Colorado State Level Registry for Provider Incentive Payments Eligible Hospital User Manual. August 2016 Version 4.1.2

Transcription

1 Colorado State Level Registry for Provider Incentive Payments Eligible Hospital User Manual August 2016 Version 4.1.2

2 Revision History Version Number Date Description Author /24/2012 Final document David A. Morton 1.1 3/2/2012 Updated images and review responses from CO 1.2 6/11/2012 Added Account Creation Is This You? instructions David A Morton Donna Underhill- Noel 2.0 6/11/2012 Changed to Xerox formatting Will Graeter /1/2012 Meaningful Use updates Will Graeter 2.4 1/15/2013 Updates from the 2.5 release. Will Graeter 2.5 7/9/2013 Sign and Upload changes requested by CO 2.6 8/8/2013 Updates from the 2.6 release, including Appeals, and expanded Recoupments and Adjustments /11/2013 Changes resulting from from the 2014 MU update Will Graeter Will Graeter Will Graeter 3.1 4/22/2014 New table of CQMs, MU content Will Graeter changes, and password period changes /29/2014 Updates to the CQM table Dhruv Patel /10/2014 Added new screenshots and other changes 4.0 5/8/15 Updated version number, corrected addresses and dates /23/2016 Changes for Release 4.1.2, Eligible Hospital MU content changes. Dhruv Patel Denise Koehn Michelle Newbold Susan Williams Confidentiality Statement This document is produced for Xerox Government Health Solutions and its State clients and cannot be reproduced or distributed to any third party without prior written consent. No part of this document may be modified, deleted, or expanded by any process or means without prior written permission from Xerox Xerox Corporation. All rights reserved. XEROX and XEROX and Design are trademarks of the Xerox Corporation in the United States and/or other countries. Other company trademarks are also acknowledged. CO R&A Eligible Hospital User Guide 2

3 Table of Contents Introduction 6 CO R&A Application Availability 6 Problem Reporting 6 Provider Manual 7 Introduction 8 Resources 8 Background 9 Program Definitions 10 Useful Acronyms 12 Eligibility 13 Eligible Hospitals 13 Qualifying Providers by Type and Patient Volume 13 Establishing Patient Volume 14 Patient Encounters Methodology 14 Eligible Hospitals 14 Definition of a Medicaid Encounter for Eligible Hospitals: 14 Payment Methodology for Eligible Hospitals 15 Eligible Hospital Incentive Payment Estimation Process 17 Adopt, Implement or Upgrade (AIU) and Meaningful Use (MU) 19 Adopt, Implement or Upgrade (AIU) 19 Meaningful Use (MU) 19 Stage 1 19 Eligible Hospitals MU Objectives: 20 Stage 2 21 Stage 3 21 Attachments 21 Provider Registration 22 Provider Attestation Process 22 Eligible Hospitals 23 Attestation Requirements for Dual Eligible Hospitals 23 Requesting Payment 25 CO R&A Eligible Hospital User Guide 3

4 Program Integrity 25 Suspension, Exclusion, Offset or Recoupment of Incentive Payment 26 Appeals 26 Attachments 27 Eligibility Workbooks 27 Incentive Payment Estimate Eligible Hospitals Only 27 Meaningful Use Requirements Eligible Hospitals 27 Overview 28 Dates 28 Application Architecture 28 Materials and Preparations 29 Method 30 Login Accessing the CO R&A 30 CO R&A login from the Provider Outreach Web portal 30 CO R&A login directly from the CO R&A login URL 32 Creating a New CO R&A Account for Eligible Hospital Users 34 Accepting the End User License Agreement (EULA) 38 Changing Your Password 38 Navigating CO R&A 40 Hard and Soft Stops 40 Save and Continue 40 Navigation Bar 41 Applying for the Incentive as an Eligible Hospital (EH) 41 Home Page 42 Workflow Section Details 45 Step 1: About You Section 45 Step 2: Confirm CO Medicaid Eligibility Details 47 Step 3: Attestation of EHR Details 50 Meaningful Use Section 54 Step 4: Review and Sign Attestation Details 63 Step 5: Send Year X Attestation Details 64 Accessing Reports 65 Reports for Eligible Hospitals 65 View Payment Information 65 Payment Calculations for Eligible Hospitals 65 Appeals, Adjustments and Recoupments 69 Appeals 69 Adjustments 69 Recoupments 69 CO R&A Eligible Hospital User Guide 4

5 Attaching Files 69 The Attach Documentation Section 69 Timing Out 71 Troubleshooting 71 Accessing Help 71 Help Text Displays 71 Definitions 73 CO R&A Eligible Hospital User Guide 5

6 Introduction This document contains two manuals the first being Provider Manual the other is the User Manual. The Provider Manual must be read and understood by the Eligible Hospital (EH) Representative there is a bullet item in the Colorado Registration & Attestation System EH Attestation Agreement that demonstrated the EH Representative s acknowledgement that they have read and understood the Provider Manual. The goal of the Provider Manual is to give Eligible Hospital Representative a clear understanding of the overall EHR Incentive Program and describe the Colorado Registration & Attestation System from the perspective of the State of Colorado. Understanding and acknowledgement of reading the Provider Manual is required to complete the Colorado Registration & Attestation System and obtain EHR Incentive Payment. The Provider Manual describes in detail all aspects of the EHR incentive program i.e. Program definitions, how to establish patient volume, payment methodology, registration, eligibility, and attestation. The goal of the User Manual is to help guide Eligible Hospital (EH) Representative through the process of completing their State s application for the Centers for Medicare & Medicaid Management s (CMS s) EHR Incentive Program Payment. This application is submitted through the Colorado Registration & Attestation System (CO R&A), a web tool designed to capture all information needed for the approval of the EHR payment, and to submit the application to your State. Users are called Eligible Hospital (EH) Representatives because they are representing the Hospitals interests. CO R&A Application Availability The application is on the Web and is available 24 hours a day, 7 days a week, and is accessible from the internet. Problem Reporting For general Help, all CO R&A web pages have a Help Link that opens up a copy of this User Manual. For CO R&A Web application assistance, you can contact the SLR Help Desk designated to support the CO R&A. Phone: (866) SLRHelpdesk@xerox.com CO R&A Eligible Hospital User Guide 6

7 Colorado Medicaid Electronic Health Records Incentive Program Provider Manual CO R&A Eligible Hospital User Guide 7

8 Introduction The Colorado Medicaid EHR Incentive Program will provide incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate Meaningful Use of certified EHR technology. Background, eligibility and registration procedures are laid out in the Provider Manual, but if you are ready to start your EHR registration and attestation process, please visit the Provider Outreach Page. Resources Colorado State Medicaid HIT Plan (SMHP) Version 1.0 located at SMHP Document Colorado Provider Outreach Page located at Medicare and Medicaid EHR Incentive Program located at Office of the National Coordinator for Health Information Technology located at The Colorado Regional Health Information Organization (CORHIO) is the State-designated entity for all Colorado Medicaid EHR Incentive Program outreach activities. CORHIO provides a wide range of assistance with program-related questions and can be contacted using the information below: Colorado Medicaid EHR Incentive Program Coordinator MedicaidEHR@corhio.org Phone: Xerox is the State-designated entity for all technical assistance related to the Colorado Registration & Attestation System (CO R&A) and Provider Outreach Page. For technical questions please contact Xerox using the following contact information: Xerox HelpDesk SLRHelpdesk@xerox.com Phone: CO R&A Eligible Hospital User Guide 8

9 Background The Centers for Medicare & Medicaid Services (CMS) has implemented, through provisions of the American Recovery and Reinvestment Act (ARRA), incentive payments to eligible professionals (EPs) and eligible hospitals (EHs), including Critical Access Hospitals (CAHs), participating in Medicare and Medicaid programs that are meaningful users of certified Electronic Health Records (EHR) technology. The incentive payments are not a reimbursement, but are intended to encourage EPs and EHs to adopt, implement, or upgrade certified EHR technology and use it in a meaningful manner. Use of certified EHR systems is required to qualify for incentive payments. The Office of the National Coordinator for Health Information Technology (ONC) has issued rules defining certified EHR systems and has identified entities that may certify systems. More information about this process is available at Goals for the national program include: 1. Enhancing care coordination and patient safety; 2. Reducing paperwork and improving efficiencies; 3. Facilitating electronic information sharing across provider, payers, and state lines; and 4. Enabling data sharing using state Health Information Exchanges (HIEs) and the National Health Information Network (NHIN) Achieving these goals will improve health outcomes, facilitate access, simplify care and reduce costs of health care nationwide. The Colorado Department of Health Care Policy and Financing will work closely with federal and state partners to ensure the Colorado Medicaid EHR Incentive Program fits into the overall strategic plan for the Colorado Health Information Exchange (CO-HIE), thereby advancing national and state goals for HIE. In order to participate in the EHR Incentive Program, both EPs and EHs are required to begin the registration process in CMS National Level Repository (NLR). CMS official website for Medicare and Medicaid EHR Incentive Programs can be found at This website provides detailed information on the EHR Programs including program eligibility, meaningful use requirements, certified EHR technology, and a comprehensive list of frequently asked questions and respective CMS responses. For Colorado Medicaid-specific information, EPs and EHs should visit This Provider Outreach Page site provides detailed information on the Colorado program, eligibility, requirements, certified EHR technology and frequently asked questions specific to Colorado.. CO R&A Eligible Hospital User Guide 9

10 Program Definitions Attestation Documentation is a completed letter or document from the EHR vendor that is produced on the vendor s letterhead or on an with the vendor s logo. The letter or document should contain: Provider name and point of contact Vendor name and point of contact Certified system name, version and ONC certification number CMS EHR certification ID Acknowledgement of adoption, upgrade or implementation Adopt is defined as acquiring, purchasing, or securing access to certified EHR technology Acute Care Hospital is defined as a health care facility that: Has an average length of patient stay of 25 days or fewer; and Has a CMS Certification Number (CCN) that has the last four digits in the series or ; or Is a Critical Access Hospital Adopt, Implement or Upgrade (AIU) is defined as: Acquire, purchase, or secure access to certified EHR technology (i.e. copy of the purchase order, contract or software license are acceptable indicators) Install or commence utilizations of certified EHR technology such as staff training, EHR data entry, and establishment of data exchange agreements (i.e. copy of the contract, software license, evidence of cost or contract of training, or payroll records are acceptable indicators) Expand certified EHR functionality, such as staffing, maintenance, and training, or upgrade existing EHR technology to certified EHR technology (i.e. copy of purchase order, contract or software license are acceptable indicators) Children s Hospitals are defined as a certified children s hospital, either freestanding or hospital-within hospital that: Has a CMS Certification Number (CCN) that has the last 4 digits in the series ; and Predominately treats individuals less than 21 years of age Hospital Based is defined as an eligible professional that is reimbursed by Medicaid for ninety-percent (90%) or more of their Medicaid claims during the relevant EHR reporting period in a hospital setting, including inpatient or emergency department settings Medicaid Encounter for an Eligible Professional (EP) is defined as services rendered to an individual on any one day where: Medicaid paid for all or part of the service; or Medicaid paid for all or part of the individual s premiums, co-payments, and costsharing This includes encounters for dual eligible individuals CO R&A Eligible Hospital User Guide 10

