TheraOffice MIPS Q&A #1

December 11, 2018

Hosted By:

Nick Austin

Hey everyone. Thanks Thompson introduction. So happy everyone could attend. Today’s webinar. We actually did really really well in attendance here. So that means that a lot of people have a lot of questions about this program. We have no other plans other than the answer the questions from you guys.

So feel free to keep getting those submitted. You might just also be here just as an observer seeing what other questions people are asking maybe the questions that we answer start triggering other questions. So always feel free to give them submitted. We’re gonna probably do this for about an hour and we’ve got another one scheduled for later in the month.

Given the attendance in this one we might schedule out a third kind of depending on availability. But let’s go ahead and get started. So first question is what exactly qualifies the PT to have to opt into Maps. So to be considered to be required for the mips program in 2019, you have to have submitted 200 units.

Have to have treated 200 distinct patients and have to have been paid in allowables 90,000 from Medicare. Hi, I’m sorry for the 200 distinct patients. Those are also distinct Medicare patients. And that is that is the traditional Medicare. It is not Medicare Advantage plans between those three the unit’s pretty much everybody satisfies those the allowed a lot of clinics do tend to end up or a lot of providers tend to be over that but the most rare one is definitely the 200 patients that is as a hard threshold to meet.

And it’s because if you treat Medicare patients throughout the entire plan of care and they don’t see any other providers other than you that it’s most like it’s unlikely that you will be getting through 200 patients through the full year. So that’s the hardest one to meet. Expectation that the kpk released that they expect somewhere around five percent of Petey’s to be considered to be required participation in this program, and we’ve kind of run the numbers on our side and we’re seeing about that same level of requirement from PTSD.

So the next question is it’s very general question. What all do we have to do to be in lips? So this is basically a question. That’s a starting point of I imagine the person who has this they had, you know, not really don’t really know anything about this and sign up for me. This is the first webinar what I recommend to everybody who’s just kind of learning about the program now is to go into our training center and to view the previous webinars that we’ve done on this there have been three previous webinars.

First one is General about the program. The second one goes into the specific measures and the. Supposed to say whether the update update got yes update. Sorry, we’ve been doing so many webinars answered so many questions. I’m just losing track of even the webinars I did myself. So third one is related to update is important that you watch all three of those specifically the first two are.

Pretty much necessary. So if you’re at a starting point don’t know much about the program definitely start with us first two webinars and then watch the third one the update as well. Next question is how do we enroll in mips? I think this is in reference to is there any additional action that needs to be taken to participate in the program beyond what we’ve already talked about me answer is no.

If you’re going to do claims-based submission, then Medicare will just see that you’re submitting those claims and there’s no additional enrollment step that you need to do. If you’re doing registry submission will be submitting the data to Medicare in your behalf. No additional involvement required.

Next question is does the PT have to be the one to do height and weight or can the intake staff obtain prior to being taken back for the evaluation? So this one is. This one is really in a kind of a gray area of answers. I can only tell you what the measure specifications say, which is the PT attests to taking the patient’s height and weight.

Yes, or no. Sorry if I’ll have to check the documentation on this one. So we’ll do this one in the follow-up. But I know that it has to be taken. I’m not sure if they use these specific words at the PT having to do it or the provider having to do it or if they left it as it just needs to be not self-reported.

It’s all double check on that. I would probably say it’s okay. If you have the front desk to take those measurements and then have the provider actually confirm those measurements. So I think that that would probably be sufficient, but we’ll do a follow-up on that one.

Next question is this photo the only way to report the outcome measures upon discharge. So this is related to there’s a few different outcome type measures. So there’s the pain assessment measure. There’s the functional outcome assessment measure and then there are the functional status change measures to 17th and 223 and for the pain assessment and the functional outcome assessment.

You only did you need to report those. I’m evaluation and re-evaluation. Nothing needs to be done for those measures at discharge. For the functional status change measures those need to be reported both at or you need to essentially take those tests at evaluation and it discharged the reason need to do to have it at this charge for that.

One is the way that measure works is that is measuring the stat the difference between. The predicted score and the actual score at discharge. So they predicted evaluation and you can actually compare the two was it more or less than what the predictive value was. And that’s what you’re reporting on for that particular measure that is a photo specific thing.

So you only need to report at discharge for measures to 13 or two 17 through 23.

I would like to know if you have any the functional measures yet for Medicare the other questions what measure should we use for our neck patient’s so the functional measures might need a little more clarification on this one the measure specification documents which indicate which quality measures.

Each different discipline is going to be able to report on those are not yet available from Medicare. You know, we’re in December already and those have not been released yet. We are expecting them around December 19th. That’s kind of the date that I’ve been hearing. So still waiting yet on those.

