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Functional Limitation Reporting: More Claims Problems

March 19, 2014 4 Comments

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?  GroundhogIn 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 24th.  Now just today another problem “popped” up.  They are sprouting faster that the unwelcome gopher in Caddy Shack.  It would appear that this new problem is that the 10th visit is not posting to the common working file (CWF), and because of this all subsequent therapy visits billed after 60 days are denying.

Functional Limitation Reporting: The Provider Alert from FCSO

Here is how FCSO (First Coast Service Options – Florida Part A & Part B MAC) notified providers on their email list today:

New outpatient therapy functional reporting claims processing issue:

Medicare guidelines require that providers bill a functional therapy G-code at every progress reporting period, which occurs at least once every 10 treatment days on the tenth treatment. This is specifically outlined in MLN Matters ® article SE1307 external pdf file.

The Medicare system is programmed to post all therapy service claims that are billed within a reporting period to CWF. A national system problem has been identified that is causing the tenth therapy treatment to not post to CWF. Because of this system issue, subsequent therapy services billed after 60 days are denying.

First Coast Service Options Inc. (First Coast) has received a number of inquiries related to this issue. We are working with The Centers for Meedicare & Medicaid Services (CMS) to address this issue. First Coast will provide an update once more information is known. We apologize for any inconvenience this issue is causing and we ask that providers not file appeals at this time.

Issue: A new national system problem has been identified that is causing the tenth therapy treatment to not post to CWF. Because of this system issue, subsequent therapy services billed after 60 days are denying.

Resolution: We are working with CMS to address this issue.

Status/date resolved: TBD

Provider action: We ask that providers not file appeals at this time.

Just today I spoke with two small therapy providers (single clinics) reporting financial problems because of the volume of Medicare claims that are outstanding due to errors in functional limitation reporting.  Both providers indicated problems with either their billing software or a change in their clearinghouse, rather than incorrect reporting on the part of the therapy staff.  If you are a physical therapy provider and a member of APTA, please provide feedback (must sign in as member) on the problems you are having with reporting functional limitation non-payable G -codes.

Are you receiving rejected claims as a result of reporting on these non-payable G-codes for functional limitation reporting?  Have you checked your MAC’s website therapy page or issue page to see additional problems they may be having in adjudicating functional limitation reporting codes?  What other problems are you having with functional limitation reporting of non-payable G -codes?

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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Comments (4)

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  1. I have 3 words: class-action lawsuit. Anyone else.

  2. anamarie says:

    Here Here Lise! We are having an issue with our Noridian Claims!

  3. anamarie says:

    THANK YOU NANCY for always keeping us informed! You are amazing!

  4. Jamie says:

    We have been having CMS (Cahaba) denying claims since Oct 2013. randomly though. Once Jan hit it was all over the place. We have our g-codes and Pqrs documentation down to breeze. And I might add we know what we are doing. However when we called CMS initially we were told by reps and even supervisors that we only could use a CH or a CN as the choice of modifiers for OPT. They didn’t understand their own MLN. We had 15 open tickets with CMS Cahaba and still no news as of yet. What was worse there was no comment anywhere on the web or CMS claims issues and we couldn’t figure out how we were the only ones having problems with claims and getting paid. It took CMS two months to post a problem to the claims log. Just this past week we were told by Cahaba reps that CMS denies there is a problem and says there system is denying the claims correctly. But then we have to figure the source of that information. So providers are just sitting in the dark waiting for the govt. to fix their computer problems? Well let’s look at the govt website for healthcare? The website is now a national joke. We are looking for some ray of hope here. Cahaba (region C) says it’s not their fault it’s CMS. This is the first article I have found that even talks about this issue. Thank you Nancy!

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