PT MANAGEMENT

Question 1

administration is defined as and its duties

Answer 1

Administration is the skilled process of planning, directing, organizing, and managing human, technical, environmental, and financial resources effectively and efficiently. Administration includes the management by individual physical therapists of resources for patient or client management and for organizational operations. Ensuring fiscally sound reimbursement for services rendered • Budgeting for physical therapist services • Managing staff resources, including the acquisition and development of clinical expertise and leadership abilities • Monitoring quality of care and clinical productivity • Negotiating and managing contracts • Supervising physical therapist assistants, physical therapy aides, and other support personnel

Question 2

define management, management style, leadership

Answer 2

Management • Formally recognized leadership of an organization • Act of realizing org. goals through efforts of others • Allocation of responsibilities & provision of resources • Management style • The ways a manager responds; based on values, information, experience, creativity, habit, constraints & supervisee characteristics • Leadership • Intentionally influencing the beliefs & actions of willing followers

Question 3

McGregors X and Y!! Blanchard 4 styles

Answer 3

X: autocratic- • Y: democratic (laissezfaire) heory X and Theory Y represent two sets of assumptions about human nature and human behavior that are relevant to the practice of management. Theory X represents a negative view of human nature that assumes individuals generally dislike work, are irresponsible, and require close supervision to do their jobs. Theory Y denotes a positive view of human nature and assumes individuals are generally industrious, creative, and able to assume responsibility and exercise self-control in their jobs. One would expect, then, that managers holding assumptions about human nature that are consistent with Theory X might exhibit a managerial style that is quite different than managers who hold assumptions consistent with Theory Y. Read more: http://www.referenceforbusiness.com/management/Str-Ti/Theory-X-and-Theory-Y.html#ixzz3ONGEIHPM Blanchard’s 4 styles 1. Directing 2. Delegating 3. Supporting 4. Coaching Charismatic • Consultative • Delegating • Persuasive • Transactional • Transformational

Question 4

Directing delegating supportive coaching

Answer 4

see chart slide six for details Directing - telling someone what to do and how to do it and when to do it by now letting any room for error delegating- telling someone how to do something but not really giving them specific instructions on how to do it and this might be beyond the scope of the employee but, it is also the most challening. Supportive- managers that are easy going and work along side the employees and care about their feelings coaching- a share between directing and supporting requires good two way communication between staff and teacher

Question 5

six manager types type 1 autocratic 2 consultative 3. Persuasive 4. democratic 5. chaotic 6. lassize faire

Answer 5

autocratic - this manager makes desicions alone and often has a well runned group but usally leads to unhappy suboradinates cause of desicion making constraints consulative- the desicions are made with both the employee or company in mine persuasive- will usually tell them that the right course of action has been taken and still has sole desicion making powers democratic - decisions made by the employee and the manager together. chaotic- put most the deiscion process making on the employee but it more based on speed and agility than anything else lassize faire- gives employees most the desicion making abilities and kinda hands off style -

Question 6

difference between work groups and teams

Answer 6

work groups - are more indivuval and focus on the individual than more of the person him or her self teams- are more realient on each other

Question 7

unidesclipline, mulitdisplinary, and interdiscplianry

Answer 7

uni - basically there is one team and one team leader multi- there are several teams and share common goals yet work independently yet talk to one another interdisclipinary- they ually work together like OT and PT relationship at croft-on care

Question 8

Innovator developer activator maximer stablizer

Answer 8

Innovator - one who creates and brings new ideas to the table developer- ready fire aim- taking on og solutions flexibility activator- getting things done and overcoming obstacles build and tenacity maximer- working together with people of all kinds this type of person is the best build and maintain diplomacy stablizer- keeps shit running smoothly some call him ex lax but will maintain the status quo very well.

