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


This week, we have been notified that phase 2 and phase 3 providers are receiving ADRs for October claims for resident’s who were at or over the $3,700 threshold.  Phase 1 providers who have pre-approval are receiving ADRs as well.


So, we are approaching December 1st.  Do you see light at the end of the tunnel for the Manual Medical Review?  Well, if you were in phase 1, you have been working diligently to obtain pre-approval of therapy visits for


Phase 2 providers are approaching their debut for submitting their pre-approval requests for part B therapy residents who have met or will meet the $3700 threshold for OT and $3700 threshold for PT/ST.  You may have already submitted your pre-approval

What’s In Store for Quarter Four?

The manual medical review of therapy claims is well on its way for phase 1 providers.  I am going to take a break from the Manual Medical Review this week and talk about our focus for the fourth quarter—coding and

Are You Surviving?

Are you surviving the manual medical review process?  Are you preparing for your phase-in date by working on the process in your facility? I just had a challenging last two weeks rolling out trainings company-wide discussing all of the MAC/FI

Threshold Pre-Approval Processes Posted!

MAC/FI Links Below for the Manual Medical Review process. Functional Pathways’ training will begin the week of September 10th. Palmetto: Palmetto Outpatient Therapy Caps and Threshold Process CGS: CGS Therapy Cap Exception Cahaba:   Cahaba GBA Manual Medical Review Process of

To Post or Not to Post—-Will They Post?

Well, if you are anything like me, you are anxiously awaiting the famous Medicare Manual Review of Therapy Services process from your MAC/FI.  When are they going to post on their website on how to request approval for therapy treatment days


Phase information is now available!! CMS has developed a tool which will allow providers to search by their NPI (National Provider Number) to determinae their phase. Providers can now identify which Phase they are in for rollout of the manual medical review