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Functional Limitation Reporting

Functional Limitation Reporting: More Claims Problems

Functional Limitation Reporting: More Claims Problems

Functional limitation reporting: more claims problems are being officially reported today – Wednesday, March 19, 2014.   When will it stop? The better question is when will it be resolved?  In a recent post  on functional limitation reporting, I discussed problems that were reported in the common working file that are scheduled to be corrected on Monday, March […]

March 19, 2014 4 Comments
Functional Limitation Reporting Claim Rejections

Functional Limitation Reporting Claim Rejections

Will it ever stop?  The problems with functional limitation reporting claim rejections that is.  Grant it, there are some confusing scenarios that create provider side problems in coding, but the bigger issue is the continued problems with CMS and the Medicare Administrative Contractors adjudicating claims.  Because of the difference in reporting and adjudication for those reporting on the […]

March 13, 2014 4 Comments
Writing Functional Therapy Goals

Writing Functional Therapy Goals

Are you writing functional therapy goals?  I guess I better take that a step back and ask if you are accurately writing functional therapy goals for a Medicare Plan of Care.   Required elements of the Medicare Plan of care include 1) Diagnoses; 2) Long term treatment goals, and 3) Type, amount, duration and frequency of therapy […]

March 11, 2014 4 Comments
Functional Limitation Reporting Trouble With Unplanned Discharges

Functional Limitation Reporting Trouble With Unplanned Discharges

Trouble, trouble I say in River City, that is trouble everywhere you look with functional limitation reporting and unplanned discharges.  Not quite the problem that Professor Harold Hill faced, but let’s sing along with a chorus of  “76 Trombones”. In a nice neat world, all patients continue with therapy until their planned discharge, and there […]

March 3, 2014 0 Comments

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RACs

RAC Work Pause and Therapy Manual Medical Review

RAC Work Pause and Therapy Manual Medical Review

The CMS RAC Work pause of the Recovery Auditor (RAC) program will provide some work load relief for outpatient therapy providers in the short run, but in the long run 100% of therapy claims over the $3700 thresholds will be reviewed.  So what does this mean for therapy providers?  Check your mail, if you are […]

February 24, 2014 1 Comment
RAC Audit Stoppage Not Likely to Affect Therapy ADR

RAC Audit Stoppage Not Likely to Affect Therapy ADR

CMS announced this week that the Recovery Audit program (RACs) would pause for a period of time so that the current ADR requests can process through the RAC reviews.  RAC audit stoppage is not likely to affect therapy ADRs.  In what might have been a false sense of “freedom” rehab providers reading RAC Monitor’s special […]

February 20, 2014 2 Comments
Appealing Medicare Denials – 5 Things You Must Know

Appealing Medicare Denials – 5 Things You Must Know

Appealing Medicare denials is likely to be a reality for all outpatient therapy providers this year. Therapy over the $3700 cap is subject to 100% mandatory medical review by the Recovery Auditors (RACs) through 3/31/2013.  In fact those reviews, if not favorable, will first frustrate you, then possible anger you, then compel you to file an […]

February 11, 2014 0 Comments
ALJ Appellate Forum – What Therapy Providers Need to Know

ALJ Appellate Forum – What Therapy Providers Need to Know

The ALJ Appellate Forum on Wednesday, February 12th will be chock full of information that all outpatient therapy providers need to know.  If you have provided therapy over the $3700 caps (threshold) there is 100% RAC review of your claim(s).  Technically this is the OMHA Medicare Appellate Forum, but the provider industry has been quick […]

February 8, 2014 4 Comments