2021 New Year FAQ: WebPT EMR

As we get ready to ring in 2021, here are some common questions and answers to help your clinic easily transition into the new year.

Download the slides here.

IN THIS ARTICLE

Patient Information

If I want to ask my patients to confirm their information on file, is there an easy way to do this?

Yes! Pull up the patient chart from the patient’s active cases. 

  1. Click on Patient Info.
  2. To view all the patient demographics and insurance all on one page, click the Printer Friendly link at the top right of the window.
  3. To print the patient’s demographic and insurance information, use your printer options or Ctrl+P. Then choose the printer from the printer dialog window.
How can I pull a patient list to see which patients need updated policy dates?

Policy dates will only show in the Patient List in Analytics. Click here for instructions on how to generate a report of patients with missing or expiring policy dates. 

A patient has legally changed their last name, should I start a new case?

Best practice is to create a new patient chart so there is a record of both names. Then, in the current/old chart, they can create a case note explaining the situation. This is important for members with billing integrations especially! Review the Patient Name Change article for more information.

Documentation

Should I start a new case because it is a new year?

Not necessarily. You can continue to document in an established case if treatment continues normally. Typically, a new case should only be created under the following circumstances: 

  1. Patient changed insurance mid-treatment 
  2. Patient developed a newly diagnosed (untreated condition) 
  3. Patient returns to therapy after discharge with complaints similar to previous treatment
Should I do an Initial Exam or Re-Examination?

An Initial Exam is needed if you start a new case. A re-examination is needed if there has been a significant change to the patient’s condition. 

  • If a patient is being treated for shoulder pain and falls and is re-injured, you would perform a re-examination to determine the new status of the shoulder. 
  • If a patient returns to therapy after being gone for some time without being discharged, you will re-examine the patient to see if there have been any changes to the initial reason for therapy.

Review our article on Documentation Note Types to help you determine when to use different note types.

Insurance

How do I add a new insurance for a current patient? 

You can add a new insurance within the Patient Info section of the WebPT EMR. When adding a new insurance for a patient, it is essential to edit the current case and update the insurance(s). Click here to learn how to add and apply a new insurance for an existing case.

Will insurance policy dates and visit counts auto-reset?

You will need to manually update Insurance Policy dates. Be sure to verify the reset date is set to the appropriate year. If you would like to generate a patient list report of expiring policy dates, click here to learn more.

Do I need to add the policy dates?

You will need to add policy dates if the patient has a new policy. Review our Add or Reset Insurance Policy Visits article to learn more.

Can I leave the policy dates blank?

While this is not a required field, we strongly recommend adding policy dates for recordkeeping purposes. If you have a billing integration it is VERY important that this field be filled out for information to flow between the two systems correctly.

EMR + RevFlow 

Integrated members cannot leave the policy dates blank for an insurance provider. The insurance will be rejected if the policy dates are not completed, which means you would not be able to successfully bill that insurance provider for therapist services. Review our RevFlow Integration article to learn more. 

EMR + Therabill

Policy dates in the EMR do not integrate into Therabill as the effective dates on the insurance card. If adjustments are made in the EMR, please remember to make the updates in Therabill too. Updating the effective dates, or archiving the termed policy insurance card helps to ensure the right insurance is invoiced.  

We highly recommend re-verifying your patients' insurances at the start of the year. Many plans run on a calendar year and benefits reset as of January 1st. You can keep a record of the verification in the chart notes in the patient chart, as a simple note or Post It note in the client chart in Therabill.

What about the previous amount spent for Medicare? If I entered an amount for 2020, do I have to remove it for 2021?

Yes, you need to remove the amount for 2021. Check out how here

EMR + RevFlow

Integrated members must remove the amount entered for 2020. You can use the Medicare Threshold Report to help you locate all of your Medicare patients.

EMR + Therabill

Yes, you need to remove the Therapy Cap amount for 2021 both in the EMR and on the insurance card in Therabill, if added. Open the client’s Medicare insurance card, and in the Advanced Information section you can update the amount.

Do I need to add in the deductible for Medicare?

All members must add the deductible for all insurances, not just Medicare, regardless of integrated or not with a billing system. The deductible amount for Medicare Part B for 2021 is $203.00

  1. Navigate to the patient’s chart and click Patient Info.
  2. In the Insurance section, select the Edit icon on the Medicare type insurance.
  3. Click Next.
  4. In the Policy Information section, enter the deductible amount in the Deductible field. Ensure the Deductible Met checkbox is unchecked. Click Next when done.
  5. Click OK.
  6. To save your changes, click Save Patient at the bottom of the screen.