Question 9

coaching

pacesetting

democractic

afflitative

visionary

commanding

Answer 9

slide 11

Question 10

the goverment controls what and makes polciys requarding what think ACEQQ

Answer 10

Public Policies: government policies, express general
principles, guide management of public affairs
• Eligibility
• Access
• Quality (efficiency, effectiveness)
• Cost-benefit, value based
• Nations/Governments
• Protect health of population
• Build infrastructure to protect public health
• Manage /regulate health services
• Collect/ disseminate information about health services
• Finance all of the above

Question 11

the different types of goverment

communist

Socalist

Comprehensive

welfare

entrepreneurial

Question 12

what is the country with the best overall ranking in healthcare???

Answer 12

UK

Question 13

what does the healthcare world pay for??

why are we different than other healthcare system??

think about how we pay

Question 14

what is the PT-PAC and how many members are on the PT board for the APTA

Question 15

different insurance types who pays for these

medicare

medicaid

S-CHIP

VA

Employer or self insured

Question 16

what is the national average of medicare beneficaires in 2012 that make up the state population

Answer 16

16 percent

Question 17

what did medicare start up as??

Answer 17

social security act in 1965 then medicare came on the scene in 1972 and then HMO’s in 1975

HCFA to administer medicare in 1977

1980 - medicare HH started to cover more

OBRA 1987 - upadted the conditions in a nursing home and made standards for them

Question 19

why is medicare going to see numerous more beneficiaries

Answer 19

due to the sudden increase in baby boomers in the next 30 years or so.

Question 20

what does the United health care act or obamacare now worry about 4 areas

Question 21

medicare makes up how much of the national budget

Answer 21

16 %

Question 22

what is covered by my medicare a and what is covered medicare b

Question 23

How many medicare beneficiaries are there in medicare but, how much is spent on the top ten percent

Answer 23

35.4 million people

57 percent of the money is spent on the top ten percent :0

9,000 for tpyical resident

55,750 for someone in the top ten percent

Question 24

What does medicare C do??

Answer 24

Medicare C”… Medicare Advantage
• Medicare contracts with companies to administer
managed care plans
• Same essential benefits but may have extra benefitshowever
more restricted network, utilization reviews
• Different copayments
• Medicare Advantage plans pay the claims

bridge the 20 % co-pay sometimes

Question 25

how many people are enrolled in the medicare advantage plan compared to traditional medicare

Answer 25

28 % and the other 72 % is covered by tradtional medicare

Question 26

what does medicare D cover

Answer 26

Medicare D
• Covers prescription drugs
• To get Medicare drug coverage, you must join a plan run
by an insurance company or other private company
approved by Medicare. Each plan can vary in cost and
drugs covered.
• Enrollees either have Traditional Medicare + Medicare D
or Medicare Advantage

Question 27

what is medigap think the “gap” in medigap

Answer 27

Medigap
• Supplemental insurance for original Medicare patients to
help defray costs & may offer additional benefits
• Regulated by CMS
• 10 plans allowed
• Medicare Select: supplemental health insurance
available in some states, identical to 10 standard policies
except patients have to go to specific physicians &
hospitals…. Except in emergency situations

Question 28

whats a prospective payment system

Answer 28

basically determines the rates for medicare

Question 29

how the PPS per area remember each area of healthcare is covered differently

Question 30

were does medicare by the most in terms of individual services

Answer 30

home health care

Question 31

how many dually elgible for both medicare and medicaid

Answer 31

9 million

Question 32

give me the main branches of the hospital staff under of course the administration

Question 34

s-copropate vs. c- coportate

LLC or Limited libality cooperation - where shareholders aren’t responsible for any debt for the company

Answer 34

corporations are subject to double taxation; that is, one tax at the corporate level on the corporation’s net income, and another tax to the shareholders when the profits are distributed. S corporations have only one level of taxation. All of their income is allocated to the shareholders.

However, C corporations have greater tax planning flexibility and can shield shareholders from direct tax liability. In addition, S corporations are subject to limitations, such as the number and type of shareholders they can have.

Question 35

Rules for a busines to be a provider of medical insurance

Question 36

process for creating a mission statement it must have what 4 things??

Question 37

how does medicare determine its rates by the DRG diagnosis related group or pricer software determines how much to pay for each code.

Question 38

what things will insurance not pay for if these conditions are present

Question 39

whats a patient assessment instrument

Question 40

who covers patients up to the first 100 days in a SNF part b or a

Question 41

who sers the RUG limits???

