TheraOffice MIPS Q&A #2

December 27, 2018

Hosted By:

Nick Austin

All right. So the number one question we have been receiving throughout this entire time is should I participate it’s the same question that everybody has big and it’s the hardest question they answer because there’s a lot of different factors that go into it. So I can’t tell you for certain on whether or not you should participate but we can offer some guidelines some some kind of rules.

Bomb that we use to help us with that communication with you guys. So to start off if any of the following are true, we recommend participation. Do you have any required providers? So any providers that are over? 90,000 allowed to hundreds of sick patients and 200 units you have any required providers then the answer is pretty simple.

Yes at some level you should be participating in the program the seven percent penalty on Medicare allows allowables is just too high of a number to ignore in any way so you got any required providers you should be. The next thing is are you a current photo user or planning on using photo in 2019?

There’s a lot of overlap in this program between the quality measures in the Improvement activities for photo. So if you’re a photo user not only can you report on all six measures, but it’s an easier program than because you’re already doing the majority of. Already within your existing process.

So your photo user we recommend participating in mips. Also if you have a very high Medicare payer mix, so we’re talking over a hundred thousand in Medicare allowables, then you should. Strongly consider it because if you’re treating that many Medicare patients, then there’s a lot of potential bonus for you.

Even if you’re not required, so we’ll see occasionally as clinics will have over a hundred thousand or individual providers lab over a hundred thousand and aloud’s but the. Patients are say a hundred hundred fifty somewhere in that range. So they’re not technically required. But because they do have a decent amount in Medicare allowables.

It would be beneficial for them to participate in program other good rules of thumb. Your average allowed per provider is less than 65,000. We do not recommend group participation the same thing applies for individual and individual providers allowed is less than 65,000. We do not recommend individual participation.

So we use that 65k number as kind of a break-even point with regards to the positive payment adjustment and the cost of the registry. So if you’re below 65,000, then you’re probably not going to make back what it is in terms of the cost of the registry. It’s still a preference for you and maybe you can exceed at the program.

You know with minimal minimal penalty or minimal positive payment adjustment, but 65 cases good kind of rolled some number that we utilize that we would suggest that does get countered. If your photo user then you should definitely report even if you’re under 65k. Okay. The next question is I haven’t been contacted back yet.

I submitted my stuff is website and I haven’t received any information yet. So the response we’ve received so far with regards to our therapist registry has been incredible if we’ve gotten a lot of a lot of inquiries about it and our sales team has been working very hard in reaching out to everyone to make sure that they get signed up.

If you have not been signed up yet. Don’t worry. We will be reaching out to you soon. Also, I know some people are concerned because that January 1st is right around the corner here as long as you’ve run the mips wizard from within TheraOffice before then you’re going to start collecting on January first, even if you haven’t officially completed all the paperwork.

For the registry, so we’re allowing you to that that signup period all the way extended out to March 31st. So we don’t get back to you before the end of the year as long as you’re wearing that mips wizard. You’re going to be collecting that data right a big in the year. So just keep that in mind as you’re going through that process.

Okay. Next question is will there be any new measures added? So right now without the use of photo we’re at four of six quality measures and the question that remains is will the measure specification documents that are still do allow any additional measures for Petey’s to be to report on mainly The Falls measures.

Or the diabetes measures. So as you might be aware the government is currently in shutdown. So we’ve also heard that the office responsible for releasing the measure specification documents is included in that truck down. So when these will come out. We do not know originally we heard December 19th, and then we heard January 1st, and now we’re hearing hearing January 4th.

So the goalposts can’t keep moving here. We don’t know when this is going to be released. So we cannot confirm whether or not additional measures beyond the four existing process measures are going to be available. The if it is January 4th know that there is a 60% reporting threshold for the year.

So you still have the potential to get a maximum score in mips. If you start late as long as you meet that sixty percent reporting threshold as long as your performance rate is still a hundred percent amongst that sixty percent. So even if you’re starting up late can still succeed in this program.

Okay. The next question is should I participate as group this is a lot of confusion kind of with regards to group and individual which one should I do to start off with reporting as a group or individually is completely a choice. It’s not tied to a small practice. It’s not tied to anything else other than you as a you choosing which which submission type you should do so reasons to submit as a.

I want everybody in my company to participate in mips. You can still do it individually if you want them, but generally if you want every single person participating then group is a good option for you. Another good reason is I plan on expanding in 2019. We’ll be adding staff that are also want involved in mips.

So if a provider starts in, you know, September of 2019, they’re not going to be eligible to be reporting individually just because they might. Not reach any reach any of the thresholds, but if you’re reporting as a group your company’s reporting as a group, they can start doing the mips measures immediately and then receive a payment adjustment a later later time.

So if you want everybody included and you’re going to be expanding your staff group is a good option. The other thing is the average allowed per provider is above 65 K. So this is an important thing to look at in that we’ve seen some clinics have high degree of variance between their providers with regards to the Medicare allowance.

It kind of looks like the way that their scheduling patients is is more patients direct more Medicare patients directed to specific providers and if that’s the case. And your Medicare volume is within only a few select providers. Then you should consider reporting individually for those select providers because there’s not as much value in reporting on the other providers.

So as long as your average Medicare allowed for providers above 65k and it looks like they’re pretty consistent between them group is a good option for you. The other thing to keep in mind is that we don’t have to actually enlist you as a group in any way. So when you tell us that you were going to report as a group.

all we’re doing with that information is storing it on our side for the registry. Actually telling Medicare that you’re reporting is a group until we do the data submission in quarter one of 2020. So if you change your mind in the middle of the year that you want to switch from individuals a group or grouped individual you can do that the same thing will make that decision.

Once we do the data submission as to whether or not you’ll be spending as an individual or group. The main thing I would say is if you’re switching from Individual to group make sure you’re doing data collection on. As many of those providers as you can because you want to make sure you meet that sixty percent threshold if you would or worse of any as a group.

All right, that’s it in terms of our FAQ part of us. We’re now just going to open this up to questions and I’m just going to go through kind of one at a time here. Feel free to get your questions submitted through that QA section of the zoo meeting and hopefully we can get all of these address today.

Okay. So here’s a good question. If we choose not to start participating in January of 2019 with maps but then run a report in the third quarter and it says that we will hit all three criteria what happens so. This because you said third quarter that would definitely not be good. Luckily you’re in this webinar today.

So you’re hearing all about this and knowing to be prepared as possible for this the mips participation lookup tool should get updated. Around March and as long as you’re checking with in March, you’re gonna have plenty of time to continue to collect the data and report for mips. As long as you’re starting in March if it’s the third quarter.