What measures should we use for our neck patients? So this might be related to the photo submitting for photo but not being able to submit on the neck patients within the therapist registry. So I would say that you are unable to report on neck patients for functional status change within the therapist registry if you are a.

Clinic who sees a significant number of neck patients to the point that you do not think you will be able to report on other body parts or the functional status change for other body parts because the volume is so low on those and so high on the neck measurement. That the being honest I would recommend photos registry at that point.

If you’re seeing that many Mac patients, then you probably got to submit on their qcdr. And again, if you’re a photo customer, this is only for the functional status changes. If you’re a neck patient, you can definitely submit on the functional outcome assessment pain assessment. Just fine.

Okay. Next question is we do not have photo. This is Mimi consummate any of the outcome measures or will the TheraOffice mix wizard include prompts that still enable us to submit this data? What are the outcome measures worth percentage-wise in our overall score we can estimate the outcome measures.

Are we risk of scoring below 30. So if you do not use Photo then you’re not. Testing anything that ends up getting risk-adjusted because that’s that’s part of the requirement is you have to use a risk-adjusted outcome measure to measure within those functional status changes. If you’re not using any outcome measures that risk adjust then you will not be able to report on those specific measures now, Well, the therapist wizard include prompts will enable us to spit stata cats minimum unless you’re unless you’re tracking that data.

So percentage-wise in your overall score. What does that mean? Is there a question that only unofficially be answered right now? Because we don’t know what’s going to change with regards to the measure set and whether or not the specification documents include other measures. So as of right now there are four measures that are within TheraOffice that you can submit for process and those four confirmed through the final rule that CMS released.

So within that final role we know those four get submitted. Will there be a fifth or sixth measure using the false assessments that were thought to be phased out, but maybe they’ll get face back in and diabetes measures and anything like that. If there are any additional measures. It’ll change the answer this question as of right now what it means you would score a four out of six.

And depending on how you score on those measures, even if you scored an absolute minimum on the four out of six measures you would be scoring. Three persons who would be 12 out of 60 take that multiply it by 85% and then assume you’re scoring a 15 out of 15 on the Improvement activities and use that as 15% Basically at you’d have to do the math on it.

But as long as you’re performing well within the for quality measures, you won’t be under the 30 point threshold. Also, I know that got really confusing but here’s the other thing that I would say on this if you sign up with our registry and at the end of the year, it turns out you’re going to score under a 30 and would receive a penalty and you’re only considered to be eligible.

Then we won’t submit the data for those providers the event one of the advantages to using the registry is some data submission time. You can pick and choose which providers to enroll based off of how they did within each of those measures. So you do have some flexibility there in terms of how you’re reporting us.

When will the update be available to download for on-site clients? We are aiming towards next week. So you should see it. I don’t know if it’s gonna be the beginning the middle or the end, but you should see it by the end of next week There’s a chance that it falls into the following week, but were hoping to have that available by the end of next week.

We are a small Clinic who has chosen to opt in the mips and provider data via claims. We will then only be reporting on quality measures, correct? Can you please verify the for quality measures must report on yes, or. If you’re reporting by a claims, you will be reporting on the quality measures, but you still do have the option of them reporting on the Improvement activities.

So that’s a really really important part of this kind of thing. It was like extra credit. I would highly recommend anybody to submitting claims to also report on the Improvement activities that’s going to need to be done through the qpp site. We will not be offering anything within TheraOffice to report that data for you for claims-based submission.

We will be doing so for registry submission because we’re controlling that data submission, but for claim space you have to make those FS stations directly to CMS through the qpp site for those Improvement. Okay. So make sure you do those key. Please verify the for quality measures must report on.

So the for quality measures that we know about the for Quality process measures that we know about as of right now in this could change next week are the BMI current medications pain assessment functional outcome assessment. Those would be the four main ones whether or not that extends two additional ones will be making sure to let you know as that information becomes available.

Next question. Can you sign up as a group and then change to individual the answer to this question is? Yes. So when you sign up as a group to Let’s assume you’re doing this through the registry because that’s the only place that group is available you sign up as a group through the registry send a process.

We collect your data as part of a group. And then come January 2020 when we go to submit your data. We look at it and say alright your group consists of say 10 providers and nine of those providers did a hundred a hundred on the rib score. They were perfect in every way and then you’ve got one provider who really failed.

Just completely missed the boat on on all the measures and they scored say three out of a hundred well in that scenario if you were to submit as a group The that one provider is going to pull down those hundred out of a hundred scores from the other providers. So you might want to change. Your submission method from group to individual so that you can get the hundred out of a hundred on the nine providers that did perfect and then that one provider would basically receive a neutral payment adjustment it would offer the most benefit to you guys.

