Transcript Ingenix InSite User Group

Ingenix InSite
Provider User Group
April 12, 2011
Approval Code: IN331
Ingenix InSite User Group: Welcome
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© Ingenix, Inc. 2
Ingenix InSite User Group: Agenda
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10:00 AM
10:02 AM
10:10 AM
10:25 AM
 10:50 AM
© Ingenix, Inc. 3
Welcome
InSite Operations Announcements
EDPS Update
Documentation and Coding Focus On:
Diabetic Foot and Peripheral Artery Disease
Q&A
InSite Operations Announcements
Presented By
Jerry Gauchat
InSite Operations Announcements –
Data Refresh Update
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Data Refresh Update
– InSite data refreshed April 4th
– Next monthly data refresh is targeted for May 9th
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REMINDER: MAY 9th, 2011 is the next data refresh when years will shift
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Reports shifting years in InSite
– In January and April data, the new 2012 PY or 2011 Dates of Service
(DOS) will begin to be reported and InSite drops the oldest year of data.
– Reports shift years on reports depending on which time period is the most
actionable for the specific report.
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The data in InSite will shift years for the following reports on May 9th, 2011
• Prevalence
• Members with Declining RAF
• Patient Management
• PCP RAF
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HCC RAF Detail Report
– New FFS Normalization value used for calculations; only impacts 2012 PY
data
© Ingenix, Inc. 5
InSite Operations AnnouncementsQ1 2011 Release (4/4/11)
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Recent Enhancements:
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Provider Verification Re-Engineering
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New Group Validation Approver Role
New Annual Attestation Process
Re-Formatting (upon export) of Key Reports
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CSI, MWOV, SOAH & HCC RAF Detail
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Modified SSN to a PIN / Removed Collection & Storage of DOB
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Learning and Resources Documentation Modifications
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Mouseover Content, Label and Tooltip Updates
© Ingenix, Inc. 6
InSite – Process Changes for Provider Validation
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PREVIOUS PROCESS:
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All New Groups must initially validate each provider is associated to their group prior to gaining
access to member level data in reports
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New Providers to Groups added in a monthly data refresh are not required to be validated
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Validation had been required every 6 months (Validation Summary showed a period start/end
date)
PROCESS REVISIONS:
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NEW ROLE: Each group must have one or more assigned, “Validation Approver(s)”. The new
role will be the only ones with read/write access to perform Provider Validation.
All
other provider group users will only have “read” access to the Provider Validation tab.
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Initial Validation is still required for all new groups
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New Providers to Groups added in a monthly data refresh are required to be validated each
year prior to yearly attestation
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Yearly attestation required of designated Validation Approvers
© Ingenix, Inc. 7
Re-Formatted Reports (Upon Export)
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Reports Re-Formatted:
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CSI (including quick views)
HCC RAF Detail
Summary of Accepted HCCs (SOAH)
Members Without Office Visits (MWOV)
Modifications made:
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Moved report names to the header
Added page numbers to the footer
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Ensured column names appear on each page
Standardized field sizes and page orientation to allow for “print ready” export
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SSN Modification / DOB Removal
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Forgot Password Screen - Current
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Forgot Password Screen – New
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DOB has been removed
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SSN has now been re-named PIN; communication to be sent by InSite Operations
requesting all users modify their current SSN value with a new 4-digit PIN.
