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ICD‐10

ICD‐10 Medicare Acknowledgment Testing P.1.

Other ICD‐10 Testing P.2.

ICD‐10‐CM vs. CPT Coding P.2.

AOA Webinar: ICD‐10 is Coming! Be Ready. P.2.

PQRS & Other Incentives

AOA: Avoid Future Medicare Negative Adjustments Pp.3,4.

Medicare’s Value Based Modifier (VBM) Penalties P.5.

PQRS: July Transition from IACS to EIDM P.6.

∙ The Way of the Future: AOA’s Registry MORE Pp. 7,8.

CMS‐WPS

Medicare Surveying Patients Satisfaction P.9.

Medicare DME

Medicare: DME Post‐op Glasses Documentation Must be Maintained for Seven Years P.10.

Billing Correct Date of Service for Medicare DMEPOS Post‐op Items P.11.

Coding Questions

PQRS reporting via EHR, GPRO, and Registry P.12.

Lid Surgery Reimbursement P.12.

July 2015

Nebraska Optometric Association Volume 15, Issue 7

NOA 3rd Par ty Newsletter

ICD-10 Acknowledgment Testing

Please forward to all of your doctors and staff Click FILE and Click PRINT for a Printed Copy of This Newsletter

When can you submit claims for Acknowledgement Testing?

You may submit acknowledgement test claims anytime. The sooner, the

better. Details at http://tinyurl.com/mznxke5

On October 1, 2015 ICD‐10 code sets will replace ICD‐9. CMS announces a national testing week for current direct submitters (providers and clearinghouses) June 1‐5, 2015. This testing week will give trading partners access to the Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI) for testing with real‐time help desk support. The event will be conducted virtually.

What you can expect during testing:

Test files must be created as a Test with a T in the ISA15.

Test claims with ICD‐10 codes must be submitted with current dates of service since testing does not support future dates of service.

Claims will be subject to existing National Provider Identifier (NPI) validation edits.

Test claims will be subject to all existing EDI front‐end edits including Submitter authentication and NPI validation.

Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected by Medicare.

Testing will not confirm claim payment or produce a remittance advice.

MACs and CEDI will be staffed to handle increased call volume during this week.

More information is available at http://tinyurl.com/lfsb4m5

Any providers that are planning to participate in this acknowledgment testing that are currently using the WPS Medicare supplied PC‐Ace program please contact the EDI helpdesk to obtain a utility that can be installed to assist with your ICD‐10 testing.

EDI Helpdesk: (866) 518‐3285 option 1


Vo lume 15, Issue 7

Implementation of ICD‐10‐CM will not change the reporting of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, including CPT/HCPCS modifiers for physician services. While ICD‐10‐CM codes have expanded detail, including specification of laterality for some conditions, providers will continue to follow CPT and CMS guidance in reporting CPT/HCPCS modifiers for laterality.

Coding for ICD-10-CM: Continue to Report CPT/HCPCS Modifiers for Laterality

ICD-10 Deadline October 1, 2015: Talk to Your Vendors, Clearinghouses, Billing Services, Health Plans

Get Ready Now with the New CMS Quick Start Guide at http://tinyurl.com/nz7eaj3!

While ICD‐10 is almost here, you still have time to get ready. But you must get ready now.

Talk to Your Vendors and Health Plans –ask about their readiness and testing opportunities…. Health Plans Billing Services Clearinghouses

Call your vendors to confirm the ICD‐10 readiness of your practice’s systems (See resource http://tinyurl.com/

orxt5kl )

Confirm that the health plans, clearinghouses, and third‐party billing services you work with are ICD‐10 ready

Ask vendors, health plans, clearinghouses, and third‐party billers about testing opportunities

Tips You can use forms available in the Road to 10’s Template Library at http://www.roadto10.org/template-library/ to guide discussions with vendors, health plans, clearinghouses, and billing services.

