2019 Preview & TheraOffice .11 Release

November 29, 2018

Hosted By:

Nick Austin

Thank you everyone for attending today’s webinar. It’s the third in a series that we’ve been doing related to mips and the beer Updates. This one is really focused on kind of the TheraOffice side and also touches on some industry stuff that maybe we didn’t fully cover. In the previous webinar so very excited to kind of get the this whole mips project or mitts webinars wrapped up happy to announce that we’re also going to be doing to Q&A webinars throughout December which are just focused on questions and answers.

We know that’s a big highlight for a lot of people attending because they’ve got specific questions that they’re looking to get answered. So this one is going to be a little bit shorter so up plenty of time for Q&A at the end. So make sure to get those submitted. So let’s go ahead and get started.

So first off if you have not attended the previous two webinars It’s Made Easy with her office and mips measures and scoring summary highly highly encourage that you attend both of these webinars. Um, they’re very critical to the success of the or to understanding the mips program how you’re going to be doing it within TheraOffice.

Both of those webinar should now be available in the training center. So if you were to just open up TheraOffice go to help and then Training Center, you’ll be able to watch the recorded version of those. Also during the last webinar we decided to tap it a little bit differently with regards to the questions in that the last webinar.

We had to add sir. Ask all the questions and then we kept them on our side answer them and we are right in the process of right at the end of the process of getting those sent out to everybody. So look out for those coming out to you soon. Also one more thing is the registry signups we had in the previous webinar.

We had had a poll asking people for their interest level with regards to the registry. We’re going to be doing additional follow-ups for anybody that answered that way but the official sign up can actually now be found at TheraOffice.com registry. Alright, so the next part that we kind of left unknown in the previous webinar was with regards to photo.

We’re happy to announce today that the ther office registry will be able to report on quality measures to 17 through 23 or the functional status changes stewarded by photo. So photo users will have this information populate automatically based on the results from photo side. So if you’re using that photo plus integration, we are automatically going to populate the registry with the results of those measures.

The only exception for this is that photo in the 2019 reporting year is actually doing a new qcdr for the neck impairments. Those are that specific qcdr will not be available from TheraOffices registry. You would need to use photos registry in order to report on that one. Alright, so the next thing we want to go over is really just the industry changes.

So in addition to the mips ruling there was a few other things that came down through the physician fee schedule at the end of the year. In the major one had to do with functional limitation reporting being the program ending as of January 1st 2019. So I’ve alluded to this a few times in the previous webinars, but I want to go through this very specifically in terms of how we’re handling it and how you should be perceiving it so.

For Medicare insurances, they will no longer require functional limitation reporting codes or the functional reporting section of TheraOffice that will no longer be required as of dates of service of January 1st, 2019 and moving forward. If you had any commercial insurances that work that that adopted the program you would need to contact those Commercial Insurance has directly and find out whether or not they’re going to continue to use functional reporting.

As a heads up. This does not impact anything with regards to progress note the requirements. This is just functional limitation reporting just that program. Nothing to do it progress notes. Nothing to do with the new mips program. This is just a functional limitation reporting that is ending as of January 1st.

So how will you handle it with? Another office while web customers will have their function limitation reporting requirement turned off for all Medicare insurance has on January 1st. On-site customers will need to update this manually through the insurances screen in January. So we’re going to do extra reminders on this will be sending out emails on this.

So the exact step-by-step instructions will be given to everybody right at the start of the year. We’re going to be doing kind of a few email blasts on the first day of the year for everybody whether or not your web or on site those Commercial Insurance has it they’re changing their requirements to mount no longer require function reporting you’ll need to do that manually within each insurance.

Whether or not you’re on site or web.

Okay. So the next change is the therapy cap. The therapy cap is unfortunately still required to be tracked despite the fact that it has technically been repealed and this soft therapy cap has been increased to 20 40 as of 2019. So just like every single year web customers will have their caps updated automatically.

On-site customers willing to download a TI from Adam manager again instructions are coming out that first work day of the year with specific instructions on how to handle this. Peso the other major change that came down in this physician fee schedule had to do with something that they eluded to back when they repeal the financial cap, which is the new modifiers for ptas and OTAs.

So this this ruling was decided in the 2019 physician fee schedule. But it doesn’t actually go into place until 2020 so you don’t need to worry about this for now, but you are going to start hearing a lot about it if you haven’t already and basically what it is is a PTA or an OT a requires a specific modifier if that PT or OT a furnished more than 10% of the service.