You probably don’t have enough to meet the 60% threshold, which means you’re not going to succeed. You basically couldn’t sign up at the registry at that point. Even if you did claims-based submission, you wouldn’t reach the six percent threshold. You wouldn’t get credit for it. Essentially if you find out your required providers and third quarter of the reporting year that you require for you’re out of luck and you’re going to get hit with a penalty.

So what I would recommend don’t wait, we’re doing lots of follow-ups with you guys throughout the first quarter 2019 because it’s really really look at it as March 31st is kind of the the date of decision making that’s when you really need to decide whether or not you’re in or out of this program.

Okay. Next question. Is there any way to manually submit outcome measures if we don’t have photo so not for the existing functional status change measures that are there. So when we say the photo measures we mean its 2:17 through 223 their specific lead developed by photo. And for those for those to report those through the therapist registry need to be utilizing the TheraOffice and photo.

Plus integration so that does require the use of photo to report that through TheraOffices registry. Thanks for asking is can we add ABC activities balance the confidence scale to reporting measures? Absolutely. You can always go into the functional outcome tests within TheraOffice and add new tests in there and you know that that’s completely allowed make sure to mark it as function and if it measures pain as well then make sure to indicate our check that pain check box to make sure that it covers both pain assessment and functional.

Okay. Next question. I was attempting to set up the mips wizard should I select new document types as well as PT? We only do physical therapy. So if you’re seeing new document as one of the types in that mix wizard, then that’s basically something that was created on an accident you can skip that one, but this leads into another question of whether or not.

You should include which document types you should include and the way that we always think of it as if there is a chance that within that documentation type you’re going to report a PT or OT evaluation CPT code for a patient that is over 18 years of age. Then you should make sure that that document type is updated form its compliance.

Okay, so treating a patient with an eval CPT code. That is over 18 years of age. As long as those things are met then you should be including that. Okay. Next question. Do you mean that you get the bonus by achieving a 60 percent reporting and is the bonus point five percent of allowables in the penalty of up to seven percent of allowables build in 2021.

So as long as you reach a sixty percent reporting threshold, then that means that the data that you. Satisfies the data completeness criteria, as long as you need the data completeness criteria, then they’re going to be able to assess your performance met percentage based off of your data submitted as long as that performance met percentage is high enough.

You’ll receive a essentially a mips core out of I believe it’s zero to a hundred and as long as then based on that mips chord then your. Receive a payment adjustment percentage that ranges from negative 7 percent to technically a positive seven percent, but the positive seven percent won’t ever get that high.

I think our estimates put it at somewhere between three and four percent and that is for allowables build in 2021. So yes, if you’re at like 60 or if you’re at 70 percent reporting percentage, so you do 70% of your patients for the year. And so you’re starting a little bit later in the year. I would really really caution everybody at against looking at that sixty percent reporting threshold in terms of which patients you can skip out on the reason I say that is because if you fall under the 60% you cannot report that measure it is completely.

Ignores it and you get penalized for it. So be really really careful about paying extra attention to that sixty percent and trying to be right above that threshold. You should aim for a hundred percent reporting fresh performance or a hundred percent reporting and then also a hundred percent performance.

That kind of should be the target. If you need to start late know that that’s where the leeway comes from. If we set up the wizard to warn therapists, can we make Miss required to lock notes on 1 1 2019. So essentially if you did something in the Wizard that you want to reverse just contact support and will be able to help you with that.

Next question is where can I find the update? So the update should be pushed out to everybody now hold on site and web customers. So you should receive a prompt win for on first login to download the update. You can also go through administrator and do the check for updates there and then push up permissions on the updates to the rest of your staff.

Is there a chance Medicare will do a soft start and delay the mandatory participation? Possibly. Yeah, I mean it’s possibility given kind of this delay of information, you know, if I’ll say this part in previous years of this program The Measure specification documents were available December 1st.

That was always the tart like the date of availability for those documents. That was very typical now, we’re not seeing until January. So is there a possibility that they do something? Yeah, it’s a possibility but we don’t know for sure and I wouldn’t count on it. Not for this. Does it benefit us to participate in both the therapist qcdr in the photo qcdr know you only want to be reporting on one because between the ther office qualified registry in the photo qcdr, the data submission towards Medicare is it’s only going to be through one of them.

So if there be no reason to sign up for both. Next question is have you done Street at how photo will be used in Tio to meet mips? We have not just because as long as you’re using the photo integration, we’ve got enough data. We kind of build out the plus integration to pull in individual scores that tells us enough information so that we can score those photo functional status change measures.

So that’s why you need to utilize the photo integration because it already take handles the mix portion of that. Will there be an update before January 1st? No because we were planning on doing a last minute update based off of special specification documents coming out. I’m not coming out. We’re holding off on that until the new year.

Next question do we have to bill Medicare with G codes and use function V as of January 1st. If we are doing mips do we do it for providers that are not participating? So Medicare the functional reporting section is gone. It doesn’t do anything anymore not required for anyone after January 1st, except maybe some insurance has been.

Decide to start Emporium, but as for Medicare the functional limitation reporting G Codes are gone that being said what we would recommend doing if you’re participating in mips is completing a functional outcome assessment or a functional outcome test, which would be things like oswestry bird balance Completing those either on paper or through function Vibe and then that will score the mips assessment for the functional outcome assessment measure and the pain assessment measure.

So we recommend doing that for all patients because you’re going to be participating for all patients. So with regards to your activities for directly for your that your patients that you’re treating your going to continue to have them take functional testing. You’re just not going to be doing functional report.

Okay. Next question is how do I do the Mets wizard? So we are going to be pushing out some additional information here in the next few days that tells you guys kind of walk you guys through step by step on how to complete them. It’s Wizards more information that’s not available directly in that wizard is you’re going through it if you have any questions directly on it, I would recommend.

Contact the support essentially once you upgrade or once you update to the new version. It’s going to prompt you for them. It’s wizard you go into administrator and there’s a section under administrator think it’s called mips configuration Wizard and then you simply answer the questions. Are you participating?

Are you going to be doing registry or claims? Do you want to enforce the requirement of performance on each measure?

Next question is are the measures only reported on evaluations or to therapist have to report on progress notes and discharges. So when you have to report is based entirely off the CPT codes that you’re using. So if you use an evaluation. Or re-evaluation CPT code then you need to report it doesn’t matter if it’s a initial evaluation document type or a progress note document type or a discharge document type.

