Countdown To Functional Reporting, Day 5!

With 1 business day before the start to Functional Reporting, we’ve compiled a list of some of frequently asked questions that our support team has answered, along with some questions that have been asked during the Functional Reporting training webinars.

What Is Functional Reporting?

Functional Limitation Reporting is a mandated claim-based reporting process by which you indicate to Medicare patient function, condition, and outcomes achieved.  It becomes mandatory for all Medicare patients as of July 1st, 2013.  Below are a few links that will help you with all of the details.

TheraOffice FLR Webinars (signup and previously recorded) – START HERE!
TheraOffice Landing Page and FAQ
TheraOffice 6/27/2013 New Updates
APTA FLR Landing Page
CMS Functional Reporting FAQ

 

I am on the 2007.2 or 2009.1 version of the software and need to upgrade.  How do I do that?

In order to update to the latest version of the TheraOffice software, you’ll need to upgrade to our TheraOffice 10.1 On-Site or migrate to TheraOffice Web.  If you need to have this upgrade done, contact TheraOffice Support as soon as possible, as available slots will fill up quickly.  The process involves taking a support representative taking backup of your database, running updates, and then installing the newest client on each computer.  The process could take time depending on the size of your database and what version upgrading from.

 

It is July 1st, and some of my Medicare patients are receiving popups about requiring G codes, while others are not.  Why is this?

If you had a patient that you correctly submitted g-codes for before July 1st, the next required code submission would come 10 visits after the most recent g-code submission.  The logic put in place for your visit counts is accounting for this and not yet requiring g-codes for that patient.  Below is the exact wording from APTA regarding the issue: Those providers who have submitted functional limitation data to the Centers for Medicare and Medicaid Services (CMS) prior to July 1 do not need to restart functional limitation reporting on the first date of service on or after July 1. Instead, for those patients only, therapists can wait to submit functional limitation data until the next required reporting interval (eg, at the patient’s 10th visit or at discharge).

http://www.apta.org/Payment/Medicare/CodingBilling/FunctionalLimitation/

If you did no previous submission, then it is most likely related to the patient not having an insurance that requires them.  You can ensure the insurance is setup correctly by going to Manage -> Data -> Insurances and then checking the Functional Reporting field.  Also, I recommend running our Ready Check report by going to Documentation -> Tools -> Functional Reporting Readiness Report.  That will show you a list of items to review that could cause issues after July 1st.

 

I will need to start reporting a discharge code on the last visit for every patient, can you load in a Discharge/Daily Note for me?

To load in a Discharge/Daily Note, it is best for technical support to complete the process for you.  If you need this note because you want to make sure to submit a discharge code for Medicare patient’s final visit, it is important to keep in mind that Medicare does not require that closing g-code if no formal discharge was done on the last visit they were seen.  Medicare will not penalize you for not closing out a reporting category as there is no way for you to do this in instances where the patient suddenly does not come back.

If you would still like to have this loaded in for you, please contact Technical Support and they will complete the process for you.

 

I am receiving a new screen at appointment check-in instead of the regular copay screen.  How do I go back to what it was before?

The purpose behind this recently added feature is to provide the front desk staff with additional information regarding the functional reporting process.  As many functional tests involve a questionnaire, the front desk can play a critical role in maximizing efficiency.  If your clinic’s process makes no use of the front desk in this process, this screen can be disabled.  To do this, go to Administrator, click Application Options, Scheduling, and uncheck the box next to “Enable Functional Reporting Alerts On Check-In”.

 

I want more of a warning for completing these codes then on the 10th visit.  How do I adjust my alerts to receive the warning ahead of time?

There will be two areas that you can adjust the threshold for these FLR alerts.

  • Documentation Patient Navigator Alert: To adjust the alert that displays in the yellow bar at the top, you will need to open Administrator.  Go to Alerts & Tasks -> Alerts.  Find the alert labeled “G Codes Due – Discipline 1” and double click on it.  Modify the yellow value to be how many days in advance you want the yellow alert to appear.  Also adjust the message that appears to the right of the value box.  By default, this is set to one, so it will trigger on the 9th visit.  Do not adjust the red or green values.
  • Schedule Check In Alert: To adjust how often the Check In Screen requires you to check the box to acknowledge the functional reporting information, open Administrator and go to Application Options -> Scheduling.  Modify the Functional Reporting Alert Visits value to reflect what visit # you want to make it required to check that box.  By default, this is set to 10, so you will only have to check that box on the required visits.

