2019 TheraOffice Wrap-Up

December 26, 2019

Hosted By:

Nick Austin

Hey everyone. Welcome to today’s webinar on 2019 their office wrap up. My name is Nick Austin and I am the director of product management here at hands on technology. The goal of today’s webinar is to quickly go over some final need to know items for 2020. There’s a lot happening with the PTA modifiers, the sophomore season of MIPS for PTs as well as the transition on of Medicare insured ID numbers with so much changing, we figured it would be a good idea to offer one more webinar before the end of the year because much of this is a recap of what has already been discussed, be it through webinars or newsletters.

We are going to have plenty of time for questions. A central goal of today’s webinar is to get those outstanding questions answered in a group format that hopefully can benefit everyone. So before we begin, just a few quick housekeeping items. A copy of today’s webinar will be available through the training center and in a followup email.

Same goes for the PowerPoint used today. We’ll be doing all questions at the end, so feel free to get them submitted as the webinar goes. With that being said, let’s go ahead and get started.

For today. We will quickly be covering five topics before moving onto those questions. First, we’ll discuss the Medicare transition from HICN to MBI. If you are familiar with this, it’s okay. There is still time to get prepared, but it will require quick action. Next, we will discuss the importance of knowing what you bill and what steps you can take.

Now to get a better understanding of that process. Who then move on to some subjects covered in the previous webinars, including the correction on the tobacco measure, how to get ready for the PTA, OTA modifier change that goes into effect in January, and how to get started with MIPS in 2020.

In 2017 Medicare nouns that they will be transitioning from the old HIC and numbers to the new MBIs or Medicare beneficiary identifiers. New insurance cards were mailed out to the Medicare patients in April, 2018 and since then, Medicare has been able to process claims with either the HICN or the MBI.

This transition period is ending on January 1st and then any claim submitted after with the old HICN will no longer be accepted. Regardless of the date of service. Every PT clinic has already been making this net change naturally as patients bring in their new ID cards. However, upon further inspection, we noticed not everyone has fully transitioned over.

For this reason, we released a new report called 2020 update to Medicare insured IDs. This report is available now for web customers from report viewer and for onsite customers. They only download it through the admin manager. Their approval list out all Medicare patients with an outdated insured ID separated between high and low priority based on if the patient is still actively being seen.

All of the high priority patients should be updated before the first of the year, while low priorities are up to you. If you do not update the low priorities, your staff should still be aware of the need for the MBI on new patients as well as resubmissions on old claims. The good news is that this process, or in this process is that your local Medicare administrative contractor or Mack has within their provider portal, a patient MBI look up tool.

With the information output from this report, you’re able to look up the new MBIs without even contacting the patient. Details on this process are laid out in the report itself. There isn’t much time left in the air, but if you weren’t aware of this at all until now, there is still time to have somebody go through that information and get it updated before you start submitting claims.

In the 2020 preview for assistant modifiers webinar. I brought up the idea that cuts were being proposed for PTs in coming years in 2021 Medicare is going to be cutting reimbursement on a variety of yet to be determined CPD coats in total, the expected impact is an 8% cut to physical therapy services for many reasons, and is more important now than ever to have a good grasp of how you’re actually billing.

How long are you treating patients for compared to how many units are they billing? What are your insurance contracts allow? How much do you get reimbursed per CPT code per insurance? If you cannot easily answer these questions, it will be important in 2020 to get a better grasp of your billing practices.

A good place to start is using the charts to collection ratio report in their office. This drilled out report allows you to look at your average reimbursement per CPT code per insurance, giving you a detailed look at where your revenue is actually coming from. As I mentioned in the previous webinar, we’ll be doing several educational webinars in 2020 including the first one in March on how exactly Medicare reimburses you.

Also, if there are any other billing subjects you would like to see covered in the webinar, please feel free to let us know. We’re always open hearing ideas and what you would like to see. Okay,

so a bit of unfortunate news. Now. In our previous webinar, we introduced the MIPS tobacco measure as now being available for PTs in 2020. We based this information on the inclusion of the tobacco measure as well as several others into the PT OT specialty set. The assumption was that when the new measurement specification documents came out, they would be adding PTCP codes to the measure.

This was the case for all of the newly introduced measures except for the tobacco measure. Ultimately, it is the measure specification documents that dictate what can be submitted. So unfortunately this means the physical therapists will not be able to submit on the tobacco measure for 2020 as a result.