EMR + Therabill

The Deductible field in the EMR does not integrate into Therabill. If you want to add a Post It note to keep a record of the deductible amount in the client chart in TB, please review here

If a patient has met the deductible for 2020, and we have checked the Deductible Met checkbox, will it automatically uncheck itself after January 1, 2021?

No. You need to manually uncheck the Deductible Met checkbox. From the patient’s chart, navigate to Patient Info, and Edit the Insurance. Check out these instructions.

Will WebPT’s Medicare cap tracker reset on January 1, 2021?

Yes, the automatic cap will reset; however, if there is a "prior amount used" entered into the Medicare insurance on the patient chart, that will need to be manually taken out in order for the cap to reflect the correct adjusted amount. 

Will the KX Modifier reset?

Yes. The modifier will reset on January 1, 2021. Note: You can manually turn on the KX modifier. Click here to learn how to do this manually.

What are the Medicare Thresholds for 2021?

The annual dollar amount for the Medicare threshold resets on January 1, 2021. Although the hard therapy cap has been repealed, there is still a soft therapy cap—meaning all therapists must apply the KX modifier once the threshold amount has been reached in order to receive payment for medically necessary services. 

  • The 2021 therapy threshold is $2,110 for physical therapy and speech-language pathology services combined and $2,110 for occupational therapy services alone. 
  • The targeted medical review (MR) threshold will remain at $3,000. 

If you provide outpatient therapy services higher than the threshold amounts, a Medicare contractor may review your medical records to check for medical necessity. In the WebPT EMR, the calculated estimate of patient progress toward these thresholds resets with the new calendar year. So, the KX modifier will no longer be automatically applied to claims for patients who had exceeded the threshold in 2020.

I bill Tricare, do I need to use the CQ and CO modifiers?

If Tricare is the primary or secondary insurance on a patient’s case, the CQ and CO modifiers will be automatically applied to any services furnished by a PTA or OTA. This feature will be enabled in early January 2021, however any payment differential will not take effect until 2022. So these modifiers will not impact payments in 2021. Click here to learn more about adding modifiers in 1.0, or here for the SOAP 2.0 workflow.

How can I contact my CMS Regional Office?

Here is a link to the CMS regional offices: https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/index.html

CPT Codes

The following CPT code updates will take effect on January 1, 2021

Untimed Codes

The following codes will be added to the WebPT EMR.

  • 99072: Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease
  • G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours (DC only).
  • G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional, 5-10 minutes of medical discussion (DC only).
  • G2250: Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment (PT/OT/SLP).
  • G2251: Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion (PT/OT/SLP).

These new virtual care codes are valued the same as the codes for virtual check ins.

Temporary Codes

Regular therapy services and management delivered via telehealth have been added to the Medicare telehealth list on a temporary basis. This set of temporary additions will expire at the end of the calendar year that the public health emergency for COVID-19 expires. Click here for more information on temporary telehealth CPT codes.

Retired Codes

These codes will no longer be paid by Medicare, however, other payers may accept them so they will not be removed from the EMR.

  • 98966 - Telephone assessment and management service (5-10 minutes of medical discussion)
  • 98967 - Telephone assessment and management service (11-20 minutes of medical discussion)
  • 98968 - Telephone assessment and management service (21-30 minutes of medical discussion)
  • 99453 - Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
  • 99454 - Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
  • 99457 - Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month99458 - (Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes)
  • 99091 - Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.
Allowed Code Pairs

Starting Jan 1, 2021, therapists are allowed to use the following paired codes for services performed on the same day:

  • 97110 + 97164
  • 97112 + 97164
  • 97113 + 97164
  • 97116 + 97164
  • 97140 + 97164
  • 97150 + 97164
  • 97530 + 97116
  • 97530 + 97164
  • 99281-99285 + 97161-97168
  • 97161-97163 + 97140
  • 97127 + 97164
  • 97140 + 97530
  • 97530 + 97113

MIPS

Why is my MIPS tab missing? I saw it the other day. 

The MIPS platform will automatically reset on January 1st and requires MIPS to be repurchased and setup. Until MIPS 2021 is enabled (estimated availability is late January 2021), you will only see the MIPS tab on notes with a date of service in 2020. For backdated notation, the date in new notes must be set to a 2020 date of service, saved as a draft, and re-opened for the MIPS tab to appear.

