Medicare isn’t the Only Payer Requiring FLR

Written by Erica Cohen on July 15, 2014

On July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) began requiring that all clinicians who provide—and bill for—outpatient physical, occupational, and speech therapy services under Medicare Part B complete functional limitation reporting (FLR) for all eligible Medicare patients. As of last year, Medicare began denying claims that did not include complete FLR data.

Once Medicare got this bandwagon rolling, it didn’t take long for private health plans to jump aboard—including UnitedHealthcare’s Medicare Advantage Plans (effective August 1, 2014). As of today, most private carriers still do not require FLR. (However, that may change.) For now, here are the plans that do:

  • MVP Gold
  • Health Net Medicare Advantage
  • The Veterans Administration
  • Texas Workers’ Compensation
  • Coventry
  • Geisinger Gold Medicare
  • WellCare, Freedom Healthcare, AARP, CarePlus, and Physicians United (Florida)
  • Soundpath Health (Washington)
  • Highmark (Pennsylvania, West Virginia, and Delaware)
  • Amerigroup Medicare Advantage (New Mexico, Texas, Tennessee, Florida, Maryland, New Jersey, and New York)
  • Today’s Options and Amerigroup (New York)
  • Anthem BCBS
  • Medica Medicare Advantage (Minnesota)
  • Blue Cross Blue Shield (BCBS) Medicare Advantage (Minnesota and Idaho)

To the best of our knowledge this list was current at the time we created this blog post, but—as we all know—things in the healthcare world can change fast. If you have questions about a specific plan (on or off this list), please inquire directly with that carrier.

Chances are pretty good that more private payers will adopt the FLR standard, so we will post that information right here on functionalimitation.org, and on the WebPT blog, as it becomes available. Please check back often.

Posted Under: Functional Limitation Reporting
About Erica Cohen

Erica Cohen is a writer and editor with experience in both the healthcare and technology industries. After graduating summa cum laude from Arizona State University, Erica obtained her Master of Arts from the University of Chicago in Social Science. She currently runs her own writing company in San Francisco, California. For questions about functional limitation, please email functionallimitation@webpt.com.