To avoid confusion, we decided to scrap the tobacco measure from the dot 16 update. It might rip here at a later date, but included in the DOT’s 16 update to potentially lead some to think it was okay to report on that measure when in fact you would be getting no credit for it.

Also on January 1st services rendered in part by PTs and OTs will need to be in. We’ll need to include an assistant modifier. CMS is using a 10% de minimis standard to determine if the modifier should be added. This means that if 10% of your treatment minutes for an individual CPT code are done by a PTA, the modifier will need to be added.

That might sound like a lot of work, but their office has tried, simplified it a bit for you. If an assistant is contributing minutes on the treatments, you will need to fill out the assistant minutes column in the treatment section. If no PTA is involved in the treatment, you should ignore that assistant minutes column and only focus on the total minutes remaining column.

No increase in work for PT only scenarios. Also two more things to know your code. Treating no modifier as required. Also, if your clinic is classified as a critical access hospital or CAH, you are exempt from indicating assistant minutes and including the new assistant modifiers on your claims.

The last piece that needs to be talked about is the 20 MIPS 2020 participation. If you’re enough familiar with MIPS, the best place to start is with all our previous webinars. Just search for the term MIPS within our training center, and you’ll find multiple webinars in the last year where we covered all things MIPS.

The next step is for everyone to download the dot 16 update. We’ll be prioritizing the release of this update to MIPS participants, but if you are wanting it before the end of the year, please let us know. After downloading the update, the next step is to run the MIPS configuration wizard. You’ll be prompted to do so upon signing in for the first time.

If you have any change in your participation level in 2020 from 2019 you will indicate this through the wizard will contact you directly on how to proceed with those changes in mind. For everyone else. You will download the changes and then be prompted for completing your myths provider participation window.

For anyone who is certain they are participating in 2020 your most important first step is confirming the provider participation window is configured correctly for the 2020 reporting year.

Thank you to everyone for attending today’s webinar. Like I mentioned, it was pretty quick. Uh, the goal of today’s webinar is to cover, uh, those, those, those questions. So I know we’ve already gotten a few of them submitted. people joined up right away and got them submitted instantly. So I’m going to start going through those questions that we’ve already gotten submitted.

Hopefully we can get them all answered today. If you have any questions, please feel free to get them submitted and we’ll do our best to, uh, to cover them today. So just to review what’s been submitted now. Thanks.

All right, we’re going to start going through the questions now. first one is, is, does Mismeasure two 82 include all pediatric patients? So these are MIPS measure 22 is the dementia measure. And, uh, yes, the dementia measure is for all patients, even pediatric patients. Uh, so regardless of age, there’s no age restriction on that one.

It’s kind of unique in that sense. Uh, next question is, what about un-timed codes? Can untimed codes be billed under the PT and the PTA data? All of the time codes. So, you w. With regards to who you’re billing it under. There’s no change in who you’re billing these things under. the assistant modifiers are related towards the individual treatments and whether or not the PTA contributed towards those.

And it does apply for untimed codes just as much as it does for time codes. So if you have an on time code and the PTA is contributing 10% of that untimed code. Based off of the minutes, even though I, I know it’s untimed when we say on time, it’s just untimed for the sake of how many units you build for.

But there is still time that is being contributed towards rendering that service. So even for the un-timed codes, the 10% of minimum standards still applies, uh, as it relates to adding the PTA modifiers. And just to reiterate, cause I’ve heard this come up before, the  the, um. Who you’re billing things under should not change because of this PTA modifiers cause be tame modifiers in any way.

your submitting provider, uh, I’m a claim that’s going out. Should that change in any way? Next question. is the OT. Is OT excluded from the tobacco to, uh, no. OTs can actually still report on those. but unfortunately we decided to not include the tobacco measure to start off in the dot 16 update.

Our concern was because of kind of the, the change in that measure, between PTs originally being. Thought to be included in that measure too, not being included. That there was concern that if we included the measure to begin with, people would be, including that and their measures set and then trying to report on it, adding the codes and then it never actually counting for them cause PTs weren’t involved in it.

So we will re be reviewing that and seeing if we can add it in as an OT only one or if it can be included in the 2021 reporting year, we’ll be on the, uh, be watching that carefully. Next question. Uh, we’re exempt from MIPS. Is there something we should do or just not answer? So you’re going to keep getting prompted, uh, for, for MIPS.

