Medicaid Provider Incentive Program. Meaningful Use for Eligible Professionals Ohio Association of Community Health Centers

Transcription

1 Medicaid Provider Incentive Program Meaningful Use for Eligible Professionals Ohio Association of Community Health Centers Presenters Emma Esmont, Management Analyst John Mack, Project Manager Elbony McIntyre, Project Manager July 18, 2012

2 Agenda Topics RECAP Eligibility Patient Volume AIU Meaningful Use Overview Meaningful Use in MPIP System 2

3 RECAP

4 RECAP: MPIP Eligibility Eligible Professionals: physicians, optometrists, dentists, certified nurse midwives, nurse practitioners and physician assistants (when practicing at an FQHC/RHC so led by a PA) An eligible professional cannot be hospital-based An eligible professional is hospital-based if 90% or more of his/her Medicaid encounters are furnished in an inpatient hospital (POS 21) or an emergency room (POS 23) setting in the calendar year prior to the payment year This exclusion does not apply to the eligible professional qualifying as practicing predominantly through an FQHC or RHC 4

5 RECAP: Patient Volume Eligible Participants Medicaid Patient Volume Requirements Physicians 30% - Pediatricians 20% Optometrist 30% Dentists 30% Certified Nurse Midwives 30% Nurse Practitioners 30% Physician Assistants (PAs) when practicing at an FQHC/RHC that is so led by a PA 30% OR The eligible professional practices predominantly through an FQHC or RHC 30% needy individual patient volume threshold An eligible professional practices predominantly if over 50% of an eligible professional s total patient encounters over a period of six months in the most recent calendar year occur through an FQHC/RHC. 5

6 RECAP: Patient Volume Calculation Any continuous 90-day period in the preceding calendar year Medicaid Patient Volume Medicaid Patient Encounters (Medicaid Patient Encounters * County SCHIP Factor) Total Patient Encounters Needy Individual Patient Volume Medicaid Patient Volume for eligible professionals practicing predominantly through an FQHC/RHC Needy Individual Patient Encounters Total Patient Encounters 6

7 Reminder! Patient Volume Selection Pediatricians that do not have a Medicaid Patient Volume of 30%, but have a Medicaid Patient Volume of at least 20%, may attest as a Pediatrician. Eligible professionals practicing predominantly through an FQHC/RHC that do not have a Medicaid Patient Volume of 30%, but have a Needy Individual Patient Volume of at least 30%, may attest as an eligible professional practicing predominantly through an FQHC/RHC. MPIP allows eligible professionals to enroll as part of a group practice/clinic in order to meet Patient Volume thresholds 7

8 Eligible professionals must attest to adopting, implementing, or upgrading to certified EHR technology to be eligible for MPIP RECAP: Year 1 AIU Requirement Adopt: Acquiring, purchasing, or securing access to certified EHR technology Implement: Installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements Upgrade: Expanding the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or Upgrading from existing EHR technology to certified EHR technology per the EHR certification criteria published by the ONC 8

9 Meaningful Use

10 What is Meaningful Use? To be eligible for incentives, eligible professionals must be able to demonstrate that they are using certified EHR technology for three fundamental purposes: Meaningful use: e-prescribing, electronic patient health histories, clinical decision support tools, and other meaningful uses Connectivity: connecting to other providers through a health information exchange to improve access to the full view of a patient s health history Reporting: Submitting information on clinical quality measures and other measures in accordance with federal standards 10

11 What is Meaningful Use? Meaningful use is using certified EHR technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Maintain privacy and security 11

12 Meaningful Use: A Staged Approach 12

13 What is Meaningful Use: A Staged Approach 1 Stage 2 implementation changed to

14 Meaningful Use Criteria Stage 1 Eligible professionals must complete: = MU 15 core objectives 5 of 10 menu set objectives 1 of 5 must be a public health measure 6 clinical quality measures (CQMs) 3 core or alternate core, 3 of 38 from menu set All measures have been pre-selected and defined by CMS in collaboration with ONC 14