© Ingenix, Inc. 9
Learning and Resources Documentation Updates
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Training
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Ingenix Insider
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Feb 2011 (Atrial Fibrillation)
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Mar 2011 (Chronic Kidney Disease)
Utilities and Tools
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Updated PAF Program Tab Help file
2011 InSite Years Shifting Guide
Updated ICD9 to HCC Mapping with Descriptions, RAF & Hierarchy document
Information Resources
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Updated Provider Solutions (Capitated) document
© Ingenix, Inc. 10
Mouseover Content, Label and Tooltip Updates
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Mouseover Content Changes
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Group and Provider Summary Report
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HCC RAF Detail Report
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Priority
Patient Management Report
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HCC RAF & Total RAF for current and previous DOS Year
CSI Report (and CSI High Risk Members Quick View) and MWOV
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Prelim and Adjusted RAF (for previous PY and one year prior to previous
PY); no changes required for current PY
PCP RAF Report
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Prelim and Adjusted RAF
HCC RAF & Total RAF
SOAH Report
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© Ingenix, Inc. 11
Removed NP reference on PCP Name column
Mouseover Content, Label and Tooltip Updates
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Tooltip Changes
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PCP RAF Report
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Members with Declining RAF
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Report description
Provider Validation button
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Description of members included on this report
CSI Quickviews
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Description of calculated average RAF
Modified verbiage to match “to be” functionality
Label Changes
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Members with Declining RAF Report
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Risk RAF changed to HCC RAF
Patient Management Report
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Average Risk RAF to Average HCC RAF (Report Summary section)
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Risk Level, Risk RAF to Risk Level, HCC RAF (Filter)
Risk RAF (HCC Score) to HCC RAF (Column Header)
© Ingenix, Inc. 12
InSite Operations Announcements –
Q2 2011 Release
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Upcoming InSite Updates
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New HEDIS/STARS PAF Versions
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No changes to PAF Management functionality
Summary of Accepted HCCs (SOAH)
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Modify query to access report more quickly
Upon export - HCC and description will match
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Systematic User Entitlement
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Learning & Resources Tab
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© Ingenix, Inc. 13
Adding April, May & June 2011 Ingenix Insiders
» Removing all 2010 Ingenix Insiders
Removing 2010 ICD-9 Brochure
Further docs to be added as required
FYI #1
Presented By
Pam Holt
Baby Boomers Age-in To Medicare
 Two months ago 1st baby boomers “Aged In” to Medicare
– Beginning of an epic wave of growth & change in senior
population
 64 million people will be enrolled in Medicare in 2020
– 17 million more than today (36%)
– Making seniors the fastest growing Healthcare market
© Ingenix, Inc. 15
CMS Update
Encounter Data Processing System
(EDPS) Overview
Presented By
Patty Brennan
Quality and Compliance Director
CMS Regulation- IPPS Final Rule
 CMS issued rule to authorize the expansion of the collection of
encounter data beyond the 5 elements required for RAPS
submission:
– “Given the increased importance of the accuracy of our risk
adjustment methodology, in the FY 2009 IPPS proposed rule (73 FR
23667), we proposed to amend §422.310 to provide that CMS will
collect data from MA organizations regarding each item and service
provided to an MA plan enrollee.
– This will allow us to include utilization data and other factors that
CMS can use in developing the CMS-HCC risk adjustment models in
order to reflect patterns of diagnoses and expenditures in the MA
program.
– Specifically, we proposed to revise §422.310(a) to clarify that risk
adjustment data are data used not only in the application of risk
adjustment to MA payments, but also in the development of risk
adjustment models.”
© Ingenix, Inc. 17
Purpose for Expansion of Collection of
Encounter Data
 CMS has indicated that the expansion is required
for the following purposes:
– Measure healthcare utilization in MA
organizations
– Calibrate MA specific Risk Adjustment Models
– Calculate Disproportionate Share Hospital
(DSH) payments
 10/29/2010 – CMS held national meeting to
discuss initial requirements and timing
– Encounter Data Processing System (EDPS) will
eventually replace RAPS
© Ingenix, Inc. 18
EDPS Implementation Time-Line
2010
Oct
Nov
2011
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
2012
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
October 29th, 2010
•CMS held Industry Meeting
•Announces policy changes
•Announces release timeline
September 12th, 2011
•Initial file testing begins:
>Professional format
testing
March 30th, 2011
•Initial file testing begins:
>EDI translator & frontend processing edits
June 30th, 2011
•Initial file testing ends:
>EDI translator & frontend processing edits
July 18th, 2011
•Initial file testing begins:
>Institutional format testing
January 3rd, 2012
•Go-Live for 2012 dates-of-service:
>Institutional & Professional
formats
February 6th, 2012
•Front-end testing (end-to-end)
begins:
>DME Module
>Pricing system
May 7th, 2012
•DME processing & pricing system
go-live
© Ingenix, Inc. 19
May
EDPS vs RAPS- Significant Changes
There will be major differences between the Encounter Data Processing
System (EDPS) and the current Risk Adjustment System. The
most significant and consequential are as follows:
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Data collection changes from 5 elements to all elements of the
HIPAA standard 5010 (up to 900 elements)
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Submission of data from all types of service
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CMS will be responsible for filtering data to determine if eligible for Risk Adjustment
MA plans must submit data within 12 months from date of service
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Under RAPS submission, data for 1/1/2009 – 12/31/2009 is not finalized until 1/1/2011 which
allows a 24 month period.