Question 42

what determines if medicare A will pay for in home visits what action

Question 43

How much payment reduction is seen with medicare part B with outpatient PT

Question 44

What are the two options PT’s for medicare patients and what if the facility does not accept medicare patients??

Question 45

how much can nonpraticipating PT clinics charge for nonmedicare services

Whats the MPPR about???

Question 46

Is health and wellness covered by the medicare system???

Question 47

What is an advanced beneficiray notice

Question 48

What is an LCD and NCD what are the new conditions in which a service gets covered or not??

Question 50

Jimmo v. Sebellius settelment agreement was about what???

Question 51

What the basic steps for negotiating a contract

Question 52

way patients pay for service

Answer 52

pay per visit (per diem)

fee for service

per episode so like x amount of times a patient shows

captitiation

multiple procedure or cascade

patient (self pay)

Question 53

What is CPT

is MMT ROM PT eval or Pt reval untimed or timed

are modalities timed or untimed

Answer 53

Current Procedural terminology

all of these are untimed codes

Question 54

Does medicare cover infrared

Then 97014 must be billed as G0238 what is this timed code for

how many times a day can untimed codes be billed

Answer 54

97014 is eletrical stim

no medicare doesn’t cover infrared

untimed codes can only be billed once a day

Question 55

Taping of any joint you will have to justify it by how think like function and mobility

Answer 55

There are no CPT codes that define “taping”
* Determine the goal of the taping and base your CPT code on that
goal.
* If that goal is for immobilization, then the strapping codes may be
appropriate.
* If the goal is to decrease pain for exercise or improve proprioception then
use the appropriate CPT code for that goal.
* Include the time for the taping in your time for that procedure
* Be sure to use that terminology in your documentation to support the
billing
* “to facilitate proprioception”, “to align for pain free exercise”…
* You can bill the patient for tape to use at home and may be able to be
charged for tape used during treatment.
* Review your payer policy.

Question 56

how are modalities consider timed codes and how long should you bill for them??

what about gait training, ,massage, ther ex, NDT, aquatic therapy are these timed codes???

Answer 56

you must attend to them Application of a modality to one or more
areas; each 15 minutes
* 97032 – electrical stimulation (manual)
* 97033 – iontophoresis
* 97034 – contrast baths
* 97035 – ultrasound
* 97036 – Hubbard tank

Therapeutic procedure, one or more areas,
each 15 minutes;
* 97110 – therapeutic exercise to develop strength and
endurance, range of motion and flexibility
* 97112 – neuromuscular re-education of movement, balance,
coordination, kinesthetic sense, posture, and/or
proprioception for sitting and/or standing activities
* 97113 – aquatic therapy with therapeutic exercises
* 97116 – gait training (includes stair climbing)
* 97124 – massage, including effleurage, petrissage and/or
tapotement (stroking, compression, percussion)

Question 57

Just remember as a good rule of thumb anything that you have to be there for and with constant attendance it will be a timed code!!!

Answer 57

97140 – Manual therapy techniques
(mobilization/manipulation, manual lymphatic drainage,
manual traction), one or more regions, each 15 minutes
* 97530 – Therapeutic activities, direct patient contact by the
provider (use of dynamic activities to improve functional
performance), each 15 minutes
* 97535 – Self-care/home management training (ADLs and
compensatory training, meal preparation, safety

97542 – Wheelchair management (assessment, fitting, training)
each 15 minutes
* 97545 –Work Hardening/Conditioning initial 2 hours
* 97546 –Work Hardening/Conditioning each additional hour (anything basically where you perform situations where the person mimics what he or she does at work or at a praticular sport
* 97750 – Physical Performance Test/Measure
* (Balance assessments, functional capacity evaluations)
* 97760 – Orthotic(s) management and training (including
assessment and fitting when not otherwise reported), upper
extremity(s), lower extremity(s) and/or trunk, each 15 minutes
* 97761 – Prosthetic training, upper and/or lower extremity(s),
each 15 minutes
* 97762 – Checkout for orthotic/prosthetic use, established
patient, each 15 minutes

procedures, and instruction in use of assistive technology
devices/adaptive equipment) direct one-on-one contact by
provider, each 15 minutes

Question 58

What constitues a timed code???