11 Medicaid Encounter for a Eligible Hospital is defined as services rendered in an emergency department and/or services rendered to an individual per inpatient discharge where: Medicaid paid for all or part of the service; or Medicaid paid for all or part of the individual s premiums, co-payments, and costsharing This includes encounters for dual eligible individuals (i.e. individual eligible for both Medicaid and Medicare) Medicaid Management Information System (MMIS) refers to the electronic Medicaid claims payment and reporting system Needy Individual Patient Encounter is defined as services rendered to an individual on any one day where: Medicaid or CHIP+ paid for all or part of the service; or Medicaid or CHIP+ paid for all or part of the individual s premiums, co-payments and cost-sharing; or The services were furnished at no cost; or The services were paid for at a reduced cost based on a sliding scale determined by the individual s ability to pay This includes the Colorado Indigent Care Program Physician Assistant (PA) led Federally Qualified Health Clinic (FQHC) or Rural Health Clinic (RHC) means: The PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, the PA would be considered the primary provider); or The PA is a clinical or medical director at a clinical site of practice; or The PA is an owner of an RHC Patient Volume refers to the proportion of an EP s or EH s patient encounters that qualify as a Medicaid encounter. This figure is estimated through a numerator and denominator as defined in the State Medicaid HIT Plan for Colorado (SMHP) Pediatrician is defined as either: 1) a Board Certified Pediatrician that is a Medical doctor or Doctor of Osteopathic Medicine; or 2) provides greater than fifty-percent (50%) of their services to patients eighteen years or younger Practices Predominately refers to eligible professionals for whom fifty-percent (50%) or more of his or her total patient encounters occur at a federally qualified health center (FQHC) or rural health clinic (RHC) State Medicaid HIT Plan (SMHP) is a document that describes the State s current and future HIT activities CO R&A Eligible Hospital User Guide 11

12 Useful Acronyms ARRA American Recovery and Reinvestment Act (2009) AIU Adopt, Implement, Upgrade (certified EHR technology) CAH Critical Access Hospital CAP Corrective Action Plan CCN CMS Certification Number CHIP+ Children s Health Insurance Program Plus CHPL Certified HIT Product List CMS Centers for Medicare and Medicaid Services CO R&A Colorado Registration & Attestation System CPOE Computerized Physician Order Entry CY Calendar Year (January through December) EHR Electronic Health Record EH Eligible Hospital EP Eligible Professional FFY Federal Fiscal Year (October 1 through September 30) FFS Fee-For-Service FQHC Federally Qualified Health Center FTE Full-Time Equivalent FY Fiscal Year HCPF Colorado Department of Health Care Policy and Financing HIE Health Information Exchange HIT Health Information Technology HIPAA Health Insurance Portability and Accountability Act (1996) HITECH Health Information Technology for Economic and Clinical Health Act HMO Health Maintenance Organization HPSA Health Professional Shortage Area HRSA Health Resource and Services Administration IHS Indian Health Service IT Information Technology MCO Managed Care Organization MMIS Medicaid Management Information System MU Meaningful Use NPI National Provider Identifier ONC Office of the National Coordinator for Health Information Technology PHI Protected Health Information POC Point of Care POP Provider Outreach Page PPO Preferred Provider Organization REC Regional Extension Center RHC Rural Health Clinic SMHP State Medicaid Health Information Technology Plan TIN Tax Identification Number CO R&A Eligible Hospital User Guide 12

13 Eligibility Eligible Hospitals To qualify for an EHR incentive payment for each year the EH seeks the incentive payment, the EH must be one of the following: An acute care hospital (includes CAHs) that has: At least 10 percent Medicaid patient volume One CMS Certification Number (CCN) CCN with last four digits or A children s hospital (exempt from meeting patient volume threshold) CCN Hospital-based providers are not eligible for the Colorado Medicaid EHR Incentive Program. Other providers and hospitals that are currently ineligible include behavioral health (substance abuse and mental health) providers and facilities, and long-term care providers and facilities. Note that some provider types eligible for the Medicare program, such as chiropractors, are not eligible for the Colorado Medicaid EHR Incentive Program per federal regulations. Qualifying Providers by Type and Patient Volume The following lists the eligibility requirements based on provider type (see Table 6.2.1). Please note that Colorado has defined a pediatrician as either: 1) a Board Certified Pediatrician that is a Medical Doctor or Doctor of Osteopathic Medicine; or 2) a provider that serves greater than 50% of assigned patients 18 years or younger The following lists in tabular format the eligibility requirements based on hospital type (see Table 6.2.1). Table Qualifying Provider by Type and Patient Volume EH Type Acute Care Hospital Requirements 10% Medicaid Patient Volume over 90-day period in previous FFY Average Length of Stay 25 days One CMS Certification Number (CCN) CCN with last four digits or Includes 29 CAHs in Colorado CO R&A Eligible Hospital User Guide 13

14 Children s Hospital No Percentage Requirement CCN Establishing Patient Volume A Medicaid provider must meet patient volume requirements of the Colorado Medicaid EHR Incentive Program as established through Colorado s approved SMHP. For EHs the same continuous, representative 90-day period must be used to calculate both the numerator and the denominator. Patient Encounters Methodology Eligible Hospitals To calculate Medicaid patient volume, an EH should use the following formula: Total Individual Medicaid Encounters Total Patient Encounters Definition of a Medicaid Encounter for Eligible Hospitals: For purposes of calculating eligible hospital patient volume, a Medicaid encounter is defined as services rendered to an individual (1) per inpatient discharge, or (2) on any one day in the emergency room where Colorado Medicaid or another state s Medicaid program paid for: 1. Part or all of the services; or 2. Part or all of the premiums, co-payments, and/or cost-sharing mechanisms There is an exception for children s hospitals that are not required to meet Medicaid patient volumes. Eligibility Workbooks for EHs are available in Section 16.1 of the Provider Manual. CO R&A Eligible Hospital User Guide 14

15 Payment Methodology for Eligible Hospitals Statutory parameters placed on the Colorado Medicaid EHR Incentive Program for incentive payments to eligible hospitals are largely based on the methodology applied to Medicare incentive payments. The specifications described in this section are limited to which all States must adhere when developing aggregate EHR hospital incentive payment amounts for Medicaid-eligible hospitals. States will calculate hospitals aggregate EHR hospital incentive amounts on the federal fiscal year (FFY) to align with hospitals participating in the Medicare EHR Incentive Program. Colorado may pay children s hospital and acute care hospitals up to 100 percent of an aggregate EHR hospital incentive amount and has elected to do this over a 3-year period. Statute requires that no payments can be made to hospitals after 2016 unless the provider has been paid a payment in the previous year; thus, while Medicaid EPs are afforded the flexibility to receive payments on a non-consecutive, annual basis, hospitals receiving a Medicaid incentive payments after the year 2016, must receive payments on a consecutive, annual basis. Prior to 2016, Medicaid incentive payments to hospitals can be made on a nonconsecutive, annual basis. The aggregate EHR hospital incentive amount is calculated using an overall EHR amount multiplied by the Medicaid share. Colorado EHs are responsible for using auditable data sources for inputs to calculate Medicaid aggregate EHR hospital incentive amounts, as well as determining Colorado Medicaid incentive payments to those providers. Auditable data sources include: Hospitals Medicare cost reports State-specific Medicaid cost reports Payment and utilization information from the Colorado MMIS (or other automated claims processing systems or information retrieval systems) Hospital financial statements and accounting records The Colorado Medicaid EHR hospital incentive amount is based on: 1) the overall EHR amount equal to the sum over 4 years of the base amount (defined by statute as 2,000,000); 2) the discharge related amount defined as $200 for the 1,150 th through the 23,000 th discharge for the first year (for subsequent years, CMS assumes discharges increase by the hospitals average annual rate of growth based on the most recent 3 years for which data are available per year); and 3) a transition factor for each year equal to 1 in year 1, ¾ in year 2, ½ in year 3, and ¼ in year The statute specifies that for hospitals the payment year is determined based on the FFY. Section 1886(n)(2)(C) of the Act provides the Secretary with authority to determine the discharge relate amount on the basis of discharge data from a relevant hospital cost reporting period, for use in determining the incentive payment during a FFY. FFY begins on October 1 of each calendar year, and ends on September 30 of the subsequent calendar year. For purposes of administrative simplicity and timeliness, Colorado will use hospital data from the hospital fiscal year that ends in the FFY prior to the first payment year. CO R&A Eligible Hospital User Guide 15

16 2. The discharge-related amount is $200 per discharge 1,150 through 23,000. To determine the discharge-related amount for the three subsequent years that are included in determining the overall EHR amount, Colorado will assume discharges for the individual hospital have increased by the average annual growth rate for the individual hospital over the most recent 3 years of available data from an auditable data source. Colorado requires that the auditable data source used for discharge data is the individual hospital s Medicare Cost Reports from the three years prior to the FFY that the hospital wishes to receive an incentive payment. Per federal regulations, if a hospital s average annual rate of growth is negative over the 3 year period, it will be applied as such. 3. The overall hospital EHR amount requires that a transition factor be applied to each year over a 4 year period. This transition factor equals 1 for year 1, ¾ for year 2, ½ for year 3, and ¼ for year 4, as provided for in sections 1886(n)(2)(A) and 1886(n)(2)(E) of the Act, and as incorporated through section 1902(t)(5)(B) of the Act. The Medicaid Share, against which the overall EHR amount is multiplied, is essentially the percentage of a hospital s inpatient, non-charity care days (excluding nursery, swing and skilled bed days) that are attributable to Medicaid inpatients. More specifically, the Medicaid share is a fraction expressed as: Estimated Medicaid inpatient-bed days + Estimated Medicaid Managed Care inpatient-bed days X Estimated total charges Charity Care charges Estimated Total inpatient-bed days As indicated in the above formula, the Medicaid share includes both Medicaid inpatient-bed Estimated total charges days and Medicaid Managed Care inpatient-bed days. In addition, because the formula for calculating the Medicaid share requires determination of charity care charges, Colorado is asking hospitals to use the individual hospital s Medicare Cost Report data as an auditable data source to determine the charity care portion of the formula. In the absence of sufficient charity care data to complete the calculation, statute requires the use of uncompensated care data to derive an appropriate estimate of charity care, including a downward adjustment for bad debt. CMS interpreted bad debt should be consistent with the Medicare definition of bad debt as promulgated at (b)(1). Finally, if a hospital advises that there is simply not sufficient data that would allow the estimation of inpatient bed-days attributable to Medicaid Managed Care patients the statute directs that such figure is deemed to equal zero. Likewise, if there is simply no sufficient data for the State to estimate the percentage of inpatient bed days that are not charity care (that is, [estimated total charges charity care charges]/estimated total charges), the statute directs that such figure is deemed to equal 1. Unlike Medicaid EPs, who must waive rights to duplicative Medicare incentive payments, hospitals may receive incentive payments for both Medicare and Medicaid, contingent on successful demonstration of meaningful use and other requirements under both programs. The last year that a hospital may begin receiving Medicaid incentive payments is FFY States must make payments over a minimum of 3 years. Additionally, in any given payment year, no annual Medicaid incentive payment to a hospital may exceed 50 percent of the hospital s aggregate incentive payment. Likewise, over a 2-year period, no Medicaid payment to a hospital may exceed 90 percent of the aggregate incentive. Colorado has broken the incentive payment calculation down into steps for a more simple view. CO R&A Eligible Hospital User Guide 16

