Welcome everybody to the call. We got through our technical difficulties and we are ready to go. On the call this afternoon, we are focusing on how to submit data using the Q PP submission portal for our 2017 transition year. We hope you have prepared some questions for us because we are here to help you and provide as much assistance as possible. Please, during the webinar, please use the chat box if you would like to, to ask questions or you can wait until the end. We will open up the phone lines then. Our objectives today are to help you navigate the CMS MIPS  data service and report data for the 2017 performance year through the CMS portal. Our presenter today is Holly Errand. She is a project manager  and a very knowledgeable person for the Great Plains QIN Quality Payment Program Office Hour. She has  enjoyed a 20 year career in healthcare. She has built her skill set from several different areas of the healthcare community. The highlight of her career is time spent working on the -- as a clinical research specialist, director of quality management, risk manager and CEO of her own quality control infancy. She is a change agent in South Dakota and has a strong passion for assisting rural and frontier practices. And fortunately Tammy McNeil is unable to present today. Without further ado, Holly I will turn the presentation over to you.  
>> Thank you Patty and welcome to our webinar. Sending love out to Tammy McNeil because she is suffering from a severe case of bronchitis. We're happy you are on that we know being part of the discussion will be difficult. She will be on chat if you want to talk to her. We are really happy to provide assistance and navigating the Q PP submission portal. We know and I'll four states we are working in, there are some difficulties. We are here to provide some assistance. So drumroll please. There is a new portal out there. You can find the portal at the www.qpp.cms.gov website that you have been using throughout the year to work out  -- lookup MIPS information, a p.m. information.  Now there is a sign in tab and that's where you submit and manage data. They are on the right. That's the sign into the QPP you will be using your EIDM  ID and password. I know a lot of us don't know if we are supposed to have a EIDM account . What roles are we supposed to have? The people that need a EIDM account, which is the enterprise identity management system  through CMS is any clinician and that would be independent individual clinician, in the groups that have eligible clinicians, MIPS  APM is and there certain  APM's that will need  EIDM accounts. If you are submitting data to the portal, if you've got  an EHR or IT vendor that will be submitting data to the portal. And also if you want to view any data submitted on your behalf. An important note and some of the questions we have been seeing from different providers is those that are in a Medicare Shared Savings Program, ACO. Do we need an account to send in any information and yes you do need a EIDM account  and roll so you could submit advancing care requirements and are MIPS and to get the  ACO-11 quality measure.  Make sure you are getting account if you are in one of those. And you have login and password information. So really, the EIDM account  is not where we start. We start with the CMS enterprise portal login. You will find that link here on the slide. We'll provide these slides to you. This is really where you start. We have two user guides as well. If you are in an ACO, you use that user guide. Need to be able to have a CMS enterprise portal login. Within that portal, you'll be requesting program access to the physician quality and value program. Many of you have -- you have not submitted data private -- previously or did not access your QR you are reports, you will have to request access. Under that program, that quality program, you'll find there -- there are different roles you need to request. Based on your organization designation whether a shared savings ACO with a group or an individual clinician or groups participating in MIPS are individual clinicians, when you enter into the CMS portal and request access  under the physicians quality and value programs, they will ask you to's -- select a group. Which is a role type. There different types of roles under each one of these designations of who you are. Once you select one of those groups, then you will select the EIDM role.  Let's say you are in a shared savings ACO and you will be submitting data through the web interface. You would select the PQRS provider and the role you want  is web interface submitter. If you are an individual clinician, you will select the role type for submitter -- you would select PQRS provider and individual practitioner  representative. If you are the provider, you would be the provider upriver and then individual practitioner. So this is a good tool to have depending on what type of designation your group or provider is. Then you will know which one to select. Once you have that role, and you have given -- been given approval from CMS. You will get that in your request for access, you will have pending request and once that is approved you can go to the www.qpp.cms.gov website and  click on the sign on and then you will be able to enter your EIDM user account information to login.  