As you may be aware, there will be new reporting requirements for outpatient therapy services beginning 1/1/13.

The Middle Class Tax Relief and Jobs Creating Act of 2012 section 3005(g) amended section 1833(g) of the Social Security Act to require a claims-based data collection system.  The system will collect data on beneficiary function during the course of therapy services in order to better understand patient conditions, outcomes, and expenditures.  This data collected from the functional reporting will be used in developing an improved payment system for part B outpatient therapy services.

 An overview of the new reporting requirements are outlined below:

  1. All Medicare part B providers must begin claims-based reporting of patient’s functional status using 42 nonpayable G-codes and 7 severity/complexity modifiers
  2. Reporting goes into effect January 1, 2013 with a testing period through June 30, 2013
  3. Claims submitted July 1, 2013 and after will be returned/rejected if the necessary G-codes and severity/complexity modifiers are not included on the claims
  4. Non-payable G-codes and severity/complexity modifiers are to be reported at the outset of the therapy episode of care, at least once every 10 days, and at the time of discharge
  5. Documentation to support the G-codes and severity/complexity modifiers billed must be reflected in the medical record
  6. Requirements are for part B traditional Medicare and is not applicable to the Medicare Advantage Plans
  7. Provider billing office personnel need to be knowledgeable of these reporting requirements—we recommend contacting your billing software vendor for support with training

Functional Pathways has been preparing for the functional reporting requirements. Our employees will be attending comprehensive trainings throughout January and February 2013 to ensure their comfort level and compliance with the new processes.  After we complete our trainings, we will then be ready to work with our clients/business office managers to be sure claims will be ready for July 1st. In addition, our therapy software, Rehab Optima, will be rolling out changes to accommodate and ensure reporting compliance the week of January 7, 2013. Providers will need to contact their billing software companies to determine their readiness and training for your Business Office Managers and billing personnel.


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