To change that type of submission at a later date. So the that’s another advantage of spending as a group once we get that data submission period we’ve got lots of options in terms of how we want to handle it.

Next question is how do we know if we should submit individually by clinic or by company? It’s the only have the options between individually and by group there is no by clinic or by company oral. There’s no by Clinic. It’s either individually or by tax ID number. So between the two, what should you do?

What we recommend is if you only have select providers you want to include the program. Obviously, you should do individual if you want every single provider within your company to submit and you want to aggregate all the scores together. You would submit as a group. That’s mainly the difference between the two I can tell you what we’ve been seeing a lot of people do is lean more towards the individual side.

Picking and choosing which providers they’re enrolling. I think that just has to do with the program’s new people are looking for more of a soft rollout than a hundred percent of their company. What is the deadline to enroll in the mips? So this kind of? Two deadlines that we’ve got associated with us.

Now first deadline is December 31st, and that is making your decision as to your level of participation. You really know going into the new year what your level of participation is who’s going to be collecting this or are you going to be collecting data for these measures? I would say that’s a soft deadline because you can start off at a later time.

So we do recommend starting January 1st. The next deadline is March 31st. That is the last day that we will be doing registry signups. So if you want to sign up for the therapist registry you need to do so by March 31st.

Next question is if Nick doesn’t neck Disability Index is not a functional test any longer what test should be used for next that Medicare recognizes a satisfactory for function report? Okay, I think this is a little bit of a mix-up on what we’re talking before with. The neck patients for photo neck Disability.

Index is still a functional test that is satisfactory for functional outcome assessment the functional outcome assessment measure for not patients completely satisfies that that is completely fine. Well, we were referencing to with regards to the neck patients was that if you are a photo. Okay, only for photo users and you wanted to submit for neck patients as part of the registry.

Then we recommend using photos registry instead of ours for those specific neck patients. If you have high neck volume at because basically photo did is they created a qcdr which is a separate new measure for their neck patients instead of including it in kind of the other category that they have it in before.

So neck is billion decks still a good functional test can still use it for the functional outcome assessment measure and also function reporting was referencing here. Also reporting as of January 1st is officially gone. Our next question is how do you therapist? How do you new therapists affect our company score?

So if you’re reporting within a individual setting then the new therapists would get scored individually, they’re brand new therapists who enroll in Medicare for the first time in 2018. They do not need to participate mips if they enrolled in Medicare in 2018 that are starting with your clinic in 2019.

It’s going to depend on whether or not they meet the thresholds within each of their different facilities kind of depends on when they enroll they enroll in the middle of the year, or if they join your company with in the middle of the year most likely but never going to be considered required because it wouldn’t meet the thresholds within each of their tax ID numbers.

They submitted under they start with you right at the beginning of the year and they see a lot of Medicare patients and there’s potential that they could be involved in which case you want to get them participating along with everybody else. The individual setting for a group setting any new providers.

If you’re deciding to submit as group any new providers that you hire you would need to collect data for them. Just as you do for all your other providers because even if that individual provider is only there for half the year they will they should be collecting data because it’s going to be part of your overall group submission in 2020.

Next question is if we cannot submit outcomes, can we set the performance met option to only require the other components? Answer this question is yes, the performance met requirement does not extend to the photo tests because the photo tests work in a different way. So with the photo cast you’re doing an evaluation based on whether or not you did a photo test.

You do not discharge again. If that is a patient that took the initial evaluation protest and we’re kind of leaving the requirements for that summary screen for locking the note. We’re leaving the functional status change. Measures outside of that. So to answer your question directly. Yes, you can enable the performance met requirement if you are not doing a comes.

Next question is do you have any info on how the Improvement activities are going to be handled within the therapist registry at this time? We do not have the details of how that data is going to be submitted. The reason for that. Is that the. SS stations for the Improvement activities won’t actually be done until January of 2020.

So how that’s going to be configured. We’ve got a few different options right now and we’re kind of still playing around with which option we feel is best. We can either have you do it directly through TheraOffice software. Maybe we can have you going to a website. Maybe it’s done through a phone call with a written copy.

We’re kind of weighing or different options right now and how we’re going to do that. But know that it’ll be handled well in time for the data submission for the 2019 reporting year. This force is how long does it take a PT to Gainer track record, you’ll need to elaborate on this one a little bit and additional question for so I’m not sure what you mean by the track record part.

Can we remove the mips units for the other insurances when we are batching will it show on our plates? So if you are opting into the claims based submission, then the mips requirements will only come down for the Medicare insurance has sewn on Medicare insurance has the mips CPT codes will not get added to your claims this all be handled through TheraOffice.