So this is a really new data station portal they have put together. CMS did hire outside of government to put the program together. It has been user-friendly and we've had a lot of good compliments about the system. I'm hoping will find it manageable. They are providing you one location to put in data. From MIPS. It saves on the fly. You can enter information, log out, come back and the information is still there . Now there are some characteristics about this type of an application that may not give you much confidence. But because there is no save button -- you can be assured you enter information, you log out and come back to update or put additional information, that information is still there. So when you are logging in, you'll put in your user ID, your password and you will be required to click on a button or a box that you agree with the terms and conditions of using a federal system. Then you will be given this next is verifying code. The phone number you put in your CMS portal, they will be sending you a code which then you will enter into this box, submit the code and that brings you to your account dashboard. Some navigation tricks with the dashboard, on the left-hand side it's going to identify you by name. It will give you a static pain on the left where you will be able to navigate through the system. Here in the middle you'll find it will list the APM practices you are associated with. Once you click on one of those practices or entities, you will find that it then gives you the clinician that are under the practice and also the TINs  under that practice. This is a great place for you to see who you are associated to and what ID numbers you are associated to. -- Please verify those are correct. This is just sample data we have here. This is not anyone's tax ID number. On the right-hand side you will see under the tax ID that is 3746, this is where you would select and -- report as group or individual. So if you click on individual, you'll notice there is one clinician that is connected to that tax ID number. And again, please verify the -- this is the correct provider and number. On the right it allows you to choose a category to do your submission. This is the group reporting. When we were back on the dashboard and drawer tax ID number, and you selected group reporting -- this would come up. So this is the place where you then would be able to start reporting your quality measures, your ACI, advancing care information and improvement activities. So let's start with group reporting for quality measures. I'm not going to be able to go through all scenarios for different -- I thought group reporting would be the scenario that may apply to most people. Again, you see on the left dashboard, it gives you your navigation of where you are. You are doing quality measures. There's instructions here that you can access and it shows you what has already been submitted for the profile. Right now there are no quality measures submitted at this time. You have a couple of options on how you can submit data. You can do a file upload or, if you have a registry or EHR submitting data for you, you would contact them. Let's do the file upload. The acceptable upload file format is going to be either a JSON/XML or a QRDA III XML.  So the JSON/XML is a style that would be given  to you either from your registry or other shoe CDR you employ to correct that data for you. The QRDA III XML is something that would be  generated from your EHR. If you have that ability to generate the file from your EHR, the QRDA III XML, you generate it , export it to your desktop and then upload it. You can drag-and-drop, you can browse for this particular file in your system. And you would click on upload and then they would be in there. What you want to see want to have put the information in, you would want to see this little status here that says, "complete". And I am hoping -- there we go. So you will see your file name and then you are going to want to see status complete here. You can delete files from here, you can remove certain files -- it can take up to 50 files depending on the size. They did indicate about 50 files if needed. So once you have uploaded that file, the system does a check to ensure the file structure is correct and the measure criteria is correct. So at that point, you do get a score. Just a tentative score of what your measure scored against the benchmark and what that equals for your category score. Okay? So from here you can delete this data, you can do a no other -- another file upload. So let's take a look at what also it gives you went to have uploaded your information. So it gives you the measures they have selected to give you the highest composite score for this category. And as you know, there is a potential of 10 points on each measure. You'll notice some measures may have 11 points. They may have a bonus applied to them. So if you wanted to click on a measure just to get the full description, you can see here want to do that, you click on the arrow, it gives you benchmark data, performance and it gives the score. So you can see here based on the 93.66 performance rate, the points from the benchmark file, they've gotten the full 10 points and the bonus is that they did it in into an reporting that gives them the one extra bonus point. So this is a great way for you to identify which measures were selected. What the point breakdown is and then also what your category score is. All right. So you have done your quality upload. And again, you look back on your left pain here and you can move to advancing care information. You will notice when you get here, there are two tabs, either add a station or