So in terms of time, they spent more than ten percent of it on it. Then you would need to include these CQ modifier for pts. And the co modifier for OTS or OTAs. In addition to these modifiers the payment for these services will also be reduced by 15% So that was part of that essentially was the payment made in order to get the therapy cap repealed where they were going to get the funds from was by reducing payment on PT aota services.

So we got nothing changes in this update that you guys are getting before the end of the year. We will have something in the second half probably of 2019 to prepare for this 2020 requirement.

All right. So timeline with regards to the update before we start going into the details of what that looks like. So we are currently in the beta stage for the dot 11 update. They have a few customers testing it now on December 10th. We will begin the web roll out. So between now and December 10th, we’re going to continue to scale up ETA but on December 10th, we start the web rollout and December 17th on site.

Roll up against and then by December 31st, all customers will be updated all customers. Should they want to be up there? And we have a few out there that tend to move slower on the updates. You can still do that here. Just if you’re wanting to report on my lips, you got to get updated before the end of the year.

So we are ensuring that it’s available to everybody before the end of the year. Now. One other thing to mention is. And I mentioned this previously in the other webinars is that we’re still waiting on some correspondence from Medicare in the form of the measure specification documents. And basically what these measures specification documents are the details of how you report on different quality measures within Maps.

So some things that could happen with regards to those. It could change the codes that we need to actually report on it could include us in a few additional quality measures such as diabetes or Falls. We could be included in those through those measure specification documents, even though they weren’t any actual final rule.

So if that is the case, we are planning on doing kind of a last week of the year update to account for those new quality measure. Should they should they come up? Unfortunately, we just don’t know as of yet Medicare is not releasing any information and we’re hearing sometime between December 1st and December 19th for that remaining information.

So. These things can still change a little bit what we recommend everybody is make sure to pay attention everything as were leading up to that January 1st. So make sure that you receive the newsletters make sure you’re receiving emails from us. And as long as you are will make sure to alert you to any updates become available that are required for the program.

All right. So next we’re going to go through a kind of the changes that are within the update and some of these are going to be redundant from previous versions or previous webinars. I wanted to include them here just so that you have access to everything right within here for the changes. You saw the slide before we’re adding in a new BMI section that BMI section details out every part of the mixed quality measure.

So you’re indicating whether or not they’re eligible or not eligible. If the patient doesn’t want to tap their height or weight taken you check that box for patient not eligible. They would be considered a denominator exclusion and they wouldn’t count against you from it. Then you’ve got your height and weight BMI gets calculated for you automatically and then you’ve got your follow-up plans to that check box list.

The next section that gets updated is the medication history. This is an existing section. We’re just going to be updating it. So that includes those correct columns according to what needs to be collected for that quality measure. So you’ve got your medication name your dosage or frequency and your route of administration.

And then you also have check boxes for no current medications or a test to current medications being documented image note and then the assessments is going to score for the mips quality measure based off of what you have entered into the the other area. So one thing that I want to comment on for this because we received a few questions about it was what do I do if the patient doesn’t know some of the information.

Let’s say they don’t know the dosage for the medication that they’re taking. So what I would do in that instance is I would put you know, unknown or patient doesn’t know in the dosage columns that you complete that column. But essentially all you’re all you’re doing all you’re responsible for is using every means you can of getting this medication information at the time of service.

So if you are talking the patient and the patient doesn’t know then that that does qualify as meeting the performance of this measure. But you just make sure need you need to document it and I would also recommend asking the patient to follow up on their next visit with that information if possible.

Alright, the next one is the functional testing section. Again. This is the same thing that we were shown before with regards to this section getting updated with the pain assessment and functional assessment drop downs that are based off of which tests are using whether or not it’s linked to pain or function.

And then we’ve got the summary or screen that appears when you go to lock a note in the update and if your enabled for nips through that mips wizard with you’re going to go for a minute here and you go to lock the note and there’s an evaluation or re-evaluation code. Then we’re going to assess how you did on each of those measures at locking the note and you’ll be able to see whether or not you met the performance or you did not need it.

You see any red x’s on the screen make sure to go get them, correct. We’ve we’ve had a little bit of a response with regards to the scoring and kind of the strict requirements of pretty much being perfect on those scoring’s and unfortunately that is how they’re scoring it. So we really do have to strive for Perfection as much as possible.

So we’ve created a lot of different mechanisms within the software of for minders and locks that really prevent you from. Submitting something. That’s incorrect data what what we need to kind of put on you a little bit in terms of managing this and knowing what is required on each note is you need to kind of make sure of two things if you’re claims-based submission.