17 Eligible Hospital Incentive Payment Estimation Process Step 1: Calculate the average annual growth rate for the last 3 years of available data using hospital cost reports PRIOR YEAR CURRENT YEAR INCREASE/DECREASE GROWTH RATE Fiscal Year (3 Years Prior): 20,114 20, % Fiscal Year (2 Years Prior): 20,774 21, % Fiscal Year (1 Year Prior): 21,375 22, % Total Increase/(Decrease): 9.10% Average 3 year Growth Rate: 3.03% Step 2: Calculate Discharge Related Amount using the annual growth rate calculated previously PAYMENT YEAR: PER DISCHARGE AMOUNT TOTAL DISCHARGES DISALLOWED DISCHARGES ALLOWABLE DISCHARGES AMOUNT 2012 $200 22,000 1,149 20,851 $4,170, $200 22,667 1,149 21,518 $4,303, $200 23,355 1,149 22,206 $4,441, $200 24,063 1,149 22,914 $4,582,773 Total Discharge Related Amount: $17,497,729 Step 3: Calculate the overall EHR Incentive amount for 4 years with the transition factor Base Amount: YEAR 1 YEAR 2 YEAR 3 YEAR 4 $2,000,000 $2,000,000 $2,000,000 $2,000,000 Discharge Related Amt: Aggregate EHR Amt: $4,170,200 $4,303,637 $4,441,120 $4,582,773 $6,170,200 $6,303,637 $6,441,120 $6,582,773 Transition Factor: Transition Factor Amt: $6,170,200 $4,727,727 $3,220,560 $1,645,693 Overall EHR Incentive Amt: For 4 Years $15,764,181 CO R&A Eligible Hospital User Guide 17

18 Step 4: Calculate the Medicaid share from the hospital cost report data (Estimated Medicaid inpatient-bed-days + Estimated HMO inpatient-bed-days) Est. Medicaid IP-bed-days * ((Est. total charges - Est. charity charges)/est. total charges) Total Medicaid Inpatient Days: ,500 Total Medicaid HMO Inpatient Bed Days: 1,350 Total Medicaid and HMO Inpatient Bed Days: 18,850 Total Hospital Charges: Total Charity/Uncompensated Care Charges: Total Hospital Charges - Charity Charges: Divide by Total Hospital Charges: 5,000,000 1,000,000 4,000,000 5,000,000 Non-Charity Percentage: 80.00% Total Hospital Inpatient Bed Days: 50,000 Total Hospital Inpatient Bed Days excluding Charity: 40,000 Medicaid Share: 47.13% Step 5: Calculate the annual Medicaid EHR Incentive Program Payment ANNUAL MEDICAID EHR INCENTIVE PROGRAM PAYMENT Year 1 Payment: YEAR 2012 PERCENTAGE 50% PAYMENT AMOUNT $ 3,714, The State of Colorado has designated that 50% of the payment be made in Year 1. Year 2 Payment: YEAR 2013 PERCENTAGE 40% PAYMENT AMOUNT $ 2,971, The State of Colorado has designated that 40% of the payment be made in Year 2. Year 3 Payment: YEAR 2014 PERCENTAGE 10% PAYMENT AMOUNT $ 742, The State of Colorado has designated that 10% of the payment be made in Year 3. Year 4 Payment: YEAR 2015 PERCENTAGE 0% PAYMENT AMOUNT $0.00 The State of Colorado has designated that 0% of the payment be made in Year 4. A workbook for EH incentive payment estimation can be found in Section 16.2 of the Provider Manual. Eligible Hospital providers are encouraged to estimate their hospital s incentive payment with this workbook. CO R&A Eligible Hospital User Guide 18

19 Adopt, Implement or Upgrade (AIU) and Meaningful Use (MU) Adopt, Implement or Upgrade (AIU) The federal regulations allow EHs in the Medicaid EHR Incentive Program to receive incentive payments for year one if they adopt (acquire and install), implement (train staff, deploy tools, exchange data) or upgrade (expand functionality or interoperability of their) certified EHR systems technology. At the time of attestation, the EH will be required to provide either a vendor letter on letterhead or an with a vendor logo printed out and submitted with attestation agreement. * If providers have already attested to the Medicare Incentive program then they must meet Meaningful Use requirements in Year 1 of the Medicaid EHR Incentive Program. However, there is an exception for dual-eligible EHs which can attest to AIU in the first year of the Medicaid EHR Incentive Program. Initially, the option to attest to Meaningful Use will not be available; however, attestation to Meaningful Use requirements will become available in late Meaningful Use (MU) Meaningful Use of EHR technology is a major goal of this program. CMS has determined that MU will be rolled out in three stages. The current rule provides specific information on Stage 1 which focuses heavily on establishing the functionalities in certified EHR technology that will allow for continuous quality improvement and ease of information exchange. These functionalities include: Electronically capturing health information in a structured format Using that information to track key clinical conditions and communicating that information for care coordination purposes Implementing clinical decision support tools to facilitate disease and medication management Using EHRs to engage patients and families Reporting clinical quality measures and public health information Stage 1 Colorado has ruled that Stage 1 MU criteria will be the same as CMS MU Criteria. Therefore, the Medicaid MU requirements simply mirror those of the Medicare EHR Incentive Program. Though some functionality are optional in Stage 1, as outlined in discussions later in this CO R&A Eligible Hospital User Guide 19

20 manual, all of the functionalities are considered crucial to maximize the value to the health care system provided by certified EHR technology. CMS encourages all EHs, and CAHs to be proactive in implementing all the functionalities that improve patient care, the efficiency of the health care system, and public health. Current federal regulations indicate that providers practicing in multiple locations must provide meaningful use data only for locations where certified EHR technology is being utilized. To meet Stage 1 MU criteria, EHs must meet all Objectives. Exclusions are generally not granted for EHs/CAHs. Following are the elements required. Eligible Hospitals MU Objectives: 1. Protect Patient Health Information 2. Clinical Decision Support 3. Computerized Provider Order Entry (CPOE) 4. Electronic Prescribing (erx) 5. Health Information Exchange 6. Patient Specific Education 7. Medication Reconciliation 8. Patient Electronic Access (VDT) 9. Public Health Reporting Table Hospital Clinical Quality Measures Clinical Quality Measures Measure Number Clinical Quality Measure Title Identifier Emergency Emergency Department Throughput Median time from Department (ED) - 1 ED arrive to ED departure for admitted patients NQF 0495 ED -2 Emergency Department Throughput Admission decision NQF 0497 time to ED departure time for admitted patients Stroke 2 Ischemic Stroke Discharge on anti-thrombotics NQF 0435 Stroke 3 Ischemic Stroke Anticoagulation for A-fib/flutter NQF 0436 Stroke 4 Ischemic Stroke Thrombolytic therapy of patients arrive NQF 0437 within 2 hour of symptom onset Stroke 5 Ischemic or Hemorrhagic Stroke Antithrombotic therapy NQF 0438 by day 2 Stoke 6 Ischemic Stroke Discharge on statins NQF 0439 Stroke 8 Ischemic of Hemorrhagic Stroke Stroke education NQF 0440 Stroke 10 Ischemic or Hemorrhagic Stroke Rehabilitation NQF 0441 Venous Thromboembolism (VTE) 1 NQF 0371 VTE 2 assessment VTE Prophylaxis within 24 Hours of Arrival Intensive Care Unit VTE Prophylaxis CO R&A Eligible Hospital User Guide 20

21 NQF 0372 VTE 3 Anticoagulation Overlap Therapy NQF 0373 VTE 4 Platelet Monitoring on Unfractionated Heparin NQF 0374 VTE 5 VTE Discharge Instructions NQF 0375 VTE 6 Incidence of Potentially Preventable VTE NQF 0376 Additional Information on Clinical Quality Measures - Page 303 Stage 2 The goals for the Stage 2 MU criteria, consistent with other provisions of the Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of HIT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible. This includes the electronic transmission of orders entered using CPOE and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests, genetic tests, genomic tests, and other such data needed to diagnose and treat disease). MU Objectives 1. Protect Patient Health Information 2. Clinical Decision Support 3. Computerized Provider Order Entry (CPOE) 4. Electronic Prescribing (erx) 5. Health Information Exchange 6. Patient Specific Education 7. Medication Reconciliation 8. Patient Electronic Access (VDT) 9. Public Health Reporting Stage 3 The goals for Stage 3 MU criteria are focused on promoting improvement in quality, safety and efficiency leading to improved health outcomes. Additional goals include enhanced decisions support for national high priority conditions, patient access to self-management tools, access to comprehensive patient data through robust, patient-centered HIE and improved population health. CMS has indicated that more information on Stage 3 will be released at a later date. Attachments The following are required documents for both AIU and for MU: Colorado EH Eligibility Workbook ONC/CHPL Certification Screen Print EHR Dashboard Report for MU Hospital Cost Report MU Workbooks EHR Contract or proof of purchase letter signed and dated by vendor CO R&A Eligible Hospital User Guide 21

22 Provider Registration Both EPs and EHs are required to begin the registration process at the national level with the Medicare and Medicaid registration and attestation system (also referred to as the NLR). Providers must supply their name, NPI, business address, phone number, tax payer ID number (TIN) of the entity receiving the payment and hospitals must provide their CCN. EHs are eligible to receive incentives payments from both Medicare and Medicaid incentive programs. If EHs are seeking payment from both Medicare and Medicaid, select both initially. If Medicaid is selected, the provider must choose only one state. Providers must revisit the NLR to make any changes to their information and/or choices, such as changing the program from which they want to receive their incentive payment. After the initial registration, the provider does not need to return to the NLR before seeking annual payments unless information needs to be updated. EHs seeking payment from both Medicare and Medicaid will be required to visit the NLR annually to attest to meaningful use before returning to the Colorado Registration & Attestation System (CO R&A) to attest for Colorado s Medicaid EHR Incentive Program. The NLR will assign the provider a CMS Registration Number and electronically notify the CO R&A of a provider s choice to access Colorado s Medicaid Incentive Program for payment. This CMS Registration Number will be required during the online attestation process in the CO R&A. Allow 2 business days for the NLR registration information to be transmitted to the CO R&A prior to proceeding with provider registration and attestation process in the CO R&A itself. Once attestation is complete and payment has been disbursed to the eligible TIN, the CO R&A will notify the NLR that a payment has been made. Provider Attestation Process Colorado (in conjunction with a contracted program developer, Xerox) has built a secure provider website to house the attestation system. The Colorado Registration & Attestation System (CO R&A) will be the state-level attestation system for the Colorado Medicaid EHR Incentive Program. Once an EH s information has been received by the CO R&A from the NLR, the EH will be able to continue to the attestation process. The attestation process is a contractual agreement with the Colorado Medicaid Program. By signing the attestation agreement, the EH agrees to all the requirements of the Colorado Medicaid EHR Incentive Program and is legally bound to this agreement. Following is a description, by provider type, of the information that a provider will have to report or attest to during the process. CO R&A Eligible Hospital User Guide 22

