Medicaid EHR Incentive Program Eligible Professionals

Transcription

1 Medicaid EHR Incentive Prgram Eligible Prfessinals Payment Year 1 Adpt, Implement, Upgrade New Hampshire Department f Health and Human Services Office f Medicaid Business and Plicy

2 First Year Attestatin Optins This presentatin prvides infrmatin n Adpt, Implement, Upgrade Eligible Prfessinals (EPs) attesting fr the first time may attest t either Adpt, Implement, Upgrade (AIU) r Mdified Stage 2 Meaningful Use (MU) If AIU is selected and the EP: Submits Medicare claims: CMS will impse a Medicare reimbursement penalty until the EP becmes a meaningful user Des nt submit Medicare claims: there is n penalty If the EP attests t Mdified Stage 2 MU in the first year (and, hence, is a meaningful user ) there is n penalty 2

3 Table f Cntents Tpic Page NH Medicaid EHR Cntacts 4 Medicaid EHR Resurces 5 Registratin and Payment 6-11 Eligibility and Attestatin Criteria General Eligibility 14 Prvider Type 15 Certified EHR Technlgy 16 Patient Vlume Grup Patient Vlume Practice Predminantly Hspital-based Adpt, Implement, Upgrade 38 Individual Supprting Dcumentatin 39 Grup Supprting Dcumentatin 40 3

4 NH Medicaid EHR Cntacts Andrew Chalsma (Directr f Data Analytics and Reprting, New Hampshire Department f Health and Human Services) Eve Fralick (Prject Directr, UNH Institute fr Health Plicy and Practice) Cntact Infrmatin inf@nhmedicaidhit.rg Help Desk: (603)

5 Medicaid EHR Resurces New Hampshire Medicaid EHR Incentive Prgram Website EP Eligibility Wrksheet (calculate eligibility prir t attesting) Establish Practice Request Frm (submit Grup patient vlume) NH Guidelines fr Meaningful Use and Clinical Quality Measure Supprting Dcuments (screensht and reprting requirements) Guidelines fr Practicing at Multiple Lcatins (calculate MU and CQM data fr EPs that wrk at mre than ne lcatin) Training presentatins CMS EHR Incentive Prgrams Website ns-and- Guidance/Legislatin/EHRIncen tiveprgrams Registratin and Attestatin Infrmatin Mdified Stage 2 Meaningful Use Infrmatin and Specificatin Sheets Links t CMS Registratin site 5

6 REGISTRATION AND PAYMENT 6

7 Registratin fr Prgram Year 1 The fllwing data is needed t register fr the Medicaid EHR Incentive Prgram in the first prgram year: Natinal Prvider Identifier (NPI) Natinal Plan and Prvider Enumeratin System (NPPES) User ID and Passwrd Tax Identificatin Number (TIN) Payee NPI and TIN (if reassigning payment) Fr users attesting n behalf f EP: Identity and Access Management System (I&A) web user accunt (User ID/Passwrd) assciated with EP s NPI CMS Registratin ID (btained fllwing successful registratin n the CMS Registratin website) 7 digit New Hampshire Medicaid Prvider ID 7

8 Prgram Year 1 Registratin Prcess EPs registering fr prgram year 1 must fllw these steps: Step 1: Register n the CMS registratin website ( Step 2: Wait hurs (fr CMS t transmit data t NH) Step 3: Navigate t the New Hampshire Medicaid EHR Incentive Prgram website ( Step 4: Select the Register and Attest in NH link in the menu bx n the right side f the webpage Step 5: Click the epip (Electrnic Prvider Incentive Payment System) lg t pen the NH registratin and attestatin website and lg n t epip Step 6: Register and attest EPs d nt need t re register r lg n t the CMS Registratin site after the first year except t update registratin r payee infrmatin 8

9 epip Lg On Infrmatin If this is the EP s first time registering n epip, a prmpt will display t create a passwrd that will remain active fr six mnths If the EP previusly registered n epip, enter the passwrd; if prmpted, reset it t a new passwrd If the EP previusly registered n epip but desn t recall the passwrd, refer t the next slide 9

10 Reset/New Passwrd If the same address is in use since the previus lg n: Navigate t the epip lg n webpage ( Select the link belw the Accunt Infrmatin bx that says, Frgt yur passwrd? Click here t reset yur passwrd. epip will display a prmpt t enter the EP s address; 7 digit NH Medicaid ID; and NPI An will be sent with instructins fr resetting the passwrd If a different address is in use (r the address that was previusly used is unknwn): Send t inf@nhmedicaidhit.rg The NH Medicaid EHR Office will verify identity; btain the new ; and send a new passwrd 10