Double check that you’ve identified all systems that use ICD codes—e.g., practice management systems, electronic health record (EHR) products—when contacting vendors

Update contracts with vendors and health plans as needed

Transition costs for small medical practices could be substantially lower than projected earlier:

Many EHR vendors are including ICD‐10 in their systems or upgrades—at little or no cost to their customers

Software and systems costs for ICD‐10 could be minimal for many providers

To learn more about getting ready, visit cms.gov/ICD10 for free resources including the Road to 10 tool designed especially for small and rural practices, but useful for all health care professionals.

AOA Webinar: ICD-10 is Coming! Be Ready. Don't get caught unprepared for ICD‐10. AOA members can register for a free webinar, presented by Coding

Expert Dr. Rebecca Wartman. The webinar will take place on July 14, at 8:00 p.m. EST

To register, go to https://attendee.gotowebinar.com/register/1304332319250637058


NOA 3rd Par ty Newslet ter

From the AOA:

Taken together, solo optometrists who do not participate in PQRS or the EHR

incentive program in 2015 could face a 7 percent payment reduction on Medicare

covered services billed in 2017.

Doctors who do not satisfactorily report data on quality measures and do not

participate in the Electronic Health Record (EHR) Incentive Programs this year will see

payment reductions two years from now.

To avoid the 2017 payment reductions, doctors must satisfactorily meet

performance and participation expectations in each of these programs:

1. the Physician Quality Reporting System (PQRS),

2. EHR Meaningful Use Program and the

3. Value‐based Modifier (VBM) program.

Outlined below are the basic steps that need to be taken to participate in these

programs to avoid penalties in 2017.

PQRS payment penalties: 2% penalty

A negative payment reduction of 2 percent will be applied in 2017 for covered

services billed by Medicare physicians who do not satisfactorily participate in PQRS in

2015.

To avoid these penalties, doctors must meet requirements to satisfactorily report

or participate in PQRS in 2015.

If you have not already begun reporting PQRS, see http://tinyurl.com/c2532ay for requirements.

AOA has developed extensive resources to assist optometrists in PQRS participation,

and members can access these resources, including webinars, publications and other

resources, by going to http://tinyurl.com/oquopfe

Medicare EHR Incentive Program payment reductions: 3% penalty

A negative payment reduction of 3 percent will be assessed in 2017 for all Medicare

physicians who are not meaningful users of an EHR in 2015. This reduction will be

applied to covered professional services provided by the doctor during 2017.

Continued on next page...

AOA: Avoid Future Medicare Negative Adjustments

To avoid the 2017

payment

reductions,

doctors must

satisfactorily meet

expectations in

each of these

programs:

1. PQRS

2. EHR

Meaningful Use

3. Value-based

Modifier (VBM)



To avoid these penalties, doctors must demonstrate meaningful use of an EHR as

described at http://tinyurl.com/ppw477q.

Optometrists who did not successfully participate in the incentive program in 2014

will see a 2 percent payment reduction beginning on Jan. 1, 2016. However, there

are hardship exemptions available for doctors who meet certain requirements. These

doctors can avoid the 2016 payment reduction by applying for a 2016 hardship

exception by 11:59 p.m. ET, July 1, 2015. For more information on the specific

hardship exemptions available and the necessary paperwork that must be submitted,

go to http://tinyurl.com/oxnb57g.

VBM payment adjustments: 2% to 4% penalty

The basis of the VBM is participation in PQRS. Optometrists with nine or fewer

doctors in their practice can avoid any penalties under the VBM simply by

participating in PQRS. Those optometrists who do not participate in PQRS will receive

the 2 percent PQRS payment reduction and an additional 2 or 4 percent VBM

payment reduction based on practice size.

To avoid these penalties, doctors must

1) Participate in PQRS;

2) Access your Quality Resource and Use Report (QRUR); and

3) Know how your practice might be evaluated. See http://tinyurl.com/nq7k3b4

AOA has developed a VBM resource page (see http://tinyurl.com/qh97cj4) where doctors can

find more information about how VBM will impact reimbursement in 2017 and into

the future. See more on the VBM payment adjustment on the following page.