EHR. If you're QRDA file also includes your  ACI information, you will see a score here under the EHR tab because that file that you provided will also populate the ACI measures. So if you are going to do attestation, you will have to select that and you will have to enter your information manually in terms of numerator, denominator and your reporting period here. Okay? So entering your reporting period is needed to unlock the other measures in the category. So you can enter in your reporting period. It could be at least 90 days up to one year. Want to do that, you will have to choose they measure set that you are going to be using. That could be either the transition measure set or the advancing care information measure set. There's an explanation on which measure set you can select. But if you're having trouble, knowing which one you should select, they do allow you to look up your certified technology. So your EHR, you can enter it here and this goes back to the OMC Chapel website. It searches for you and it will bring back which addition and measure set you should select. So as we select our measure set, you will have these three to choose from, you can have the transition, advancing care or a combination if you are using 14 and 15 certified product that you select your measure set. And it will bring up those measures that are part of that set. There are some of the stations that are new for this year that you will have to ensure you select. One of those is the patient center home Attestations and in advancing care information,  there are four of them and we will go through those. To show you are aware. So in the macro legislation, there was a requirement that eligible clinicians, providers, groups are testing there is no knowing or willfully, any type of information blocking on the technology that is being used. This particular Attestations says  we have not done anything knowing and willingly to limit any type of an operability or information blocking. This is a required Attestations  under the ACI category. You will have to submit that. And then the next is ONC is doing director reviews to ensure certified technology is functioning as it should be. Your Attestation here says you acknowledge if there is a review and you are asked to participate, you will cooperate  in good faith. The second part is, if that's has already been requested, that you cooperated. This is also a required Attestation.  And then the third you will see when you first open the ACI measure set, this is an optional one. This is again ONC surveillance. Again if they are doing any type of surveillance on your certified product and you are requested to assist with this, that you would cooperate in good faith. Again, if requested, that you did cooperate in good faith. Okay? I'm just looking in chat. I apologize. I'm kind of going through these. I did see this -- from Donna McCarthy. Let me go back and look up certified technology and do a search on it -- and the demo and how that works. I apologize Donna. We don't have the ability to do a demonstration with the product. It is one of the things we asked CMS if we could have some type of sandbox or demonstration environment. But unfortunately, we were only able to provide screenshots for this. CMS does have videos on YouTube and on their channel that does go through Attestation. They do have someone doing a full demonstration of those.  Okay. So the last Attestation you will see in the  ACI measure sets is going to be the certified technology was used. This is an optional one but it's very important that you select it here if you're going to be submitting an improvement activity that has part of it that's an activity you are using certified technology. An example is, let's see, it is 24/7 access improvement activity and that one indicates we have provided patients 24/7 access and also that the providers have access to the certified technology. And that improvement activity, you would be selecting yes and then you would want to ensure that you select this Attestation that you submitted an activity  using certified technology. All right.  
>> So Holly?  
>> Yes.  
>> This is Patty. I'm just wondering, we do have a lot of questions in the chat. Do you want to wait until the end and we will take them then? Payment let's go ahead and take some. That's fine yes.  
>> Okay. I'm going to go back up to the beginning. One of them says, when we went to verify all providers under the website, it shows that many providers not under our TAN. -- PIN. -- TIN. How do we go about changing that? Payment that has been an issue. We have had a call with CMS and they are aware of those issues and they are trying to do some fixes on those. They hope to have those fixed by the cut off of March 31. That we don't know that will happen. If you are doing individual provider only, select those providers that you are obviously going to be submitting data for. If you are doing a group, I think there's some assurance the file you upload for your quality measures and your ACI measures, they are only going to have the providers information that are truly in your -- under your tax ID number. This is not a great answer, but I guess we have to have a little bit of faith in CMS us they -- that they will fix those problems. I would just go out to Pecos and take a look and make sure any of those providers on Pecos and all of those are accurate. Those are about the only things I can give you on that. Unless someone else has information on those.  