It’s based entirely off your CPT code usage. So you Valerie vo then you need to report or every other visit you do not.

All right. So here’s a good one. Please provide a sample misreporting on a patient. I haven’t had a chance to observe and study this so basically. Patient comes in and they’re going to be treated for an evaluation and let’s assume that this is under the registry scenario where we’re covering this for all patients.

So patient comes in you’re going to hand them a functional test just like you always did in the past or maybe you didn’t may be only there for Medicare, but you’re going to have them a test like a bird balance or oswestry test and you want to make sure that that test covers both function and. So example is oswestry covers function and pain the lfs lower extremity functional scale covers only function.

So if you were to give them a lie FS you want to also give them a visual analog scale so that I can cover pain so. Once you’ve covered function and pain and you’re also going to make sure want to make sure to grab to get their BMI. It can’t be self-reported but it can come from The Physician so it came on the referral or you know, if you’re in direct contact with the position you can get that information from them.

They can’t come directly from the patient. So you got everything from the position or you have to measure it yourself. So you want to get their height and weight. And then you also want to get a copy of the current medications. This can be either an image note or it can be I’m just telling you and you documenting it within that section.

So those are kind of the main pieces that you want to be able to take on so function assessment pain assessment current medications BMI what you have all the information that’s going to be available through various sections in the documentation. You want to make sure to complete it. And then once you go to lock your note, you’re going to get a lip summary screen that’s going to tell you whether or not you met the performance on each of those four measures.

If you did, you can lock your note. You’re good to go. If you didn’t you’re going to see a red X you’re going to need to complete it in order to get credit on the map assessment and that’s essentially lips and a 2 minute summary. Alright, next question is I’m still confused about the photo measure.

Can you explain this again? Are we still waiting for Medicare to release this information? We’re not waiting for anything to be released with regards to the functional status change measures the the photo measures basically how those work is that if you’re using a photo test photo survey, what photo will do is they will risk adjust their predictive.

Further predicted value for where the patient should be at discharge. So you take the first test they risk adjust they give you a predicted value of impairment at discharge. And then once you take the the discharge test again or take the test again at discharge, they’ll come up with an actual score at this church and then based off of the difference between the actual score.

And the predicted score you’re able to report through hoops, whether or not the patient exceeded the expectation or fell below that expectation. That’s what makes the photo measures unique compared to the functional outcome assessment measure that their risk adjusting and looking at a predicted value and indicating whether or not you’re above or below it.

Those measures are only available for photo users only available to report through the therapist registry from photo users, utilizing the integration. Okay. Next question. I have less than 60 5K in Medicare allowables. So I don’t plan to participate in mips, but should I still sign up with immense registry for potential future participation the answer to this is no you basically every year of mips is going to be treated independent of every previous year.

So if you’re not participating in 2019, but might want to in 2020 we’re going to have the same sign up period again in 2020. We’re going to be able to contact us and sign. Sign up for the registry. Every year will be independent of each other one. Yep. So this this refers back to a previous question.

We had referring to document types when you’re updating them. It’s wizard. The only options are physical therapy occupational therapy and it says new document type twice that new document type is essentially an error somebody at some point went in and said new. Within the documentation designer and it created these extra document types that don’t do anything don’t serve any purpose when you are going through the Mist wizard.

If you see anything listed that says new document type, you can ignore it. You do not need to update it. Next question is the new version of TheraOffice available to download. Yes. It should be available go to administrator and then update manager and you should be able to download through there.

Next question is is there going to be a walkthrough with all we need to input into TheraOffice for maps? I would recommend making sure to attend the second webinar that we did. It was the mips measures in scoring summary. Webinar is available through the training center. That one probably goes into the most detail on how each of those sections are filled out.

How each of those myths specific sections are filled out. So it make sure to attend that webinar, but we will be looking to provide additional information in the beginning of the year on filling all this information. So next question is do you have to pay for the registry to use the photo measure?

Yes. And the reason for that is that the photo measures are actually registry only the can’t be submitted through claims. And the reason for that is that their measures are looking at a difference between a previous and a predicted and an actual which means you have to go look back. Like it’s a conjunction of multiple things at once.

That’s why it needed to be registry only why claims based submission wouldn’t work for it. So, yes, you have to use a registry either TheraOffices registry or photos registry to submit on those photos measures.

Alright, next question is based on how far off is set up the midsections, which says what sections need to be completed to turn the sections green, for example, the pain assessment and functional assessment part under the functional testing doesn’t turn green unless doing an. So in order to get those who turn green, you have to enter in a functional test and that functional pass needs to have a score and an impairment associated with it that functional tests need to be linked to pain and or function through manage data functional testing.

But you basically have to fill out those sections in order for that to flip over same thing goes for with current medications. You’ve got to have something listed in the grade or you have to have the check box for in the image note. And then for BMI, you essentially have to be filling out the BMI with a follow plan or indicating that the patient is not eligible.

If you were doing that already and it’s not working, I would recommend contacting technical support and they should be able to fix whatever issue is that’s happening with that. Next question. Why is the pain assessment not with the pain section in TheraOffice? This is a good question. The reason that we pulled it out or we didn’t include it in the pain assessment was because the.

Documentation on the pain assessment measure specifically stated that it need to be done with a standardized test and because of that terminology of standardized tests, we knew that that test. What potentially could have been done through the functional testing section? So we wanted to keep them together both for the sake of having less sections to worry about with regards to where you’re looking at firm.

It’s and also for the fact that there’s some existing functional tests like oswestry that can cover both function and pain so we wanted that overlap to. Directly within the functional testing section. So I completely hear this concern and it was one going into this. We hope this works out nicely for people within that functional testing section, but we’ll keep our ears open on in terms of whether or not that disrupts the workflow.

Okay. Next question what date range is the mips eligibility report within the mips configuration wizard interoffice drawing that data from the date range that we use is for the first determination period and it runs from October 1st 2017. So to September 30th 2018. Okay, so that’s the first determination period That’s What Medicare is using.

So that’s what we have hard-coded into the wizard. Okay, next question when we check with Medicare online none of our therapists qualify for mips, but hot info we had several that did is this because your data is using all Medicare patients which include Managed Medicare plans that Medicare will not have.

Potentially, yes, you know it’s an unfortunate thing the nips wizard the calculation that’s made they’re using that determination period or any Miss reports that we’ve created for this they’re all estimations. They’re all its best as we can gather from what’s on our side. Ultimately The Source should be from Medicare.

