Medicare PQRS and Functional Limitation Scoring

As most of you are probably aware, Medicare has implemented two new scoring systems in which you will be required to participate in order to avoid reimbursement claw backs in the future. These new measures are called PQRS and Functional Limitations.

If this is brand new to you, please visit your professional association websites for more information as soon as possible to learn more about these new initiatives. Again, non-participation could have financial implications where reimbursement from Medicare is concerned.

In a nutshell, PQRS is used to indicate a particular condition that a client may be associated with such as being a Diabetic or having a high Body Mass Index. It’s generally a one-time reported score. Functional Limitation reporting, on the other hand, is more of a measurement of success – how was the patient doing at their initial assessment, what are their goals and how are they progressing, right up until discharge.

These new measures are reported by using special codes called “G” codes and several new modifiers. These are entered in the same way that your current CPT charges & modifiers are entered and will be submitted to Medicare using your existing method of claim submission (e.g. via Clearinghouse, directly to Medicare, etc).

The nature of these new measurements is complex and again we urge you to turn to your respective professional associations for further information.

That being said, our goal for Practice Perfect is to help you with a) the actual entry and submission of these new codes and b) automating this process – reminding you when scores are due and prompting you as to which codes are relevant.

Here is what we currently have planned regarding these new initiatives:

  • Phase 1: Make the PQRS ‘questionnaires’ available to be able to qualify clients for these new measurements. These are already available at:
  • Phase 2: Installation of all of the G-Codes and Modifiers so that you can begin to send the necessary results to Medicare – this will be completed in February 2013, several of these codes may already exist in your software.
  • Phase 3: The ability to indicate which clients are candidates for which PQRS/Functional Limitation measures and have the therapists ‘reminded’, at the specified intervals, as to when the scores need to be entered and which codes can be used. Eg; every 10th visit a note will pop up reminding the therapist that a functional score is due and will ‘force’ the therapist to pick a code and modifier that is within the guideline for that measure. This will be available in April 2013.
  • Phase 4: Reporting to show submission rates and acceptance success for PQRS and Functional Limitation scores. This will be available in June 2013.

We will continue to communicate new developments and let you know exactly when relevant Practice Perfect software updates become available. For more information, please either contact our support department at (877) 510-7473 or email us at [email protected].

Thanks for your continued support!

The Practice Perfect Customer Support Team

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