MediServe - Rehabilitation



MediServe - Rehabilitation
More than 25 Years Serving the Rehab and
Respiratory Community
About MediServe
Acute Care
Private Practice
•CORE Focus (Compliance, Outcomes, Revenue, Efficiency)
•250+ Clients
•Based in Chandler, Arizona
A Few of Our Rehab Clients
Claims-Based Outcomes Reporting (CBOR):
July 1 is nearing, Are You Prepared?
Loli Fulton, OTR/L
Shawn Hewitt, OTR/L
MediServe Product Managers
CBOR Agenda
CMS Review and Update
Compliant and Efficient Workflows
FAQs from our Industry Community
The Right Tools for your Tool Box
Claims Based Outcomes Reporting
The Middle Class Tax Relief and Jobs Creation Act of 2012 (MCTRJCA; Section 3005(g); states that
“The Secretary of Health and Human Services shall implement, beginning on January 1, 2013, a
claims-based data collection strategy that is designed to assist in reforming the Medicare
payment system for outpatient therapy services subject to the limitations of section 1833(g) of
the Social Security Act (42 U.S.C. 1395l(g)). Such strategy shall be designed to provide for the
collection of data on patient function during the course of therapy services in order to better
understand patient condition and outcomes.”
This claims-based data collection system is being implemented to include both 1) the reporting of
data by therapy providers and practitioners furnishing therapy services, and 2) the collection of
data by the contractors. This reporting and collection system requires claims for therapy services
to include nonpayable G-codes and related modifiers. These non-payable G-codes and
severity/complexity modifiers provide information about the beneficiary’s functional status at:
• The outset of the therapy episode of care,
• Specified points during treatment, and
• The time of discharge.
CR8005 MLN Matters:
Claims Based Outcomes Reporting
Medicare Part B…Primary AND Secondary
Test Period: January 1, 2013 – June 30, 2013
CBOR Compliance Mandatory: starting July 1, 2013
Must use outcome measures that map to a 7 point scale
AM-PAC, FOTO, OPTIMAL and NOMS were recommended by CMS in IOM
Reporting Frequency: Initial evaluation, on or before
every 10th visit, re-evaluation, and discharge (if patient
attends the discharge session).
Claims Based Outcomes Reporting
Claims Based Outcomes Reporting
Claims Based Outcomes Reporting
Evaluative Procedures. The presence of an HCPCS/CPT code on a claim for an
evaluation or re-evaluation service listed as follows requires reporting of
functional G-code(s) and corresponding modifier(s) for the same date of
CMS Update
One-Time Visits:
Therapist documents and codes all 3 G code/Modifier
sets (current, goal and discharge)
Addition of CPT code:
96125- Standardized cognitive performance testing per
hour of a qualified health care professionals time, both
face-to-face time administering tests and time
interpreting results and preparing report.
On or before 10 visits (not 30 days)
CR8005 MLN Matters:
Focus on CORE
• Requirement for G-Codes and Modifiers be in the ‘documentation’ and on
the bill
− If they can’t find it, they’ll deny
• CBOR Conversion Tool and Cards: translates outcome scores to modifier
• Real-time exception reporting for a clean bill out
− Denial Prevention
• Integrated workflow into the documentation for therapists
CBOR Workflow
*Don’t forget your G codes and modifiers must accompany a CPT code for a date of service!
CBOR Workflow
*Don’t forget your G codes and modifiers must accompany a CPT code for a date of service!
CBOR Workflow
*Don’t forget your G codes and modifiers must accompany a CPT code for a date of service!
Challenges you will face…
Compliance Challenges
Evaluative CPT is charged without an associated G Code/Modifier…and
visa versa
Current/Discharge level codes are present without a Goal level code…and
visa versa
Goal level is lower than the current level
G Code is Present without an associated modifier
Improper G Code transition
Presence of Current and Discharge levels on different impairments
on the same date of service
Presence of 2 or more different primary functional impairments
coded on the same date of service
Primary impairment G Code has been discharged without a new
impairment G Code in the subsequent treatment note if continuing
Duplicate G Code/Type of the same primary functional area on the
same date of service
Challenges you will face…
Compliance Challenges continued:
Clearly identifying patients that are Medicare Part B
Multiple modifiers that can be on a claim: 59, KX, GN, GO, GP, C Modifier
G codes do not require the KX modifier
Charge master modifications that are required to support G codes and
Tracking the 10th visit
Therapist forgets to do a standardized assessment
Common Questions about Claims-Based Outcomes Reporting:
Tools for your Tool Box…
MediServe CBOR Conversion Tool…FREE
Order FREE CBOR Cards
Visit our website:
Please allow for 4 week delivery time!
CBOR Highlights in MediLinks
Easily select the correct G-code and modifier based on therapist
Alert therapists and managers automatically when G-codes need to be applied
Monitor claims based data collection compliance using specifically designed
reports in MediLinks
Comply with all CMS G-code scoring rules for evaluations, progress notes,
goals and discharges
Seamlessly change from primary G-codes to subsequent functional categories
ICF-based content aligns to CMS’ new functional impairment categories, so the
system will adapt easily to future changes, including DOTPA
Insert a variety of standard outcomes measures like Boston University’s AMPAC™ – see how you can use the AM-PAC at your facility…
Eliminate denials due to missed recertifications by tracking progress notes and
recertification requirements simultaneously
Tools for your Tool Box…MediLinks
Don’t Forget
CMS is not playing around…
They will deny your charges starting July 1st if
they are not coded accurately
Free CBOR Conversion Tool:
Free CBOR Cards:
Online CBOR Frequently Asked Questions
Send additional questions to:
[email protected]