>> [ silence ]  
>> I see from Rhonda, how do we go about changing our role? So Rhonda you can go ahead and request access for a new role just how I had shown you. And then if you have a security official, that person may get the email you that you had requested this new access. They would have to approve it. Dave Gordon, one of your doctors is listed as a non-Payson facing even though she saw more than 100 Medicare. Non-Payson -- nonpatient facing is based on the code you enter in on their claims. If you are using non-patient facing codes, then that person is deemed a nonpatient facing provider. On the CMS QPP  page 417, you can find a link that shows you all of the nonpatient facing codes that CMS considers for that status. What if we have Inacio and part of our providers RCC P plus. Are we including all CCC P plus providers? Great question. I'm not fully versed and CPC plus we have people online that are working on that. Let me look here. [ silence ] Patty, is Tracy on the line that can help with CPC plus questions? Payment  
>> I'm not sure that she was able to join, but let me check.  
>> All right. We are going to get back to that question. Let's see. Moving to the next question here. So Donna again. Quality data was submitted to the vendor and when we checked we were surprised by the results having 128 eligible clinician submitting as a group. We were expecting be eligible 70 points and we maxed out on 60 for the group. We are confident we had more than 100 patients on each of our measures. Any insights? The 60 points based on you know the provider type and your volume, 60 points probably is the max score for that group. But we would have to know a little bit more Donna about the makeup of your group. And that might be something you could take off-line with your state Representative  here on the team. We'll have that contact information for you. Maribeth, are these providers automatically populated? Yes they are. CMS has those populated for you. Donna, I see you have a question about bonus points. If you could expand, we could handle that one. Staff, ACO quality measures on her behalf, and we need to document anything in the QPP portal,  there may be some shared and you will have to enter for the ACL quality measure -- ACO-11, you have to enter that into the  portal. If you have any -- if you're in a shared savings track one and you have some providers not on your participant list for the ACO, they may be eligible for MIPS so you would have to submit their data through this portal.  All right. We'll come back to some of these questions. I think we left off here. Let me go through a little bit more on this. I did see one that I think it that's important from Deb. It says, we report via claims for your quality measures -- you will be able to see those results Deb. CMS gave us the timeline of a few weeks when we talked to them last. So I don't have a particular date of when you will see that information. And I can't guarantee you will see it before the 31st. Do know they are real -- they are working on getting that uploaded.  
>> Okay Holly, go ahead and just keep going. What I'll do is I'll look through the chat again and kind of let you know where we left off in a few minutes.  
>> Thank you Patty. I appreciate that. We were on these Attestations you will see in the ACI measures that . Let's just look at that, that screen. Once you enter your reporting period and your measure set, then that will unlock the measures and you will see here in your screen that they have a place where they show you your score as you go. So zero out of 100, it gives you the place if you are testing this way versus EHR, you just enter in your numerators and denominators. You can click on the down arrow and you can see the specifications of this measure in case you are still wondering what that measure really means. And also if you are taking the exclusion, you can have a place to enter that information there. In the last role they did make those exclusions for E prescribing and health information exchange effective for 2017 and 2018 and effective of those transitional measures. Those are written here. You will also find it when you are on the screen, when you click on that down arrow, it will be in the measure specification as well. And here is where you see I had talked about the CEHRT used  Attestation you click it here  in ACI to get the bonus point for any activities you select in the improvement activities category. So essentially this is very similar to what we used in meaningful use in that Attestation portal of just  entering numerators and denominators. Once you have entered all your information, it will give you a final score for the category. And then it will say category success. That's an indicator you have entered all the required information here. All right. Moving to improvement