And the patient is Medicare. You need to make sure that the system knows that it’s Medicare because if we don’t know that it’s Medicare and you’re doing claims-based. We’re not going to prompt you for any of these things because it wouldn’t be required if they’re not Medicare. So that’s going to be a really really important thing from your side making sure that if that patient is Medicare that it’s indicated before the evaluation is done.

And then the other thing is if you were doing an evaluation or re-evaluation based off of the CPT code that you’re you’re billing that you make sure that those that eval code or that re thou code is in the system when you’re locking the note there in the note when you’re when you’re locking it if for whatever reason we’ve been trying to think on our side and the scenarios, which you could leave out me thou code and we really can’t think of them, but that’s something that everyone.

It’s going to have to prepare for as best as possible. Because if you’re handing it having to add in that e Valerie Val code at a later time in accounting is potential that you missed out doing it within documentation missed out on actually completing those measures so really important from your side on those two things make sure insurances are correct.

Make sure you’re building the right codes we lock the note.

Kevin so with regard to the update. I want to talk a little bit about sequencing because I know a lot of you that when you go to update you are wanting to test on a few computers before you roll it out to everybody. So real quick on this. After downloading the update, you will start to receive a pop-up at login telling you you need to run the mips wizard.

So any client think it’s updated. They’re going to see receive that pop up until you complete that mips wizard doing so will require that all other users also download that update. So let me be clear on that. If you download the update and are testing it on say three individual computers before it gets rolled out.

Everybody else. Don’t complete the mitts wizard until you’re ready for everyone else to download it because it will enforce that requirement once mips is required. You’ve got to be on the dot 11 update in order to lock in. So really important you got to run that Miss wizard before January 1st, but you should not run it until you’re ready for all users to download the.

And one more thing to note on here and it has to do with that Miss wizard. If you are an on-site customer that is planning on doing claims-based mips emission and you have custom documentation. Please contact the support department and this is a very specific scenario. On-site claims based and custom doc.

Please contact support. The reason we say this is that mips wizard goes through a documentation update. And if you’re doing claims-based submission, you’re going to have to be doing that update on January 2nd. So we want to kind of prepare for that in case there’s something in that custom documentation that throws off at upgrade.

So again if you’re that. Combination on-site claims-based custom doc make sure to contact us at your convenience whenever you get a chance some point in December.

Alright, so now let’s kind of take you through each step of the mips configuration wizard. We had eluded this to this a few times. Now, you guys kind of see the steps involved in here. The first one is just kind of an intro page where it’s giving you the link to the mips landing page, which is TheraOffice.com from it’s basically what it’s doing is it’s saying make sure you view the webinar.

So if you’re in today’s webinar, you’re probably already passing that first step.

The second step is the major step that everyone’s kind of been asking for recently, which is a breakdown of your eligibility based on that first determination period so through this mips wizard, we’re going to run a script against your database to find out what your number of units are. What are your allowed amounts?

And what are your total distinct patients per provider and then tell you your level of Eligibility whether or not it’s group only meaning I didn’t meet any of the thresholds. At what about which means they met one or two of the thresholds or required which means they met all three thresholds. And we’re also going to give you a summary at the bottom of required eligible estimated penalty of ignoring taking into account the required for providers and the estimated potential bonus of full participation.

So if you score a hundred out of a hundred what we think that could potentially mean for a bonus doesn’t guarantee anything. Obviously an estimation because it’s based off of a lot of different factors, but it might help in terms of understanding this a little bit. So real quick on this. I want to talk a little more about these numbers and and kind of qualifying them a little bit.

This is based off of the data that we have within TheraOffice. It is as good as we can get in terms of getting you that information the final determination as to your level of Eligibility is completely up to CMS. It’s on that qpp website for the participation look up. I’m sure you’ve been linked to it a few times already.

I’ve been through us or through other third parties the problem with that qpp participation look up. It’s for the 2019 reporting Year. We will not see that populated. I’ve heard we won’t see a populated until March. Okay, so if that doesn’t get populated until March, but you have to start making the decision as to whether or not you’re reporting in January that obviously poses a problem.

So we’re presenting this data. And it’s not going to be perfect because it could have some discrepancies between what we have in TheraOffice. And what Medicare has on their side their side is the final decision final word. But we want to help guide you in some way on this to other things to mention is this is based off of the insurance type being set to Medicare.

