What is the definition of progress?  According to ‘The Free Dictionary by Farlex” online, the definition of the word ‘Progress’ as a noun is: Movement, as toward a goal; advance Development of growth Steady improvement A ceremonial journey made by a

Government Reports Regarding 2012 MMR Process

There has been a lot of chatter in the industry about the Government Accountability Office’s (GAO) report regarding the quarter 4, 2012 manual medical review process.  According to the GAO, CMS did not provide therapy contractors timely guidance which ultimately resulted in


Functional Limitation Reporting testing period ends June 30, 2013 (testing period: 1/1/13-6/30/13).   All claims beginning July 1 must have the functional limitation reporting G- codes and severity modifiers or your claims will be rejected and returned. If for some reason

CERTS—Are these breath mints??

LOL—Yes they are mints if you are looking to improve your breath but these days, we as an industry are just trying to catch our breath! A “CERT” stands for ‘Community Emergency Response Team’ if you are referring to first aid products or ‘Computer


We have been informed of RAC activity in Region A (Performant Recovery, Inc.) for the following states:  Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. RAC Issue in Region B (CGI)

RAC Manual Medical Review

We are well into 2013 and moving along with the manual medical review by the RACs for claims over the $3,700 threshold.  Where do you stand?  Have you received ADRs as a result of being over the $3,700 threshold?  Did


I just spent eight hours traveling to beautiful Charlotte North Carolina to participate in Functional Pathways 360 CEU Symposium event!  While driving, I spent a lot of time thinking of the conversations I have had this week with therapists and

What are LCDs??

Often we receive questions from the field regarding coding of therapy diagnoses and we wish we could just “add” any ICD-9 code to the computer system.  However, we have to base the selection of the codes off of the Medicare

Functional Limitation Reporting

I know that the mandatory ‘go live’ date isn’t until July 1st for claims to be in compliance with G-Codes and Severity Modifiers.  However, why wait until the last minute?  If you haven’t contacted you software vendor to discuss when

Reasonable and Necessary Therapy Services

We have been hearing for years that therapy services must be reasonable and necessary.  Now, with all Medicare Part B claims over $3,700 being reviewed by RACs, MACs conducting focused Probe audits, and don’t forget about the ZPIC audits, it is even more important that therapy