activities, again, if your QRDA file  does include activities, it will populate these again. You have the Attestation tab or the  EHR tab, if you are testing by manual entry. Again, you have a reporting period here so you would enter that. Just a reminder, if you had one provider that is doing this improvement activity for continuous 90 days and you can claim -- then you can claim that improvement activity. A similar set up here where your score is tracked as you go along. Here's the first Attestation you will see in the improvement activities . If you are a Patient Centered Medical Home and you have achieved that certification from any program as they list here, you can use that and you will get full credit for improvement activities category. So again into your reporting period and that unlocks the measures and you can see that first Attestation  is PCMH. You can move down to the search criteria and you can see they have provided, you can either filter on the subcategories, achieving health equity, you can filter on weight, so let's say you are just doing the high waited mind, you can filter by that. If you're only doing a search eligible you can look it up that way. You can type in part of the name of the particular activity and you can search for due to the volume of these, it may be difficult to look through them all. This is a good way to get to the once you have selected. Okay? So again, this is very easy to do. You are just clicking on the yes circle. If you are choosing that improvement activity. They will show you if this is a CEHRT eligible activity. Knowing it is, you would want to make sure that in that ACI category you clicked on that  Attestation.  They did indicate to us that CMS has the special statuses applied to providers. So that would be like rural, mall practices, [ name unknown ], those special statuses. At the time when they showed us, the criteria for improvement activities, is for any of those special status, is that you only needed two medium waited or one high waited. But I have been seeing in that was as of yesterday, the score if you did that, if I selected just this one or selected one high priority -- because that's all I need to do because I indicated to be a special status rural solo provider -- then my score is only going to show here of 20 out of 40. And you won't get that category success little icon. They told us to be assured they are working on that. And making sure those scores would then go up to 40. I don't have a timeline of when that will be completed. They did expected to be completed before 31 March. Again you can check your information. They may get it fixed next week. I don't know. You can into your information and check and see if it is changed. If you are not under special status, you have entered your information, you will get the 40 out of 40. If you achieved the correct number of activities and get the little category success icon. Okay. So you have entered all that information, now what? Well at this point, you are done. Because it saved all your information and I know there is no save button, there's no print button. If you do want to have something that will give you a little bit of security, you could go ahead and do some screenshots of what your scores were or potentially those measures. Just to know you entered it. But we have been given assurance from CMS the information is saved and there is no save button or print button. So the deadlines you have, so March 31 the MIPS providers,  up until that time you can change, remove, add, view. After March 31, the system will be locked in terms of entering information, it will be view only available. All right Patty. Let's move on to some more questions.  
>> From where we left off, I wanted to say thank you for putting the YouTube link out there as well as the patient facing and counter codes documents. Dana Olson wants to know about, they have both hospitalists and clinic practitioners they bill for under the same tax ID number, can we attach for the hospital listed as individuals and then all the other providers as a group?  
>> You select one Attestation submission  either individual or group. But -- this is a but -- CMS has said, if you enter data into the portal as an individual and as a group -- let's say Doctor Smith is a hospitalist under my PIN and I enter his individual information, his quality, is ACI and improvement activities as an individual. But then I go in and I do my TIN  as a group, CMS will not combine them. They will take whatever is the best score for the provider. Okay? So Doctor Smith's information would have to be within the group too. So if you didn't have Doctor Smith in your group submission and you had it as an individual, they will not aggregate that together. But they will select whichever gives him the best performance score.  
>> Great.  