Answer 58

Time spent in formal/informal assessment of
related function/impairments
* Time spent educating client/caregiver related to
intervention with the client present
* Education, problem-solving and carry-over are highly valuable
services!
* Billable when the client is present and participating
* Time spent in face to face intervention

Question 59

how long should timed modalities be used to count for one unit in medicares eyes

not 15 minutes

Answer 59

Timed modalities must be completed for at least
8 minutes in order to bill a unit for Medicare.
* Both set up and intra-service time can be
included.
* The “total time” spent performing all timed
modalities in a visit is what determines the
number of units to be billed for Medicare

Question 60

Know these units for billing time

how much is 1 unit 2 units 3 units 4 units 5 units 6 units

Answer 60

8 – 22 minutes = 1 unit
23 – 37 minutes = 2 units
38 – 52 minutes = 3 units
53 – 67 minutes = 4 units
68 – 82 minutes = 5 units
83 – 97 minutes = 6 units

Question 62

examples of billable units

Answer 62

37’ of ther ex
* 38’ of manual therapy
* 7’ of ultrasound
* 8’ of ultrasound
* 60’ of e-stim
* 15’ of ther ex and 30’ of
manual therapy
* 10’ for RE and 30’ of ther ex
* 97110 x 2
* 97140 x 3
* Non-billable
* 97035 x 1
* G0283/97014
* 97110 x 1, 97140 x 2
* 97002, 97110 x 2

Question 63

what two things must you include in your bill to medicare

think total time and what else??

shoud documentation support the codes billed

Answer 63

Medicare requires 2 times to be documented:
* total treatment time
* total time spent in direct contact with the patient
* It is recommended to bill time in and time out but is
not required
* Documentation must support the codes billed.
* Time spent for each specific intervention does not
need to be included, only total minutes of time-based
and untimed codes. (however…)

Question 64

Whats substainal completetion!

Answer 64

There are guidelines in the CPT manual as it
relates to reporting of timed codes. It is found
directly under the Physical Medicine and
Rehabilitation section and it states, “The work
of the qualified healthcare professional
consists of face-to-face time with the patient
(and caregiver, if applicable) delivering skilled
services.”
Substantial Completion
* “For the purpose of determining the total time of a
service, incremental intervals of treatment at the same
visit may be accumulated.” This rationale was
included in the CPT manual in an effort to make
reporting of time easier.
* There is also another change in the CPT manual, on
page xii, Introduction section, titled “Time” in which it
states, “The CPT code set contains many codes with a
time basis for code selection…Time is the face-to-face
time with the patient…A unit of time is attained when
the mid-point is passed

Question 65

what is an LCD

Answer 65

Policies which are put in place by your Medicare
Administrative Contractors (MAC) that defines what is
considered reasonable and necessary.
* Providers are assigned to a MAC based on their state

Establishes what CPT codes are covered under
the policy
* Establishes expected utilization of specific CPT
codes (i.e. Paraffin = 3 times)

Question 66

What is National Correct Coding Intiative???

Answer 66

Developed by CMS to promote proper coding methodologies
and to control improper coding leading to inappropriate
payment in Part B claims.
* Policies are based on guidelines found in the CPT Manual,
national and local policies and edits, coding guidelines
developed by national societies, analysis of standard medical
and surgical practices, and a review of current coding practices.
* The purpose of the NCCI edits is to prevent improper payment
when incorrect code combinations are reported
* Updated annually
* Be sure to reference these tables

Question 67

Do medicare POC’s need to be singed or followed up by a physician

Answer 67

Yes to indicate that he or she has been seen by a physician!!!

Question 68

Every 90 days!!! the physician must sign off on a POC

Should the bills be submitted with the phyisicans signature???

