I hope you have a wonderful holiday season!

It’s a new year and Medicare Part B therapy changes continue.  As you are aware, Functional Reporting went into effect January 1, 2013 with a testing period through June 30th.  Claims submitted July 1st and after will require G-code sets and severity modifier at the outset of therapy, at 10th visit, re-evaluation, and at discharge of either the patient from therapy service or when a previously reported functional limited has resolved.  Therapists will determine the functional limitation and severity modifier to report.

Functional Pathways is committed to making this process as seamless as possible.  Our Regional Managers participated in  training on January 10th.  Therapists, Clinical Managers, and Program Managers training will be the week January 14, 2013 with a targeted completion date of February 22, 2013.  After therapists are trained, they will then begin recording the G-codes and severity modifiers.  Our partners will gradually begin seeing the G-codes and modifiers on our export files.  Our therapy software will be upgraded on January 13, 2013 allowing for this additional reporting.  After completion of  therapist training, we will be conducting client training for those who wish to attend.  Our client training target completion date is March 31, 2013.  All trainings will be conducted via webinar.

In addition to the Functional Reporting requirement, the part B caps exceptions process has been extended as well as the manual medical review process when the $3,700 threshold is met per therapy cap.  The cap amount for 2013 has increased to $1,900 for occupational therapy and $1,900 for physical and speech therapy combined.

The link below is the most recent MLN article revised on 12/26/12 regarding Functional Reporting for your reference.

MM8005 revised 12-26-12 CR8005