Functional Limitation Reporting Processing Issues

March 10, 2014
Rick Gawenda

First Coast Service Options, National Government Services (NGS) and Novitas Solutions have announced that claims reporting Outpatient Therapy Functional G-codes and modifier information may be incorrectly receiving errors from the Common Working File (CWF) causing incorrect denials. The issues have been referred to CWF system maintainer for research and resolution. CWF has acknowledged an issue that is causing some of the incorrect denials and they are working on a resolution.  However, CWF is also researching other potential issues related to the G-code processing. Further instructions will be provided once CWF has completed their research and any required system corrections.

Even though the announcement was only made by First Coast Service Options, NGS and Novitas Solutions, it’s my opinion that the remaining Medicare Administrative Contractors are also incorrectly denying claims that are correctly reporting the Functional G-Codes. Watch for further details as a Gold Member as they become available.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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