23 Eligible Hospitals 1. The EH will be asked to provide: a. CMS Registration Number b. Contact Information (Contact Name, Phone and ) c. Hospital Cost Reports (for eligibility and payment calculation purposes) d. Proof of AIU (i.e. Contract/License Agreement) e. EHR Certification Number 2. The EH will be asked to attest: To Adoption, Implementation or Upgrade of Certified EHR Technology (or Meaningful Use) 3. The EH will be asked to sign and upload: a. Hospital Cost Reports (4 years) b. Eligibility Workbook c. ONC CHPL Screen Print d. Vendor Contract and Invoice e. MU: EHR Reporting Period Workbook f. MU: MU Objectives and CQM MU Report(s) g. Signed Attestation Agreement Once the electronic attestation is submitted by a qualifying provider and appropriate documentation is provided, Colorado will conduct a review which will include cross-checking for potential duplication payment requests, checking provider exclusion lists and verifying supporting documentation. The attestation will be electronic and will require that the EH attests to meeting all requirements as defined in the federal regulations. Some documentation will have to be provided to support specific elements of attestation. For instance, providers who attest to AIU of certified EHR technology will be required to submit either a vendor letter on vendor letterhead or some other form of contractual agreement with vendor logo. Attestation Requirements for Dual Eligible Hospitals During the first year of the program, most eligible providers will be required to attest to adopting, implementing or upgrading to certified EHR technology. However, if your facility has previously attested for Meaningful Use with Medicaid, then re-attesting to AIU is no longer an option and that EH be required to attest to Meaningful Use requirements in the first year of the Colorado Medicaid EHR Incentive Program. See Table 11.2 for a more detailed description of requirements for attestation. Table 11.2 Attestation Requirements for Dual-Eligible Hospitals DUAL-ELIGIBLE HOSPITAL PARTICIPATING IN: Payment Year Medicaid Incentive Program ONLY Medicaid 1 st, then Medicare in same FY Medicare and Medicaid Simultaneously/Medicare 1 st, then Medicaid in later FY CO R&A Eligible Hospital User Guide 23

24 Payment Year 1 AIU AIU (Medicaid 1 st ) MU, 90-day reporting period (Medicare 2 nd ) MU, 90-day reporting period (BOTH) Payment Year 2 MU, 90-day reporting period MU, 12-month reporting period MU, 12-month reporting period Payment Year 3 MU, 12-month reporting period MU, 12-month reporting period MU, 12-month reporting period CO R&A Eligible Hospital User Guide 24

25 Requesting Payment Upon completion of the attestation process, including: 1) submission of the electronic attestation; 2) receipt of required documentation; and 3) review and acceptance by Colorado Medicaid, an incentive payment will be approved. Incentive payments will be batched weekly and sent out similar to any other Medicaid payments. Program Integrity Colorado Medicaid will be conducting regular reviews of attestations and incentive payments in an effort to reduce fraud and abuse. These reviews will be conducted similar to the current audit process and can occur at any point during: 1) provider enrollment, 2) pre-payment, and 3) post-payment. Therefore it is the responsibility of the EH/CAH to maintain records applicable to attestation to the Colorado Medicaid EHR Incentive Program for at least 7 years. Selection for audit may be based on the following criteria: Risk assessment Random sampling Specific MU measures Red flags In the event an audit results and deficiencies are identified, a Corrective Action Plan (CAP) will be issued to the EH to ensure that they come into conformity with the program requirements. The CAP will identify: Actions that the EH should take to correct deficiencies, Specific items that will bring the EH into compliance with the program requirements, Recommended improvements, and A reasonable completion date. CO R&A Eligible Hospital User Guide 25

26 Suspension, Exclusion, Offset or Recoupment of Incentive Payment Suspension, exclusion, offset or recoupment of payments will be handled according to the Colorado Medical Services Rule There are several conditions that may result in an offset or recoupment of payments issued to EHs. These include, but are not limited to: Failure to comply with audit obligations Provider is under an active audit at the time of payment Deficiencies are found as a result of an audit Credible proof/allegation of fraud committed during attestation Credible proof/allegation of fraud related to participation in the medical assistance program Exclusion/suspension /termination from Federal Government Exclusion/suspension /termination from medical assistance program Financial balance owed to the State of Colorado In the event that the Colorado Department of Health Care Policy and Financing or the Colorado Audits and Compliance Division request an offset or recoupment of any incentive payments made by the Colorado Medicaid EHR Incentive Program, the EH will be notified. The EH may choose to refund the payment in a full lump sum or an automatic recoupment will be set up to deduct the balance owed from future Medicaid claim payments. Colorado reserves the right to automatically offset Medicaid EHR Incentive payments by any amount owed to the Colorado Medicaid Program by the EH. Appeals A provider may request an appeal in accordance with the Colorado Medical Services Board Rule (Appendix B). A provider that wishes to dispute a given decision in regards to the Colorado Medicaid EHR Incentive Program is asked to first, proceed with an informal reconsideration process. If the provider is dissatisfied with the outcome of the Colorado Department of Health Care Policy and Financing s informal reconsideration decision and subsequent review, they may request a formal appeal in accordance with the procedures set for in 10 CCR Section 8.050, 3, PROVIDER APPEALS. CO R&A Eligible Hospital User Guide 26

27 Attachments Eligibility Workbooks Table 16.1 lists the workbooks that may be helpful for providers to ensure they all the information needed for AIU, eligibility calculations and incentive payments. Please note that four years of cost reports will be required from EHs to upload during attestation. Copies of these workbooks and a more detailed attestation checklist can be found at the Provider Outreach Page. Table 16.1 Eligibility Workbooks Eligible Hospitals Adopt, Implement, Upgrade Workbook: Contains requirements for attestation to AIU Eligibility Workbook: Contains information needed for hospitals to calculate Medicaid Volumes. CO EH AIU Attestation Workbook CO EH Eligibility Workbook Final Incentive Payment Estimate Eligible Hospitals Only Table 16.2 lists a Workbook that is helpful for eligible hospitals only. The Incentive Payment Calculation Workbook provides EHs with specific information on cost report data required for attestation and uses these inputs to calculate an estimation of their EHR incentive payment. Table 16.2 Eligible Hospital Incentive Payment Estimation Incentive Payment Calculations Incentive Payment Calculation Workbook: Contains information pertaining to eligible hospitals attestation requirements By inputting data into required cells, the workbook will calculate an estimated incentive payment for a particular eligible hospital CO EH Incentive Pymt Calculation Work Meaningful Use Requirements Eligible Hospitals There are specific requirements for meeting the Meaningful Use objectives. Eligible hospitals must meet all Objectives for attestation to Meaningful Use. Please note that Objectives and Measures are measured using a denominator of unique patients, regardless of whether patient s records are maintained using Certified EHR Technology. CO R&A Eligible Hospital User Guide 27

28 Overview As the healthcare landscape continues to modernize, legislation was passed to encourage the adoption of Electronic Health Record (EHR) technology in documenting patient care. Because of the American Recovery and Reinvestment Act (ARRA) of 2009, eligible Medicaid Providers are being offered financial incentives for the implementation and meaningful use of Health Information Technology (HIT) in the management of patient populations. In support of this initiative, Xerox has developed the EHR Provider Incentive Portal application, called the State Level Registry (CO R&A). By using CO R&A, you have access to a streamlined application for federally funded HIT incentives through an easy-to-use website. With self-service flexibility, you can move through registration, eligibility and attestation at your own pace while the CO R&A application stores your information in an organized manner. This application provides the most direct path to your incentive payment. Dates An EH applying for 2015 program year must have Medicaid eligibility dates between 10/1/13 9/30/14. Each State has a designated Grace Period in the beginning of the year during which users that have not submitted an Attestation Agreement can elect the year for which they are Attesting. Application Architecture The CO R&A Web application features the following: Compliance with Section 508 accessibility guidelines. Accessibility from the internet: Xerox has made every effort to make this site accessible to people with disabilities. In the event you experience difficulty accessing this site with assistive devices, please contact our Help Desk at (866) for assistance in obtaining the information you need. State of Colorado accessibility standards are available for review. Secure protected page access. CO R&A Eligible Hospital User Guide 28

29 Materials and Preparations Materials the user will need to use the software: Computers with access to the web browser. Software Adobe Acrobat Reader installed on your machine to view PDF files. The Pop-up Blocker feature of your browser should be set to Off to enable pop-up window features. Manuals and/or FAQ s that are available for distribution. Also note that this application is approved for use with Microsoft Internet Explorer versions 7.0 or higher. CO R&A Eligible Hospital User Guide 29

30 Method Login Accessing the CO R&A The CO R&A is a web-based application accessible from the internet via the Provider Outreach Web portal, or directly from a login URL. 1. Open Microsoft Internet Explorer to access the Web. 2. Type your State s URL in the address field and press the Enter key on your keyboard. CO R&A login from the Provider Outreach Web portal You can access the CO R&A Web application from the Provider Outreach Web portal. This webpage features Provider education resources as it relates to the American Reinvestment and Recovery Act (ARRA) and the Health Information Technology for Economic and Clinical Health (HITECH) acts and also provides a link to the CO R&A application login page. The Provider Outreach page displays the following: 1. Located at the top of the page is a banner that displays the following items that are visible on every page of the CO R&A application: a. Colorado s CO Department of Health Care Policy & Financing logo. b. The heading Colorado Registration & Attestation System. This is the name of the application. c. Provider Outreach Home link: on other pages in the Provider Outreach site, this links to the home page. d. Contact Us link: opens a pop-up page displaying contact information including the SLR Help Desk phone number and CO R&A Account Creation/Entry, FAQs and RSS Feeds sections. Located to the left and right of the page, these columns display the following sections: a. Important Year End Dates section: lists the last day Eligible Professional and Eligible Hospitals can submit attestations for b. Already have an CO R&A account? section: directs you to the Login page. c. Centers for Medicare & Medicaid Services (CMS) section: links in this section open up a new window and displays CMS news. d. EMR and HIPAA section: links in this section open up a new window and display news related to Electronic Medical Records (EMR) and the Health Insurance Portability and Accountability Act (HIPAA). CO R&A Eligible Hospital User Guide 30

31 e. Are You Eligible? section: clicking this link or graphic opens the CMS Eligibility Wizard, which asks a series of questions to see if a Provider would likely be eligible for an incentive payment. f. Frequently Asked Questions section: the view our list of most frequently asked questions link directs you to CMS frequently asked questions website related to electronic health record (EHR) technologies and the incentive program. g. Healthcare IT News section: a link in this section opens up a new window and displays an article related to Healthcare IT news. 3. Located in the middle of the page, the primary page content entails the following sections: a. Welcome text: This is an overview of the Provider Outreach Web portal. b. Important Web Resources section: A link in this section opens up a new window and displays the appropriate website. Standard links provided by Xerox include links to CMS and the ONC. CMS EHR Incentive Programs Registration site link: opens up a new window and displays the Medicare & Medicaid EHR Incentive Program Registration and Attestation System. Centers for Medicaid and Medicaid Services link: opens the CMS site. ONC Certified Health IT Products link: opens up a new window and displays the Certified Health IT Product List. c. Regional Extension Centers (REC) section. Clicking the link in this section opens up a new window and displays the REC website. d. Additional Resources section. Clicking a link in this section opens up a new window and displays the associated website. These include: Colorado Regional Health Information Organization (CORHIO) Colorado Beacon Consortium Quality Health Network (QHN) Colorado Department of Health Care Policy & Financing (HCPF) 4. Footer section: Located at the bottom of the page, the footer displays the following items: a. Privacy link: opens a new window with a Privacy policy displayed. b. Terms of Use link: opens a new window with the Terms of Use policy displayed. c. Accessibility link: opens a new window with the website s Accessibility policy displayed. d. Xerox Copyright. This is Xerox s copyright symbol and text. CO R&A Eligible Hospital User Guide 31