There’s no additional steps that you would need to take those. Okay, next question. I understand the four measures of BMI paying functional outcome meds, but do not understand what is expected of us as pts other than what it pertains to much for example photo. What is this do we need to do photo?

What about Improvement activities? So you do not need to do photo consider photo as a. Um bonus photo is something that you should pursue if it matches kind of the clinical philosophy of your clinic and how you’re approaching. If you’re really an outcomes-based Clinic photos of great option for you regardless of the mips program.

We’ve been partnered with photo for many years and we do so because they are best in class with regards to outcomes in the market. So photos of great option and was great option before and now it’s even better option because it messes with this program as well. But it is not a requirement to participate in the program.

If you are photo user then the program is going to be pretty straightforward and you’re going to be able to reach for the hundred and a hundred mips core and you’re going to have the potential at the exceptional performance bonus again, if you perform everything correctly. Throughout the year.

You’ve got a shot at that. If you’re not a photo user you still have a shot at a positive payment adjustment. It’s just maybe a slightly limited shot and it also depends on how what ends up happening with those additional measures that get released by CMS in the next two weeks. They might release additional options for.

Outcome measures to be submitted on they might reduce if they were to release the Falls measure both the Falls plan of care and fall assessment is new measures that Petey’s can report on then non-photo users would have six measures to report on one of them wouldn’t be an outcome but one would be a high-risk one which means how they would score it.

We’re still unsure of that but things could change on that. Okay photo not a requirement, but definitely a benefit to the program Improvement activities. If you’re participating in mips, you have to report on Improvement activities. If you’re doing registry-based submission, we’re going to have all your contact info and we’re going to do an additional follow-ups throughout the year reminding you of improvement activities and specific steps.

You can take to achieve those and then what are the instructions on how to attest to. If you were doing claims-based submission will not have your information in the same way. I will not be able to directly guide you step by step through those Improvement activities. We doing claims-based submission have to make those that have stations through the qpp site.

So there are some additional things that you have to do outside of her office. If you are participating claims based within minutes, we will be doing our best to provide that information to the you as well and will. The webinars for mips will not stop at the end of December. We’re going to be doing some additional follow-up webinars in 2019, making sure everybody’s up to speed and what needs to be done and giving them reminders on some positional apartment like Improvement

activities.

Okay. Next question is how do per diem therapists affect us and ptas how will how will how essentially ptas and per diem therapist get impacted by the match program. So again, I hate to have to qualify kind of everything with different scenarios, but it does matter whether or not you’re submitting individual or submitting group if you’re submitting.

Then you have to each one of these providers is you get treated differently and those individual per diem and ptas. Well not be considered to be required. So you don’t have to do anything for me. If they’re part of the group. Then the ptas don’t have to do anything because they’re not going to be evaluating patients or re-evaluating patients.

So the ptas don’t actually have to submit any data that have to capturing data, but they will receive the payment adjustment because they’re part of your tax ID. For the per diem therapists if they’re coming in and they’re going to evaluate a patient and you’re submitting as part of a group then they would need to do all of them.

It’s requirements that every PT does if you’re doing group everybody’s kind of on board with it regardless of how often they’re treating patients.

If we go with TheraOffice and interfaces with photo we won’t have to pay TheraOffice and photo. So there’s essentially separate fees here. So there are there. Is there office-based offering which as TheraOffice customer you get to use TheraOffice and then same thing for photo photo has their base offering then photo also has a registry and TheraOffice also has a registration.

If you’re a photo user you would be paying TheraOffice further base offering we paying photo for their base offering and then you’d be choosing either to submit through the registry by the therapist registry or photos registry you paying for one of those two Registries. So separate these on each of these things.

All right sniffling is how do we determine the percent of gain or loss when it comes to payout is a strictly based on reporting is not with patient isn’t compliant with therapy puts kind of so if you have a patient and I assume this is the photo base question because this shouldn’t it shouldn’t matter if the the patient doesn’t stop coming for functional.

Folks like I’m assessment of pain assessment. Those are only measured and eval r eval but I was really just a photo there any patients that self-discharge and never completed this search survey. Those are going to be considered denominator exceptions, which means they will not count against you so you don’t get counted.

You don’t have any penalties of patients stops coming in for therapy. Next question is have you decided on the group custom charge? Also, how does TheraOffice evaluate our Clinic to see if mips will benefit our clinic so we have figured out a group charge essentially what we’re going to be charging for that are the same $2.99 per.

Provider for eligible submitting providers and then we do 129 not eligible providers. If you’ve got a provider that’s doing a small volume of Medicare or maybe even know Medicare volume, but they are. Collecting data for non-medicare patients were charging 129 per those providers to get the full Group quote and to kind of work out all of the pricing details.

