TheraOffice ®

1. TheraOffice® Functional Reporting Hands on Technology www.rehabsoftware.com

2. Overview of Functional Limitation Reporting • Required by section 3005 (g) of the Middle Class Tax Relief and Jobs Creation Act amended Section 1833 (g) of the Social Security Act • Purpose is to collect data on beneficiary function during the course of therapy services to better understand patient conditions, outcomes, and expenditures • This data will be used to help develop an improved payment system • Functional Reporting is not PQRS

3. Overview of Functional Limitation Reporting • Implemented on Jan 1, 2013 • Will become mandated July 1, 2013 • Any claims requiring these G-Codes on or after this day without the applicable codes will be returned / rejected • Affective for all outpatient therapy services, including physical therapy, occupational therapy, and speech-language pathology • Applies to Medicare Part B outpatient therapy

4. G-codes and Modifiers • G-Codes will require a therapy modifier • Each functional G-Code set will contain: current status, projected goal status, and discharge status • There are 42 functional G-codes (14 sets of 3 codes each)

5. How to Select the Right G-codes • When reporting,select the functional limitation that most closely relates to the primary functional limitation being treated, or the main reason for treatment • With more than one functional limitation, the therapist may need to determine which functional limitation is primary • The “Other PT/OT/SLP” functional G-codes are used when the other four categories do not describe the patient’s functional limitation • Only one functional limitation shall be reported at a time • Two functional limitation categories can be reported consecutively, but not concurrently

6. Modifiers • Each non-payable functional G-code must be reported with a severity/complexity modifier • Modifiers will reflect the patient’s percentage of functional impairment • Modifiers: • CH – 0% impaired, limited restricted • CI – at least 1% but less than 20% impaired, limited restricted • CJ – at least 20% but less than 40% impaired, limited restricted • CK – at least 40% but less than 60% impaired, limited restricted • CL – at least 60% but less than 80% impaired, limited restricted • CM – at least 80% but less than 100% impaired, limited restricted • CN – 100% impaired, limited restricted

7. Choosing the Correct Modifier • Use the modifier that reflects the score from a functional assessment tool • Therapists are expected to use functional assessment tools (Oswestry, OPTIMAL, Berg Balance) to assist in determining the level of impairment • IF the therapist feels there additional factors contributing to patient’s impairment that are not accounted for in this tool, they can choose to change the modifier to what they feel is appropriate • It is crucial that this be documented in the modifier justification section as to why this adjustment was made • In cases where the therapist does not expect improvement, the modifier for the projected goal status will be the same as the one for the current status • Submitting a goal status that is equal to the current status will most likely result in a denial from Medicare • Appropriate documentation to prove medical necessity will be required to receive payment on these claims

8. Successfully Reporting G-codes • Functional G codes are required to be reported at least every 10 visits • If you do a re-evaluation and have a 97002 code you have to report regardless of which visit it is • The first claim submitted to Medicare with these codes starts a reporting period • When a discharge code is used, the current reporting period is closed • Any claims submitted to Medicare after July 1st, 2013 will need to be within a reporting period or they will be rejected • If the reporting period was started before July 1st, the rule for every 10 visits continues to apply through the transition

9. Reporting • Required on Claims: • Functional severity modifier • Therapy modifier indicating related discipline • Date of therapy service • The number of G-codes required on a claim under one therapy POC is two • Current status and goal status • Discharge status and goal status • When reporting a one-time visit where there is no plan of care, submit all three functional G codes within that category: • Current • Goal • Discharge

10. Example of Required Reporting • Mobility: Walking and Moving Around • Evaluation/beginning of reporting period #1 • G8978-Current • G8979-Goal • End of reporting period #1 (10th visit) • G8978-Current • G8979-Goal • Visit #14/End of reporting on Walking & Moving (Patient is Discharged) • G8979-Goal • G8980-Discharge