32 To get to the login page from the Provider Outreach page, click on the go directly to the State Level Registry for Provider Incentive Payments link located on the left side of the Provider Outreach webpage. CO R&A login directly from the CO R&A login URL If you have already created an account, you can also get to the CO R&A s Login page by entering the URL into your browser: Type the Colorado Registration & Attestation System URL in the address field and press the Enter key on your keyboard. From here, you will reach the CO R&A Web application Login page. You ll have three chances to enter in the correct login information before the system locks your account. If that happens, call the Help Desk for assistance. CO R&A Eligible Hospital User Guide 32

33 Throughout the CO R&A application, red asterisks ( * ) display on various fields. This symbol indicates that this field is required to be completed in order to continue through the application. The Login page displays the following: 1. User ID field: enter your User ID. 2. Password field: enter your password. 3. Login button: verifies the User ID and password you entered and opens the End User License Agreement (EULA). 4. Forgot User ID? link: select when you have forgotten your User ID. The system will ask you for your National Provider Identifier (NPI) and Tax Identification Number (TIN) as well as the answer to the Challenge Question you selected when creating your account. Once you have entered those correctly, the system will your User ID to the address entered when you created your account. 5. Forgot Password? link: select when you have forgotten your password. The system will ask you for your User ID as well as the answer to the Challenge Question you picked when creating your account. Once you have entered those correctly, the system will a link to reset your password to the address you entered when you created your account. 6. Create Account button: select this if you need to create a new CO R&A account. CO R&A Eligible Hospital User Guide 33

34 Creating a New CO R&A Account for Eligible Hospital Users To create a new account from the Provider Outreach page, select the leave this site and create an CO R&A account link located on the left side of the Provider Outreach Jumpstart page. To create a new account from the Login page, select the Create Account button. The Create Account page displays the following: 1. What is your role? pull-down menu: identify your Provider Type by selecting an option from the menu. As an individual physician or medical professional, select Individual Eligible Professional. 2. NPI text field: enter your National Provider Identifier (NPI) number. If you have more than one NPI, use the one that you used while registering with the CMS Medicaid EHR Incentive Program Registration Site. If the number entered is not recognized, an error message will appear, and you will not be able to proceed. 3. TIN text field: enter your Taxpayer Identification Number (TIN), which is either your Employer Identification Number (EIN) or your Social Security Number (SSN). 4. CAPTCHA image: a computer-generated image. 5. Generate New Image? link: refreshes the image above if you are unsure of what numbers and letters are being displayed. 6. Enter the letters/numbers from the image above text field: enter the letters and/or numbers you see in the CAPTCHA image. This is a security feature. CO R&A Eligible Hospital User Guide 34

35 7. Continue button: select this button to the open the CO R&A. You will confirm your name and the address associated with your NPI and TIN. 8. Cancel and return to Login link: opens the Login page. Clicking the Continue button opens the next page where you confirm that the information the system has pulled up is you. The Create Account Confirmation page displays the following: 1. NPI display field: the NPI you entered on the Identify Yourself page. 2. TIN display field: the TIN entered on the Identify Yourself page. 3. Medicaid ID display field: the Medicaid ID associated with the NPI and TIN you entered. 4. Name display field: the name associated with the NPI and TIN you entered. 5. Address display field: the address associated with the NPI and TIN you entered. 6. Active display field: will display true if the NPI / TIN is active with the state Medicaid program and false if it is inactive. 7. No, Go back button: returns to the previous page. 8. Yes, Continue button: opens the next page to continue creating your account. CO R&A Eligible Hospital User Guide 35

36 All records that match the NPI or TIN will be displayed, including any records with an inactive status. Only those records with an active status can be used to create an account. If the information is not correct, select the No, Go back button to return to the previous page. From there, you can either retry entering your NPI and TIN or call the Help Desk for assistance. If the information is correct you need to select an active record and click the Yes, Continue button. The following section will appear on the page: 1. User ID text field: enter a User ID Number. This must be at least 8 letters and/or numbers long, but not more than 20 letters and numbers. 2. Password text field: enter a password. Your password also needs to be at least 8 letters and numbers long and must be less than 20 letters/numbers. When you are choosing a password, you also need to make sure to include the following: At least one capital letter At least one lower case letter At least one number At least one of the following special or # or! Your password cannot be your User ID or your User ID spelled backwards. 3. Confirm Password text field: enter the password you entered above to confirm it. 4. Select a Challenge Question pull-down menu: select an option from the pull-down menu as a Challenge Question to answer. 5. Your answer to the Question text field: enter an answer for the Challenge Question that you selected above. You ll need this information if ever forget your User ID or password. 6. Phone Number text field: enter your phone number as a ten-digit number, with no spaces, dashes, or parentheses. 7. Address text field: enter your address. 8. Confirm Address text field: enter your address again to ensure it was not misspelled. 9. Create Account button: select this button to save your account. If you left a required field blank or entered information incorrectly, you will receive an error message. 10. Cancel and return to Login link: select this button to cancel all the changes and return to the Login page. CO R&A Eligible Hospital User Guide 36

37 Once you click the Create Account button, you will be routed to the final page for creating an account. The final Create Account page displays the following: 1. Account successfully created display message: signifies that you have successfully created your CO R&A account. 2. Continue to Login button: opens the Login page. CO R&A Eligible Hospital User Guide 37

38 Accepting the End User License Agreement (EULA) After your first login to the system, you will be presented with the End User License Agreement (EULA). You must read and agree with the EULA in order to continue. The End User License Agreement page displays the following: 1. I Agree with the End User License Agreement checkbox: selecting this checkbox indicates that you agree with the associated statement. 2. Print EULA link: clicking this link will open a new window containing a printable version of the EULA. A Print window will also open. 3. Continue button: opens the CO R&A home page. 4. Cancel and return to Log in link: returns you to the Login page. Changing Your Password Your password will be good for 60 days. When you login and 60 days have passed since you created the previous password, a Reset Password page will appear. You can change your password on this page. 1. After 60 days, the Reset Password page displays: CO R&A Eligible Hospital User Guide 38

39 a. New Password text field: enter a new password. b. Confirm New Password text field: enter the password again. c. Save button: selecting this button saves your new password. d. Cancel button: clears entries made into the two text fields above, and no change is made to your password. 2. Voluntary Password Change: To change your password before the 60 days have passed, select the My Account link in the top right-hand corner of the CO R&A home page. In addition to changing your password, you can also update contact information or change your Challenge Question or answer on this page. The My Account page displays the following: a. User ID text field: displays your current User ID and allows you to change it. b. Password link: select the Click Here to Change link to open the Change Password page. Current Password text field: enter your current password in this field. New Password text field: enter a new password. Confirm New Password text field: enter the new password to confirm it in this field. Change Password button: click this to change the password and open the My Account page. Cancel and return to My Account link: opens the My Account page without making a change. c. Select a Challenge Question pull-down menu: select a new Challenge Question. d. Your Answer to the Challenge Question text field: if you select a new Challenge Question, enter a new answer to the Question. e. Phone text field: displays your current phone number and allows you to change it. f. Address text field: displays your current address and allows you to change it. g. Save My Account button: saves any updated information you entered on this page. h. Cancel and lose My Account changes link: clears the information you have entered. CO R&A Eligible Hospital User Guide 39

40 Navigating CO R&A Hard and Soft Stops Certain fields are required to be populated, like the Professional License Number field on the Step 1. About You page. Other fields are both required to be populated and checked against another system to ensure they are correct, such as the EHR Certification Number field on the EHR Certification page. The State decides whether required fields are hard or soft stops. Hard Stop: the system will not allow the user to proceed to the next step without populating the field, and having it validated correctly if necessary. The information on the page cannot be saved until the field is populated correctly. Soft Stop: the user may proceed and enter other information in the system, though the field is still required and must be completed before the user can proceed to Step 4. A warning message will be displayed on the page and an icon will be visible in the Navigation Menu. At Step 4, the Attestation Agreement is produced, and at this point all required fields must be completed before it can be generated. Save and Continue CO R&A pages that require data entry have a Save & Continue button. When this is selected, measures entered onto certain pages are validated. Only the Save & Continue button will validate that the information in required fields is correct and save the results to the database. Using any other kind of navigation the Back button on your browser or links in the Navigation Menu, for example will abandon the page and the entries will not be saved. CO R&A Eligible Hospital User Guide 40

41 Navigation Bar In the CO R&A, moving through the site is assisted by the use of a Navigation Menu on CO R&A pages, though it does not appear on the Home page. Only links to pages that are available to be accessed will be active in the Navigation Menu. Inactive links appear light gray in color, while active links are blue. Icons appear next to the page links that indicate the status of each page and section in CO R&A whether it is complete ( ), has generated an error notice ( ), or a required field or task was left undone ( ). Click the expend icon to view all the submenu items. Click the collapse icon to hide the submenu items. If the user elects to attest to the Meaningful Use of their EHR Technology solution, the MU Objectives and CQM (Clinical Quality Measures) page links will appear in the Navigation Menu. If the user attests to the Adoption, Implementation, or Upgrade (AIU) of the EHR Technology solution, the AIU Method and EHR Certification page links will appear. In the example above, the provider has completed Steps 1 and 2 and is now at Step 3. A required field has not been completed. A hard stop will prevent the page from being saved. Applying for the Incentive as an Eligible Hospital (EH) After you log in as an Eligible Hospital (EH) user and accept the EULA, the EH Home page will open. The home page serves as a dashboard and navigation tool for the CO R&A application. CO R&A Eligible Hospital User Guide 41

42 Home Page The CO R&A home page for EH displays the following: 1. CO R&A Banner section: Located at the top of the page, the banner displays the following items that are visible on every page of the CO R&A application: a. Colorado s HCPF logo. b. Colorado Registration & Attestation System: the name of the application. c. My Account link: opens the My Account page. d. Help link: displays a PDF copy of this User Manual. e. Contact Us link: a pop-up page displaying contact information, including the SLR Help Desk phone number and address. f. Logout link: allows you to log out of the CO R&A Web application. g. Filing as Eligible Hospital Representative message: designates your Provider Type. h. Hospital Name display field: the name of your Hospital. i. Hospital Street Address display field: your Hospital s street address. j. Hospital City, State and Zip Code display fields: the City, State and Zip Code of your Hospital. k. Last Updated: display field: displays the last person who updated your account and the date it was updated. 2. Next Steps section: Located to the left of the page, the Next Steps section displays messages an: a. Begin/Continue/Complete your Year X submission! message: displays the year of attestation you are currently completing. b. Section link: communicates the next page in the process that must be completed. c. CMS Message display field: this will display Data has been received from the CMS Medicaid EHR Incentive Program Registration site, which indicates whether the CO R&A application has received data from CMS. View CMS Medicaid EHR Incentive Program Registration Data link: opens a pop-up window that displays your CMS record. CO R&A Eligible Hospital User Guide 42

43 3. Payment Information section: located on the left of the home page, the Payment Information section displays the following items that are visible on the home page: a. How your payment is calculated message: opens a pop-up window that explains how your payment is going to be calculated. b. Payment Status message: allows you to check on the status of your payment once your attestation has been submitted. 4. Reports section: Located to the left of the home page, the Reports section displays the following items: a. Reports message: you will see the following message when you don t have any data in the system to run a report on: Reports will be available once your information is saved. b. Report Titles: the titles of available reports will appear here. For example, the Registration and Attestation Summary Report link will appear after you have saved at least some information in the CO R&A Web application. Clicking this link opens a pop-up window displaying the report. 5. Messages sections: Located to the left side of the home page, the Messages sections displays the following items: a. Audit section: provides access to Audit messages. # display field: indicates the number of unread messages that you have. b. System Messages section: provides access to System messages. # display field: indicates the number of unread messages that you have. c. Appeals section: provides access to Appeals messages. # display field: indicates the number of unread messages that you have. 6. Workflow section (Detailed further below): located to the right of the page, the Workflow section displays the following items that are visible on the home page: CO R&A Eligible Hospital User Guide 43