Taken together, solo optometrists who do not participate in PQRS or the EHR

incentive program in 2015 could face a 7 percent payment reduction for Medicare

services billed in 2017.

For questions or additional information, contact Kara Webb, AOA associate director

for coding and regulatory policy, at [email protected].

AOA: Avoid 7% Medicare Negative Adjustment

...Continued...

To avoid the 2017

payment

reductions,

doctors must

satisfactorily meet

expectations in

each of these

programs:

1. PQRS

2. EHR

Meaningful Use

3. Value-based

Modifier (VBM)



From the AOA: Take action this year to avoid value‐based modifier penalties in 2017.

The VBM is a compilation of data elements that compares the costs of an individual doctor's care in relation to

the quality of that care. Starting in 2017, it will affect how all doctors are paid under the Medicare fee‐for‐service

program.

2015 will be the first year that the VBM will impact most optometrists as this is the first year that the VBM

applies to doctors who are solo practitioners and those with 2 to 9 Physician Quality Reporting System (PQRS)

eligible professionals in their practices. How you perform on your VBM score will determine what you get paid in

2017, the AOA explains in a new fact sheet on VBM found at http://tinyurl.com/po4vynz. The Centers for Medicare and

Medicaid Services will calculate scores based on quality and cost.

VBM plays an important role in the development of a new incentive program which was created by the

"Medicare Access and CHIP Reauthorization Act of 2015" (MACRA) See https://www.govtrack.us/congress/bills/114/hr2.

Starting in 2019, the Merit‐Based Incentive Payment System (MIPS) will combine VBM, the Physician Quality

Reporting System (PQRS) and electronic health records (EHR) meaningful use, and begin rating doctors based on

a 100‐point scale that reflects performance on quality, resource use, clinical practice improvement activities and

meaningful use of certified EHR technology.

"Optometrists should be aware that the VBM will not only impact reimbursement in 2017, but participation with

the VBM program will also help optometrists in the future as the new merit‐based incentive program is

implemented," AOA explains in its fact sheet. ODs under the MIPS program will continue to get evaluated

annually, based on the quality and costs of care they provide to patients.

AOA advises that there are several ways to avoid penalties in 2017:

Participate in PQRS.

CMS will be reviewing whether you participated in the PQRS to determine whether you qualify for an automatic

payment reduction.

Access Your Quality Resource and Use Report.

Last fall, CMS made 2013 Quality and Resource Use Reports (QRURs) available to all physicians at http://www.aoa.org/

Documents/QRUR%20Mid.pdf. The QRUR includes data that assesses your performance on cost measures and quality measures.

"This will give you additional information regarding how CMS has assessed the cost and quality of care provided

to certain patients and will help you to understand how the VBM will potentially impact reimbursement in 2017,"

notes AOA's fact sheet.

Know how your practice might be evaluated and how you'll measure up.

As an example, solo practitioners or those practices with two to nine doctors who successfully participate in

PQRS will receive an upward or neutral payment adjustment, based on CMS' analysis. ODs should be aware that

"comparative quality measures and cost data have been risk‐adjusted to account for differences in patient

characteristics that might affect costs or quality outcomes," AOA's fact sheet explains.

Medicare’s Value Based Modifier (VBM) Penalties What are your “Costs of Care” versus your “Quality of Care”?


The Centers for Medicare & Medicaid Services (CMS) would like to remind Physician Quality Reporting System (PQRS) participants and their staff of an important system update scheduled to be in place on Monday, July 13, 2015.

The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM). The EIDM system provides a way for business partners to apply for, obtain approval of, and receive a single user ID for accessing multiple CMS applications. Please read below for important information and tips to help make sure the transition runs smoothly for PQRS participants and their staff.

Useful Information and Tips for Existing PQRS Users:

Existing PQRS IACS users, their data, and their roles will move to EIDM and will be accessible from the “CMS Secure Portal” portion of the CMS Enterprise Portal at http://portal.cms.gov.