11 EP Payment Schedule EPs may apply fr up t six Medicaid EHR incentive payments thrugh 2021 T participate in the prgram, the first payment must be made by 2016 Year Eligible Prfessinal Payment Amunt (30% Medicaid Patient Vlume) Pediatrician (ptinal) Payment Amunt (2/3) (20% Medicaid Patient Vlume) 1 $21,250 $14,167 2 $8,500 $5,667 3 $8,500 $5,667 4 $8,500 $5,667 5 $8,500 $5,667 6 $8,500 $5,667 11

12 ELIGIBILITY AND ATTESTATION 12

13 Eligibility Criteria EPs must attest t the fllwing eligibility criteria in each prgram year in which they are requesting a payment General Eligibility Prvider Type Certified EHR Technlgy (CEHRT) Patient Vlume Nn-Hspital-based OR Practices Predminantly in a Federally Qualified Health Center (FQHC) r Rural Health Center (RHC) 13

14 General Eligibility EPs must meet all f the fllwing: Enrlled in NH Medicaid Licensed t practice in NH Nn-sanctined One Medicaid EHR Incentive Prgram payment frm ne state during a single prgram year One EHR Incentive Prgram payment frm Medicare r Medicaid during a single prgram year 14

15 Prvider Type Medicaid EHR Incentive Prgram EPs must attest t being ne f the fllwing prvider types Physician Dentist Certified Nurse Midwife Advanced Registered Nurse Practitiner Physician s Assistant at an FQHC r RHC 15

16 CEHRT EPs must uplad a cpy f the CMS EHR Certificatin ID (frm the Certified Health IT Prduct List) if attesting using individual patient vlume If attesting using grup patient vlume, a cpy f ne ID per grup is required 16

17 Patient Vlume EPs may attest using individual, r grup, patient vlume encunters A minimum 30% patient vlume threshld is required; hwever, nn-fqhc/rhc pediatricians may attest with 20 29% patient vlume t receive a reduced, 2/3 payment Encunters frm these Managed Care Organizatins shuld be included in the patient vlume calculatin Wellsense Meridian New Hampshire Healthy Families 17

18 Patient Vlume (cnt d) The patient vlume reprting perid is a cntinuus 90 day perid in the calendar year prir t the prgram year Fr the 2015 Prgram Year: The patient vlume reprting perid is 90 days in calendar year

19 Patient Vlume (cnt d) Medicaid Encunter Definitin All services prvided in a day by a specific prvider t a Medicaid enrlled individual. This includes: Services in which Medicaid r Medicaid Managed Care prgrams (including ut f state prgrams) paid fr part r all f the services (including premiums, c payments, and/r cst sharing); r Encunters where Medicaid paid zer dllars where Medicare (in the case f patients that are dually eligible fr bth Medicaid and Medicare) r anther third party paid fr the encunter; r Encunters prvided t Medicaid beneficiaries fr which n payments were received; r Medical services prvided t Medicaid beneficiaries that were nt cvered under New Hampshire's Medicaid prgram. 19

20 Patient Vlume (cnt d) Needy Individual Encunter Definitin All services prvided in a day by a specific prvider t a Needy individual. This includes: Services in which: Medicaid (including ut-f-state Medicaid and Medicaid-managed care prgrams) paid fr part r all f the services (including premiums, c-payments, and/r cst sharing); r Out-f-state CHIP paid fr part r all f the services (including premiums, cpayments, and/r cst-sharing); r Services were rendered t an individual n a sliding scale; r Services were uncmpensated; Encunters where Medicaid paid zer dllars where Medicare (in the case f patients that are dually eligible fr bth Medicaid and Medicare) r anther third party paid fr the encunter; r Encunters prvided t Medicaid beneficiaries fr which n payments were received; r Medical services prvided t Medicaid beneficiaries that were nt cvered under New Hampshire's Medicaid prgram. 20

21 Patient Vlume (cnt d) Examples f encunters that can be included: Claims denied due t service limitatin audits Claims denied due t nn-cvered services Claims denied due t timely filing Services rendered n Medicaid members that were nt billed due t the prvider's understanding f Medicaid business rules Examples f encunters that cannt be included: Claims denied due t the prvider being ineligible fr the date f service Claims denied due t the member being ineligible fr the date f service 21

22 Patient Vlume (cnt d) Any EP r grup may attest t Medicaid patient vlume Medicaid Patient Vlume Medicaid Encunters Ttal Patient Encunters X 100 Only EPs r grups in FQHCs/RHCs may attest t Needy Individual patient vlume Needy IndividualPatient Vlume Medicaid + Out f State CHIP + Patients Paying Belw Cst Encunters Ttal Patient Encunters X