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If 12 month rule was adopted by CMS, deadline for 1/1/2010 data would be 1/1/2011 versus
1/31/2012 under the RAPS process
© Ingenix, Inc. 20
EDPS vs RAPS- Significant Changes, con’t
 Submission of adjudicated claims data
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Adjudicated claims equals paid and denied, not pended
 CMS will apply CEM (Common Edits and Enhancements
Module) Edits
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These edits are utilized for Medicare FFS but the same level of edits may
not be needed for MA data
 The process for submission of Alternate Data (i.e. Chart
Review) still under review by CMS
 Parallel Processing
–
© Ingenix, Inc. 21
During the transition phase, plans will submit data through both systems:
• EDPS – full 5010 standard
• RAPS format to Risk Adjustment System
Key Considerations Under Evaluation
by CMS
 Timing (“Go Live” January 3, 2012)
– Aggressive timeline may cause issues for health plans
especially given the lack of fully documented requirements
from CMS
 12 Month Rule
– CMS originally indicated 12 month rule would apply but have
recently indicated that they are considering expanding the 12
month deadline for submission of data
– However, CMS has indicated a strong bias toward
decreasing the timeframe for submission of data
© Ingenix, Inc. 22
Key Considerations Under Evaluation
by CMS, con’t
 Submission of Alternate Data
– CMS has indicated that their will be a mechanism to
submit alternate data.
– CMS has signaled they are leaning toward tying the chart
audit data to a claim
– What happens when you cannot tie a chart audit to a
claim?
 The flexibility of CEM edits
– Soft or hard edits on many of the elements that are
currently not required for RAPS submission but are hard
edits for Medicare FFS
© Ingenix, Inc. 23
Diabetic Foot &
Peripheral Artery Disease
2011 ICD-9-CM
Presentation
Title Slide
Presented by:
David S. Brigner, MLA, CPC
Sr. Provider Training & Development Consultant
Diabetic
Foot Ulcers
© Ingenix, Inc. 25
Diabetic Ulcers
Foot Care:
 The sequence of events
leading to lower extremity
amputation is well known in
people with neuropathy or
peripheral vascular disease.
– While vascular disease leading to
ischemia is certainly a factor in the
pathogenesis, 60–70% of diabetic
foot ulcers are primarily
neuropathic in origin. 1
© Ingenix, Inc. 26
1. Gordois, A., et al. (2009). The health care costs of diabetic peripheral neuropathy in the
U.S. American Diabetes Association: Diabetes Care, 26:1790–1795. Website:
http://care.diabetesjournals.org/content/26/6/1790.full.
Diabetic Peripheral Neuropathy & Ulcers
Diabetes with Neurological
Manifestations 250.6X
 Peripheral neuropathy is common among people
with diabetes and can result in foot ulceration
accompanied by cellulitis or osteomyelitis, and a
severely infected or nonhealing foot ulcer may
lead to an amputation. 1, 2
1. Gordois, A., et al. (2009). The health care costs of diabetic peripheral neuropathy in the
U.S. American Diabetes Association: Diabetes Care, 26:1790–1795. Website:
http://care.diabetesjournals.org/content/26/6/1790.full.
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2. Reiber, G.E. et al. (1990). Lower extremity foot ulcers and amputations in diabetes and
amputations in diabetes. National Institute of Diabetes and Digestive and Kidney
Diseases, National Institutes of Health, Chpt 18. Retrieved from
http://diabetes.niddk.nih.gov/dm/pubs/America/pdf/chapter18.pdf.
Manifestations in the Progression of Diabetes
LOPS
Diagnosis and Treatment of Peripheral Neuropathy with
Loss of Protective Sensation in People with Diabetes
HCPCS Codes G0245, G0246 and G0247
Correct DX coding would be: 250.6X with 357.2
Note: Caution when coding “Loss of Sensation” 782.0
Consider coding “Loss of Protective Sensation (LOPS)“ 357.2
Note: Medicare covers, as a physician service, an evaluation (examination and
treatment) of the feet no more often than every 6 months for individuals with a
documented diagnosis of diabetic sensory neuropathy and LOPS, as long as
the beneficiary has not seen a foot care specialist for some other reason in the
interim. LOPS shall be diagnosed through sensory testing with the 5.07
monofilament using established guidelines, such as those developed by the
National Institute of Diabetes and Digestive and Kidney Diseases guidelines.