Make sure that you go submit the registry sign up form through TheraOffice.com register. Also, how does therapist evaluate our Clinic to see if Mitchell benefit our Clinic if you are utilizing process accounting then we have access to or we can run reports on the allowable side of things so that we can estimate out what we think.

The potential payment adjustment can be these are estimates. Obviously, they’re not perfect. There’s a lot of different variables that could impact them, but we are able to provide you some data and given that we have that claims data or payment data.

Okay, next question and hit this next thing keeps. Catching everybody up TheraOffice is not certified for neck until 2020 photo is certified, but we don’t want to pay registry feed a photo will not be at a hundred percent because of the neck requirement so under the current. Quality measures that are available if you were a therapist customer also utilizes photo, I believe it’s 20 patients as long as you had 20 patients complete the photo survey you’d want to check a photo to verify the details of that but as long as you’re 20 patients within each of the body parts, Then you would be eligible to submit on those measures.

And as long as there were two body parts you could submit on then you would satisfy the six measure requirements and be able to submit fully if CMS decides to release additional measures that can be reported on then you might be doing say Falls as one of your measures as your fifth and then photo you’d only need to have meat that 20 patient qualification on one of the body parts to submit for your 6 measure, so.

You absolutely 100% can still receive a hundred out of a hundred score as a photo user utilizing the TheraOffice registry. The only downside is that you don’t have access to the next page next page contains, which we only for see as being a problem if you are a clinic who specializes in treating

neck patients. Okay. Next question is if you put a goal of zero percent impairment at discharge and you discharge at 25% to do get penalized for not meeting your goal. Should you be more realistic for goals as opposed to putting 0% impairment? So this is not. We wouldn’t that this is not exactly related to the Mets part.

So you’re setting your own goals within the goal section. That’s not impacting. However, you’re submitting through the registry the impairment the predicted impairment values that we referenced earlier were in relation to photo. So if you. Go through the photo process and photo predicts a photo score at discharge.

And then you treat the patient and then add discharge the patient takes the photo survey again. They will be evaluated. Further new risk-adjusted score and that will be compared with the predicted score was and then whether or not you’re positively or negatively compared to the predicted score is the mips measurement that we report on you will at not be penalized.

Even if all of your patients fall under the predicted value, if you never achieve that predicted value, you will not be penalized for that. It’s still considered performance met the photo measure the goal of the photo measure is to prove that you’re able to track the difference between what the predicted value was and what the actual value was.

And if you’re doing that then you’re achieving the goal of that that measure which is tracking that risk-adjusted

difference. Alright, next question is what timeframe do we have to sign up with TheraOffice registry? So we did decide to extend the registry signups for TheraOffice to March 31st. So there is a late sign up option that will be available to users. Should they need to we do encourage people to try to sign up for the registry before the end of the year or into really to reach out as soon as possible the other thing to mention on this is that if.

If you are a clinic who attended, I believe it was in the first webinar. We asked question of would you be interested in receiving more information about the fair office registry? If you are somebody who indicated guess on their we still do encourage you to go to TheraOffice.com registry. That’s kind of the final entry.

Once you fill out that form, I’m TheraOffice.com registry. One of our sales people is going to be contacting you for all of the final details in terms of getting signed up. So even if you said yes during the webinar, we still encourage you go to that site you fill out that

form. Where do we send in the outcome measures? So for functional outcome assessment you’re doing that just through the mips registry or claims-based does work as any other measures for the photo measures of social status change to 17 to 23 those need to be submitted through a registry. So nothing you can do to submit those by claims those working in a different way.

So they must be done through registration. Okay, next question just to clarify photo is required to report on measures to 17 through 23. Yes. The photo tests are required to report on those measures. Those measures were stewarded by photo is set up specifically for photo. So yes photo is required for those

measures. So another question, I think he’s probably tied together. How do I obtain the previous training webinars? I’m totally confused on what is going on in this is my first webinar. This is not a good webinar to be your first webinar. I apologize about that. Maybe we should have made that a little clearer in the dock then the information that we’re sending out.

This is entirely QA based because we know the questions are kind of. Amassing we’re with regards to this program. So go into TheraOffice or going to your therapist program. And then if you go into the help section and then Training Center, you’re going to see access to all the online training videos that we have and within there are there are there are three previous mips webinars that we did that.

Are more than just a QA. They actually take you through the full power points take you through the entire program what it means what are the requirement levels and this will would make a whole lot more sense after viewing those those women are so highly recommend. If this is your first webinar, I highly highly highly recommend attending those or viewing those pre-recorded webinars.

Those are going to help you understand the program and then based off of what you’re seeing. From those webinars you probably have additional questions will do additional Q&A webinars to get those questions answered. Next question we’re talking fast and you slow down, please. I apologize about that.