So if you didn’t participate in 2019 cause you were exempt, you would still want to go into the MIPS configuration wizard. And it’s going to ask you, it’s going to tell you you didn’t participate in 2019. Are there any changes in 2020? In which case you’ll just say no, and it will. Stop you there. I’ll finish up the wizard and you’ll be done.

so you still want to do it. Otherwise you’re going to keep getting that prompt. after the update. Uh, next question is, what is the modifier for the PTA? Uh, the modified for the PTA is the CQ modifier. for OTAs. It is the, uh, C O modifier. Okay.

All right. Next question is, PTA is full patient treatment on schedule for Medicare patients? Uh, will they have to manually change all the treatment time to PTA, uh, and couldn’t assist them? No. Based off of, uh, their provider type, uh, to automatically determine the minutes in the PTA column. We, we thought about that option when we were going through the development process on this when we weighed that versus, the.

User that’s logged in at the moment to determining whether or not their assistants and for me fill minutes, we did not want to base it off of who was locked in. And the reason for that is because you’ll sometimes have PTA, is completing documentation where they only partially did the minutes. And you’d also have a therapy full time providers who were treating with a PTA.

And the full time provider is the one that’s indicated in the minutes and the treatments column. So. Whoever’s logged in, just knowing who they are wouldn’t be enough in the cold treatment scenario. it would be in a non code treatment scenario, but because of the code treatment scenarios, the part that’s really gonna kind of complicate things on this.

That’s the part that we were, uh, more concerned about. So definitely understand that perspective. If you’ve got a bunch of BTAS and the PCAs are treating, uh, there are no code treatments. They’re all just treating individually that this. It seems like a little bit more work than it, than it needs to be. We apologize on that.

It is something we’re going to be monitoring in 2020 and seeing, kind of what the response to it is, how many of the code treatment scenarios end up kind of, uh, making it complicated for people. We’ll be paying attention to it and seeing what is kind of the best path moving forward. It’s kind of a two year transition period until payment actually gets impacted by this. So we’re optimistic that we can find kind of a, a nice point for both PTs and PTs. Uh, that’ll involve as minimal work as possible.

Okay. Next question is, how do we make MIPS data poll to our generated notes? we frequently get medical record requests for chart audits and we’ll need written documentation of our myths, measures and plans. We find it imperative that we, when we code MIPS information to insurance companies that is not generated.

The notes, if you could contact support directly on this one, uh, so that we could follow up with you directly. I have not heard of any commercial insurances requiring MIPS information. They actually should have. No impact on your misinformation at all, even though it’s technically that their patients, whether or not you reported on the, those myths measures, uh, shouldn’t be relevant to those commercial payers in any way.

I’ve not heard of this in any way, so it’s something we would definitely, uh, need to know about and need to follow up a little more directly on that one. So please contact support on that. And, um. Let them know that you were in the webinar and that’s when this question came up. And, uh, they’ll come talk to me about, well, we’ll get something figured out for this.

I think there’s a ways of getting that information out, put it to them, should they need it. And it just, uh, this is definitely a new scenario I haven’t heard of yet. Uh, next question is, when is the dot 16 update available? So we are just, we just entered beta for it. Uh, so we’ve got some customers that are beta testing this for us and would be looking to release it on Monday and Tuesday of next week.

That’s when the updates will start to get released again, I mentioned in the previous webinar that we’re prioritizing, uh, customers that we know are missing. The participants so that they can get hit the ground running in 2020. Uh, if you’re a nonmember MIPS participant, there is actually nothing in that.

Got 16 update for nun myths participants. It’s all myths related. but that update will become more widely available. early 2020. Again, if you’re ms participant, uh, we should know about it. If your registry customer or if you attended the previous MIPS webinar, that’s how we’re going to be knowing who’s.

Who are those ms participants and will be prioritizing them for getting the update on Monday and Tuesday of next week. Yeah. All right. We’ve got a few more questions in here. how do we know, or how do we show anyone that we did the plan of care required by MIPS measures if it’s not in the documentation, so you shouldn’t.

So this kind of goes hand in hand with that question earlier as to, uh, the MIPS measures and getting them on the documentation themselves. So your medical record is your software plus everything, uh, everything that touches the patient anyway, so it’s all, everything within their office. Uh, it is not required on the generated reports that you send out, uh, their progress notes, or plan of cares to indicate what you did within.

Uh, for any of the myths measures, there’s nothing, there’s no myths, requirements that state specifically that that information needs to be on your, uh, reports that are submitted to Medicare or submitted to the physician for signing off on in any way. So if you didn’t need to prove it through an audit.