The only thing I would caution on is if you’re checking Medicare online. If this is through the qpp participation lookup tool their data is only available for the previous 2018 reporting error and has not yet been updated for the 2019 reporting year. So, I don’t know where exactly you’re getting that information from I would say we would a hundred percent defer to Medicare whatever they’re saying is correct.

Whatever we’re saying is just within our system. So you should definitely follow what they say. Just make sure that you’re following the right thing that if it’s 2018 reporting your data, that’s not what what you want to be looking at. Okay, next question. How do we report a measure such as BMI Falls risk assessment in TheraOffice?

So you would. With regard to the BMI. We’re building an in we’ve got that new section that’s available through the update. And again, I would completely recommend attending that second webinar mips measures and scoring summary. That one’s going to go into the details of how you’re feeling that out with regards to Falls risk assessment.

That one’s still up in the air as to whether or not it’s going to be included in 2019. We don’t know yet. Nobody does until those measure specification documents come out soon as they do. We’ll make sure to update things and let everybody know. But as of right now that one’s still up in the air.

Next questions is starting January 1st. We do not need to add G Codes for Medicare patients. If when you say G Codes, you’re referencing functional limitation reporting G Codes. Then the answer to that is yes, correct. You do not need to add functional reporting or functional limitation reporting G Codes for Medicare patients.

I only qualify that because technically a lot of codes that are going to be used for MEPS are also G Codes coincidentally, so. Yes, but with her that’s functional annotation reporting that is gone for Medicare as of January first.

Okay, next question. I use contract pts during my winter months in my small office. Should I have them report on lips? If you are reporting as a group, then yes, you will have to have them report on maps. If you are reporting individual providers, then you do not need to have them report on maps.

So this is definitely one where the group kind of whether or not you’re spending individual or group impacts that workflow.

All right. So this next question is pretty complex. But hopefully we can address this one or two small practices each under five clinicians one Clinic is set up as an IP T and each individual is submitted electronically on 1500s. The other Clinic is a rehab agency and does institutional claims electronically on you Bo Force.

We do pt OT and we’ll be doing SLP soon. Is there a difference between the two what do you recommend? I do do I need any of this? So let’s start with the one that is a rehab agency and submit institutional claims. So if you’re a rehab agency, you submit institutional claims you do not have to participate in mips you actually I don’t think you can participate in maps.

The reason for that is that none of the claims data that you’re sending to Medicare? Is that the provider level there’s actually no providers that you have that are credentialed under Medicare. You’re just getting all you’re doing is credentialing your tin. So without that individual provider data Medicare doesn’t know whether or not that doesn’t even know that that providers submitting under your 10.

So they never become a required provider. They never become an eligible provider because there’s not even any units attached to that provider. So for institutional Clinic they do not need. For the clinic that is submitting professionally on 1500 claims. Then you would essentially need to determine using that the criteria that we talked about on the first slide of this should you participate using that criteria to understand whether or not you should is anybody considered required if they are required men?

Yes, you should if they’re not required then you have to look at Louisville’s and determine whether or not this is the right thing for you. I recommend that. You run the mips wizard and look at what the allowables are for your providers within the professionally submitting clinic and make the determination based off of those

values if we specify a pain measure and a function measure for the patient. Does that mean we don’t have to use Photo are those. So if you were doing a pain measure and a function measure for a patient, then you are satisfying the pain assessment measure and the functional assessment measure, you are not satisfying the functional status change measures because you’re not using photo.

That’s fine. You can report on four out of six. That’s totally okay. You’re not probably not going to get the exceptional performance bonus, but you will have satisfied pain and function which are two of the six process measures. So they’re not completely interchangeable. But the measures the the test that you’re using for pain and function do cover those two specific measures.

Okay, we’re getting this money questions with regards to like that that specific thing the pain essentially there’s you have to think of these as different measures there’s pain assessment there’s functional assessment and there’s functional status change. Okay pain and function are both for both can be satisfied using any functional status change.

Any functional outcome assessment tools that you have Quest Reedsburg balance any of those things will satisfy pain and function the functional status change measures are outcome measures developed by photo that can only be satisfied through the use of the photo measures within our registry. So does the only ways of satisfying those but it doesn’t impact the pain in the functional assessment those can be satisfied with anything.

With never clarified that it can that it had to be the clinical staff to do height and weight for BMI or could intake coordinators front desk staff do their do further clinical staff. Yes, the the intake coordinators front desk staff can do it. It does not need to be the provider. We’ve double-checked the terminology on that and it was fine for somebody else to do it.

It just cannot be self-reported is the only thing that they they say in there. Okay, next question. Can you give us a guess as to what percentage of your hot clients are participating voluntarily so good question. I don’t know if I can because I will say that there’s a still a large percentage of clinics out there who have no idea that this is that any of this is happening.

So, you know, I would say it’s pretty hard for us to say exactly how many are voluntarily participating and. Here’s what I would recommend for for somebody who’s kind of thinking along this wavelength is I wouldn’t worry too much about what other people are doing and I wouldn’t pay any attention to somebody telling you that you should report for the sake of you know, it’s a good program and you should get involved in it for the sake of the future and what it could potentially mean down the road.

I would look at the financials if this for your clinic individually. You know, I would not report for anybody. That’s under 65k and allowables I wouldn’t do group if I was under 65k and average allowables across that group. You know, I would I would make sure to report if I’ve got a require provider.

I would pay attention to those things. Specifically for you because every Clinic we look at as a different case with different circumstances that change whether or not they’re participating in the program. So I would focus on whether or not it’s going to be beneficial to you. If you’ve got high Medicare volume, I’d totally consider it.

I think it’s worth. I think it’s worth it to participate. If you’ve got high Medicare volume, you’ve got really low Medicare volume, you know, it’s a lot harder of a cell at that point.

Next question what mips cord you have to achieve to get any bonus anything over a 30 gets you a positive payment adjustment. Okay and 30s pretty easy to get the payment adjustment starts getting starts increasing more once you get to the exceptional performance bonus, which is available at a score of 80.

Next question is what is the registry collect on all patients and not just medicare’s because they can Medicare base pretty much forced it because they can and yeah, that’s that’s definitely been one of the biggest complaints whether or not this is considered an overreach by Medicare know that we’re not reporting any patient specific patient data to Medicare through the registry where only put.

Reporting the summary of the values. But yes Anjali why because they can. Next question, so just to be sure if you are so many on claims you only report on the Medicare Part B claims when you build the boundary Val, what about Medicare Advantage plans? So not Medicare Advantage just Medicare Part B claims.