Users will then access the “PQRS Portal” to submit data, retrieve submission reports, view feedback reports, and conduct various administrative and maintenance activities.

Users should ensure that their IACS account is active and current, and that they’re able to log in.

Users should reset their IACS password if they think their password might expire before 5:00 p.m. Eastern Time, July 3, 2015.

Users should not make changes to their user profile or submit a request of any type that cannot be approved prior to 5:00 p.m. Eastern Time, July 3.

Users should not register for a new account in EIDM prior to the system update on July 13, 2015. This will only complicate moving their IACS account to the new EIDM system.

For additional information, reference the EIDM Quick Reference Guides, which will be available in July on the Physician and Other Health Care Professionals Quality Reporting Portal, and the CMS EIDM User Guide.

Useful Information and Tips for New PQRS Users:

To register for an IACS account, visit the CMS Enterprise Portal at http://portal.cms.gov and click “New User Registration” under “Login to CMS Secure Portal.” NOTE: New IACS registration requests will be cut off as of 5:00 p.m. Eastern Time on Friday, July 3, 2015. After that point, new users will need to wait until the EIDM system launches on Monday, July 13, 2015 to request a new account.

Work with the QualityNet Help Desk to get any pending IACS account requests approved before 5:00 p.m. Eastern Time, July 3, 2015. Also, do not register for a new account in IACS if it cannot be approved prior to this date.

For additional information, reference the EIDM Quick Reference Guides, which will be available in July on the Physician and Other Health Care Professionals Quality Reporting Portal, and the CMS EIDM User Guide.

For Additional Assistance Regarding IACS or EIDM:

Contact the QualityNet Help Desk at 1‐866‐288‐8912 (TTY 1‐877‐715‐6222) from 7:00 a.m. to 7:00 p.m. Central Time, Monday through Friday, or via email at [email protected].

CMS PQRS : Additional Information on July 2015 Transition from IACS to EIDM

Vo lume 15, Issue 7


Optometry's clinical registry was launched at Optometry's Meeting®, June 24-28, with three

participating electronic health record (EHR) systems, and more vendors are anticipated in

the months ahead.

The Registry has two main independent functions:

To submit your PQRS codes;

To provide a quality improvement tool for your practice.

AOA MORE (Measures and Outcomes Registry for Eyecare), by Prometheus ResearchTM,

will integrate data from doctors' EHR systems to provide a systematic way of collecting

patient data that helps enhance outcomes, procedures and standards of practice. See the

AOA MORE page at http://tinyurl.com/q5nrxqj

The initial EHR vendors include:

Eyecare Advantage by Compulink Business Systems, Inc.

MaximEyes by First Insight®

RevolutionEHR by Health Innovation Technologies

Optometric practices use a variety of EHR systems and AOA MORE will add more EHR

vendors in the near future. The registry is an AOA member benefit, but will be available to

nonmembers for a fee.

WHAT IS A REGISTRY?

In simplest terms, a registry is a database. It is not an Electronic Health Record (EHR). More

comprehensively, a registry provides a systematic way of collecting information from multiple

EHRs that allows health care to be evaluated to improve outcomes, procedures and standards of

practice. Registries can collect data on treatment options and outcomes to determine best

practices based on evidence. Medicare allows registries to be used to submit quality measures in

the Physician Quality Reporting System (PQRS).

WHY DO I NEED A REGISTRY?

The overall goal of a registry is to empower doctors to make the best decisions for their patients

and improve health care outcomes. Registries can determine disease prevalence for your own

patient population and best treatment options available per disease. Registries will determine

gaps in health care (i.e., where an individual OD can expand his/her services) or best practices

for patient care.

(Continued on page 8)

The Way of the Future: AOA’s Registry MORE An Eyecare Clinical Registry for Reporting PQRS & Enhancing Quality of Care

Vo lume 15, Issue 7


The Optometric Registry will also create an evidence-base for optometry that will fuel future research

and impact the development of evidence-based clinical practice guidelines.

