IF you are billing Medicare for ANY physical therapy services, regardless of who performs them, it is your responsibility to train your staff and adopt compliance policy on the proper use and documentation for this mandatory reporting.
Beginning July 1, 2013 Medicare will reject and return claims that do not contain required functional G-codes and severity modifier information and auditors will also begin assessing the medical records for the required documentation necessary to support the selection and use of the codes when performing pre and post-payment reviews.
Under this new rule non-payable G-codes and modifiers must be included on the claim forms after June 30, 2013, to capture data on the beneficiary’s functional limitations. In addition Medicare requires that the therapist, physician/NPP furnishing the therapy services also document and track the G-codes and modifiers used for this reporting in the beneficiary’s medical record of therapy services. Mandatory reporting applies to ALL practitioners who furnish outpatient therapy services, including physical therapists, occupational therapists, and speech-language pathologists in private practice, physicians and NPPs (including, physician assistants (PAs), nurse practitioners (NPs) and clinical nurse specialists (CNSs) and those therapists who furnish services in the institutional settings. Mandatory reporting applies to specific claims for ALL episodes of therapy, NOT just those above the therapy caps and includes all therapy services furnished personally OR “incident to” the services of physicians or nonphysician practitioners (NPPs)”
It is incumbent on you to adopt compliance policy and train your providers and staff on the proper use and documentation for this mandatory reporting.
THE SOLUTION: · Your “Complete” package for compliance with Medicare’s mandatory reporting of functional status on therapy claims. We have done it all for you and put it on a CD-ROM!!!