So if your advantage plans are set to Medicare and those are not counted in the mips determination period Then This Will overestimate a little. Also, I recommend that if you’re even close to be considered to be required, so let’s say you’re over on the unit’s you’re over on the allowance, but your patients are sitting at a hundred and eighty and it would be 200 for them to be considered a choir if they’re that close.

I would just consider them to be required again that that’s your decision. Ultimately that qpp participation look up that is the final determination as to let your level of enrollment program.

Alright, so the next screen decide whether or not you’re going to participate in lips at all simple yes or no question any level of participation you would answer. Yes on this.

And the next question is indicating whether or not you’re going to be submitting through claims or through registry. If you choose the claims option and you’re good, if you choose the registry option, we’re going to give you a link to the sign up page simply clicking TheraOffice registry with in here does not actually qualify you as being part of the registry.

You need to go through that sign up page at TheraOffice.com registry. So you need to go through that process. Even if you’re selecting in this through the wizard if you were using someone else’s registry, you still want to choose TheraOffice registry with in here. You’re going to be collecting the data in our system and then we’ve got work early next year on getting that data over into that other registry that you are submitting them.

Okay, and then this screen looks at the hundred percent performance met, you know, kind of locking down the system so that when you are locking a note does it prevent you from locking the note if you have any of the quality measures set as performance not. So answering yes here, which we do recommend is going to prevent anybody from locking the note.

One thing to note is that this is only for all providers. This is the system-wide thing. It is not n Pi. So if you want that lockdown requirement of not preventing anybody from locking nut without this you will need to have it across the entire database. It’s got to be for all providers. If not, if you’re only going to be doing this sitting individually for a few providers, they will still get that summary screen or it’s telling them performance math performance.

Not met. It just won’t prevent them from locking.

All right, and this last screen here essentially is going to list out your documentation. In this case. It’s the documentation that hasn’t already been upgraded. The database was working in already upgraded their PT and OT documentation. Here’s where you would select the document types to include those those nips changes.

Right now speech therapy isn’t kind of a weird place and that we don’t even know what measures they’re supposed to be reporting on we probably won’t know that until those specification documents are coming out. So right now it’s really structured just for PT and OT will kind of see what those speech measures end up looking like.

One other thing to note is if you’ve got other documentation types like FCS, you should ask yourself if you would ever use an eval or eval code on those patients and if so, they should be upgraded to MEPS for SES. You don’t typically use those codes. So you wouldn’t upgrade those from its with regards to Pediatrics all of the measures.

Are 18 years or older? So you kind of have to ask yourself a question of do you ever perform an evaluation or a re-evaluation code using a Pediatrics documentation type for a patient that’s over 18 years old of age and I know it sounds like a strange question sounds like you definitely wouldn’t be doing that.

But what happens if a patient turns 18, and then you do a re-evaluation after they’ve turned 18 that would qualify for mips. And if you’re still using a pediatric documentation type form you want to make sure that those are updated to include the MEP sections. So it really ultimately have to ask yourself.

The the use of those codes and for which patients and that will help you kind of understand whether or not you should upgrade that individual documentation type. If you have any questions in a unique scenario for ask them during this QA or always contact our support department may be able to help you as well.

All right. So I think I’m done talking about MEPS for the rest of his webinar. We’re going to go into the few other things that we have in the update that I think you guys will like this first one being the major one. We’ve had this request for a long long time. And finally the controls were updated in a way.

Allowed us to deploy this change. So we do have a spellcheck upgrade coming in at 11:00 update that will involve real time spell checking. So as you’re typing out the sentences and any text boxes through documentation, if you misspell something it is going to underline it and read and then you can just right-click directly on that word and you’ll see the suggestions for that misspelling.

So definitely a highly requested feature happy to get it rolled out in the style of an update. The next thing is some of the controls are changing with regard to those grids. We updated kind of the the back end of how we how we are populating those so now you can click and drag up and down the different fields or the different rows within each of the grids of documentation.

Also, we upgraded the patient information screen. This one’s getting pretty crowded. We didn’t like that the tabs were kind of hiding some information that some people weren’t seeing as much so we now included it basically all in one screen with a scrolling up and down to account for everything.

So everything you had before is still available. Just changing the format a little bit of this.

All right, and the other big announcement with regard to that I’ll have an update is it includes support for deep TheraOffice patient portal? And I know many of you have been waiting very anxiously for this for a very long time and we. Continue to work on it through while we’re also working on all the other projects and so the dot 11 update does allow use of the therapist patient portal.