You don’t worry about but that’s only for claims-based submission. If you doing registry have to do all patients claims-based submission is only Medicare and it’s only for the Medicare Part B. Next question. Do we update the wizard if we are undecided if you’re undecided I would not run through the wizard wait until you’ve made your decision and then went to the wizard indicating the values you’re gonna have to deal with an annoying pop-up.

I believe that starts. I think it started today actually, so you’re going to start getting the pop up a bunch do not have to do that. If you are still undecided and because of that sixty percent reporting threshold that you need to meet. You do have a little bit of leeway in terms of making your decision.

Next question is can you please verify or clarify for functional status change measures? What does it mean to have 20 patients minimum per body part. We specialize in vestibular rehab. So for any measure that you’re reporting to Medicare you need to meet a 20 patient minimum threshold. In order to report that measure so with regards to the functional status change measures or the photo the photo specific measures is just photo measures that means that you have to have 20 patients that you evaluated and then discharged with a formal discharge where they took the survey within a specific body part in order to report that functional status change measure doesn’t need to be a Medicare only patient because this is registry.

But you do need to meet that 20 patient minimum. So not every provider is going to meet that threshold for every one of the body parts. It’s definitely going to be some that will need to be omitted and can’t be counted because there’s not enough. If we are under the 65k threshold and choose not to participate are we forced to participate later?

The answer is no so if you’re under 65 K threshold 65k is what we use in order to know for optional participation, but you’re only required to participate if you exceed the 90k threshold for allowables. Any updates on the Improvement activities in the last webinar? Not at this moment? Like I said, we’ll have that more in later into the year.

You’ll need to do those throughout a 90-day period so we won’t have more information and that probably probably start hearing more about that and February or March. Next question, we have three individuals and RPG practice, but we’ll be reporting this year one will be out with a fur maternity leave during the summer will this impact our results at all?

Essentially for that individual TT? She will be leaving for maternity leave as long as. She’s just going to describe the data when she is there. That’s fine. But doesn’t impact anything long as she meets that 20 patients threshold, which I guess depending on how long eternity leave is as long as she’s meeting that then she’s mine.

Next question. Do we have to do our billing through TheraOffice to submit our mips codes if your claims based submission, and yes if it’s registry that know.

Okay, next question sir. One second. If Medicare functional limitation reporting is gone and I’m not planning on participating with MEPS. Is there still reporting for pqrs know so if you are not doing myth. And if you’re not doing MEPS and you don’t have to do anything, there’s no functional notation reporting.

There’s no nips. There’s no pqrs. There’s nothing for you at that point. So P cross was rolled into mips a picaresque. There is no pcard program anymore. It’s just nips and Tucks limitation reporting is gone. So if you’re not to admit you’re. Really doing anything. The only thing that I will say is none of this impacts any plan of care roles.

Those are still fully enforced and in place. So nothing is changing whatsoever with regard to the plan of cares which report to we run to determine if our providers of more lessons 65k in Medicare allowables. That’s actually available through that mips wizard. It’s like the second screen of the midst wizard, so.

It’s like first greens instruction screens that and then the next screen will tell you what those allowables are per provider. What if we were not able to get the mints wizard done by January 1st, you’ll be fine. You’re reporting percentage of the down but as long as it’s go down below 60% you’ll be fine.

So you can start the program a little bit later. Just don’t start too late and definitely don’t start after March 31st. Which webinar can we find the graph that covers functional surveys that cover function and or pain? I believe that is the second webinar. I’m pretty sure that as the second webinar which is the mips measures in scoring summary also, so if the survey can only covers function, we just simply also do the analog Pain Scale.

Along with it. Yes, you have something that I’ve only covers function just cover Pain by adding in the visual analog scale which is the easiest easiest test. You can give so for progress notes for Medicare. Should we be using the real code? So again on the Rive Al codes you are sorry. Let me backtrack a little bit.

Progress notes do not mean real codes. They’re not the same thing. The only time you should use a real code as if you’re having a drastic change in the plan of care and you need to fully re-evaluate the patient. Okay progress notes are just ten visits and you got to do a proper stuff. So no, you should not use a real code just because you doing a progress.

Will

the reimbursement pool be available from therapy only or for all mips participants? It’s for all much participants. Everything is kind of group together, which actually makes things interesting. We don’t know how in the inclusion of therapy is going to impact the overall mix course.

Please explain me on the neck and excuse when we have photo photos new next week to us. So it sounds like you guys are starting up photo. So basically what that means is you can use Photo and you can use their tests and it’s going to cover your function and it’s going to cover your pain and it’s going to have your functional status changes and you just want to use the photo tests within their you’re able to indicate the neck and as the.

Body part and you’re able to get all of that scored through the use of the photo test. If you’re not using photo there is the neck Disability Index as a functional test that neck Disability Index would cover the function. I don’t remember if it covers pain or not. But yeah, basically because you’re utilizing photo probably don’t even need to use the separate function test for that.

I thought the outcome measure reporting one high or two medium for our size Clinic is only an attestation. Is that correct? So the Improvement activities are only an attestation the outcome measure is the functional status change measures that need to be. Done through the use of photo. There’s also the functional outcome assessment measure and that is the one that needs to be done through the use of any of the any of those standardized tests that measure function.

I know that the terminology on this is very close to each other and that’s probably leaning to the some of the confusion on this stuff. And you know, I apologize it is unfortunate ly a pretty complex program.

We do not currently use photo but can we still use them? It’s wizard. Yes hundred percent photo is not required to participate in maps. It is not at all required. It just helps. Is there a dollar amount for you to be required to participate in mips? The 90,000 allowed is if you reach 90,000 allowed for the determination period year for an individual provider and you have more than 200 distinct patients that you’ve seen during that same determination period Then You’re considered to be required and you can get hit with a seven percent penalty if you do not participate.

Other than that that there’s this kid that other than that the different thresholds. We thrown out like 65k or honor K are simply guidance type thing. If we reported his own lyrics recorded with eval or retail CPT code, how is the reporting recorded on discharge? It’s not. The only time that reporting is recorded on discharge is for the use of the functional status change measures and that does not impact any of the process measures does not impact anybody that’s not using photo.

So if you’re reporting and you’re just doing the for process measures and TheraOffice, which are BMI current medications functional outcome assessment and pain assessment. Then you do not need to report it discharged only time discharged matters is for the photo measures. How do we get set up with TheraOffices registry the best place to start?