23 Patient Vlume (cnt d) Auditable encunter reprts are required (frm billing systems r CEHRT) Encunters shuld be reprted at the claim level (nt the detail level) Example: A patient with a lacerated finger has an ffice visit. The dctr des an examinatin; sutures the finger; and administers a tetanus sht. This scenari wuld result in ne encunter fr the EP. DO NOT INCLUDE HIPAA DATA IN ANY REPORTS Fully redact patient data t ensure that it is nt legible 23

24 Patient Vlume (cnt d) Nn-HIPAA patient vlume numeratr and denminatr reprts are required t have: Patient vlume reprting perid start and end dates EP s name (grups may submit ne reprt shwing all EPs) Encunter detail data and/r sum ttals (with n patient infrmatin) Including ut f state encunters is ptinal If Medicaid encunters are included in the numeratr, then ALL ut f state encunters (Medicaid and nn Medicaid) must be included in the denminatr Out f state encunters must be clearly nted n the numeratr and denminatr reprts *NEW IN 2015* EPs that attest t individual patient vlume and wrk part-time must attest t hurs wrked at their primary practice per week n epip 24

25 Patient Vlume (cnt d) Needy Individual patient vlume encunter reprts May include all payer types (Private Pay; Self-Pay; Medicare; etc.) Must clearly identify Needy Individual (sliding scale and free service) encunters; nte: self-pay encunters are nt cnsidered t be Needy Individual encunters and cannt be included in the patient vlume numeratr Surce dcuments cntaining encunter data must be saved fr six years fllwing attestatin in the event f pst-payment audit 25

26 Grup Patient Vlume Include encunters frm all prviders that prvided Medicaid services during the reprting perid (EPs; nn EPs; cntractrs, part time staff, staff that n lnger wrk at the Grup but were emplyed during the reprting perid, etc.) Cmplete the Establish Practice Request Frm (lcated n the New Hampshire Medicaid EHR Incentive Prgram website) Instructins Tab: practice letter n rganizatinal statinery Tab A: grup infrmatin and patient vlume attestatin data Tab B: list f EPs requesting incentive payments Tab C: list f all prviders (including nn EPs) whse encunters were included in the grup patient vlume calculatin Exceptin: Cmmunity Mental Health Centers are nt required t cmplete Tab C 26

27 Grup Patient Vlume (cnt d) these dcuments t the NH Medicaid EHR Office at inf@nhmedicaidhit.rg: Cmpleted Establish Practice Request Frm (EPRF) Practice letter (EPRF Instructin tab) CMS EHR Certificatin ID frm the CHPL website Prf f AIU (executed vendr cntract and prf f payment refer t slide 38 fr mre infrmatin) Grup patient vlume numeratr and denminatr reprt(s) The NH Medicaid EHR Office will: Verify the grup s patient vlume Ppulate epip with the patient vlume and CMS EHR Certificatin ID apprval t the grup that the grup patient vlume is apprved Upn receipt f the grup patient vlume apprval s, EPs may lg nt epip and attest t individual criteria 27

28 Grup Patient Vlume (cnt d) All EPs in the grup must use the same methdlgy fr the payment year Grup must use the entire grup s patient vlume and nt limit it in any way (i.e., encunters frm ALL prviders, nt just EPs, must be included) Auditable data surces are required t supprt the grup patient vlume Grup calculatin includes nly encunters assciated with the grup and nt the EPs utside encunters; if the EP wrks utside f the grup, thse external encunters cannt be included in the grup calculatin Practice's patient vlume is apprpriate as a patient vlume methdlgy fr the EP; if the EP nly sees Medicare, cmmercial, r self pay patients, this is nt an apprpriate methdlgy If an EP wrks utside f the grup, the grup can include the EP s encunters in its wn grup calculatin; hwever, the EP can register fr nly ne incentive payment, i.e., the EP cannt request a payment fr each grup that uses his/her patient encunters If tw prviders in the grup prvide services t the same Medicaid patient n the same day at the same practice site, this cunts as tw encunters 28

29 Grup Patient Vlume (cnt d) Encunters frm all prviders must be included in a grup s patient vlume: EPs; nn EPs; cntractrs; part time staff; staff that left the grup but were emplyed during the patient vlume reprting perid; etc.) Prvider Name Categry EP Status Needy Individual Patient Encunters Ttal Patient Encunters Dr. Smith MD Yes Casey Jnes NP Yes Jamie De RN N Lgan Shaw PharmD N Dr. Mre Cntractr N Dr. Jhnsn Part Time DDS N Dr. Hayes DDS Yes TOTAL 415 1,200 29

30 Practice Predminantly EPs that attest t Needy Individual patient vlume must attest t the practice predminantly criterin Practice predminantly requires that mre than 50% f an EP s encunters must have ccurred at an FQHC (r RHC) during a 6-mnth reprting perid during the prir calendar year Fr the 2015 Prgram Year: The practice predminantly reprting perid is 6-mnths in calendar year