15 EHR Reporting Periods Payment Year Medicaid Incentive Program Only 1 st payment year AIU 2 nd payment year MU, 90 day reporting period 3 rd payment year and subsequent MU, 12 month reporting period Switching Between the Medicare EHR incentive program and MPIP An eligible professional who switches to MPIP from the Medicare EHR incentive program is placed in the payment year that the eligible professional would have been in had the eligible professional begun in, and remained in, the Medicare EHR incentive payment program. Note: To be considered a meaningful EHR user, at least 50 percent of an eligible professional s patient encounters during the EHR reporting period must occur at a practice/location or practices/locations equipped with certified EHR technology. 15

16 Applicability of Meaningful Use Objectives Some meaningful use objectives are not applicable to every eligible professional s clinical practice. In these cases, the eligible professional would be excluded from meeting that specific objective e.g. a dentist who does not perform immunizations, or a certified nurse mid-wife who does not e-prescribe 16

17 Meaningful Use Denominators Two types of percentage based measures are included in demonstrating meaningful use: 1. Denominator = all patients seen during the EHR reporting period. The denominator is all patients whether or not their records are kept using the EHR technology. 2. Denominator = actions or subsets of patients seen during the EHR reporting period. The denominator only includes patients, or actions taken on behalf of those patients, whose records are kept using the EHR technology. 17

18 Unique Patient Important Definition If a patient is seen by an eligible professional more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure 18

19 Meaningful Use MPIP System

20 Meaningful Use in the MPIP System Enrollment Attestation- 4 Steps (1) Registration Verification Status (2) Patient Volume Status (3) Meaningful Use Status (4) MPIP Payment Status Confirmation Number 20

21 MPIP Helpful Hints NPI # and Password Make a note of this information Save & Continue Make sure to select after entering information (e.g. after completing each screen) Entered data will be saved prior to completing entire attestation, which may be completed at a later date Always select & then Logout before exiting MPIP 21

22 MPIP Log In Provider NPI and Password Enter NPI and Password then click Log In Enter NPI and Password then click Log In 22

23 Welcome to MPIP Click Enrollment to begin Click Enrollment to begin Page has the same look as AIU Page similar to AIU Page has the same look as AIU 23

24 Enrollment Home Note: Paid status is from Payment Year 1 The top record will begin the MU attestation process Click Enroll to start MU attestation for calendar year

25 Step 1- Registration Verify all Registration Information To update your National Provider Information, go to the CMS web site at the following link: Basic questions, same questions as AIU 25

26 Step 1- Registration Click Yes if enrolling as a group Same questions asked as in AIU Who the payment is assigned to If using needy individual patient volume, select yes and select affiliated FQHC/RHC 26

27 Step 1- Registration: Group Practice Click Yes if enrolling as a group Who the payment is assigned to Click the Radio button Yes if enrolling as a group 27

28 Step 1- Provider Registration: Group Selection This will show the groups associated with this NPI or an eligible professional can create a group 28

29 Step 1- Registration: Payment Assignment The Payee ID selected for the previous payment year will be displayed by default. Click Select Medicaid ID if you want to change/update the Payee. Click the radio button to select a payee and then click Select & Continue to save the payee ID and return to the Enrollment Status page 29

30 Completion of Step 1 The Payee ID selected for the previous payment year will be displayed by default. Click the radio button to selected a payee and then Select & Continue to save the payee ID and return to the Enrollment Status page Click Select Medicaid ID if you want to change/update the Payee. If all information is correct, select Save & Continue to navigate to Step 2 Medicaid Patient Volume Determination 30

31 Step 2- Medicaid Patient Volume Select Start Date for 3-month reporting period for Patient Volume determination If using out-of-state encounters, select Yes. Identify which States/Territories. Select the county in which your are located to display the applicable SCHIP Percentage. 31

32 Step 2- Patient Volume Continued Enter Medicaid encounters and Total Patient encounters for 3-month period Upload supporting documentation then click Save & Continue to proceed to Step 3 32

33 Step 2- Needy Individual Patient Volume If using Needy Individual Patient Volume, the SCHIP factor is not applied Enter Needy Individual Patient encounters and Total Patient encounters for 3-month period Upload supporting documentation then click Save & Continue to proceed to Step 3 33