11. Functional Reporting in TheraOffice: What’s New? • Functional Limitation Reporting Update will come with two phases: • Phase 1 • Updates within TheraOffice • The new sections that will be added to the Document Designer are • Functional Testing • Functional Reporting • Phase 2 • App: Function Vibe,will be used for tablets which will perform all of the scoring for the functional tests • For IPad or Windows 8 • Scores will be directly downloaded from the Functional Testing App right into TheraOffice • Impairment ratings will be done automatically or can be customized

12. Functional Testing and Functional Reporting in TheraOffice Functional Testing and Functional Reporting will be the two new sections added to the Document Navigator

13. TheraOffice Document Navigator • Depending on how long you have been using TheraOffice, you may or may not have two sections in the Document Navigator titled: • Outcomes • Optimal Form • These sections will eventually be phased out once TheraOffice has been updated with the functional reporting update • Therapists or system administrators can delete these sections or change the names to say Outcomes Legacy or Optimal Form Legacy • Therapists will then need to train staff not to use these options any longer • About a month or so after updating TheraOffice with the functional reporting update, these two sections can be closed out

14. Functional Testing • When in the Document Editor, click on Manage Data at the top and a list of functional test categories will appear • There will be 2 categories for each discipline • Pre-populated G-Codes will appear after updating TheraOffice • G-Codes and modifiers will also be pre-populated with the update in the Contracted Fee Schedule for Medicare • GP = PT • GO = OT • GN = Speech • Once in the Functional Testing section in the Document Navigator, a box with Functional Tests will appear • There are 15 tests total • The scores and the impairments will be listed • Based on the functional tests, the impairment rating will be done automatically

15. Functional Testing Process • First Step: • Fill out scores which will populate the impairments • Second Step • Go into the Functional Reporting section in the Document Navigator Functional Reporting

16. Functional Testing Process – “Suggest From Functional Test” • Third Step • You can choose the option for “Suggest From Functional Tests” and the document will automatically suggest categories and modifiers based on results from the functional testing section • By choosing this, the tests will be tabulated, impairments will be summed and then averaged, and average impairment will be sorted (by highest impairment) “Suggest From Functional Tests”

17. “Suggest From Functional Tests” • Data, including the CPT code and modifier for the current status and goal CPT code, will be populated based on the results from Function Vibe

18. “Suggest From Functional Tests” • Fourth Step • Selecting a modifier for the Goal Status, and a blue dot will appear on the graph that will display where the goal status is compared to the current status (blue bar)

19. “Suggest From Functional Tests” • Fifth Step • Enter any additional documentation justifying the selection of the modifiers at the bottom of the screen • Because you are being notified that this report is required by Medicare, ensure that you have the “Send” box checked • By checking this box, you will be sending these charges to Medicare on your next claim

20. Functional Testing • If a Therapist chooses not to use Function Vibe to suggest tests, they can choose the “Therapist Discretion” dropdown option which will allow them to manually input codes and modifiers • They will need to document why they chose those codes

21. Functional Testing • Example: • If your current patient is on their 30th visit you will need to update their scores with Functional Vibe or manually update scores • If their current status went up to the next level and they are less impaired, the graph will show that they are closer to reaching their goal • A yellow alert will appear informing you that you need to send this report, so therefore, you will need to click on the “send” box • Suggest charges as normal

22. Charges • The treatment charges will go in as normal • The Functional Reporting Charges will go in below the treatment charges • 2 or 3 CPT codes that you will be reporting will appear along with their modifiers and descriptions • MOD 1 will classify the discipline (GP- PT, GO- OT, GN- Speech) • MOD 2 will display the necessary modifiers

23. Charges • After adding the suggested charges, a PQRS questionnaire will appear asking you if you would like to run it • Click yes if you want to run the PQRS questionnaire

24. Functional Testing: Other • If the patient is not Medicare, a pop up will appear that will inform you that this functional reporting section is not required • We will eventually add an alert in the TheraOffice Scheduling module that will inform you upon check-in whether or not this patient is Medicare and needs to perform the functional testing