When do I need to submit my 2020 scores?

The submission deadline is March 31, 2021.  Each practice is responsible for reviewing their account, ensuring it is complete and accurate, and then indicating they are ready to submit. Healthmonix will directly communicate with Members to get their data ready. Members will need to click a submit button which will act as a digital signature to approve the data. Healthmonix will queue the data and submit it as a total sum of all of our Members’ MIPS data. 

For WebPT Member practices enrolled in our MIPS Portal:

  • Healthmonix, our registry partner, will send an email to each individual identified as an administrator in your portal account.
  • The email will: 
    • Alert you that CMS is ready to accept registry data for MIPS 2021 reporting;
    • Ask you to review your quality measure data to ensure it looks accurate and complete; and
    • Remind you to attest to your improvement activities.
  • When you are satisfied that everything in your account is in order, one of the practice administrators will click a Submit button in the portal, and data submission to CMS will commence.
What is the Extreme and Uncontrollable Circumstances Exception?

This exception policy allows you to request reweighting for one or more MIPS performance categories (i.e. Quality Measures or Improvement Activities). If you believe you have been affected by an extreme and uncontrollable circumstance or public health emergency, we recommend submitting an application. Learn more about Exception Application here.

How do I apply for the Extreme and Uncontrollable Circumstances Exemption?

Click here for instructions on submitting an application. The deadline to complete an application has been extended to February 1, 2021 at 8 PM EST. 

Where can I see my 2019 performance feedback?

Register for a HARP account to access your performance feedback, report data, and manage users. Click here for an instructional guide. 

When will I be able to look up my eligibility for 2021?

CMS recently updated the participation lookup tool for 2021. Simply visit https://qpp.cms.gov/participation-lookup?npi and enter your NPI number to determine your status. Keep in mind this is an individual-level program; you may want to check all therapists’ NPIs in your practice.

Is the performance threshold increasing?

Yes. MIPS participants must obtain 60 points or more to avoid a negative payment adjustment. This is up from the 45 points required in 2020. The additional performance threshold for exceptional performance will remain at 85 points. 

Has the MIPS payment adjustment changed?

The MIPS payment adjustments will remain at +/-9%. Eligible MIPS participants who do not report 2021 MIPS data will receive a -9% MIPS penalty against their 2023 Medicare Part B payments for covered professional services.

Are there any changes to MIPS quality measure requirements?

CMS requires all MIPS participants to have 70% data completion on all their measures, this is the same as the 2020 performance period. Additionally, CMS finalized the following measure changes:

Added to the PT/OT specialty set

  • 283: Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management
  • 286: Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia

Removed from the PT/OT specialty set

  • 282: Dementia: Functional Status Assessment

Added to the SLP measure set

  • 134: Preventative Care and Screening: Screening for Depression and Follow-up Plan
Are any changes to the Improvement Activities?

No. CMS requires 50% of the reporting group members to complete each activity in order for the group to attest to its completion. 

Are there any changes to the Low-Volume Threshold?

CMS did not propose or finalize any changes to the low-volume threshold for 2021. Essentially, that means a large majority of PTs, OTs, and SLPs will not be mandated to participate in MIPS next year.

Do I need to do anything if I added anyone to my MIPS group/providers mid-year?

If you are reporting as a group, or you acquired a therapist who is reporting individually for this year, you will need to make sure this person is set up in Healthmonix. Please email support@webpt.com including the following information:

  • Provider Name
  • NPI Number
I'm not mandated to report. What happens if I opt-in to MIPS?

If you elect to opt-in to MIPS, you will receive performance feedback, as well as a MIPS payment adjustment. Click here to learn more about opting-in as an individual for MIPS.

I'm not mandated to report. What happens if I voluntarily report data to MIPS?

If you voluntarily report, you will receive performance feedback only. Click here to learn more about voluntary reporting data.

What if I need to add another license in Healthmonix?

Please send an email to MVT-sdr@webpt.com and include that you are needing an additional Healthmonix license specifically.

When can I purchase MIPS for 2021?

We will begin selling MIPS on January 1, 2021.

Is WebPT going to do a webinar once the Final Rule is announced? How can I sign up?

Join us for a live webinar at 9:00 AM PST on Thursday, December 17th, 2020. Sign up here.

Other

I don’t see my question answered. Can I get more help?

Of course! For more assistance, please contact the WebPT Support Team at support@webpt.com or call 866-221-1870 and select option 2.