So what is the patient portal while our initial focus on it really has to do with bringing that registration process fully electronic? This includes patient demographics insurance information medical history and miscellaneous documentation sections and electronic signature of policies and also most importantly a seamless integration into TheraOffice data.

So we’re really really excited about this patient portal and we’re very anxious to get out to you. We’ve been working on for a while and we’re really excited with with what we’ve been able to produce for it. So this is going to allow us to enter into the Beta stage for the portal because this is such a big project.

We still do have to go through testing with it with a few customers before there’s the full rollover. So this this update includes capability of it, but it is not the full release of the patient portal. So what we’re going to be doing is beta will be starting on January 1st with a few web customers.

This will continue until it is available for public release for both on-site and web and are aiming our goal for that is quarter one of 2019. We will be doing lots of webinars with regards to the patient portal. What you’re seeing today is really just a mention because you’re going to see it throughout various areas of the of the software, but we’re going to be doing lots of training lots of webinars and and how it gets used.

What are the features of it? All the details of it. You’re going to see those pop up throughout January and February. So if you were interested in participating in the portal data, which we already do have some some people in line for that beta but if you are interested and would let or would like to receive any additional information on the portal.

We’re going to put up a webinar pole. So if you can if you can answer this for us will definitely hold your information and shouldn’t available beta testing slot open up. We will make sure to contact you and. Let you know. Alright, let’s go ahead and close out that poll. So again, we’ll keep in contact with you guys.

And I know this is a very brief mention of the patient portal. There’s lots more going into it. We will be touching on that in future webinars. All right. Thank you everyone again for attending today’s webinar. We do still have time for questions. So I know we’ve gotten a bunch and already I’m going to start going through those Now.

Give me a few minutes here and feel free to enter in any more questions that you have and we’ll do our best to get through as many of them as we can today. Thank you. Alright, so let’s go ahead and get started on the questions. The first one had to do it was an early question had to do with the mips wizard and kind of figure out your level of Eligibility is before we actually went through the wizard, so I assumed that when answered it.

I know that a lot of people are pretty much just waiting until they see those results before they make a decision with regards to MEPS. It’s where we’re trying to get out this this version out to you as soon as possible so that we can we can help with that. So that’s wizard. Also. The other thing is as your once you download the update if you want to jump right into administrator and look at the wizard so that you see those results in the form of kind of that report.

You can totally do that without completing the wizard. So you don’t actually need to pulley make your decision at that point. It’s just going to preview it for you. The next question is and I actually received something similar to this in the previous webinar. So gets answer in FAQ. But if we at red-flagged or will we get red-flagged if we override the pain score?

I’m balancing vertigo patients. We are a certified balanced Center. So we treat a lot of patients that have no pain and unfortunately the answer on this one is kind of strange. So when you’re reviewing the measure specification documents for the pain assessment measure, It basically lists the reasons why a patient could be considered not eligible and the patient not having pain is not one of those reasons to not test them for pain.

So even though that’s not what they’re coming in for. I think from my understanding of those measures specification documents. I think you would still be required to assess them for pain even though that’s not why they’re there. I know that sounds strange and that sounds unfortunate for for.

Situations like this question comes from where and they’re in a certified balance Center if I would recommend for anybody who thinks they’re going to experience in that problem significantly to reach out to Medicare directly or go on to that QP site and submit a question related to. To the situation for that pain assessment.

I think given the way that specification document is written. They would still be asking you to take that pain assessment, but I would confirm with Medicare on that. Okay, next question what if patient drops out and we do not have a final outcome measures is that when we get penalized you this is for the measures to 17 through 23 for the outcome measures, you will not get penalized if the patient drops out they’ll be considered a denominator exclusion You’re simply not able to assess their discharge versus initial score.

So it doesn’t count against you. That’s what the exceptions are there for.

Next question. Do we need the discharge patients from flr on December 12th, or sorry December 31st, 2018. Not that I’m aware of the program just stops the requirements for it. Stop. I don’t know if they’re actually have the requirements packed it right now since it decided to end the program, but I know that you just simply don’t need to have.

Puncture reporting codes for any tits service after January 1st. I assumed you would not need to close up the previous categories on or at the end of the year. So answers that from my understanding is no I’ve not seen anything that suggests that.

How long do we have to get the final outcome measures reported and do we have to do that when every patient so with regards to you do need to be tracking outcomes for every patient if you’re going to report those outcomes for measures to 17 through 23. For maps requires those measures are registry only register requires all patients.

