Hot Topics: Understanding Functional Limitation Reporting

Important Note about Functional Limitation Reporting:

As of January 1, 2019, Medicare is no longer requiring functional limitation reporting. However, functional limitation reporting may still be necessary for some non-Medicare payers. Therapy practices should confirm requirements for non-Medicare payers that continue to require functional limitation reporting.

The information below refers to functional limitation reporting prior to January 1, 2019

What is Functional Limitation Reporting?

The Functional limitation reporting program is a CMS data collection project that supports payment reform with outcome based data and requires therapists to report functional limitations through a series of G-codes and severity modifiers in both the medical record and on the claim.

What is the goal of functional limitation reporting?

The goal of functional limitation reporting is to help Medicare better understand beneficiary conditions, outcomes and expenditures and ultimately prepare for future payment reforms.

What are functional limitation reporting requirements for physical therapists, occupational therapists and speech therapists?

G-codes and modifiers must be included on the claim forms to capture data on the beneficiary’s functional limitations:

• at the outset of the therapy episode
• at a minimum every 10th visit
• at discharge

The therapist’s projected goal for functional status at the end of treatment must be reported on the first claim for services and at the end of the episode. Modifiers must indicate the severity/complexity of the functional limitation.

What happens if claims do not appropriately report functional limitations?

Claims without the appropriate reporting will be returned unpaid, adding documentation burdens and putting cash flow at risk. However, knowing what, when and how to complete functional limitation reporting requirements can be confusing and hard to remember. Clinicient simplifies it all.

What tools or systems can help OT, PT and SLP practices support functional limitation reporting?

An all-in-one EMR and billing system designed specifically for therapy can help.  However, not all systems are  equal. Some are easier for therapists and provide better guidance than others when it comes to functional limitation reporting and other Medicare requirements. Some of the features to look for include:

• Goal tracking and chart templates
• Reporting prompts, alerts, guided pick lists and workflow tools
• Automatic functional limitation tracking, coding and reporting
• Sign-off controls prevent claims submission without the proper G-codes and modifiers

How can Clinicient Insight help ease functional limitation reporting for therapists?

Clinicient makes it easy to comply with functional limitation reporting requirements so claims aren’t returned unpaid with:

Simple Guidance for Every Step
A functional limitation reporting wizard, goal tracking tools and chart templates put everything needed for FLR right at therapist’s fingertips as part of their normal workflow. Prompts, alerts and sign-off controls ensure therapists report as required.

Automation to Save Time and Enforce Compliance
Automatic tracking, coding, conversion and reporting of functional limitations make it fast and easy to fulfill reporting requirements.

Nothing Falls Through the Cracks
Our single system for EMR and billing ensures consistent tracking, measurement, documentation and reporting across the course of treatment. This eliminates information gaps that can cause reporting failures and returned claims.

No Unpaid Claims Due to FLR Data
Built-in controls ensure that G-codes and modifiers required for FLR are included on all required Medicare claims automatically so you get paid the first time.