44 a. Year [x] tabs: each tab represents a year in which you have completed an attestation. The most current year s tab will always be the one visible when you log in. Click other tabs to view previous year information. b. Sections: each section has a Status icon (,,, ) that indicates whether the each page has been started, whether the page has been completed, or whether it is still locked. A locked page cannot be accessed until the previous page has been completed. Each section will also have a description. The title of each section provides a link to that section. About You. Confirm CO Medicaid Eligibility. Attestation of EHR. This link will not be active until you ve already completed your registration and eligibility. Review and Sign Agreement. This link will not be active until you ve completed your attestation of EHR. Send Year X Attestation. This link will not be active until you ve reviewed, signed and uploaded your signed attestation agreement. Once you hit submit, all of the other sections will be locked for editing and will display your information as view-only. 7. Footer section: Located at the bottom of the page, the footer displays the following items: a. Privacy link: clicking this link opens a new window with a Privacy policy displayed. b. Terms of Use link: clicking this link opens a new window with a Legal Statement displayed. c. Accessibility link: clicking this link opens a new window with the website s Accessibility policy displayed. d. Xerox Copyright. This is Xerox s copyright symbol and text. CO R&A Eligible Hospital User Guide 44

45 Workflow Section Details This section describes in more detail the specific steps to take when applying for the Provider incentive. This begins with Step 1, the About You section, where you will enter your registration and contact information. Step 1: About You Section Clicking the About You link on the EP Home page directs you to the 1. About You page, allowing you to enter your registration information. The About You page displays the following: 1. < Back to Dashboard link: returns you to the Home page. 2. CMS Medicaid EHR Incentive Program Registration Record section: Please note that it can take up to three days for the CO R&A to receive data from CMS. a. Data has not been received from the CMS Medicaid EHR Incentive Program Registration site. message: this message appears if your data has not been received by the CO R&A. b. Data has been received from the CMS Medicaid EHR Incentive Program Registration site. message: this message appears if the CO R&A has received your CMS data. c. View CMS Medicaid EHR Incentive Program Registration Data link: this link is visible if your CMS data has been received. Clicking the link opens a pop-up window that displays the CMS data. If you need to make a change to your CMS data, you must make updates on the CMS site. You cannot make changes to your CMS data through CO R&A, and it takes between two and three days for changes at the CMS level to be applied to CO R&A. d. Visit CMS website link: opens the CMS website. The link is visible whether or not your data has been received. 3. Contact Person: This section allows you to enter an additional contact besides the one listed as the Eligible Hospital User. a. Contact Person Name text field: enter the name of the contact. b. Title text field: enter the title of the individual. c. Phone Number text field: enter the phone number as ten digits, with no spaces, dashes, or parentheses. d. Address text field: enter the contact s address. Initially this defaults to the address that was entered when the User Account was first created. CO R&A Eligible Hospital User Guide 45

46 4. Attach Documentation section: allows you to add a Board Certification file, though this is optional. 5. Save & Continue button: saves the information you entered. If you have left a required field blank or entered information incorrectly, an error message will appear. Once all required fields are completed, this section will be marked as complete. The 2. Confirm CO Medicaid Eligibility page will open. 6. Cancel and lose About You changes link: clears the page of any information you have just entered and returns you to the Home page. After completing this information, you can proceed to your eligibility information by selecting the Save & Continue button. The status icon on your home page will change to indicate that your registration section is complete. The green background of the first section and the icon indicate that this section has been completed. After completing this information, you can proceed to completing your eligibility information by returning to the dashboard and selecting the next step. The status icon on your home page will change to indicate that your registration section is complete. CO R&A Eligible Hospital User Guide 46

47 Step 2: Confirm CO Medicaid Eligibility Details Clicking the Confirm CO Medicaid Eligibility link on the EH home page opens the Confirm CO Medicaid Eligibility page, which allows you to enter your Hospital s eligibility information. The Confirm Medicaid Eligibility page displays the following: 1. < Back to Dashboard link: clicking this link will return you to the Home page. 2. Print Registration Attestation link: opens a PDF document containing all the information you have entered for the Hospital so far in the CO R&A process. 3. Medicaid Volume section: a. Eligibility Completion status icon: indicates whether your eligibility information is complete or if there is still some missing information on the page. b. Enter Representative Period pull-down menu: select the appropriate period for patient volumes used in determining the eligibility of the Hospital. c. Year {x} Start Date field: enter the date of the first day of your representative period. The system will automatically display the end date. Calendar icon: opens a Calendar Utility from which you can click on a date to select it. d. Year {x} End Date display field: the end date of the 90-day representative period based on the start date you entered. If you had selected Other Period from the Enter Representative Period pull-down menu, the end date will be editable. Calendar icon: opens a Calendar Utility from which you can click on a date to select it. e. Total Discharges for Representative Period field: enter your total Discharges for the representative period you noted above. f. CO Medicaid Discharges for Representative Period field: enter your Medicaid Discharges for the representative period you noted above. g. Do you have Medicaid Patients in more than one State? radio buttons: identify whether or not you practice in more than one state. When you select the Yes radio button, you must answer the question Do you want your volumes for all states to be used to determine eligibility? If the answer to this question is also Yes, a table will appear allowing you to enter encounters per state. h. Do you want your volumes for all states to be used to determine eligibility? radio buttons: identify whether or not you want to use the other states volumes to determine your eligibility. If you chose the Yes radio button, the Add a State component will appear. i. Select the Add a State button: to add another row to the table State pull-down column: select a State to enter the encounter information for that State. CO R&A Eligible Hospital User Guide 47

48 Total Encounters column: enter the encounters for the State and selected time period. Total Medicaid Encounters column Total Panel Members column Total Medicaid Panel Members column Insert link: adds the numbers to the multi-state table. Cancel link: cancels the operation. Remove link. This will remove the associated row. Select the Add a State button to add another row to the table. j. Total Discharges for a full Fiscal year field: enter total patient discharges for the previous fiscal year. k. Total Patient Bed Days for a full Fiscal year field: enter total number of bed days for all patients in the previous fiscal year. l. Average Length of Stay display field: the Average Length of Stay for the year of the hospital cost report. Calculate button: calculates the results of Medicaid Volume. The calculated results will be displayed. Display field: This is where the calculated result is displayed. m. Medicaid Volume section: this formula uses the Total Discharges and Medicaid Discharges to calculate your result. Calculate button: calculates the results of Medicaid Volume. The calculated results will be displayed. Display field: This is where the calculated result is displayed. n. Meets Medicaid Eligibility Requirements message: appears if the Calculate button next to the Medicaid Volume display field is selected. It indicates whether you have met the requirements for eligibility. Yes! Meets Medicaid Eligibility Requirements. will display if your hospital meets the following criteria: Your hospital is a Children s Hospital Your hospital s Medicaid volume is greater than 10% with an average length of stay less than or equal to 25 days and the last four digits of your CCN are between through 0879 or 1300 through 1399 No - you may wish to adjust your representative period This message displays when the information entered does not meet the minimum criteria for hospital eligibility. Acute Care and Critical Access Hospitals (CAH) must have Medicaid discharges of at least 10%, an average Length of Stay (LOS) of 25 days or less, and a CCN that ends in or to be eligible to receive an incentive payment. Children s Hospitals with a CCN that ends in are automatically eligible. CO R&A Eligible Hospital User Guide 48

49 4. Hospital Demographics Information section: Each of the following fields (or group of fields) has explanatory help text in blue beneath the field, and a more info link to help identify what the field is capturing. a. Enter the year for the current cost report field. b. Enter the Discharges for the last four years of available data fields: enter discharges for the last four years in the Year {x-4} through Year {x} fields. c. Enter the Total Discharges from the Year {x} cost report field. d. Enter the Total Medicaid Inpatient Bed Days from the Year {x} cost report field. e. Enter the Total Medicaid Managed Care Inpatient Bed Days from the Year {x} cost report field. f. Enter the Total Inpatient Bed Days from the Year {x} cost report field. g. Enter the Total hospital charges from the Year {x} cost report field. h. Enter the Total charges attributable to Charity Care from the Year {x} cost report field. 5. Attach Documentation section: Colorado requires 4 Years Cost Report Data. 6. Save & Continue button: saves the information you have just entered and opens the next page in the CO R&A process. If you have left required field blank or entered information incorrectly, you will receive an error message. 7. Cancel and lose Medicaid Eligibility changes link: opens the EH Home page, saving none of the changes made to fields on the confirm CO Medicaid Eligibility page. CO R&A Eligible Hospital User Guide 49

50 Step 3: Attestation of EHR Details EHs may either attest that they have adopted, implemented, or upgraded EHR software, or that they are actively using it in meaningful ways. AIU can only be selected in the first year and is a much easier attestation. Clicking the Attestation of EHR link on the EH Home page directs you to the 3. Attestation of EHR page. This lets you select Adopt, Implement, Upgrade (AIU) or Meaningful Use (MU) for your Attestation Type. Once you have selected the Attestation Type, you will then be able to upload documents related to your EHR Software, enter its certification number, and enter other information. CO R&A Eligible Hospital User Guide 50

51 Attestation of EHR. The first step of completing this section is to choose the type of attestation. You will be able to access this section once the About You and Confirm CO Medicaid Eligibility pages are completed. This page displays the following: 1. Attest to Adopt, Implement, Upgrade button: opens the AIU workflow. This option is available only in your first year of participating. This section contains three pages: the AIU Method page and the EHR Certification page in addition to the Attestation of EHR page. 2. Attest to Meaningful Use button: opens the MU workflow. This section contains sections: Meaningful Use Objectives and Clinical Quality Measures. Each of these sections contains detail pages. AIU Method Page Once the Attest to Adopt, Implement, Upgrade button is selected, two new navigation options appear in the Navigation Menu: AIU Method and EHR Certification. The AIU Method page is opened. This page allows you to choose the method of your AIU attestation and provide any supporting details for that choice. 1. More info link: opens a PDF document titled Attestation of AIU that explains how documentation would be attached for the selected attestation method. 2. AIU Method pull-down menu: select Adopt, Implement, or Upgrade from the menu to best describe your EHR Technology use at this point. 3. More info link: opens a pop-up window explaining the type of documentation that needs to be attached for the selected attestation method. 4. Please describe briefly how you meet text area: allows you to describe how you meet the criteria for the AIU method selected. 5. Attach Documentation section: Colorado requires a fully executed contract/license agreement with an EHR Vendor to be attached to the page. A contract can also be added. 6. Save & Continue button: selecting this will open the EHR Certification page after CO R&A ensures that all fields on this page are populated. CO R&A Eligible Hospital User Guide 51