So you should be doing it for all patients and to get their final one you’d have to have them take the test preferably on a planned discharge date. It’s a problem that everybody is facing its problem back in functional reporting. Handling, the unplanned discharge has is an obstacle with regards to outcomes tracking.

So it’s not perfect. There is no perfect answer for it. At least no one’s figured it out yet. So we’re just trying to collect on as many of them as we can. Can office staff enter a medications or only a provider office staff? Could it would say provider time? Yeah, as long as the provider is reviewing it then it’s fine.

So the front office can take like scanned image note and important as the documentation as long as that providers reviewing that information with the patient, that would be considered. Okay. Next question. Where do we need to indicate if it is a Medicare patient in the system. This is just that’s if your claims based submission.

This was this probably came in at the time when I was talking about it being really important to indicate that it’s Medicare that is for the claims-based submission. You just make sure that’s in the case and it’s utilizing the insurance type of Medicare.

What if we aren’t going with mips if you are doing anything with mips a lot of this doesn’t apply to you. You’re not going to change anything and you’re not going to be interrupted in any way. So it is still an optional program. You do not need to participate unless you’re meeting all three of those thresholds in which case you could get hit with a penalty.

Next question and this one came up before in a few instances. It is important to touch on this do we report on every 10th visit? If so, do you have to add a re-evaluation code? And even if a patient does not have a marked change? Okay. So re-evaluation codes are only to be used if there is a required change in the plan of care.

So if the patient has completely.

They have not progressed on their plan of care like you thought they were going to and it represents a marked change for that patient. Then you need to do a re-evaluation and Bill re-evaluation code. That is the only time you need to build a re-evaluation code re-evaluations are not the same as progress notes.

Progress notes are what’s required every 10th visit and on progress notes. You do not need to build for re-evaluation code. So you need to be careful about overbilling reval codes that does still happen. Make sure you’re only building those codes when you actually have to change the plan of care and those are only the those are the instances when the myths quality measures need to be reported on.

Okay, next question. What if we are only having some of our providers participating lips we were in the midst wizard it will IMPACT program for all providers. So we’ll providers we’re not participating in midst of luck. That’s about doing that reporting. So the answer to this question is if you are doing participating in mips for only select providers, then when it comes to that option of do you want to enforce this for everybody?

You have to select no. By selecting. No, it is not going to require that. You meet the performance for those for any providers, but for the individual select providers. They’re still going to receive the pop-ups for them. So it’s a little bit of a stranger scenario when you’ve got only certain providers within your system reporting on mips.

They don’t have that lockdown requirement that you get if everybody’s doing it, but they’ll still get all that summary stuff and it won’t require anything for the providers that are not participating they can bypass that information.

If you choose not to participate myth programs can still download them. It’s wizard. So if you’re not going to be the mips program, you should still go through the mix wizard on that first. Question, it’s like no, I’m not participating. It’s going to give you right to the end and you’re going to be all done.

But the system is going to essentially pester you for that every time you login until you complete that wizard. So make sure you do at least answer know within that wizard if you’re not going to be participating.

Next question for patients under 18. Do you just check not eligible and all measures so they’re not counted against us. So if a patient is under 18, and you go to lock the note, it’s not going to have mips be required in any way so we won’t even be storing any values. Those quality measures are not relevant for patients that are under 18, whatever you do in those midsections doesn’t really matter because we’re not going to store of its patients under 80.

Okay, so I think this question came in. I don’t know if it came into the registry discussion or with regards to the portal. Is there an additional charge monthly for this feature? So the registry there is a charge for it’s a yearly charge we had mentioned before it’s $2.99 per individual provider or if you’re doing a group rate.

It’s a custom rate. So there is a charge a yearly charge for the registry data submission. And there’s also going to be a charge for the patient portal, but we have not reached a final decision on Portal pricing yet.

Do you have to do photo to do the registry you do not you can do the registry and just submit on the for process measures? Next question. So we need to go through the entire photo survey as well as doing MEPS to report on those few measures. So if you were a photo user what’s going to really happen is you’re going to have those patients complete the photo survey you’re going to import that information in from photo over in the ther office the pain assessment and outcome assessment are going to get scored.

As positive because you completed a photo survey which means you didn’t outcome test to test for pain and for function and then you’re going to have to do BMI and Aaron have to do current medications within TheraOffice and populate those out as well. Okay, next question will any photo information for patients with neck issues be imported those that information will be imported into TheraOffice into the photo specific sections same as always, but we will not be populating any quality measures for neck patients because they push that off into a different key CBR.