Is there office.com registry go fill out the form that’s available. There will get an email and it will be contacting you as soon as we can to get you signed up. How much will it cost me to report mips using using photo? So if you if you are a photo user then you want to sign up for either therapist registry or photos registry.

I cannot speak on their pricing, but our pricing is $2.99 per individual provider and then a custom rate for group depending on how often that provider is treating patients and how often were collecting data for him. So. Varied rates on the cost of that again if you’re interested in the TheraOffice registry go to TheraOffice.com registry.

What is the advantage of doing the photo measures versus just doing the pain function BMI and medications you get to report on two extra measures, which means you’re reporting on the full six six. You have a better shot at. Participate in the program the downside is you have to pay for a photo. So there’s there’s an advantage and disadvantage to it.

The intent of the program is pay per performance to improve the quality of treatment of patients. So photos definitely in line with it. So there’s an advantage to it the disadvantage that there is an additional cost to it. So yeah, but both are options do not need photo to report on maps.

For all patients if we use the registry, should we ask all patients to bring a list of medication? Yes, you’re so if you’re collecting data for the registry, I would recommend in that initial phone call with the patient’s when you’re scheduling the valuation visit to let them know to bring a current list of medications.

Also, is this for new patients only in 2019 or established patients as well that we see through 12 31 2018 to 1 1 2019. So if you have a patient who was evaluated in 2018, but then re-evaluate it in 2019. That patient counts and you need to do the read the three process measures. You don’t need to do BMI.

BMI doesn’t trigger for real coats. So patient evaluated in 2018 re-evaluated in 2019, eat have current medications paint and functional assessment. We’ll miss G Codes be seen in accounting since when you are using the therapist registry and not reporting by a claims. They will not so if you’re using registry, then we don’t push them over to accounting.

They store them in a separate table. We do that because we don’t want those charges to go out on claims. Alright, the next question is this question is more myths related and less TheraOffice related. But what happens to the Medicare fee schedule if we don’t participate mips is it largely unchanged?

So if you don’t participate in mips and you’re not required to participate in mips, then the Peace Garden was unchanged what I will say on this is they are using mips. To give increases in payments to Providers and that’s their plan in future years that they’re not going to be increasing the rates of reimbursement for any CPT codes that they’re going to be doing it through the through MEPS and through offering allowing more money to be available through that program.

So in terms of you’re looking for an increase in what you’re receiving and reimbursement you’re going to have to be looking to this program. If we are web-based is the update automatically done or we have to download and update so it doesn’t work like a full upgrade and that you’re having to like do like a full reinstall you will just be able to go to administrator and then the update manager and basically down to a download to an individual.

Client computer and then push it out to everybody through there. So again administrator update manager is where you want to go for the update.

Okay with regards to using qpp tool to see if the individual therapists are most qualified. You said use the 2019 data, but we don’t have that as yet can only be reported on the until 1982. Yeah, this is this is why we’re offering you know, the mips reporting in the through the mips wizard giving you those allowable amount.

If that qpp site was updated for 2019. We wouldn’t even give any of those values through our software because we just point you say hey use Medicare use what they’ve got. Theirs is more accurate than ours. The reason we’re giving those values out why we’re trying to offer up that information, even though it is not as accurate as what Medicare has is because their site simply isn’t updated yet for the 2019 reporting.

So once it becomes updated you should absolutely use that over what’s available in TheraOffice. Next question. This is a good one because we had this come up a few times through support recently can providers use them as wizard without reporting to Medicare. So if you are seeing this program you’re saying I don’t really want to participate this year.

I don’t have anybody else required, but I am concerned that I will want to participate in a future year. What I would recommend doing is completing the Miss Wizard and saying yes, you’re going to participate you’re going to use our registry but don’t actually sign up for the registry and you’re not going to require performance.

And with the what that kind of series does is it allows you to test the update Play Around in those sections fill out your BMI, but nothing gets reported to Medicare. It’s a good option for people who are wanting to test the waters, but not actually fully jump in yet.

Should we run the mix wizard ASAP or can we wait until Monday? You can wait until Monday or you can write it now either one. Is there up a set up to only requirements reporting for everyone except for self-pay and workers comp patients? It is required to or it set up to require for everybody that utilizes the CPT codes for evaluation and re-evaluation.

So even self-pay we never see anybody actually use the CPT codes that usually just use a self paced CPT code. So they. It’s kind of filtered out and workers comp patients depending on how you have that set up if you have it set up so that you’re reporting evaluation code then it is going to be included in the MEPS data and that that is intentional.

Next question the middle mix wizard will let us know if we were required to report the midst wizard will let you know whether or not you have any individual providers that according to the therapist data meet the thresholds that would make you to be considered to be required. It’s not perfect.

There are several reasons why that data could be slightly off. So we recommend using medicare’s qpp participation lookup tool. But we have now offers us you guideline in terms of what you should be able to expect from that tool.

We’re running the Miss wizard. Give me the data on my practice to help me make a decision as to whether or not to participate it’ll definitely offer up some data that you need to contextualize that data based off of what how your clinic is. Run what you guys are planning on doing in 2000 in future years, and if you need any additional assistance on that, feel free to contact us and we’ll be happy to help.

I prefer not to do misreporting if I’m required or if I’m not required us all less than 200 Medicare patients in the 2017-2018 determination period my exempt even if I end up seeing more than 200 patients in 2018. Yes, and this is if all the values end up being accurate, which is what I would recommend.

Doing when you’re looking at the participation lookup tool. So the way it works is you actually need to pass to determination periods. And only one of them is actually one of them exist in the past and one of them is still going on as of right now. So if you did not meet all three thresholds in the first determination period regardless of how many you meet in the second determination period you are not considered to be required.

In the mix wizard. Is there a way to check and see what my medicare allowables are for the year? Yep in the midst wizard second screen of that. You’ll see all the Medicare levels. Can you achieve a score of 80 if you don’t report on outcome measures? You can with enough bonuses and potentially yes, if they change what measures we have available to report on so as of right now, we’re kind of stuck in that they only gave us for process measures if they include.

Additional process measures like the Falls assessment then it’s going to be significantly easier to reach that 80 Mark as of right now. It’s a little harder and you’re going to need some bonuses to get in there like the World bonus and a small practice bonus. But basically what we’re hoping for is the inclusion of at least one more measure potentially two would be great, but we’ll see kind of how that shakes out in the next few weeks.