52 EHR Certification Page This page allows you to identify your EHR Technology and attach supporting documentation. It appears for both AIU and MU 1. Understanding checkbox: signifies that you agree with the statement of understanding next to the checkbox. When you check this box, additional fields display. If you do not check this box, the system will not allow you to continue. a. I understand that it is my responsibility, as the provider, to ensure This is a statement of understanding as to your responsibility to demonstrate that your EHR technology is certified through the ONC. When you check the box before this statement, you will be required to complete the other field on the page. If you do not check the box before this statement, the system will not allow you to continue. b. ONC public web service link: opens the Office of the National Coordinator for Health Information Technology s Certified Health IT Product List site. The page also includes instructions to access the ONC website, find software, and retrieve an EHR Certification Number ( Once this number is entered into the EHR Certification Number field and the Save & Continue button is clicked, CO R&A will validate that the number represents approved software. CO R&A Eligible Hospital User Guide 52

53 2. Your EHR Certification Information section: When you select the EHR Certification option in the Navigation Menu, the CMS EHR Certification ID field may already be populated, containing a certification number entered for the previous year s Attestation. Otherwise you will have to enter the correct number. If your hospital has changed its software since that time, look up and enter the correct number. 3. Save & Continue button: saves the information you have just entered. If you have left a required field blank or entered information incorrectly, you will receive an error message. Once you have successfully saved the information on all pages within the AIU Attestation of EHR, the status icon on your home page will change to indicate that your Attestation of EHR section is complete. The system will now allow you move onto Step 4. CO R&A Eligible Hospital User Guide 53

54 Meaningful Use Section To attest for Meaningful Use (MU), Hospitals will enter data that has been captured by their EHR Software. A report within your EHR system should be available to help you enter the correct information in the MU fields. In the provider s second participation year, clicking the 3. Attestation of EHR link shall open the EHR Certification page directly, as the user has the option to adopt, implement, or upgrade their software in the first year of participation only. Starting with the 2014 meaningful use reporting period all EHs and CAHs need to upgrade to 2014 Edition EHR technology regardless of the meaningful use stage they need to meet. Providers may elect to enter Meaningful Use data during their first year of Attestation, but are required to enter MU information during each year after their first year. The first year of MU is Stage 1, and fields are grouped into a series of Objectives and Clinical Quality Measures. Stage 2 of the Meaningful Use program begins in 2014, and this will require more fields to be populated and data to be captured. When providers attest for MU, they will enter the data captured by their software for a specified time period 90 days for their first MU year, and a full year of data thereafter. The 2014 Edition EHR certification criteria support both revised MU Stage 1 and new Stage 2 requirements. They also include important updates that set new baselines for better interoperability, electronic health information exchange, and patient engagement. EHR technology certified to the 2011 Edition will no longer be acceptable for the purposes of meeting the Certified EHR Technology definition and from a regulatory perspective 2011 Edition certifications will expire during the 2014 MU reporting period. Beginning in 2015, all providers will address the same Meaningful Use Questionnaire during the online Attestation process. All Meaningful Use Objectives and Measures support Modified Stage 2 criteria. However, if you are planning to demonstrate Stage 1 (Meaningful Use yr 1 or Meaningful Use yr 2) in 2015, there are Alternate Measure Exclusions and Alternate Measure Responses available to you. Note: In order to qualify for the EHR Incentive payment, 80% of patients must have records in the EHR solution. In addition to pages that capture Meaningful Use information, there are two pages that capture information that is fundamental to Meaningful Use and for the Attestation for the EHR Incentive payment. CO R&A Eligible Hospital User Guide 54

55 1. EHR Certification page. The EHR Certification page in the Meaningful Use section is identical to the EHR Certification page in the AIU section except that it also contains a Supporting Documentation section. This allows the user to attach a file if needed. Select the Provider Understands Responsibility checkbox to accept responsibility for finding and entering the correct EHR Certification Number into the previous page. A link to the Office of the National Coordinator for Health IT (ONC) website is provided. 2. EHR Reporting Period page. The 2015 MU reporting period for both Stage 1 and Stage 2 performance is set to any continuous 90-day or 3-month reporting period during : Eligible hospitals and CAHs may select an EHR reporting period of any continuous 90 day period from October 1, 2014 to December 31, This page contains a checkbox and EHR Reporting Period fields. The Start Date field and End Date fields have an icon that will open a Calendar Utility that allows a user to select a date rather than enter it into the field. 3. Meaningful Use Import. This page allows providers to import Objective data. Data imported in this manner will display on the individual Objective detail pages as read only data. All validations performed on individual pages will be enforced and the appropriate visual indicators will be displayed in the navigation tree. Click the MU Import Control Document link to open technical specifications for the Import file. Note: the import function will import all records in the file or none of the records if an error occurs with the import. If all required data is not populated for the Individual objective then you will be required to manually enter and save. 4. Navigation Menu. The left-hand Navigation Menu will contain page titles that serve as links associated with the MU pages that must be completed. The majority of MU pages are collected in two groups. Clicking the name of a subgroup or clicking the expand icon will reveal all the pages in the subgroup, all of which must be completed by the user. CO R&A Eligible Hospital User Guide 55

56 5. Once all the pages in a navigation group have been completed, and all have passed their validation criteria, then the user will receive a completed icon ( ). Clicking the collapse icon ( ) will hide the title of the individual pages in a subgroup. 6. Detail Pages. Each measure includes a Detail page. For Program Year 2015, users cannot select as all Objectives are required. Each Objective within a group also includes a Detail page where users will record the applicable data. Select the Save & Continue button on each Detail page to save the data and move on to the next measure requiring input, or the next Detail page. All Detail pages include an Attach Documentation section so that users can associate a document that is relevant to the measure if desired. CO R&A Eligible Hospital User Guide 56

57 7. Exclusions. For 2015, CMS has permitted alternate exclusions for some objectives. To account for this, measures of this nature include Exclusion Yes and No radio buttons. The measure s data field will appear if the Exclusion does not apply. CO R&A Eligible Hospital User Guide 57

58 8. MU Objectives. Objectives measure how much of a provider s patient population has been entered into the EHR software for certain reasons. If the user selects the Save & Continue button with all fields completed on a page and the result fails the criteria set, a failed icon will appear. If even one Objective fails to meet its minimum criteria, the Attestation will fail. Providers must enter all Objectives and these are listed in the Navigation Menu when the MU Attestation Type is selected. Objectives generally consist of an acknowledgement that you have met the obligations, or a Numerator and a Denominator. For example, for the Objective Electronic Prescribing the user would enter: Numerator= The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically. Denominator = Number of new or changed prescriptions written for drugs requiring a prescription in order to be dispenced for patients discharged during the EHR reporting period. Objectives also have a measure validation: if the result of the Numerator divided by the Denominator and rendered as a percentage does not exceed the percentage stated in the Measure field on each Detail page, the measure is failed. 9. Clinical Quality Measures Import. This page allows providers to import CQM data in the same way the associated page allowed the import of Objective data. Data imported in this manner will display on the individual CQM Detail pages as read only data. Validation performed on individual pages will be enforced and the appropriate visual indicators will be displayed in the navigation tree. CO R&A Eligible Hospital User Guide 58

59 10. Clinical Quality Measures. Clinical Quality Measures, or CQMs, capture information about patient treatments and diagnoses instead of information about the number of patients in the EHR. There are no passing percentages, as these pages are simply intended to capture information about patients. If the participating hospital has seen no patients to which one of these CQMs would apply, you will enter 0 in the Denominator field of that page s Detail page. 11. Dually Eligible Hospitals. Some Hospitals, called Dually Eligible Hospitals, qualify for both Medicare and Medicaid incentive payments. Those hospitals that have already submitted and passed Meaningful Use measurements for Medicare automatically meet Meaningful Use obligations for the Medicaid program. CMS will send the SLR system a file called the C5, which will contain data that will automatically populate the SLR with the data entered into the Medicare EHR Incentive Program Registration and Attestation System. All pages will then be read-only for the SLR EH user with exception of any SLR additional info needed that was not in the C5 file. CO R&A Eligible Hospital User Guide 59

60 Clinical Quality Measures have been renumbered, as the NQF references are no longer used. The list of CQMs for Eligible Hospitals is in the table below. emeasure ID Title Description CMS100 AM-2-Aspririn Prescribed at Discharge for AMI hospital discharge. CMS188 CMS53 CMS60 CMS26 CMS108 CMS190 PN-6 Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients AMI-8a- Primary PCI Received Within 90 Minutes of Hospital Arrival AMI-7a- Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver Venous Thromboembolism (VTE)01 VTE prophylaxis VTE-2 Intensive Care Unit (ICU) VTE prophylaxis Acute myocardial infarction (AMI) patients who are prescribed aspirin at Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines. Acute Myocardial Infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival of PCI of 90 minutes or less. Acute Myocardial Infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay with a time from hospital arrival of fibrinolysis of 30 minutes or less. An assessment that there is documentation in the medical record that a Home Management Plan of Care (KMPC) document was given to the pediatric asthma patient/caregiver. This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission. This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission or transfer. Domain Clinical Process/Effectiveness Efficient Use of Healthcare Resources Clinical Process/Effectiveness Clinical Process/Effectiveness Patient and Family Engagement Patient Safety Patient Safety CMS73 VTE-3 VTE Patients This measure assesses the number Clinical CO R&A Eligible Hospital User Guide 60

61 CMS109 CMS110 CMS114 CMS104 CMS71 CMS91 with Anticoagulation Overlap Therapy VTE-4 VTE Patients Receiving Unfractionated Heparin (UFH) with Dosages/Platelet Count Monitoring by Protocol (or Nomogram) VTE-5 discharge instructions VTE-6 Incidence of potentially preventable VTE Stroke-2 Ischemic Stroke Discharged on anti-thrombotic therapy Stroke-3 Ischemic Stroke Anticoagulation Therapy for Atrial Fibrillation/Flutter Stroke-4 Ischemic Stroke Thrombolytic Therapy of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they must be discharged on both medications or have a reason for discontinuation of overlap therapy. Overlap therapy must be administered for at least five days with an international normalized ratio (INR) greater than or equal to 2 prior to discontinuation of the parenteral anticoagulation therapy, discharged on both medications or have a reason for discontinuation of overlap therapy. This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their plately counts monitored using defined parameters such as a nomogram or protocol. This measure assesses the number of patients diagnosed with confirmed VTE that are discharged to home, home care, court/law enforcement, or home on hospice care on warfarin with written discharge instructions that address all four criteria: compliance issues, dietary advice, follow-up monitoring, and information about the potential for adverse drug reactions/interactions. This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization ( not present at admission) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date. Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge. Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge. Acute ischemic stroke patients who arrive at this hospital within 2 hours (120 minutes) of time last known well Process/Effectiveness Clinical Process/Effectiveness Patient and Family Engagement Patient Safety Clinical Process/Effectiveness Clinical Process/Effectiveness Clinical Process/Effectiveness CO R&A Eligible Hospital User Guide 61