I will I’ll try to slow down a little bit. We got so many questions that are getting as asked here. I want to do my best to try to get through all of them today. So I appreciate everyone’s patience on

that. All right, next question a little similar to what we had before but we do get this question a lot. So I want to reiterate this one, but it submitting to the registry how welfare office be collecting information from Improvement activities. For example, we are planning to use our patient satisfaction surveys from a program we have in our iPads.

It’s program is not connected to TheraOffice in any way with TheraOffice be providing Improvement activities. We should be using or. Is there a way to upload our own Improvement activities to TheraOffice somehow? This is an excellent question. So for the Improvement activities the way to satisfy those measures is to Simply do an attestation that says you are satisfying the measures.

Okay, this means that you because in this instance this Clinic is doing patient satisfaction surveys. It’s part of the regular process. They don’t need to change anything with regards to that process. They don’t need to get the satisfaction surveys within TheraOffice. They don’t need to change the frequency or changing or document anything.

They don’t need to do any of those steps. The only thing that they have to do is make an attestation to CMS saying we are doing this Improvement. For patient satisfaction. So how do they make that attestation? Well, if there are therapist registry customer we’re going to be providing you the method of making that attestation if you are a is submitting through TheraOffice claims, then you’re going to need to do it through to PP Dot cms.gov.

So nothing your process changes Improvement activities are going to seem a little different because it’s leaving you on your own to complete the activity and then you’re simply just a testing to doing it. So hopefully that one clears that one up. Okay. Next question is if we decide to do individual registry reporting for a few individual providers, do we only pay for the registry for these individuals or for all providers?

So you the the payment structure of how therapist registry is handling? This is your paying up front and you are paying for us to collect that data throughout the year. If come data submission time you decide to only report to Medicare a subset of that data. Then there won’t be any differences in in charging because we’ve already charged you at the beginning of the year when the data collection process starts.

But again, if your plans change with what rights do you’re submitting to Medicare then that wouldn’t impact impact the the previous pricing we wouldn’t do any backdating at that in any way. Next question is how do we know if we should choose to submit via claims or registry? So if you are practice who had more than 15 providers submit under their tax ID number in the previous year then.

You do not have the option of submitting claims. You must be registry. So only small practices have the option of doing claims and even for small practices we. Recommend going the registry option. It’s more controlled. You can have a partner in crime during the process and that we’re going to be doing everything you can to help you.

If you’re doing claims-based submission your kind of handling on your own without involving us as much so you don’t you don’t get as much help with it. So something by registry, you’ve got you can do the full data submission at one time between you can choose what it is that you want to submit.

We’re going to provide quarterly reports emailed to you registry is a better option. It’s the one that we recommend for people claims. The free option. It is available within TheraOffice is only available to small practices, but we do recommend being on the registry side. Well function reporting still be included in TheraOffice updates some Medicare Advantage plans in our area require it and it’s unclear.

They will discontinue it as of January 1st. So yes function reporting all of the mechanisms for puncture reporting or still available in the system. The only thing that we’re doing is disabling the requirement for it as of January 1st. So if you still have insurances that require it depending on what their insurance type is set up.

We might automatically disabling that or even if that’s the case though, you can re-enable it and we’re going to be sending out additional communication as it gets closer to the end of the year on what steps you need to take for those but yes your Medicare Advantage plans if they’re still requiring it.

They’re still going to be able to do it after January

1st. Okay. Next question is if a PT joins us in June with the deadline to join registry is March 31st. How do we add him to track his mitts data? So if you chose to report as a group, then we would automatically be collecting his data you wouldn’t need to do anything. We just automatically would collect it.

He be required for it each time if you chose to submit individually. Then it would be too late to submit for that Provider by June. Now that being said the only way that provider would be considered to be required is if they could meet all the thresholds within six months. Should they join in June?

We don’t anticipate that pain possible for anybody since PT is our only set of required as a 5% rate. So for this particular instance if your. If your group reporting then they’ll automatically be included if their individual will be excluded for this year and then they’ll probably want to participate in the following

year. Next question is if we do registry it will collect the data for all insurances. So the therapist has to take these extra steps, but it only pulls from Medicare so. Basically, if if you’re choosing to do registry, then the requirements extend to all insurances whether or not they are Medicare or not every insurance.

If you do an evaluation code, you’ve got to do the myths quality measures doesn’t matter if their Medicare enough we’ll be collecting all of that data and then submitting it to Medicare. Also one thing to mention is good question kind of lead into this. We’ve heard some people have the concern of us submitting non-medicare patient data to Medicare and that is not the case of how the registry works.

So when we go to submit the data to Medicare, we are submitting the summarized data essentially, what are the scores for each measure for each therapist. There is no patient data. That gets submitted to Medicare through our registry, even for the even Medicare patients. We’re not submitting any any specific patient data to them only the summary of the scores for each provider.