All right next question and all right, so we have definitely gone over in terms of the time and we still have a decent amount of questions here. So. I think that this is pretty productive. So I’m going to continue to go in through here. I know if everybody has prior commitments in terms of what they need to do, you know, we’re staying late in terms of this webinar.

We can we’re going to keep answering them until I get through all of them. So if you have questions, feel free to keep submitting them we’re going to. Kind of keep going through this much as possible the response to getting this webinar or this much to this webinar in terms of attendees has been incredible.

So that tells us that hey you guys still have a lot more Miss questions to ask so. We’re going to schedule another one of these for early January so that everything can still kind of get addressed. I’m going to keep going just in case anybody’s wondering how long this is going to go for we’re going to keep doing our best to get as many of these as we can answer.

All right, so next question. We have two full-time. And one PR npt only one of those eligible to report as an individual in the first term determination period and over the 65k threshold if we choose to only have that one PT report as an individual will all the other pts be required to enter these requirements to lock their notes or can I choose within the wizard to only have that one therapist be required to enter all four items.

Yes. This will be different than if you attended the first webinar, we have made a change in the update that you are now able to individually participate providers and force the requirements on only those individual providers. So, yes, you can select only that individual provider. It happens when you’re done completing the mips wizard and only that provider will be forced into doing them if sections when locking their note.

Alright next question I can please put the slide back with the recommendations on whether to participate. Yes, if you could switch back over. There you go. All right. Next question. What is the difference between reporting on claims for reporting on registry is one better than the other is it cheaper to do one versus the other so basically with if you’re going to be reporting versus on claims, you’re going to be doing it for Medicare only.

And the only way that you can report claims is if you’re considered a small practice, which means you have less than 15 providers registry then instead of reporting every single time that you do an evaluation and re-evaluation right within the claim that you’re setting the Medicare. We collect the data and then we do the data submission at the start of the following year is one better than the other.

I strongly believe that the registry is a better option than claims-based given the increased in importance of the program. So when we used to do pqrs and there is a point five percent penalty that was. that was less critical than the seven percent penalty that you could potentially receive now so given that kind of.

Increased potential of penalty going the registry option essentially list. Somebody else has a partner in the program that helps you completed successfully and given that there are now. Additional areas that you need to report on with regards to Improvement activities. If you have claimed space then you need to remember to sign up through the qpp site to submit your improvement activities attestations through that site directly.

If you do it through the registry, then you simply tell us what those that have stations are and will provide the mechanism for you to do that. So I feel it register is better option, even though there is a cost associated with it. One of my recommendations between registers basically, we recommend registry and all cases just because we feel like it’s the safer option.

The only time I recommend claims to anybody if they had previous experience with Peter us and succeeded in the program. If in that instance, you’ve already know kind of how this whole thing works and you did it. Well in the past then you might be able to do claims just fine. Otherwise, I would recommend that straight.

Will you be getting a copy of this QA guess we are recording it. So this will go out in the training center and be available to everybody.

Our outcome measures collected one time over 90 day period to satisfy the requirement. So I think that this is actually this alludes to a question it was as previously and I think I might have given it a slightly incorrect answer on this the outcome measures. Actually, I’ll commercials appear in three different ways.

There’s the functional outcome assessment. Which is the process measure available at TheraOffice, there are the functional status change measures which are the photo measures and then there’s also an improvement activity that specifically addresses outcome measures that Improvement activity, which I believe you’re referencing is you’re referencing a 90-day period basically just requires an attestation that you’re tracking outcomes through a risk-adjusted outcomes over a 90-day period so.

That attestation satisfies the Improvement activity, but it does not satisfy the quality measures.

Can you clarify what you’re referring to when you say 20 patient threshold, is that only for those using photo that’s for everybody? Basically what it means is if you’re going to report let’s say BMI, if you’re going to report the BMI measure to Medicare you need to have 20 patients to report it on that shouldn’t be a problem for anybody who’s interested in this program because if you have less than 20 patients that you’re evaluating then you shouldn’t be participating in the program.

It’s only a potential problem for photo because the photo measures. Get split based off of the body part. So if you know, you might not be seeing 20 elbow patients. So that’s where it has more of an impact. Next question. I hear the 65k, but I thought one of the criteria was 200 distinct patients.

Yes. It is. The 65k is that is nothing Medicare specific. There’s nothing official that is. Our internal calculated. Threshold that we feel people should meet in order to participate in the program because and here’s kind of add a little bit more context to the so you guys can understand where were coming from with us.

We’ve had people approach us saying I want to participate in mips and I want to do the registry and. They’re doing that because they heard from somebody that it’s a good idea to participate and then we run the numbers on them. And we see that on average their provider seat 20,000 dollars in Medicare allowables over a year period Well in that instance because they’re seeing such low Medicare volume.

They wouldn’t even be able to offset the costs. Of the registry with the Positive payment adjustment they receive from the program. So in those instances, we were actively trying to inform them of the you know, the net loss that they might receive by participating in the program. That’s where the 65k comes in and it’s kind of a good marker for you guys to understand whether or not you should be even considering the program.

Next question. We were small Clinic reporting by claims because paying for the registry will probably be too expensive for us to budget. So we do not have photo access for submitting the status change measures that means we cannot qualify for the exceptional performance bonus, but will not get punished or owe money because of this, correct.

Can we still get money back after the two-year time period so if you’re reporting on claims as long as you meet the 30. Threshold then you’ll receive something positive on your payment adjustments for 2021. So 3030 mips points a score of 30 is the threshold for getting something back positive and 30 points is honestly pretty easy to me.

Even if you did the bare minimum on each of the process measures and did your proven activities you’d meet the 30 point threshold. Next question apks registry allows you to go into their system manually to submit the Improvement activities just TheraOffice have this capability. Yes. We don’t have a belt out now because it’s not needed to submit now.

We’re only spending this data apis registry was in effect last year as well ours is new for 2019. So we do not have the information if he’s part built out yet I a hundred percent. Ensure you that that will be available by the time of data submission. We are legally required by becoming a qualified registry to accept that data or I should say that we tested to us being able to report on so I can a hundred percent guarantee that you will be able to make your improvement activities attestations through the TheraOffice registry.

Do we have to close out all function G codes with discharge codes come January 1st. Do we still submit if we do an eval December 31st, you do not need to close out folks on G Codes. Don’t worry about any ending any of that artificially in any way. Do you have to do an eval? You have to G Codes for an eval down in December 31st.