>> Dave I wanted to respond, he said you are using non--- you're not using 99 203 and 99204, those are just MS codes. This is probably something we want to look at more closely. Let me bring up the slide where you can see your state contact person. That person I think you should reach out to directly and see if we can look at this a little closer. Thank you for the question. I haven't seen that happening. Definitely something we need to look at. Kim, where do we enter that we are small or rural? CMS already recognizes you if you're a small or rural practice. Once you log into the QPP portal, you will see your provider has a special status if they are small or rural. Just so you know, they use the HRSA definition for small or rural practice. Rhonda, you're planning to only a test for improvement activities, will the information submit without entering information on the other two? I'm assuming you're doing your pick your pace to avoid the penalty. Yes, I had the exact same question Rhonda. So what -- if you just enter the minimum amount of information that is described under that pick your pace test submission to avoid the penalty, CMS will recognize that meets the criteria. So if you just entered one improvement activity to satisfy that, they would recognize that and not apply a payment adjustment. Kim yes again claims, we don't know when it will be there but they are going to be putting the claims information on to the portal. Dave -- [ silence ] all right. We have Dorcas, when requesting access to the CMS portal, and are wanting to submit on behalf of the provider, and you select the group provider? Again I think you should reach out to whoever your state contact is here. We need to know what type of organization you would be and then the role would come from that. Beverly, I think I answered so if you submit the delete whatever their minimum criteria that you're going to submit, they will recognize that is a test submission. Okay. Yes Rhonda, just one improvement activity will satisfy the requirement to avoid the - penalty. Maribeth, does that work the same for individual providers? They may file individually or as a group at another practice. For every tax ID number, that a provider practices under, data would have to be submitted for that provider. So just one submission from one provider from one tax ID number does not satisfy a provider who practices at multiple. Let's say Doctor Smith practices at three different tax ID numbers, each one of those tax ID numbers needs a submit data whether group or individually under those tax ID numbers. In terms of the best score, they will do the best score for the tax ID number. All right. Any other questions? Great questions!  
>> I have a question -- Holly?  
>> Go ahead.  
>> I did have a question privately and it was regarding you were saying you know, the deadlines for this is March 31. And they were wondering about the Fairbury 28th deadline for just for clarification, that's for your eligible hospital reporting? That is not from MIPS.  
>> That's a whole other submission portal for meaningful use for the hospitals. I did want to say also, if you are doing web interface for those quality measures, I believe it's March 16. Does anyone want to -- I believe that's correct. That those have to be in.  
>> I believe so. But also To check on that. Maribeth didn't feel her question was answered. So if other facilities don't file for Doctor Smith, does he not score for their facility? In the scenario you were just talking about?  
>> Okay. Let me see here what she's got.  
>> Holly this is Tammy. I did add to your answer. Sorry Maribeth. Trying to understand that a little bit. I don't know if you see that at the bottom, if you want me to jump in or carry-on from there.  
>> Yeah, your answer Tammy is correct back to Maribeth. Thank you for that. Maribeth, does that answer your question what Tammy provided?  
>> [ silence ]  
>> I think you know the best thing to do -- we can only provide so much information. We only have a limited amount of time together today. Please reach out to these representatives and your state and we can provide you assistance one-on-one. You're welcome Maribeth. We're glad to answer those questions. We really do love helping our providers in our state. That is really the thing that we are dedicated to. So please reach out to them. We have a question from Brandy. She's getting mixed answers on whether or not the office is required to submit. We are rural health clinic in we have rural health specialist. They all are exempt. Any comments on this? The way rural health clinics Bell usually makes them exempt from these programs. Because these programs are mainly based on any claims that are four parts The -- part V. We have seen there may be some services that may be billed out on a claim and it may be just because of the type of service. It makes the provider that actually is in a rural health clinic eligible. I would say the best thing for you to do Brandy, would be to go out to be www.qpp.cms.gov website and they have a participant lookup tool. You can into your providers  NPI and it will tell you whether they are exempt or need to participate. Now the trick is, there are two different types of participation that they show you. It will be at an individual or group level. Okay? So there may be providers that don't meet the low volume threshold for an individual, but as a group they do. So they would have to submit data. Now if they are exempt due to provider type, then they would not have to participate. But again, I would look up all that on that eligibility tool. And Anthony go to www.qpp.cms.gov and there is a box on the right-hand side that says lookup  participation. Oh Brandy, the tool says she is required as an individual. Okay. So yeah, then look down, if she is under your clinic. It's going to say she's an individual and then it will say under what tax ID number she falls under -- make sure it's yours that she's being -- that she has been eligible for. If it is yours, then yes you would have to submit data. She may be practicing at different places which is making her eligible. Okay. Donna is asking if we walk through the algorithm as you know for the assignment of bonus points, into an reporting, over our top six measures we only had three into end bonus points. There are several different bonus points that you can get for measures. One of those is the end to end reporting. And some of the others are that it is a high priority or an outcome measure. And Donna, what is probably happened, there is a cap on the number of bonus points you can actually get within a category. So I would expect that's what it is. And it is no more than 10% of the score. So you probably hit that And only got the 3. So Anthony, understanding the lookup, how often do we need to check for eligibility? CMS send out the letters of the eligibility -- they do a look through claims data to find out who is eligible. And that is done twice a year. If you get a letter that says your exempt in the first lookup, you would not become eligible again or they won't make you eligible -- even if your claim state that you are -- in the second lookup. If you are deemed exempt from the first lookup, then you are exempt. But they do it twice look back onto claims to see who is eligible. So if you are eligible, you will be receiving a letter from CMS. Now the lookup tool for 2018 is not active on the CMS website at this time. I haven't heard -- I don't know if the other team members have the date when that will be available.  