Answer 68

When the physician signs the POC it becomes known as
the certification or re-certification.
* The certification period is up to 90 days depending on
what is documented in the POC.
* So every 90 days a physician must sign off on a physical
therapy POC to be compliant with Medicare.
* Bills must be submitted under the physician that signs the
POC.
* If documentation is audited and there is no certified POC
on file, a refund will be requested by Medicare

Question 69

What part of medicare does the salary cap pertain to???

Answer 69

The therapy cap applies to all Part B outpatient therapy
settings and providers including:
* Outpatient Therapy Centers
* Physicians, NPP, PAs, etc.
* Hospital Outpatient Therapy Centers
* Critical Access Hospitals as of 2014
* Part B Skilled Nursing Facilities
* Home Health Agencies (when not under a Home Health POC)
* Rehab Agencie

Question 70

what is the caps numerical value??

Answer 70

For 2015, calendar year CAP limit is $1,940 with a threshold of
$3,700 for:
* OT
* PT and SLP Combined
* Therapy services above $3,700 will either be:
* paid and subject to a post-payment review or
* will not be paid and will go through a pre-payment review.
* NY is one of the states required to go through the pre-payment
review process
* The CAP includes amounts allowable by Medicare (including
patient responsibility)
48

Question 71

When do you use an KX modifier

are medicare advantage plans pertain to the medical caps

What happens if you use to many KX modifiers??

Answer 71

Use the –KX modifier on claims that exceed the $1,940 limit to
signify to Medicare that the services rendered are medically
necessary.
* Do not use the –KX modifier from the start of care. Excessive
use of the –KX modifier will flag a contractor to review claims
more closely.
* Medicare Advantage plans are not required to follow the
guidelines of the Medicare CAP. You must review each plan
accordingly to determine if they require the modifiers and have
a limit to care.

Question 72

What is an Advanced Beneficiary notice??

Does Part A use this noticies???

Answer 72

An ABN is a notice given to Medicare beneficiaries to convey
that Medicare is not likely to provide coverage in a specific
case
* Must be reviewed verbally with the beneficiary or their
representative prior to providing those services
* Part B services and hospice and religious non-medical health
care institutions (RNHCIs) covered under Part A
* Inpatient hospitals, skilled nursing facilities (SNFs), and home
health agencies(HHAs) use other approved notices for this
purpose.

Question 73

are ABNS part of a medical record??

If ABN is not on file after a patient reaches a cap cna they still be billed for these services??

Answer 73

ABNs are a part of the medical record
* ABNs are not sent to Medicare unless
documentation has been requested
* If an ABN is not on file after Medicare denies a
claim based on exceeding the CAP, the
patient CANNOT be billed for these services

Question 74

What do authorizations determine think number of visits a patient can be seen

Answer 74

Many payers (including many commercial plans as well as
workers compensation carriers) require pre-authorization prior
to paying for physical therapy services
* Refer to your contracts to understand what each payer
requires
* After an evaluation is complete, the plan of care is submitted
to the insurance (generally a third party contractor) to review
the evaluation and make a determination of the number of
visits the patient can be seen for.
* An authorization generally specifies a specific number of visits
as well as a specific date range

Question 75

some examples of inusrances requiring authorizations mainly private insurances and after a certain amount of time the insurance company requires that the company send a re-eval for further evaluation to see if the patient will still be approved for the services.

Answer 75

Cigna requires authorization through Orthonet
* Aetna requires authorization through Orthonet
* Empire BCBS HMO and EPO plans require authorization through
Orthonet
* The Empire Plan requires authorization through Optum
* Oxford requires authorization through Optum
* Some United Healthcare plans require authorization through Optum
* NYS Workers Compensation follows Medical Treatment Guidelines
(MTG) and requires authorization for care beyond the MTGs

Question 76

what is the functional limitation reporting???

Answer 76

Middle Class Tax Relief and Jobs Creation Act of 2012:
* Requires claims-based data collection by Medicare
for outpatient therapy services
* Designed to assist in reforming the Medicare
payment system for outpatient therapy services
* Collects data on patient function during the course
of therapy services in order to better understand
patient condition and outcomes

Question 77

will claims without FLR be paid for??