I think technically the answer is yes. Please review required for mips is for process measures and what only outcome measures only Improvement measures both. So what’s required for mips or I shouldn’t say that if you are participating in MEPS what is available to you as a PT are the quality category and the Improvement activity category quality makes up 85 percent of your score.

Improvement activities make up 15% within the quality category. There are six there is a requirement for you to submit six measures. Okay, so you’ll be scored out of six measures. There are only four available process measures and there’s functional status change measures available through the use of photo how many of those six that you report on impacts what your photo score is or sorry your mips core is but it does not.

If you only report it 4 out of 6, you can still get credit within their okay, you get partial credit matter how much it is that you do the for could change if the Falls become available through those measure specification documents.

Okay, next question specific example one group five Petey’s in 2018. All PT’s had average of 10 K except one that had seven 70k if we rebalance Medicare patients all will be Below 65k based on your recommendation. We should not participate, correct. Yes, I would say you should not participate in that instance if your average Medicare allowed per provider is below 65k.

Another alternative for you is if you didn’t rebounce Medicare patients to have that 170k provider participate individually that is another alternative option for you. If you did want to renounce them out, then I would say no because your Medicare volume is not high enough.

Okay,

updated Tio in the midst Wizard and not pop up. I did get a pop-up saying the wizard was not complete. How do I force the wizard you have to do it through administrator. We didn’t want anybody at your stead your clinic running to the mix wizard. So we left it only with an administrator. So administrator the scroll to the bottom.

You’ll see the mips configuration wizard. As you said we would like to test the waters of mips, but can we wait to do that later in the year and run the full Wizard and use registry without signing up for it? Yes, you’re essentially not using the registry you just using TheraOffice. Nothing’s going to go into the registry.

And yeah, you can set that up at a later time.

Can you provide a summary of how the scoring is determined with a small practice bonus? We are trying to decide if we need to do photo. Unfortunately, there is like there’s like a 70 page document. That was linked to in the mips Wizard or sorry in the the mips measures and scoring summary webinar that we did the second one.

That’s 70 page document goes over in detail exactly how it is that CMS is going to score everybody. I believe that the small practice bonus is a 5 point bonus. It is added to the end of your score, but. That might be an oversimplification of it and I would reference that specific document for details on how that gets cork.

Can TheraOffice provide me report on how Medicare allowable amount in my clinic so far to help me determine if I qualify I would recommend using that mips wizard. If you’re wanting and Report Form running additional guidance on that. I would feel free to contact us and we can help you in any way that we can.

Can I just use the wizard to see if I’m required to pursue mips? And then delete it delete it. I assume isn’t backing out of it. Yes, you can open up the mix wizard go to the second screen see the allowables close out of it and no harm done. A small practice bonus and other bonus if you say there’s a rural bonus, which essentially there’s certain areas of the country that are identified as rural that you get an extra five bonus points if you are located in one of those areas.

Providers not use Photo and TheraOffice they would not report on all six measures so they would not get the bonus. Correct. They would get about us. There’s still a bonus that you can get anything after over 30 points gets a bonus. You just get more of a bonus. If you use Auto that could potentially change depending on what those measures specification documents come out to be again.

We’ll know more information hopefully very soon.

If we are not required to participate can we sign up for Taylor’s registry without Taylor reporting to Medicare? We’re not going to get feedback on performance and compliance from Tio. So do not looking to participate you’re not looking to submit anything to Medicare then through the mips eligibility wizard.

You can select yes to participate. Using the registry, but don’t sign up for a registry and also saying performance is not required. One thing I will caution on this is if you have a if you indicate that you are using the registry and you are actually wanting to get data submitted over to Medicare and make sure you go to TheraOffice.com registry and fill out the information because we will not report anything the Medicare unless you go through the process of officially signing up with us and just selecting registry in the mips Wizard.

Does not do that. You need to reach out to us and get the official sign up through TheraOffice.com

registry. We still use the 9700 one for workers comp Auto eval for some insurances. Will the data pull up this code? Yes, we have changed that to include for the 9700 ones. What is the impact when using photo and have less than 20 elbow patients will if TheraOffice register determine out who can who we can report on the scenario?

Yes, we’ll be collecting the data. If it turns out you have less than 20 then we won’t be able to swim in at the end of the year. That’ll be done through the consultations that we have as part of the registry sign up. I’ve missed this question where we test to doing the patient surveys if you’re signed up with a therapist registry, you’re going to be doing it through that registry.

It’s not available yet because you only need to make that attestation before or sometime in q1 of 2020. So we still got plenty of time to make that attestation. If you doing claim space then you need to sign up through the qpp site to make those that have stations. But again you have literally a full year.

For you have to do that. Is the 299 fee for registry reporting charge once per year once I decide to participate in reports registry. How do I set that up? So yes, the registry cost is on a yearly basis and sign up through TheraOffice.com. And then the last question that we have and regulations to everybody who attended all the way through and overtime here if we only want to participate through claims that suggested I would caution claim submission.

Just make sure that if you’re doing claim submission that you have some experience in picaresque before. But you are familiar with the program enough to do it without missing out on anything. Especially if you have required providers in your high Medicare payer mix in those instances, they would definitely be careful and I would recommend registry over claims.

All right in a few more come in. I think my announcement of that being the last one. I drove a few more questions. This is real quick here. Where’s the list of improvement measures found all available on the qpp site. I would look them all up through there. There’s like an Explorer Improvement activities that’s available definitely go through that QP site and that’s Q PP dot cms.gov.

But if you just Google QP, it’ll be the first thing that comes up. Another specific example Clinic with five pts below 65k average per provider, but we are adding photo only one pts seen two patients in 2018. Can you clarify the recommendation would be to participate based on photo but report as.

Let’s split up a treaty with two patients. Yes hit it now on the head. That’s exactly it your assumption of this is perfectly correct? Because you use Photo you can hit the full six measures and you’re already doing the majority of what’s required from its anyway, so all you’re really adding in is current medications and BMI and it’s to get a full percent or full bonus on the cyst on the program.

So I would still recommend it even if your average is below 65k you’d have to be a really low volume to not participate MEPS if you are photo user because there’s so much overlap that exist. So yes, exactly, correct.

T’ okay, if we have tested the waters by using this Wizard and registry without signing up for it and decide not to go further because you really don’t want to do it anymore. How do we remove the wizard contact support and we’ll make that adjustment for you when that time comes. Alright, so that is it for the webinar.

Thank you again for everybody attending today’s webinar. Hopefully this was helpful again interest in this has been very very high. So we’ll get another one of these schedules for early January and hope to see you then.

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