Registries aide in easier reporting of PQRS measures and avoidance of penalties.

DOES INSURANCE PAY ME TO USE A REGISTRY?

Effective July 1, 2007, the Centers for Medicare and Medicaid Services (CMS) started the Physician

Quality Reporting Initiative (PQRI) which was later renamed Physician Quality Reporting System

(PQRS). Codes for PQRS can be submitted by traditional paper-claims or directly from an electronic

medical record through a registry (known as registry-based).

Recently, the CMS discussed the success of registry-based PQRS submission compared to the

limitations of claims-based PQRS. CMS has tried to discontinue claims-based reporting in favor of

registry reporting.

WHO IS USING REGISTRIES?

Registries have many general applications: marriage registries; baby registries; sex-offender

registries; canine registries. Health care organizations are using registries to improve patient

outcomes and doctor’s ability to provide care. The National Cancer Institute, American Heart

Association, American College of Cardiology and American Academy of Ophthalmology are

examples of healthcare association registry users. An optometric registry is designed to assist

doctors in quality improvement, tracking outcomes and patient advocacy.

WHAT IS THE “REGISTRY” DISCUSSION IN MEANINGFUL USE?

Meaningful Use (MU) requirements include Core Objectives, Menu Set Objectives and Clinical

Quality Measures. The Menu Set Objectives in Meaningful Use Stage 1 (MU1) included two registry

measures that were not applicable to most optometrists: reporting to immunization registries; and

reporting to syndromic surveillance registries (for tracking disease outbreaks like SARS, Bird-Flu,

etc.).

Meaningful Use Stage 2 (MU2) requirements were released in September 2012. The MU2 Menu Set

is more selective, including only six items for which the OD must select three applicable measures.

Three of the six Menu Set Objectives are registry-based. The immunization and syndromic

surveillance registry items were retained from MU1 (and still do not apply to ODs). New to MU2 is the

Objective for your EMR to report to “specialized” registries like an eye care registry. CMS says that

reporting to registries is an integral part of improving population and public health thus their role in

MU has expanded. CMS expects health professions to increase their use of registries to improve

health outcomes.

http://www.aoa.org/Documents/EBO/Registry%20FAQ%20for%20website.pdf

(Continued from page 7)

Vo lume 15, Issue 7


The CAHPS Survey for group practices participating in the Physician Quality Reporting System (PQRS) will be carried out yearly. The first surveys were collected in 2014 for the 2013 reporting period.

In 2015, survey administration is:

Required for all group practices of 100 or more eligible providers (EPs) that register for PQRS by June 30, 2015.

Optional for group practices of 2‐99 EPs regardless of the reporting option that register for PQRS by June 30, 2015. During registration, such groups must indicate whether they are participating in CAHPS for PQRS.

You can find complete information on our Physician Quality Reporting System page at http://tinyurl.com/pwnr489.

The CAHPS for PQRS Survey measures twelve key domains of beneficiaries’ experiences of care that we refer to as summary survey measures (SSMs). A summary survey measure is a collection of survey items that assess the same patient experience domain of care.

Getting Timely Care, Appointments and Information

How Well Providers Communicate

Patient’s Rating of Provider

Access to Specialists

Health Promotion and Education

Shared Decision Making

Health Status/Functional Status

Courteous and Helpful Office Staff

Care Coordination

Between Visit Communication

Helping You to Take Medication as Directed

Stewardship of Patient Resources

The survey contains the core CG‐CAHPS Survey plus additional items to meet the needs of PQRS. The survey can be found on the Survey Instruments page at http://www.pqrscahps.org/survey-instruments/.

Source: http://www.pqrscahps.org/#AboutSurvey

Medicare Surveying Patients Satisfaction

...What will your patients say about YOU?