Next question to confirm photo risk adjustment score is the estimated discharge score and your score at discharge. Yes. There are our two performance met numerator options for for the photo measures. They are we took the. I took that as the test at eval and we took it at this church and the patient patient improved more than expected or less than expected.

Those are the two measures more or less. Both of those are considered performance met and that that’s what you’re reporting through those measures you’re not even reporting a numeric value of improvement. You’re just reporting more or less. Sex question is is there a report? I can run TheraOffice to see if ticular therapist needs 200 Medicare patients per your requirements.

This will be available through the mips wizard again, the updates coming out in the next week or two. So you should get more visibility on that. The I believe second screen of that. Miss wizard is giving you the number of distinct patients per provider. We are next question is we are not required to participate mips us.

We do not meet the thresholds if we choose not to participate. Is there anything they we need to do differently within TheraOffice. All you have to do if you’re not participating is go through the mips wizard. It’s going to ask you will you be participating in mips you answer? No, and then that’s pleasurable.

Basically finish and be done and nothing changes within TheraOffice. So real simple process if you’re not participating so you do that mr. Wizard, but you just indicate no and then you’re done. Next question is with claims based reporting is my experience from pqrs. The quality measures must be on the same claim as the eval or eval code that ends up that there are more than six minutes to report on how will this work on a claim?

That only has 6 lines. Definitely a valid point if. What we would recommend if you’re doing claim space submission to make sure that you’re submitting through and see claims and not 1500 claims and see claims do not care. How many charge lines there are they can go up to I think 24 so there’s no issues on the Nancy claim on a 1500 claim.

There’s potential problems that you could see depending on how that information gets converted on the Clearinghouse side. So we recommend anybody that’s in claims-based to Medicare to be submitting through that can see Auntie 5010 claims instead of the

200s. The question here if we have a new therapist who is not reporting in MEPS in 2018, but is co-signing with a therapist who is reporting that’s in 2018 while waiting for their credentialing to be finished. Will the therapist need to report mips on their co-signed notes answer that question is yes, the co-signing provider will go in as the submitting provider in accounting.

That’s a what that is. What will go on the claim Medicare will see that provider and have it count for them. So yes for co-signers that are involved in the program you. If they’re co-signing on an evaluation that evaluation needs to meet Miss commits Miss requirements if that cosigner is participating in the program.

Next question. I am a photo customer if I decide to register mix with TheraOffice TheraOffice will submit our information, but it will interface with photo. Correct. Yes. So photo customer. Who is utilizing the therapist registry we will be submitting both the process measures from TheraOffice and also the photo measures utilizing the integration.

So the only way I would say if you’re a photo customer make sure your integration is set up so that it’s using the photo goals and photo

outcome section. This one’s a little unrelated. Why is the nine seven five three zero being targeted and out the 1 1 0 or 1 1 2. I think this is in relation to difference in pay on the therapeutic codes and you know. Essentially, why is Medicare is losing these it’s a good question. I don’t know Medicare with the mips program is looking to move to a pay per performance model.

So they don’t have differing payments based off of which charges you rendered yet at the same time. They’re also changing the reimbursement structures for the CPT codes. So, I don’t know the answer to that question. It’s a good one for Medicare and recommend asking them. Okay, next question. We’re at TheraOffice customers.

The measures will be automatically in the software no matter whether we volunteer to participate or not. So if you go through the Mists wizard, you see you’re not participating. We will not be updating your documentation to include the BMI section to update the functional testing to do all of those things.

Eventually that will probably become standard as part of everybody’s documentation. But that’s also going to depend on how the mips program ends up changing over time. Next question is we have PT’s practice completing the Miss requirements this year, even if we don’t join the registry or do a submission so we don’t have to pay for something.

We are not using. Yes they can and you know what they could actually technically practice next year as well. Even if they’re not participating. So if. Once you receive the update if you choose to submit under the registry option what’s going to happen is we’re going to be collecting all of your data in the background for those measures and we’re only going to be submitting them if you’re actually signed up as a therapist registry.

So technically what you could do is choose the registry option, but then that actually sign up for the registry. We would be restoring the database in your local storing the information your local database not transferring it to the registry database and would allow you to complete those measures without actually submitting any of that data.

To Medicare only thing I’d say and that is be careful about doing that because if your intention is to actually get that data submitted, you must do your sign up with a therapist registry before March 31st. So if you are going to be submitting that way make sure to get that sign up done.

If you submitted a registry sign up form, but have not heard back yet because we are going through the process right now. You are definitely you did the right thing and you will be receiving contact here as soon as possible. Next question is related to those measures to 17 through 23 TheraOffices registry can submit on those measures and we will be able to do that automatically because we’re receiving information from photo in order to populate those so.