© Ingenix, Inc. 28
Centers for Medicare & Medicaid Services. "CMS Manual System." Pub. 100-04
Medicare Claims Processing: Transmittal 498 (2005): p. 4. Web. 12 Nov 2010.
Diabetic Ulcers - PVD
Diabetes with Peripheral Circulatory
Disorders 250.7X
Peripheral vascular disease is not uncommon among those
individuals with diabetes. The disease causes damage to
the large and small blood vessels of the legs and feet.
National Center for Chronic Disease Prevention and Health Promotion, (2008, July 23). 2007 National
Diabetes Fact Sheet. Retrieved March 17, 2009, from CDC: Diabetes Public Health Resource Web site:
http://www.cdc.gov/Diabetes/pubs/estimates07.htm#8
© Ingenix, Inc. 29
Underlying Disease – Diabetes Mellitus
 Example:
– “Type I uncontrolled diabetic atherosclerosis of the plantar
surface of left midfoot with associative ulcerative cellulitis”
• 250.73
Diabetes w/ peripheral circulatory disorder (Type I, Uncontrolled)
• 440.23
Atherosclerosis of native arteries, extremities w/ ulceration
• 707.14
Ulcers of the plantar surface, midfoot (except pressure
ulcers), unspecified
• 682.7
Cellulitis, foot, except toes
 The underlying disease is coded first, followed by the
manifestation(s) code.
 The linkage has been established as “diabetic” and
the 4th digit is properly assigned on the 250.7X.
© Ingenix, Inc. 30
Underlying Disease – Diabetes Mellitus
 Be Specific – Coding mistakes can be costly
If the same scenario was documented as:
No cause and effect
relationship established
 Example:
– “Type I uncontrolled diabetes with atherosclerosis of the plantar
surface of left midfoot with associative ulcerative cellulitis”
• 250.03
Diabetes without Complications
• 440.23
Atherosclerosis of native arteries, extremities w/ ulceration
• 707.14
Ulcers of the plantar surface, midfoot (except pressure
ulcers), unspecified
• 682.7
Cellulitis, foot, except toes
With this example, there is nothing indicating that the atherosclerosis of
the lower extremities was due to the diabetes.
© Ingenix, Inc. 31
Peripheral
Vascular (Arterial)
Disease
© Ingenix, Inc. 32
Be Specific – Identify the Problem
Vague Vascular Codes:
 443.9 – Peripheral Vascular Disease, Unspecified
 459.9 – Vascular Disease (Circulatory Disorder), Unspecified
 440.9 – Atherosclerotic Vascular Disease, Unspecified
© Ingenix, Inc. 33
Documentation & Coding PAD / PVD
Recommended language:
– PAD / PVD - Peripheral arterial disease, peripheral vascular
disease, and claudication are coded to 443.9.
• It is important to note that this code excludes atherosclerosis of the
arteries of the extremities.
– Atherosclerosis - of native arteries of the extremities,
Category 440, is further classified as such:
– 440.21 With intermittent claudication
– 440.22 With rest pain
– 440.23 With ulceration (see ulcer coding rules)
– 440.24 With gangrene
– 440.20 Unspecified
© Ingenix, Inc. 34
Documentation & Coding PAD / PVD
Recommended language:
Peripheral Vascular diseases as a result of
atherosclerosis of extremities:
 Atherosclerosis of Native arteries of the
Extremities (440.2x).
– For coding purposes, the physician must document
that the PVD is due to atherosclerosis (ASPVD)
before a code from 440.2 may be assigned. 2
– Further specification is needed for specific coding
if the physician documents vague diagnoses as
peripheral vascular disease or intermittent claudication.
1 Coding
2
1
Clinic, 1992, 4th Q, page 25
3M Health Information Systems (2008, April). Coding for peripheral vascular disease. In, For The Record, Vol.
