have Heather Smith, Director of Quality, APTA, provide an extremely informative Functional Limitation Reporting webinar on Tuesday, April 15. The presentation still proves that there is a lot of confusion around G-codes. A number of follow-up questions were included in the webinar survey and we’ve highlighted some of the most asked questions.

The goal of the inservice was to understand better these three areas:

  • Understand the components of functional limitation reporting
  • Recognize the functional limitation reporting categories and modifiers for 2014
  • Identify common functional limitation reporting errors

Clearly, the inservice delivered. By the wealth of questions and issues that were presented post webinar,  it’s also easy to see that the roll out of this initiative has been one of the most confusing and least understood workflows of nearly anything rolled out by CMS.  A total of 21 questions were placed into Mediware’s clarifications on Claims-Based Outcomes Reporting (CBOR) and G-codes FAQ que to be answered.

Even more pressing were three areas that, although we believe to know the answer, we are uncertain about and have forwarded information to CMS to provide improved insight.

What are the three most complicated areas?

1.) 60 day episode of care. If 60 days has lapsed and a person returns that did not have a previous episode ‘d/c’ed’ by coding the bill; why is the new bill rejected?  This should allow a new episode to begin.
2.) If a discipline is seeing a patient and that same patient comes to the same discpline for a new prescription (with the same functional area issue) and is treated on visit five with a re-evaluation, how is that date of service coded to allow the billing to drop? Are three codes dropped that day (and ignored for billing purposes), or do you submit an ‘update’ of the original functional issue to enable billing of the evaluation to occur?
3.) A patient surpasses an original goal and the therapist wishes to continue to see the patient for the same functional limitation but wishes to advance the goal. What is the proper way to code the bill when you want to do this? D/C the original and reclassify at the next visit or continue to show progress as advanced beyond the goal until the appropriate d/c time?  And if that is done, will it influence payment?

Although we don’t really know the CMS expected answers to these and we don’t believe they were answered in MM8005 or SE1307, when we get the answers we’ll let you know.

In the meantime – visit our newly updated CBOR FAQ related to Functional Limitation Reporting (FLR) or Claims-Based Outcomes Reporting (CBOR) … you decide which title is more telling of the regulation and the value of that exercise!

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