So it’s no longer part of the other General Orthopedic measure 223. It’s not neck is in part of 223 anymore so we won’t be won’t be. Doing any myths related things for neck patients for photo.

Yeah, and so we got a few questions on that real quick to just touch base on that again. The reason that we will not be doing that is because within the therapist registry we are not able to report on the qcdr that photo is just starting up for the first time this year. So our registry only reports on the quality measures the the for process ones plus the seven functional status ones.

I’m but will not be reporting on their new qcdr. I imagine what’s probably going to happen is that we’ll get moved into the same section as the others once it goes to his first year. So in future years, we do anticipate reporting on those just not for this first year as they’re rolling it out as a qcdr instead of a public measure.

Is there information on the second Miss webinar about spending through claims or registry? Yep, the first two webinars are entirely mips-based and you’ll see I think the first one was probably the best one for deciding between claims or registry. Second one was talking more specifically about the measures, but I definitely recommend both webinars.

How do we sign up for mips if we do on-site claims just go through the mips wizard after you’ve received the update and you will be all set. We’d like to know the group pricing for the registry go to TheraOffice.com registry submit your registry request, and we will get you an official quote on the registry pricing.

It doesn’t it doesn’t require you to do anything. It doesn’t commit you to anything by by making that that that requested to just simply signals to us that we need to produce a quote for you.

Have you made the medication area Auto populate into new case so that you do not have to copy and paste also will it be available to update during a current case? Yes, the medication area is going to be available. In an existing case to update should you need to for with relation to mips? You only actually need to update it.

If you are doing a real code. Also, if you are doing a new case and you populate the medication list of previous case you will need to do a copy case information. Now one thing is a heads up the medication. Section is changing the actual field in it are different than what they were before. So if you filled out the medication History Section before in a previous case with different fields, it’s now going to have new fields and it’s not going to populate so you will need to manually re-input the medication history for a new or for a patient that.

Didn’t have those fields filled out in the previous ones. It’s going to be better moving forward but in that transition period you might have to re-enter the medication information.

If we are not participating in midst because we Bill any you Bo for to simply answer no during the wizard in that update any documentation for the quality measures documentation rains the same for a company then yes, that’s all correct answer no and you’re all done. Did I miss the miss webinar is wanting to know what the charges again the mips for registration you sign up with our registry $2.99 per provider per year and those that’s for the individual rate.

You’re looking for the group rate. It’s going to depend on how many providers you have Medicare volume on the non eligible providers whether or not they’re seeing Medicare patients at all. So this kind of Freedom factors that were using to determine that group rate again, go to TheraOffice.com registry for that registry request.

Registry is available for both on-site and web. No no issues there. If you’re on site if you’re a larger group for the registry and your on-site and still all works just fine. Same same concept applies between the two. Yes, it’s the Medicare site already said we are not required for mips. But as he stated today, we need to keep checking that until March 2019.

It’s a little unfortunate. So when you look at that, it’s QP P dot cms.gov participation and there’s participation look up and when you look when you type in your MPI in there, it’s going to give you a 2017. 2017 status and in 2018 status but what you’re looking for is the 2019 status which they have not populated yet.

And I’ve heard rumors that it will not be populated until March. So that’s that’s the threshold that you’re really looking at. That’s the one that matters for this 2019 reporting year.

Do we only start reporting for new patients starting one one or all patients? What if patient started at the end of 2018 without misreporting do we just take measurements at our eval even though there are no measurements reported from IEEE and previous read else you will need to report formats on patients after one one even if they were evaluated.

Previous to January 1st. So patient. Let’s say was evaluated in December and none of these measures were taken and then come January 15th. You were doing a revaluation for that patient not a progress note, but a re-evaluation with a revaluation CPT code that you would need to do the MEP sections for them.

If we perform an evaluation on December 31st are expected to report flr G codes in order to have the claim accepted. I think the answer is yes, according to Medicare according to what they say. Yes. The answer is yes. I don’t know whether or not they’ll actually end up rejecting that claim if you didn’t but officially the answer is yes.

If providers are qualified in a p.m. Programs and isolated you miss in 2018. It’s a tricky question because you have to be an advanced APM. There are lots of apm’s that are out there a p.m. Being alternative payment models and you have to be in one that is considered an advanced 8 p.m. I would check with you know, if it’s like a bundled payment program.