>> [ silence ]  
>> I have not heard or seen any information about that yet.  
>> All right, we're coming up on five minutes left. Any other questions? I see Maribeth has one, we didn't get the second letter -- Maribeth, a second letter probably wasn't needed. There wasn't any further eligibility for your providers. If you ever have any questions about eligibility using the lookup tool, that's the best way to find that. Yes Brandy again, I know you are asking about the provider at the rural health clinic, the data would have to be submitted from the clinic. I doubt the hospital has the ability to generate any MIPS measures. If you do have the ability to  generate data from your clinic, that's where it would probably have to come from.  
>> The reason that's happening Brandy is because that provider is probably a method -- participating and method 2 billing. [ Indiscernible ].  
>> [ silence ]  
>> Anthony, Jamie just put up the look back periods for eligibility. -- Tammy just put them out. She may not be speaking but she is a heck of a resource person.  
>> These have been awesome questions. What an awesome presentation Holly. Holy smokes! That was full of great information. We still have three minutes left if anybody has any questions. Thank you so much for the dialogue that has been going on.  
>> Yeah these webinars can get stuffy, but it's really about your engagement that makes this a good webinar. I really appreciate everybody who is out there sending in questions.  
>> Yeah absolutely.  
>> Patty and Holly, I had a request, this is Tammy -- from one of the attendees to compile the Q&A from the questions and answers and send those out. I think once we get the information back from the WebEx host, we can take a few minutes and put that all together and send it out so everybody has that all in a nice laid out format. I think that's a great idea.  
>> I do to. That's also something we could put on our website.  
>> [ silence ]  
>> I have a quick question. I can't really type it. We are in the QPP portal and what makes us decide if we are just advancing care measures or advancing care information transition measures?  
>> It's really based on your certified technology, your EHR basically of what the product is certified for. So they can either be certified for the 2014 standards or the 2015 standards. So based on that, if you're just using 14 certified product, then you are going to choose the transition measure. If you're using 15, you would use just the advancing care measures that. If during your reporting period, you had may be an upgrade to 15 and you're using both 14 and 15 certified product data, then you could use the combination. And they did have that. If you look on the ACI, you can type in your certified technology, your EHR name -- and it will look it up for you. And tell you which measures that to use if that's helpful.  
>> We tried to lick ours up. That functionality is not working at this time.  
>> [ laughter ] go ahead and reach out to your state representative here on the slide. You can look up on the ONC chapel website, we can help you walk through that. You can select your EHR and the version and it will tell you which standards you are certified too. It will help you to understand which measures that to select. Reach out to whichever state you are in, which ever you -- representative and they will help you walk through that.  
>> Thank you.  
>> You're welcome. Brandy, you are looking to fill out an application for MIPS APM access  -- which type I need to choose? I'm not sure the type, but the program is the division quality and -- [ Indiscernible ] program. We are at the top of the hour. I think you all for your participation and engagement. Recharge your state representatives here and we will be glad to continue these conversations and provide assistance. And thank you to my team. You guys are great.  
>> Thanks so much. Have a great day everybody.  
>> [ Event Concluded ]  
>>  
>>