Answer 77

Became effective January 1, 2013, but testing phase ran from
January 1st to July 1st.
* July 1, 2013 started the actual reporting requirement when
claims would be returned not paid if not successfully
reporting.
* Edits were not turned on until January 1, 2014
* Claims paid through 2013 even with improper coding
* Only now are we understanding the full impact of improper coding
* Claims without proper FLR codes are not paid by Medicare

Question 78

Who is required to use the FLR codes

Answer 78

anyone under medicare part B therapy act

Question 79

what are the 3 stages to report for FLR

Answer 79

current status- so status at the beinging of therapy

Projected goal status- where should the patient be in x amount of weeks

discharge status- where should the patient be upon discharge

must report two codes each visit

Question 80

what are some functional codes that are hard to define by G codes

Answer 80

The “Other PT/OT” functional G-codes are used when one of the
four other codes does not describe the patient’s functional
limitation as follows:
* A patient’s functional limitation is not defined by one of the
four codes
* A patient whose therapy services are not intended to treat a
functional limitation (i.e. wound care or lymphedema)
* When an overall, composite or other score from a functional
assessment tool is used and does not clearly represent a
functional limitation defined by one of the four above (i.e.
FOTO)
Functional Limitation Categories

Question 81

What should make sure that they include when billing for functional limitations

Answer 81

Use the severity modifier that reflects the score from a
functional assessment tool or other performance
measurement instruments. This tool must remain consistent
throughout the reporting on this primary limitation.
* If multiple measurement tools are used during the evaluation
process, clinical judgment should be used to combine the
results to determine a functional limitation percentage
* Therapists can use their clinical judgment in the assessment of
the appropriate severity modifier. Therapists will need to
document how they made the modifier selection so the same
process can be followed in succeeding assessment intervals

Question 82

scoring of impairments on G codes

it goes CH- CN starting at 20 on CI because CH is 0%

CN is 100 percent impaired so what is CK

Answer 82

0% impaired, limited or restricted
CI 1% to <20% impaired, limited or restricted
CJ 20% to <40% impaired, limited or restricted
CK 40% to <60% impaired, limited or restricted
CL 60% to <80% impaired, limited or restricted
CM 80% to <100% impaired, limited or restricted
CN 100% impaired, limited or restricted

Question 83

pay close attention to the severity modifiers and the numbers they correspond to!!! match it with the functional outcome measures

Answer 83

Pay close attention to the assessment tool you are
using and how it is scored.
* Does the score represent a percentage of
impairment that is similar to the severity modifiers?
* Let’s look at a couple of outcome tools

Question 84

what functional outcome measure most the therapist choose???

Answer 84

Therapists are required to report on the primary functional
limitation for Medicare patients. If there is more than 1
functional limitation then providers must make a
determination as to which functional limitation is primary.
The therapist may choose the functional limitation that is:
* Most clinically relevant to the successful outcome of the
patient
* The one that would yield the quickest and/or greatest
functional progress
* The one that is the greatest priority for the patient

Question 85

Can you report more than one functional limitation???

Answer 85

You can only report on one functional limitation for
each patient at a time
* Report on the primary functional limitation. If the
treatment goal is achieved than a new functional
limitation will be required.
* Report the discharge coding and goal status on the
visit that the functional limitation has resolved. The
following visit report the new functional limitation

Question 87

how many visits must you report the patients progress

Answer 87

INITIAL EVALUATION – reporting required when evaluation
and POC are completed. Report on CURRENT STATUS and
PROJECTED GOAL STATUS.
* EVERY 10th VISIT – reporting is required AT LEAST once every
10th visit (same DOS that related to the progress report).
Report on CURRENT STATUS and PROJECTED GOAL STATUS.
* DISCHARGE – reporting required on the discharge date of
service, except when therapy services are discontinued by the
patient prior to the planned discharge. Report on PROJECTED
GOAL STATUS and DISCHARGE STATUS