 

What is the purpose of the new checkbox “Functional Reporting Has Been Verified” that appears in the check-in screen?

It is not uncommon to quickly close out of a screen you are used to seeing just so that you can quickly move through your work.  We know how important it is to submit these codes when they are required, so we wanted to purposely slow down the front desk staff when this was something that was required of them.  This box affects nothing other than allowing you to check in the patient.

 

I do not currently use any functional tests.  Which ones should I use and where can I get them from?

Part of the 10.1.0.9 update was a readiness check that we built into the Documentation module.  To access this, open Documentation and go to Tools, then Functional Reporting Readiness Report.  Here, you will get a list of the functional tests that we have pre-loaded into our system, as well as links to the tests themselves that you can download and/or print.  Soon, we will be releasing a standalone app called Function Vibe that will allow you to score these tests through a tablet, eliminating the paper portion entirely.  Based on customer feedback, we feel this is a much better option than including the test itself in your documentation, as that would require your providers to do additional time-consuming data entry.  Even the paper option is a better alternative than an electronic copy that only your provider can fill out.

 

Under functional testing, do I enter the raw score or the calculated score under the score column?

Either the raw score or the calculated score for each test will work, though a consistency between your providers is going to be important.  Make sure that if you enter the raw score in this field, you modify the calculation / test instructions accordingly.  It is the impairment column that really matters and is what affects the modifiers that end up getting suggested.  A calculated score means the impairment will automatically translate for you, while a raw score will require a User Calculated setting.

 

How do I submit a discharge code within the functional reporting section?

To submit a discharge code, you will want to first complete the functional testing section as normal.  Then in the Functional Reporting section, before suggesting G-Codes, change the Report drop-down to say “Discharge & Goal”.  Now, click the Suggest From Functional Tests button and it will auto populate the Discharge Modifier for you.  If you are only discharging the category and not the patient, you will receive an alert in the following visit that g-codes are once again due.  At that time, you will need to either delete the existing category and re-suggest or manually select a new category to report on.  Make other adjustments as needed.

 

Do I need to submit a penny charge or a zero charge for functional reporting codes?

Medicare has stated that they will accept either a zero charge or a penny charge with any functional g-codes.  However, some replacements, intermediaries, and clearinghouses have shown over the past few months to require only one way and not the other.  If you need to change the amount that you are currently sending, this can be done through the contracted fee schedule.  To do this, open Accounting and go to Manage, Data, Contracted Fee Schedule.  Edit the Medicare and Medicare KX fee schedules so that the charge column has $0.00 or $0.01 for each of the FLR charges.

 

I have a Medicare Secondary patient that it states is requiring g-codes.  How do I get around this?

Any patients that will have their claims submitted to Medicare after July 1st will require these g-codes.  This includes patients that are Medicare Secondary.  Here is CMS’s official response. Yes, Functional Reporting is required when Medicare is the secondary payer. http://www.cms.gov/Medicare/Billing/TherapyServices/Downloads/Functional-Reporting-PT-OT-SLP-Services-FAQ.pdf

 

What do I do about my Medicare Advantage/Replacement insurances?

This varies from insurance to insurance.  To know 100% whether or not an insurance requires these codes, it is best to contact them directly and ask.

 

I added g-codes to the functional reporting section, but they didn’t get pulled into Accounting.  What did I do wrong?

We recommend following the below three steps when finding out why codes did not get sent through.

  1. Was the Send checkbox checked in the functional reporting section?  This needs to be checked in order for the codes to get sent across.
  2. While in the Charges section, do you see the FLR codes listed there in the read-only section?  Do they have all of the correct modifiers?
  3. If they are missing any modifiers, it is probably related to the insurance not being setup correctly.  To fix this and any other insurances that might be having the same problem, I recommend running the readiness check we built in the most recent update.  To access this, open Documentation and go to Tools, Functional Reporting Readiness Report.  That should list all insurances that might have a problem with their fee schedule / default modifier.

 

I need my charges by rendering / submitting provider report to have columns for modifiers.  How do I do that?

We have recently updated our standard reports so that these two reports have columns for modifiers.  To get these reports updated, you will need to run an update through the Add In Manager.  Open TheraOffice Administrator and go to System, Add In Manager.  Select Download Add Ins.  Select Reports on the left hand side, and then Install.

If you have a custom version of this report that needs updating, please submit a custom report request to get this further updated.

 

Should you have any additional questions, please contact us, or post comments below and we’ll get back to you.

 

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