I would check with whoever’s kind of running that program and seeing if you are. Consider to be an advanced APM. There’s there’s there’s very specific qualifications for you to get excluded from myths because you’re in an APM. So unfortunately cannot answer this question without knowing all of the details and really I think you’re gonna end up having to check with Medicare to confirm whether or not that qualifies.

Could you please discuss the differences between claims based versus registry-based claims from its so the registry it’s registry submission because it doesn’t go on the claims at all. It’s basically when you submit claims which are only available for small practices of 15 providers or less you are including additional CPT codes as charges Medicare processes those you only have to do it for Medicare patients if you’re doing the registry.

You’re doing the same kind of quality measures, but you doing it across all patients instead of going on the claims. We’re storing it in a registry database and then we’ll be submitting in January of twenty twenty-two Medicare so claims happen throughout the year on your actual claims registry.

We’re collecting and submitting it a one-time in the following year.

Would we be penalized if we did mips only on eval and never charge for evals? No mrs. Ever documented again in the patient. No, no penalty. They only care about whether the dates of service that you didn’t email or a ravel on. So you did on the e-value never charged or eval which is going to be the case for a lot of clinics out there lot of clinics.

Very very rarely used re-evaluations. Then there’s no additional work you need to do for that patient only though.

Next question if we don’t report on Photo data and only use the four other measures, how are we going to score high enough to get a bonus or are we ever going to score high enough to get a bonus? You will score high enough without using outcome measures as you’re not sending any outcome measures.

Medicare is only allowed you for process measures. So you would only be scoring 4 out of 6, which means it’s going to put you out of reach of the exceptional performance bonus, which is really where the majority of the money is in the program. You can still get a positive payment adjustment for anything after a score of 30.

But it definitely does increase drastically, once you get into the exceptional performance bonus range, which I believe is it starts at 80. So the purpose of the program is pay per performance and tracking quality. So if you’re not tracking quality through outcomes, unfortunately, you’re probably not going to be able to get a full full High high-end score in the program.

So utilizing the photo electronic scoring of their tests and and paying for the photo-based service is completely separate from paying for any registry service. They are two completely distinct and separate options.

You see that we do not need photo to use the registry. We report on four measures about six measures. The requirement for measures is all that you have to report on if you’re not going to be reporting on outcome measures. So 6 is the requirement means you’ll not get full credit if you’re not reporting outcome measures.

None of our patients qualify for mips individually, but what if we do as a group does that make us mandatory for use as a group? No, we have received this question before if all of your individual providers and none of them are considered to be required then. They don’t they don’t get combines in the group unless you’re submitting as a group.

So so it’s kind of a tricky situation in that. What happens is you choose whether or not you want to submit individually or as a group? And that is done after they make their determination through that determination period so Medicare is going to figure out for every n Pi within your within your tax ID whether or not they’re considered to be required based off that past determination period data, and that’s a requirement of.

Necessary or not, if you choose to submit to Medicare and you’re choosing to submit to submit as a group, then everybody’s data will get combined together and you need to meet thresholds as a group combined. But that’s only if you’re choosing to submit as a group which you would only choose to do if you decided to participate the program anyway, so.

It essentially becomes you from fully enrolled in the program. If you choose to submit as a group if you choose to opt out of the program to submit individually each MPI is treated separately.

If a patient is evaluated on 12/31 and we do flr codes. Do we need to submit mips on their second visit? You would only need to submit mips for that patient. If you re-evaluated them and build a re-evaluation CPT code mips and flr are not connected in any way.

Does the number of providers include ptas it is the when Medicare is doing their count of the number of providers in during the determination period to figure out if your tax ID number should be flagged with the determinate or the special designation of small practice. They are looking at how many npi’s are attached to that 10 with regards to claim submission.

So. Yeah, it depends on how many guys that they actually have and the claims data that you’ve submitted to them throughout the year again, whether or not you’re considered to be a small practice will be indicated in that participation look up but probably will not be available until sometime early next year.

All right, so I think that’s going to be a four questions for today. I know we went a little bit over in terms of time. I there are a few questions that were left unanswered. We’re going to do some follow-ups with you directly. We’re looking to kind of get a little bit more information on those before we answer them, but we will definitely do.

Some additional follow up with you guys in terms of doing our best to get as many of these these questions answered as we can. So, thank you again for attending today’s webinar, and feel free to let us know if you need have any other questions either through support or through one of those Q&A webinars that we’re going to be doing in December.

So thanks again and have a great day, but.

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