20 No.8 p. 28. Retrieved March 10, 2009 from: http://www.fortherecordmag.com/archives/ftr_04142008p28.shtml
© Ingenix, Inc. 35
Documentation & Coding PAD / PVD
When Assigning Atherosclerosis
of Arteries of the Extremities 440.2X
Recommended language:
Patients documented as atherosclerosis with
intermittent claudication due to atherosclerosis
are coded to 440.21
If claudication is documented without mention
of atherosclerosis, only code 443.9
Ulcers: Codes from
Subcategory 707.1x
(Ulcer of lower limb)
should be assigned
in addition to 440.23
or 440.24
Patients documented as atherosclerosis with
neither gangrene nor ulceration, but with rest pain
are coded to 440.22
If rest pain is documented without
mention of atherosclerosis, only code 729.5
All patients documented as atherosclerosis
without gangrene, but with ulceration are
coded to 440.23
If ulceration is documented without
mention of atherosclerosis, only
code 707.9
All patients documented as atherosclerosis
with gangrene are coded to 440.24
If gangrene is documented without
mention of atherosclerosis, only
code 785.4
© Ingenix, Inc. 36
Rules of Coding PAD / PVD:
Ischemic Ulcers
 Subcategory 707.1x Ulcer of lower limbs, except
pressure ulcer
▪ First: Code any underlying or causal condition
Example:
– Atherosclerosis of Extremities w/ Ulceration
- 250.7x – Diabetic PVD with Ulceration … or
- 250.8x – Diabetic Ulcers, Unspecified
- 440.23
▪ Second:
Code associative ulcers to the highest level of
specificity
Example:
–
–
–
–
–
–
–
© Ingenix, Inc. 37
707.10
707.11
707.12
707.13
707.14
707.15
707.19
Ulcer of lower limb, unspecified
Ulcer of thigh
Ulcer of calf
Ulcer of ankle
Ulcer of heel and mid-foot
Ulcer of other part of foot
Ulcer of other part of lower limb
Rules of Coding PAD / PVD:
Other Ulcers
Chronic Ulcers of Skin
Others of importance
 Chronic ulcer of other specified sites - 707.8
 Chronic ulcer of unspecified site – 707.9
 Venous stasis ulcers (leg):
– with varicose veins (any part or unsp. site) –
454.0
– chronic venous insufficiency, NOS, without varicose veins
(use additional code for any associated ulceration 707.10 707.9) - 459.81
– with varicose veins and inflammation or infection (any part or
unsp. site) – 454.2
© Ingenix, Inc. 38
PAD Documentation & Coding –
(Generalized & Unspecified)
Recommended language to avoid:
 Diagnostic statements that do not impact severity
adjustment as they are default coded to 440.9:
(Atherosclerosis - generalized and unspecified)
– Arteriosclerotic (vascular) disease (440.9)
– Generalized arteriosclerosis (440.9)
– Arteriosclerotic endarteritis (440.9)
– Arteriosclerosis obliterans (440.9)
– Arteriosclerosis with calcification (440.9)
© Ingenix, Inc. 39
Documentation & Coding PAD / PVD –
(Diabetic PVD)
Recommended language:
Vascular diseases often occur as a
manifestation of diabetes:
 Diabetic Peripheral Circulatory Disorders
(250.7X and 443.81)
– If the PVD is due to diabetes mellitus, codes 250.7x and
443.81 would be assigned. (Not 443.9)
– Provide the appropriate linkage for the diabetes with
Peripheral Circulatory Manifestations (250.7x)
© Ingenix, Inc. 40
Documentation & Coding PAD / PVD –
(Other & Unspecified)
Recommended language:
Vascular diseases of other and unspecified
types of PAD / PVD:
 Other Peripheral Vascular Disease
(PVD), Unspecified (443.9)
– Peripheral arterial disease, peripheral vascular disease, and
claudication are coded to 443.9
▪
It is important to note that this code excludes
atherosclerosis of the arteries of the extremities
(440.20 – 440.22).
– This code is assigned if there is no additional documentation
regarding the type of manifestation of PVD / PAD.
© Ingenix, Inc. 41
Underlying Diseases & Manifestations
DM Coding
Concepts
See Provider Tool Book
© Ingenix, Inc. 42
Underlying Disease – Diabetes Mellitus
 Coding of Underlying Disease (Etiology)
and Manifestation
• Code both the etiology (underlying disease) and the
manifestation of the disease.
• The underlying disease is coded first.
• Both the underlying disease and the manifestation are
in the present tense.