31 Practice Predminantly (cnt d) Practice predminantly denminatr: all encunters at EVERY lcatin at which the EP wrked during the reprting perid (including nn- FQHC/RHC encunters) Practice predminantly numeratr: FQHC/RHC encunters during the reprting perid Practice Predminantly FQHC r RHC Encunters X 100 Encunters Frm All Lcatins 31

32 Practice Predminantly (cnt d) Practice predminantly reprts with encunter data must be upladed fr every lcatin at which the EP wrked during the reprting perid (including nn-fqhc/rhc lcatins) Nn-HIPAA practice predminantly numeratr and denminatr reprts must include: Reprting perid start and end dates EP s name Encunter detail data and/r sum ttals (with n patient infrmatin) Out-f-state encunters REPORTS MUST NOT ANY INCLUDE HIPAA DATA Fully redact patient data t ensure that it is nt legible 32

33 Practice Predminantly (cnt d) Occasinally, Medicaid claims reprts will shw encunters frm an rganizatin at which an EP did nt wrk but was listed n the claim (fr example, if the EP was the referring prvider but was errneusly listed as the rendering prvider ) In these instances, the EP must uplad a letter frm that rganizatin stating that the EP did nt wrk during the reprting perid Ensure that the reprting perid dates are listed n the letter t verify that the EP had n encunters during that perid Surce dcuments cntaining encunter data must be saved fr six years fllwing attestatin in the event f pstpayment audit 33

34 Hspital-based EPs that attest t Medicaid patient vlume encunters must attest t the hspital-based criterin The hspital-based criterin requires that mre than 10% f an EP s Medicaid Place f Service cde 21 (Inpatient) and Medicaid Place f Service cde 23 (Emergency Department) encunters ccurred utside f a hspital setting during the prir calendar year Fr the 2015 Prgram Year: The hspital-based reprting perid is 34 calendar year 2014

35 Hspital-based (cnt d) Hspital-based denminatr: all Medicaid encunters at EVERY lcatin at which the EP wrked during the reprting perid Hspital-based numeratr: all Medicaid POS cde 21 and 23 encunters at EVERY lcatin at which the EP wrked during the reprting perid Hspital Based Medicaid POS 21 + Medicaid POS 23 Encunters Frm All Lcatins Ttal Medicaid Encunters Frm All Lcatins X

36 Hspital-based (cnt d) Hspital-based reprts are required nly upn request f the NH Medicaid EHR Office If requested, nn-hipaa hspital-based numeratr and denminatr reprts must include: Reprting perid start and end dates EP s name Encunter detail data and/r sum ttals (with n patient infrmatin) Out-f-state encunters REPORTS MUST NOT ANY INCLUDE HIPAA DATA Fully redact patient data t ensure that it is nt legible 36

37 Hspital-based (cnt d) Occasinally, Medicaid claims reprts will shw encunters frm an rganizatin at which an EP did nt wrk but was listed n the claim (fr example, if the EP was the referring prvider but was errneusly listed as the rendering prvider ) In these instances, the EP must uplad a letter frm that rganizatin stating that the EP did nt wrk during the reprting perid Ensure that the reprting perid dates are listed n the letter t verify that the EP had n encunters during that perid Surce dcuments cntaining encunter data must be saved fr six years fllwing attestatin in the event f pstpayment audit 37

38 Adpt, Implement, Upgrade EPs must uplad the fllwing dcuments t demnstrate that they have adpted, implemented, r upgraded certified EHR technlgy: Vendr cntract shwing legal cntractual bligatin that is fully executed (signed and dated by all parties) Prf f payment (paid invice; purchase rder; credit card receipt; bank invice; etc.) Surce dcuments shwing prf f AIU shuld be saved fr six years in the event f audit 38

39 Individual Attestatin Eligibility Supprting Dcumentatin EPs attesting t individual patient vlume CMS EHR Certificatin ID Patient vlume numeratr and denminatr reprts Practice predminantly numeratr and denminatr reprts (frm every lcatin) Hspital-based numeratr and denminatr reprts (nly upn request f the NH Medicaid EHR Office) Executed cntract with EHR vendr Prf f payment (Physician Assistants in FQHCs/RHCs): letter frm facility directr that the EP is a(an): Primary prvider in a clinic Clinical r medical directr at a clinical site f practice RHC wner 39

40 Grup Attestatin Eligibility Supprting Dcumentatin the fllwing t the NH Medicaid EHR Office: CMS EHR Certificatin ID Cmpleted Establish Practice Request Frm Practice letter Grup patient vlume numeratr and denminatr reprts (inclusive f all EPs and nn-eps that cntributed t patient vlume) Executed cntract with EHR vendr Prf f payment Refer t previus slide fr practice predminantly r hspital-based individual dcumentatin requirements 40

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