That you would be able to prove it from within their office itself, and we could assist you with that. Should that come up, as long as you’re documenting it within the office software, uh, then that is part of your medical record, which is sufficient for the requirements for MIPS. So hopefully that answers your question.

I have other started seeing evil coats denied when treatment is rendered on the same day for Medicare a reason code C O one 51. I’ve not heard of anything on this. wide-scale. So it might be a specific scenario of a code getting a code, getting suggested when. For whatever reason, maybe they only allowing a certain number of units of that code or not to be built with another code or limit to the number of units for the case for the patient.

And so that, that’s pretty specific scenario. If you could, again, feel free to get that submitted to the support department. We can review the specific instance of that code coming up more carefully.

Next question, uh, is the EA S I form for maltreatment, uh, need to be scanned if negative. so within the Mismeasure themselves, they only require that you document the name of the tool used. They do not mention anything of the specific, uh, results of that tool. Um. Being included in your medical record for the maltreatment one specifically, and I think you probably already know this, given the way you phrased the question, if it comes out as positive, then you have to do the followup plan to the adult protective services.

So you would definitely want to document what, uh, the positive results are for the negative results. Nothing in the measure specifications indicate that your full results need to be documented. They only say document the name of the screening tool used.

Okay. Next question. How do we know when we attest to MIPS and other measures? so if this is for, this could be two ways. The word test makes me think it’s for improvement activities. So a real quick touch on this, cause it’s another kind of important subject. So for the 2019 reporting year, you also have to do a, a set of improvement activities based off of whether or not you have any, uh.

Low volume threshold exemptions, you know, rural or small practice. So those attestations for the therapists registry customers are going to be made through a document that gets sent out. Uh, right at the start of the year. We just finished. Uh, with that documents that’s ready to go out. And basically it’s just, you’re going to be getting a PDF file.

You’re going to be indicating what those measures are, the improvement activities that you’ve tested to, submitting it back to us with your signature, uh, electronically. And then we will get that. Information submitted along with your quality data. as part of that registry process, if you were a claim submitter for 2019, it is really important that you take that extra step to make your FST patients for your probe.

Activities through QPP is website. So it’s qpp.cms.gov you’d have to sign up through there. indicates all of your information your as a submitter. For claims or you’re, you’re a provider. And, uh, if you’re doing individually for claims, then you’d need to go, uh, and, and make that sign up. It’s really important that you take that extra step if you’re a claim submitter to go get signed up through QPP site, because right now all you’re doing is submitting to them your quality data.

So I believe you also have to do a low volume threshold, a opt in process that the registry takes care of for you automatically. But if your claims, you have to go through that process. So again, real important claims, go make sure to sign up on qpp.cms.gov to address those additional things. And then, uh, for the other measures, you know, if your quality.

Again, all of that’s done through that provider participation window with an administrator. So, uh, for 2019, that should have already been done. It should’ve been done. It kind of started the year when you figured out which measures you want to do a test or to, uh, opt into. And then for Reggie or for 2020, uh, you’ll have to be doing that after you received the dot 16 update.

So, yeah. Get the dot 16 update update. Go through the MIPS configuration wizard, and that’ll take you to the provider participation screen where you’ll indicate which measures for which providers you’ll be doing in 2020. All right. Two more questions and we’re going to wrap it up here. So the first one is, uh, what are the common improvement activities for physical therapists?

Uh, the list on QPP was 53 pages long. Yup. Uh, they do have a long list on their side, so we actually have a good long article out there. And improvement activities where we give our kind of suggestions on common ones that we expect PTs to be a testing too. So what we’ll do is I’ll follow up with you after this webinar and have somebody email you over a link to that blog article where we’ll indicate to, you know, which ones you think you should be looking into.

Um. So we’ll follow up directly on that one. Uh, the next question, uh, who do I speak to about getting set up with the myths registry through their office? So, uh, if you go to their office doc Tom slash registry, there is a signup page. Uh, it’s non-committal page. So basically just submitting your information through there just gets us that information so we can contact you and work through a quote on that.

So, first, most important step for anyone who’s looking to sign up with a registry. Do that. Their office.com/registry uh, if you’re having any issues with it, feel free to contact our support department. We’ll be able to assist you with that as well. but take that step and then we’ll contact you directly though, take you through that signup portion.

All right. That looks like it is it for questions for today. Thank you again, everybody for attending today’s webinar. Hopefully you found it informative. and if you have any additional questions, feel free to get them submitted through our support department will be able to help you in any way that we can.

Otherwise, have a happy new year and good luck in 2020. Thanks and have a great day. Bye.


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