Vo lume 15, Issue 7


Under Medicare regulations, a provider or supplier that furnishes covered

ordered DMEPOS items, clinical laboratory services, imaging services, or

covered ordered/certified home health services is required to:

Maintain documentation for 7 years from the date of service, and

Upon the request of CMS or a Medicare contractor, provide access to that

documentation.

The documentation to be maintained includes written and electronic documents

(including the National Provider Identifier (NPI) of the physician who ordered/

certified the services.

Maintaining and Providing Access to Documentation

CMS or a Medicare contractor may request access to documentation as

described. The term “access to documentation” means that the documentation

is actually provided or made available in the manner requested by CMS or a

Medicare contractor.

All providers and suppliers who either furnish, order, or certify DMEPOS items,

clinical laboratory services, imaging services, or covered ordered/certified

home health services are subject to this requirement and are individually

responsible for maintaining these records and providing them upon request.

CMS recognizes that providers and suppliers often rely upon an employer or

another entity to maintain these records on their behalf. However, it remains

the responsibility of the individual or entity upon whom/which the request has

been made to provide documentation. All individuals and entities subject to this

documentation requirement are responsible for ensuring that documents are

provided upon request and may ultimately be subject to the revocation basis

associated with not complying with the documentation request.

Medicare: DME Post-op Glasses Documentation Must be Maintained for Seven Years

As a DME

Supplier, you

must:

Maintain

documentation

for 7 years from

the date of

service, and

Upon the

request of CMS

or a Medicare

contractor,

provide access to

that

documentation.


1633 Normandy Court, Suite A Lincoln, NE 68512

http://nebraska.aoa.org/

Nebraska Optometric Association

The NOA Third Party Newsletter is published monthly by the Nebraska Optometric Association with the assistance of Ed Schneider, O.D., Third Party Consultant. To reach Ed (aka Dr. Quack):

BEST to contact via Email at: [email protected]

Fax number is 402-464-1214. Call Ed before faxing.


Proof of delivery (POD) is a Supplier Standard and DMEPOS suppliers

are required to maintain POD documentation in their files. For medical

review purposes, POD serves to assist in determining correct coding

and billing information for claims submitted for Medicare

reimbursement. Regardless of the method of delivery, the contractor

must be able to determine from delivery documentation that the

supplier properly coded the item(s), that the item(s) delivered are the

same item(s) submitted for Medicare reimbursement and that the item

(s) are intended for, and received by, a specific Medicare beneficiary.

Suppliers, their employees, or anyone else having a financial interest in

the delivery of the item are prohibited from signing and accepting an

item on behalf of a beneficiary (i.e., acting as a designee on behalf of

the beneficiary). The signature and date the beneficiary or designee

accepted delivery must be legible.

For the purpose of the delivery methods noted below, designee is

defined as "Any person who can sign and accept the delivery of durable

medical equipment on behalf of the beneficiary."

Proof of delivery documentation must be available to the Medicare

contractor on request. All services that do not have appropriate proof

of delivery from the supplier will be denied and overpayments will be

requested. Suppliers who consistently fail to provide documentation to

support their services may be referred to the OIG for imposition of Civil

Monetary Penalties or other administrative sanctions.

Billing Correct Date of Service for Medicare DMEPOS Post-op Items

Vo lume 15, Issue 7

Noridian must be able to determine from delivery documentation

that the supplier properly coded the item(s),

that the item(s) delivered are the same item(s) submitted for Medicare reimbursement

and that the item(s) are intended for, and received by, a specific Medicare


Dear Dr. Quack: Wondering if you had heard anything about Medicare not covering lid lifts.... the ophthalmologist we mainly work with said even with the correct documentation Medicare is denying.

Dr Quack’s Quote: I forwarded your query to a couple OD practices in Nebraska, and their responses indicate reimbursement is difficult but not impossible. Apparently comprehensive documentation is paramount. The Medicare documentation requirements can be found in the LCD entitled “Blepharoplasty, Blepharoptosis and Lid Reconstruction” found at http://tinyurl.com/otmzxbm.