Question 88

Multiple Cases Running Concurrently

Answer 88

When you have a patient who is currently being treated and is
being evaluated for a new body part and a new case is being
created:
* Continue to report the primary functional limitation on the 1st case
* On the evaluation of the 2nd case, report as if it was a one-time visit
and report all 3 codes (Current, Projected goal and Discharge)
* Continue to report on the 1st case at the appropriate reporting
intervals
* Be sure to include the 2nd case in the visit count
* Both cases treated on the same day = 1 visit for reporting purposes
* Each case seen on different days, count each day (you may be
reporting on visit #5 on the 1st case in this scenario

Question 89

when can you have two g codes

Answer 89

Two G-codes (CURRENT STATUS and GOAL STATUS or
DISCHARGE STATUS and GOAL STATUS)
* The functional severity modifier (CH, CI, CJ, CK, CL, CM, CN)
* The therapy modifier representing the related discipline
(GP = PT, GO = OT, GN = SLP)
* The date of the service
* A nominal or no charge ($0.01 or $0.00)
* A billable and separately payable service (actual therapy
services being billed)
* DO NOT include KX or -59 modifiers on these codes

Question 90

do FLR codes apply if medicare is the secondary payer

Answer 90

Do FLR codes apply when Medicare is a secondary
payer?
* Yes - Claims for Medicare as a secondary payer (MSP) hit the
same edits as if primary. So all rules apply when a patient has
MSP

Question 91

Does Medicare Advantage require FLR codes

Does VA require FLR codes??’

Answer 91

Do FLR codes apply to Medicare Advantage Plans?
* Some Medicare Advantage plans require FLR codes. Check
with the individual plans. (UHC, Todays Options, MVP Gold)
* Veterans Administration is requiring FLR codes

Question 92

Can you report earlier than the 10th visit yes but, just remember say if you write a progress note on the 8th than the next visit will be like the 18th

Answer 92

I report earlier than the 10th visit?
* Yes you can report any time on or before the 10th
visit.
* The visit following the reporting date restarts the
count for the next reporting period. For example:
If a progress report is completed with FLR codes on
the 8th visit then the next reporting period must be
on or before the 18th visit.

Question 93

what happens if you miss a progress report?? think no more payments until that last claim is submitted

Answer 93

What happens if you forget to report a G-code
at a scheduled reporting?
* The claims for that date of service and all
subsequent dates of service will be returned unpaid.
* Claims can be resubmitted with the proper codes to
receive payment.
* Submitting claims in sequence is very important in
order to avoid issues with FLR and payment

Question 94

Can the discharge FLR code and the new FLR code be
documented in the same progress note?

Answer 94

When an FLR code is being discharged and a new FLR code
will be required on the next visit, both codes can be
documented in the medical record at the progress report
* The new code will then be added on the next visit and the
documentation needs to state something like “the G-codes
and modifiers used in todays’ functional reporting are found
in the progress report dated MM/DD/YY”.

Question 95

Can a PTA report FLR codes?

Answer 95

Can a PTA report FLR codes?
* Yes – when documented previously by the
therapist

Question 96

can you modify a goal if it was orignally reported as obtainable yes but, if you modify a goal you need to change up your POC to see what is gonna be done to change this goal.

Answer 96

Can the initial projected goal status be changed if has been
determined during the course of treatment to be
unobtainable?
* If you perform a re-evaluation during the episode of care, you can
re-establish the projected goal at that time.
* If during the episode of care it is determined to be unobtainable,
then document this in the record and adjust the severity modifier
at the next reporting interval
* REMEMBER:
* If the long-term goals need to be significantly modified then you
would need to re-certify your plan of care

Question 97

Can a specific functional limitation category be
used more than once per episode of care?

Answer 97

Therapists would not generally use a category more

than once per episode of care; categories should not

be used consecutively.
* A category may be used twice if a patient has 2 cases
running simultaneously

Question 98

What FLR codes do I report on an evaluation
when it has been determined that no further
treatment is necessary and no further visits will
be received?

Answer 98

You will need to submit 3 G-codes
* CURRENT STATUS
* PROJECTED GOAL and
* DISCHARGE STATUS
* In this instance the severity modifiers may or may not
be the same for all three codes reported.