But we have to be receiving that information over from photo to do that. So to submit on those measures you need to be a photo user but you can be submitting through either TheraOffices registry or photos registry to submit on

those. Next question is I do not understand the photo. Peace. Do we have to register for photo or will TheraOffice have these reports within the mips wizard? So if you are going to be submitting a measures to 17 through 23, which is optional you can choose to submit them choose not to submit them.

If you’re going to be submitting them. Then you need to be a photo user and need to have the photo integration built out. If you do then we will be able to submit it through TheraOffice registry. Next question is how often do we need to attest that we are doing the Improvement activities through the key P site.

So again, you only need to do that attestation through the q p site. If your claims based submission. How often would you need to do it? You need to do it once for the entire reporting

year? Alex question, do you have to sign up through Medicare to participate in mips or you just start collecting data? You just start collecting data. If you are registry then we are going to be submitting that data for you. If your claims then that data is automatically going to go on your claims which tells Medicare you are choosing that option for data submission.

Your photo is not done it discharged. You stayed. It does not count against you. Can you confirm this again? Yes, so got a photo patient that came in for evaluation. You scored them accordingly and then they never came in at discharge that patient would be considered part of the denominator exclusions because you were never you know, they were just non-compliance.

They never took the test, which means it would not count against

you. Next question is right. Now we have two special designations one is a small practice and one is a hpsa which states one high or two medium activities to report what would happen if these designations changed, so if you did not have these designations then this is in relation to the. Number of improvement activities need to report on so if those Nations changed once the qpp participation look up site changed, then the number of activities you would have to report on what increase I think it’s the to hire, you know for medium kind of thing.

But with those special destinations, then you’re just have a lesser amount that you need to report on. All right, we’re getting close because only got about five more questions here. So real close to getting through this right at the end of the hour here one

second.

Okay.

So second question is a little bit tricky going off of a previous question. If we have a therapist start with us in 2018 who had met the requirements for MEPS as the previous practice from 2017 2018. Would they be required to report meant if they start with us so. The answer to that question is that they have to satisfy both.

Both determination periods. The first one is already past the second one is undergoing. Now. They have to satisfy both determination periods under the same tax ID to be considered required. So to answer your question. Would have been required in the previous one and they would not have seen any data related to that provider in the new one which means they wouldn’t be required under the previous tax ID.

And if they were considered required under your tax ID, they would be considered required for the program because there would be no previous data if they were considered. Not required under your tax ID, but previously required a different tax ID. They would be considered not required. So it’s very complicated.

That’s about as complicated as it gets with regards to the requirement levels of the program. I would definitely say under that scenario. If you’ve got a patient kind of joining you in 2019, you’re going to have more availability to that participation look up for this reporting year. That should help you in understanding whether or not that particular provider is required.

Next question even discharges where the data is collected from correct eval r eval is where the process measures are collected from eval and discharge is only specific to the photo measures discharge is only photo measures can’t reiterate that enough because I don’t want everyone to think that.

Discharges where you need to start collecting pain assessment or functional outcome assessment. That’s not true discharge is only for photo sessions. The only measures that it matters for in

any way. Next question is one re-evaluation enough to bill for per each patient case or when it’s required. Make sure that you are only billing re-evaluations when there is a significant change in the plan of care and it requires a full re-evaluation of that patients plan of care. So re-evaluations, I would recommend looking up some articles on winner evaluation should be used there is no such requirement for.

I talked to plenty of customers who never submit a revaluation or only very rarely under very specific circumstances do not think re-evaluations are ever required as part of a case or should be on any sort of routine. When do we anticipate the final rule for Medicare and final rule actually came down several months ago and they were waiting for now is the measure specification documents for anticipate those somewhere around December 19th.

They really should have those you typically hear they have them sooner this year for whatever reason they ended up getting pushed back a little bit, but that’s that’s around them were expecting. Next question is in 2020. Do you get lump sum incentive payment or is it paid as per claim payment is paid per claim payment.

So they just make a payment adjustment instead of receiving $30 for specific CPT code you’re going to receive you know, 29 or 28 or 31 or 32 depending on what that payment adjustment is. Alright, so that is it for questions. We got through a lot today. Thank you everybody for submitting all of your questions.

Hopefully we answered them, and hopefully we’re clear on them. I know we went through a lot when they’re really really fast. If you have any other follow-up questions, feel free to get them submitted or support department, and we’ll also be doing another one of these webinars on the 27th. So more things come up between now and then make sure to get signed up for it.

Thank you again. Everyone for being in the tens today. Hopefully you found this helpful and have a

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