The detailed documentation required by the LCD include:

Patient complaints and findings secondary to eyelid or brow malposition (Six requirements are listed)

What photographic documentation must demonstrate (Four sub-categories listed)

Visual fields documentation required (Five sub-categories listed)

Relief of eye symptoms associated with blepharospasm.

The above documentation must be complete, and is always requested, apparently in an attempt to eliminate lid surgery for cosmetic purposes.

Lid Surgery Reimbursement

PQRS reporting via EHR, GPRO, and Registry

Dear Dr. Quack, Our software, MaximEyes, creates a report for PQRS which they said can now be electronically submitted to CMS after the end of the year. We have been putting the PQRS codes on our claims up until now. It sounds like we can stop doing that now & then just submit the report at the end of the year. I saw your article in the newsletter about GPRO registration. That is a different portal than just submitting it directly is that right? I am also wondering if the measures have changed because our report generated by our software has nothing about macular degeneration. It also does not correspond directly to each of the PQRS codes we have been using. Thanks for your help.

Dr. Quack’s Quote: I am not familiar with the ins‐and‐outs of various optometric software. There are about 20 of them, and their respective abilities are constantly changing, as you are aware. So I can’t comment on a specific company like MaximEyes. However, as Dr. Quack understands it...

With CEHRT (certified electronic health record technology, like MaximEyes), it is possible for the software to report PQRS directly. GPRO (group reporting) can also be done with CEHRT (see http://tinyurl.com/jvqjvnj)

And, be sure to read the two page article in this issue on Registry reporting. MaximEyes has signed on with the AOA MORE registry, and registries appear to be the future in PQRS reporting.

Regarding the Measures: The PQRS measures that seem most appropriate for ODs, and recommended by the AOA as well as Dr. Quack, can be found at http://tinyurl.com/nqc9798 I don’t know how that matches up with your software. I hope that helps a little, anyway!!

Vo lume 15, Issue 7

Dr. Quentin Quack’s Queries and Questionable Quotes ~~~~~~~~~~~~~~~~~~~~~~~~~~

Third Party Questions from NOA Doctors and Staff Dr. Quentin Quack


The administrator of a troubled hospital, on vacation from his professional woes,

wandered into a back‐alley antique shop in San Francisco's Chinatown. Picking

through the objects on display he discovered a detailed, life‐sized bronze sculpture

of a rat. The sculpture was so interesting and unique that he picked it up and asked

the shop owner what it cost.

"Twelve dollars for the rat, sir," said the shop owner, "and a thousand dollars more

for the story behind it."

"You can keep the story, old man," the hospital CEO replied, "but I'll take the rat."

The transaction complete, the troubled CEO left the store with the bronze rat under

his arm. As he crossed the street in front of the store, two live rats emerged from a

sewer drain and fell into step behind him. Nervously

looking over his shoulder, he began to walk faster, but

every time he passed another sewer drain, more rats

came out and followed him. By the time he's walked

two blocks, at least a hundred rats were at his heels,

and people began to point and shout. He walked even

faster, and soon broke into a trot as multitudes of rats

swarmed from sewers, basements, vacant lots, and

abandoned cars. Rats by the thousands were at his

heels, and as he saw the waterfront at the bottom of the hill, he panicked and

started to run full tilt.

No matter how fast he ran, the rats kept up, squealing hideously, now not just

thousands but millions, so that by the time he came rushing up to the water's edge a

trail of rats twelve city blocks long was behind him. Making a mighty leap, he jumped

up onto a light post, grasping it with one arm while he hurled the bronze rat into San

Francisco Bay with the other, as far as he could heave it. Pulling his legs up and

clinging to the light post, he watched in amazement as the seething tide of rats

surged over the breakwater into the sea, where they drown.

Shaken and mumbling, he made his way back to the antique shop.

"Ah, so you've come back for the rest of the story," said the owner.

"No," said the hospital CEO, "I was wondering if you have a bronze lawyer."


Dr. Quentin Quack’s Quacked Humor