New Info on Manual Medical Review Process

CMS posted last night with final guidance on the Manual Medical Review for therapy claims above $3,700.  Medicare Administrative Contractors (MACs) will conduct prepayment reviews until March 31, 2013 then beginning April 1, 2013 Recovery Audit Contractors (RACs) will conduct all reviews


Functional Pathways wanted you to be aware that you might receive non-compliance alerts for outpatient therapy functional reporting G-Codes and severity modifiers from your MAC. These alerts do not apply to institutional claims.  There will be no alert messaging for institutional

Outpatient Therapy Claims Crossover Problem

In the Thursday March 7, 2013 CMS FFS Provider e-News reports problems impacting crossover of Medicare Part B Outpatient Therapy Claims.  CMS reports that providers who bill Medicare for outpatient therapy may have recently noticed an increase in the frequency of Health Insurance

News: CMS responds regarding MMR & Therapy

CMS posted updated information about the agency’s Manual Medical Review process. The annual Medicare Part B therapy benefit for each Medicare beneficiary is $1,900 for Occupational Therapy and $1,900 for Physical Therapy/Speech Therapy combined.  There are exceptions to the these therapy caps for reasonable and necessary


Functional Pathways will be hosting Functional Limitation Reporting Webinars for all of our partners beginning this week.  The invitations have been sent out to all Administrators for all nine currently scheduled webinars.  Administrators can foward the invitation to the Business Office Managers

“Triple Check? Why? We Don’t Get Denials!”

Functional Pathways is committed to ensuring that the therapy treatment we provide is skilled in nature as well as reasonable and necessary.  We strongly recommend and encourage our partners to include us in their triple check process.  Why?  Because we


Life is about change, right?  Well we certainly have been seeing change again with part B therapy. Therapy Cap and Manual Medical Review:  The exceptions process was extended through December 31st of this year which also extends the manual medical

Functional Reporting and Manual Medical Review

I hope you have a wonderful holiday season! It’s a new year and Medicare Part B therapy changes continue.  As you are aware, Functional Reporting went into effect January 1, 2013 with a testing period through June 30th.  Claims submitted July

Preparing for Medicare Implementation

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


Compliance is defined as the act of adhering to, and demonstrating adherence to, a standard or regulation.  As you know, in the medical field, there are numerous regulations and they are constantly changing. Functional Pathways is passionate and committed to