34 Step 3- MU Status: Summary of Measures Select Start MU Info Attestation Enter encounters associated with EHR 34

35 Step 3- MU Status: EHR Technology 90 day reporting period, in current CY System will EHR Certification Adding ID EHR from location previous payment year If using the same certified EHR solution from previous payment year, select Yes then Save & Continue 35

36 Step 3- MU Status: EHR Technology cont. New CMS EHR Certification ID 90 day reporting period, in current CY If using a different EHR from the previous year: - Enter new CMS EHR Certification ID - Select No Radio Button - Check type(s) of Documentation for upload - Must Adding be legally EHR location and/or financially binding - Upload documents (required) - Save & Continue after document upload 36

37 Step 3- MU Status: EHR Technology cont. 90 day reporting period, in current CY Selecting Save & Continue at Step 3 will initiate the ONC Web Service to validate Adding the CMS EHR EHR location Certification ID. If unsuccessful, the user will be prompted to enter a valid Certification ID. 37

38 Step 3 MU Status: Reporting Period Select Start and End Date for MU EHR reporting period Must be at least 90 days for first MU Attestation Reporting period This for is the subsequent information MU needed attestations if adding is 365 days an EHR location Click to add a location of an EHR 38

39 Step 3- MU Status: Adding EHR Location 39

40 Step 3 MU Status: Patient Encounters This is the information needed if adding an EHR location > 80% of Unique Patients is required for certain MU Objectives 40

41 Step 3- MU Status: Summary of Measures Select Start MU Info Attestation Enter encounters associated with EHR 41

42 Step 3- MU Status: Core Measures- Y/N Example of a YES/NO Measure Select Yes if functionality was enabled for the length of the MU EHR reporting period, then select Save & Continue 42

43 Step 3- MU Status: Core Measures- N/D Example of a Numerator/Denominator Measure 43

44 Step 3- MU Status: Core Measures- Exclusion Example of an Exclusion Measure Exclusion Example: Eligible professional sees no patients 13 or younger. If exclusion applies Eligible professional does not report numerator & denominator for the measure. 44

45 Step 3- MU Status: Core Measures Summary Click on the Pencil icon to edit any of the MU info entered 45

46 Step 3- MU Status: Menu Measures Summary At least one of these Eligible professional must report on at least 5 Menu Set measures At least 1 of the 5 must be a Public Health measure: Immunization registry Syndromic surveillance Lab results (EH only) 46

47 Step 3- MU Status: Menu Measure- Public Health Immunizations Exclusion applies if an eligible professional did not perform immunizations during reporting period Indicate if the test was successful Eligible professionals must perform at least one test of electronic submission to immunization registry Follow-up submission is required if test is successful 47

48 Step 3- MU Status: Menu Measure Select Radio buttons, then enter numerator and denominator. Once entered, click Save & Continue to Proceed. 48

49 Step 3- MU Status: CQM Summary Clinical Quality Measures (CQMs) Eligible professionals must report on 6 (3 from core/3 from a set of 38) CQM results must be generated from the certified EHR system Zero (0) is an acceptable CQM denominator value if that value was generated by the certified EHR technology 49

50 Step 3- MU Status: CQM Measure Enter Numerator and Denominator 50

51 Step 4- MPIP Payment Status 51

52 Step 4- MPIP Payment: Overview Eligible professionals will see an overview of what they are attesting to before clicking Confirm & Submit. 52

53 Step 4- MPIP Payment: Attestation Summary Summary of what the eligible professional is attesting to 53

54 Step 4- MPIP Payment: Legal Notice Agree & Continue 54

55 Step 4- MPIP Payment: Submission One more chance to review Enrollment Summary before submitting attestation 55

56 Medicaid MU Attestation Complete! This is the confirmation number of the completed attestation 56

57 Additional Meaningful Use Resources Public Health Reporting ODH websites: Immunizations Electronic Laboratory Reporting Syndromic Surveillance SMEDMainPage.aspx 57

58 Additional Meaningful Use Resources State Rule Ohio Administrative Code 5101:3-57 CMS EHR Incentive Programs CMS EHR Meaningful Use Overview MU Specification Sheets for Eligible Professionals (Core & Menu Measures) 58

59 MPIP Website Contact Us! Send us an ! Or call us at JFS-MPIP 59

60 Questions 60