• ICD-9 states," the most commonly used
etiology/manifestation combinations are the codes for
Diabetes Mellitus” 250.XX, [XXX.XX].1
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health
Statistics (NCHS), (2008, October). ICD-9-CM official guidelines for coding and reporting.
Retrieved August 13, 2010, from Department of Health and Human Services (DHHS) Web site:
http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide10.pdf
1
© Ingenix, Inc. 43
Underlying Disease – Diabetes Mellitus
250.00 is over-reported
 Diabetes Mellitus, code 250.00 without mention of
complication is appropriate at times.
 However, if complications exist, code to the specific
complications and manifestations.
© Ingenix, Inc. 44
Underlying Disease: Make The Connection
 The documentation MUST make
the connection.
 Document and code to the
specific complications and
manifestations in the chart.
 In order to code a disease or
condition as a manifestation of
DM:
– it must be stated that the disease
or condition is diabetic or due to
Diabetes.
(The Coding Clinic, Third Quarter 1991, pages 7-8)
© Ingenix, Inc. 45
Importance of Specific Coding
 What System is being Affected?
– 250.4X Diabetes with renal manifestations
– 250.5X Diabetes with ophthalmic manifestations
– 250.6X Diabetes with neurological manifestations
– 250.7X Diabetes with peripheral circulatory disorders
– 250.8X Diabetes with other specified manifestations
– 250.9X Diabetes with unspecified complications
© Ingenix, Inc. 47
Diabetes Coding Tool
© Ingenix, Inc. 48
Diabetes w/ Peripheral Circulatory &
Other Manifestations
Review:
“Diabetic PVD”
vs.
“Diabetic atherosclerosis
of L-extr with associative
ulcers”
© Ingenix, Inc. 49
See DM Coding Tool
Diabetes w/ Peripheral Circulatory &
Other Manifestations
This represents
Diabetes “Associated”
with Peripheral
Circulatory Disorders
250.7x is hierarchical to 250.8x
and therefore places the MA
member into a higher risk
category for expected resource
allocation
This represents
Diabetes “Associated”
with Other Specified
Manifestations
© Ingenix, Inc. 50
See DM Coding Tool
Diabetes w/ Peripheral Circulatory &
Other Manifestations
This represents
diabetic PVD unspecified
or specified types of
atherosclerotic PVD of
lower extremities
“Diabetic” (atherosclerosis) of
lower extremities (440.23)
with ulcerations (701.x) is
coded with 250.7x
250.7X
440.23
707.1X
+
© Ingenix, Inc. 51
See DM Coding Tool
Total Codes =
3
Diabetes w/ Peripheral Circulatory &
Other Manifestations
This represents
Diabetic PVD
“unspecified atherosclerotic
cause”
The proper code for “Diabetic” PVD,
“Unspecified” is 443.81
(Not 443.9)
© Ingenix, Inc. 52
See DM Coding Tool
Specificity Makes a Difference!
“Diabetic” PVD
(unspecified
atherosclerotic cause)
(Unspecified)
“Diabetic” PVD
(atherosclerosis) of lower
extremities, with ulcers
(440.23) and (707.1x)
(Specified)
Documenting and coding more
specifically places the member in a
higher risk category for expected
resource allocation
© Ingenix, Inc. 53
See DM Coding Tool
Specificity Makes a Difference!
Example:
“Diabetic PVD with Ulcers”
250.70
443.81
250.80
707.10
Note: Assign 250.8x when
“diabetic” ulcers are not due to
atherosclerosis
© Ingenix, Inc. 54
See DM Coding Tool
Specificity Makes a Difference!
Example:
“Diabetic PVD with Diabetic Ulcers”
250.70
443.81
250.80
707.10
Note: Assign 250.8x when
“diabetic” ulcers are not due to
atherosclerosis
© Ingenix, Inc. 55
See DM Coding Tool
FYI #2
Presented By
Pam Holt
Patients “At Risk” for PAD
 Ingenix can provide a report for your patients that are
“At Risk” for PAD
– Ad Hoc (not available on InSite)
– Request through your Ingenix Market Consultant
© Ingenix, Inc. 57
User Group Feedback Survey
 We want your feedback!
 Survey is to be sent immediately after this call
© Ingenix, Inc. 58
Question and Answer
© Ingenix, Inc. 59