News

The Centers for Medicare and Medicaid Services (CMS) has issued an update further clarifying the regulations on the new functional limitation reporting requirements, which was included in both a Medicare Learning Network resource and in transmittal R2622CP. Per the Middle Class Tax Relief Act of 2012, CMS was required to collect information on claim forms regarding beneficiaries’ condition and function, any therapy services furnished, and outcomes achieved on patient function. The new reporting requirements were implemented on January 1. 

To ensure a smooth transition, CMS sets forth a testing period from January 1 to July 1, but after this date, any claims submitted without the proper G-codes and modifiers will be returned unpaid. The major points of clarification contained in the update include several topics, such as reporting instructions for 1-time therapy visits, submission of functional limitation data for more than 1 therapy plan of care, and guidance on using the “Other PT/OT” functional limitation category. 

The functional limitation reporting requirements are included the CMS-released Medicare Benefit Policy Manual. An additional resource for reviewing the latest updates and revisions is the CMS website, which provides resources to help members meet the new reporting requirements. 

Source:  Centers for Medicare & Medicaid Services