62 CMS72 CMS105 CMS107 CMS102 CMS178 CMS113 CMS9 CMS55 CMS32 Stroke-5 Ischemic Stroke antithrombotic therapy by end of hospital day two Stroke-6 Ischemic Stroke Discharged on Statin Medication Stroke-8 Ischemic or hemorrhagic stroke Stroke education Stroke-10 Ischemic or hemorrhagic stroke Assessed for Rehabilitation SCIP-INF-9 Urinary catheter removed on Postoperative Day 1 (POD1) or Postoperative Day 2 (POD2) with day of surgery being day zero PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation Exclusive Breast Milk Feeding Emergency Department (ED)-1 Emergency Department Throughput Median time from ED arrival to ED departure for admitted ED patients ED-3 Median time from ED arrival to ED departure for discharged ED patients and for whom IV t-pa was initiated at this hospital within 3 hours (180 minutes) of time last known well. Ischemic stroke patients administered antithrombotic therapy by the end of hospital day two. Ischemic stroke patients with LDL greater than or equal to 100 mg/dl, or LDL not measured, or, who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge. Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services. Surgical patients with urinary catheter removed on Postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero Patients with elective vaginal deliveries or elective cesarean sections at >= 37 and < 39 weeks of gestation completed. Exclusive breast milk feeding during the newborn s entire hospitalization. Median time from emergency department arrival to time of departure from the emergency room for patients admitted to the facility from the emergency department. Median time from emergency department arrival to time of departure from the emergency from for patients discharged from the emergency department. Clinical Process/Effectiveness Clinical Process/Effectiveness Patient and Family Engagement Care Coordination Patient Safety Clinical Process/Effectiveness Clinical Process/Effectiveness Patient and Family Engagement Care Coordination CMS111 ED-2 Emergency Median time from admit decision time Patient and Family CO R&A Eligible Hospital User Guide 62

63 CMS171 CMS172 CMS30 Department Throughput admitted patients Admit decision time to ED departure time for admitted patients SCIP-INF-1 Prophylactic Antibiotic Received within 1 Hour Prior to Surgical Incision SCIP-INF-2 Prophylactic Antibiotic Selection for Surgical Patients AMI-10 Statin Prescribed at to time of departure from the emergency room for patients admitted inpatient status. Surgical patients with prophylactic antibiotics initiated within.one hour prior to surgical incision. Patients who received Vancomycin or a Fluoroquinolone for prophylactic antibiotics should have the antibiotics initiated within 2 hours prior to surgical incision. Due to the longer infusion time required for Vancomycin or a Fluorquinolone, it is acceptable to start these antibiotics within 2 hours prior to incision time. Surgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure). Acute Myocardial infarction (AMI) patients who are prescribed a statin at hospital discharge. Discharge CMS185 Healthy Term Newborn Percent of term singleton live births (excluding those with diagnoses originating in the fetal period) who DO NOT have significant complications during birth or in nursery care. CMS31 EHDI-1a Hearing screening prior to hospital discharge This measure assesses the proportion of births that have been screened for hearing loss before hospital discharge. Engagement Patient Safety Clinical Process/Effectiveness Clinical Process/Effectiveness Patient Safety Clinical Process/Effectiveness Step 4: Review and Sign Attestation Details Clicking the Review and Sign Attestation link on the EH Home page directs you to the 4. Review and Sign Agreement page. This is where you will review the attestation agreement. Once you have had a chance to review it, you must print it out in order to sign it. Once signed, the agreement must be scanned and then uploaded into the CO R&A. The Review and Sign Attestation page displays the following: 1. The Step 1: Print to Sign Attestation section contains the Print to Sign button. When selected, this will print a copy of the Attestation Agreement. 2. The Step 2: Scan and Upload Signed Attestation section contains an Attach Documentation component that will allow you to upload the Attestation Agreement. You have the ability to remove and attach different files until you submit your final attestation. Colorado requires a Direct Deposit Form in addition to the Attestation. 3. Save & Continue button: saves the information you have entered on this page and opens the Home page. CO R&A Eligible Hospital User Guide 63

64 4. Cancel and lose Review changes link: clears the page of any information you have just entered and opens the Home page. Once you have successfully saved the signed attestation, the status icon on your home page will change to indicate that Step 4 is complete. The system will now let you move onto Step 5. Step 5: Send Year X Attestation Details Clicking the Send Year X Attestation link opens a pop-up window allowing you to send your Hospital s attestation agreement to the State. The Send Attestation to State window displays the following: 1. Send Attestation button: clicking this will submit your attestation agreement to the State. All steps in the workflow section of your home page will be locked down after this is done. You will not be able to make any more changes to the section, but can still view the information you entered on a report. The Send Attestation to State window will appear displaying the expected time period for payment and other payment-related information. 2. Cancel and Do No Send link: returns you to the Home page. After sending the agreement, a System Message will arrive that designates the time and date. CO R&A Eligible Hospital User Guide 64

65 Accessing Reports Reports for Eligible Hospitals Located to the left of the page, the Reports section displays the following items: 1. Reports message: the following message appears if you don t have any data in the system to run a report: Reports will be available once your information is saved. 2. Registration and Attestation Summary Report link: some information has been saved to the CO R&A web application, this link appears. Clicking this link opens a pop-up window with the Registration and Attestation Summary report results. This report prints all of the Attestation information that you have already entered. The Registration and Attestation Summary report displays the following: a. Identifying Information section: displays the information entered when the CO R&A account was created, including NPI, TIN, Phone Number, and Address. b. Filing Information section: displays the EHR Incentive application information, such as user type, program year, and payment year. c. Contact Person section: the name, phone number, and of the EH s contact. d. Confirmation of Eligibility section: displays the information saved when you completed the Confirmation of Eligibility section. e. Summary of Meaningful Use sections: These three sections list your Hospital s Objective and Clinical Quality Measure data. You can print this report after you have saved any of your information in the CO R&A Web application. If you print the report before all of the areas have been completed, only those sections with saved information will print on the report. You can also filter the report by year. View Payment Information Payment Calculations for Eligible Hospitals Located to the left of the page, the Payment Information section displays the following items that are visible on the home page: 1. How your payment is calculated link: opens a window that explains in detail how your payment is going to be calculated, including the per-discharge amount and the patient volumes entered for your Hospital. a. < Back to Dashboard link: returns you to the home page. CO R&A Eligible Hospital User Guide 65

66 b. How Your Payment is Calculated page. c. States may pay hospitals up to 100 percent a detailed explanation as to how your payment will be paid. d. Information icons: click one of the small i icon to open a pop-up window containing information or instructions on the associated field. Clicking the information icon beneath the Year 4 cell opens this help window: e. Initial Amount section. Annual discharges w/growth factor row: displays the discharges with growth factors applied to Year 2 through 4. Year 1: total discharges up to 23,000. Year 2: Year 1 amount plus the average annual growth rate (+1%) up to 23,000. Year 3: Year 2 amount plus the average annual growth rate (+1%) up to 23,000. Year 4: Year 3 amount plus the average annual growth rate (+1%) up to 23,000. Disallowed discharges row: displays the discharges that are not allowed as part of the calculation. Metric: the per discharge amount is calculated based on the 1150 th 23,000 th discharge. Year 1: the disallowed discharges for year 1. Year 2: the disallowed discharges for year 2. Year 3: the disallowed discharges for year 3. Year 4: the disallowed discharges for year 4. Allowable discharges row: displays discharges that are allowed as part of the calculation. Metric: Year {X} Annual Discharges with growth factor 1149, with a maximum of 23,000 allowable. Year 1: the allowed discharges for year 1. Year 2: the allowed discharges for year 2. CO R&A Eligible Hospital User Guide 66

67 Year 3: the allowed discharges for year 3. Year 4: the allowed discharges for year 4. Per Discharge Amount row: displays the amounts per discharge, currently $200 for all hospitals. Metric: the per discharge amount is $200 for all hospitals. Year 1: $200. Year 2: $200. Year 3: $200. Year 4: $200. Discharge Related Amount row: displays the amounts calculated on the allowable discharges. Metric: Year {X} Allowable Discharges X Per Discharge, which is $200. Year 1: the sum of allowed discharges for year 1 multiplied by $200. Year 2: the sum of allowed discharges for year 2 multiplied by $200. Year 3: the sum of allowed discharges for year 3 multiplied by $200. Year 4: the sum of allowed discharges for year 4 multiplied by $200. Base Amount row: displays the base amount for all hospitals, which is $2,000,000. Metric: the base amount is $2,000,000 for all hospitals. Year 1: $2,000,000. Year 2: $2,000,000. Year 3: $2,000,000. Year 4: $2,000,000. Gross Amount row: displays the sum of the base amount for all hospitals plus the discharge related amount. Metric: Year {X} Discharge Related Amount plus Base Amount of $2,000,000. Year 1: the gross amount for year 1. Year 2: the gross amount for year 2. Year 3: the gross amount for year 3. Year 4: the gross amount for year 4. Transition Factor row: displays the transition factor applied for each year. Metric: the transition factor is reduced each year. CO R&A Eligible Hospital User Guide 67

68 Year 1: Displays the transition factor of 1. Year 2: Displays the transition factor of Year 3: Displays the transition factor of Year 4: Displays the transition factor of Annual EHR Amount row: displays the sum of the year s gross amount multiplied by the transition factor. Metric: Year {X} Gross Amount X Transition Factor Year 1: the annual EHR amount for year 1. Year 2: the annual EHR amount for year 2. Year 3: the annual EHR amount for year 3. Year 4: the annual EHR amount for year 4. Overall EHR Amount row: displays the sum your EHR amounts for all four years. f. Medicaid Share section. Medicaid Inpatient Bed Days field: displays the Medicaid inpatient bed days that entered on the Confirm Eligibility page. Medicaid Managed Care Inpatient Bed Days field: displays the Medicaid Managed Care inpatient bed days that entered on the Confirm Eligibility page. Numerator field: displays the sum of the two previous fields: Medicaid Inpatient Bed Days + Medicaid Managed Care Inpatient Days. Total Inpatient Bed Days field: displays the inpatient bed days that you entered on the Confirm Eligibility page. Total Charges field: displays the total charges you entered on the Confirm Eligibility page. Total Charity Care Charges field: displays the total charges that you attributed to charity care on the Confirm Eligibility page. Denominator field: displays the results of Total Inpatient Bed Days x ((Total Charges - Total Charity Care Charges) / Total Charges. Medicaid Share field: displays the results of (Medicaid Inpatient Bed Days + Medicaid Managed Care Inpatient Bed Days) / (Total Inpatient Bed Days x ((Total Charges - Total Charity Care Charges) / Total Charges)). g. Aggregate EHR Amount section. The Aggregate EHR amount is the Overall EHR Amount x Medicaid Share. If a Recoupment or Adjustment has been made to this Payment Year s Attestation, that information will be reflected here as well. CO R&A Eligible Hospital User Guide 68

69 Appeals, Adjustments and Recoupments Appeals EH Providers are able to appeal a rejection of their Attestation or other decisions made by the State. The rules and details are specified by the State of Colorado, and will follow guidelines established by CMS. All communications and the progression of each Appeal will be handled by State representatives. Adjustments An Adjustment in SLR is an official change in the payment amount of a provider s EHR Incentive payment. Hospitals will likely have several adjustments. Each time a Hospital s final payment is changed, several of the Payment Years are likely to change. For example, a 2012 Cost Report establishes the payment that will be made to a Hospital. The 2013 Cost Report causes the provider to submit revised data, and this changes the overall payment amount. Recoupments A Recoupment is a return to the State of the full amount paid to the provider for a Payment Year. This will usually be the result of Audit showing a mistake in the Medicaid claims percentage. As with Appeals and Adjustments, State representatives will handle the communication with providers regarding all Recoupments. Attaching Files The Attach Documentation Section Attach Documentation sections are available in several pages of the CO R&A. These identify documents that must be attached like a Cost Report, Software Sales contract, and the Attestation Agreement itself and identify documents that are optional. CO R&A Eligible Hospital User Guide 69

70 A table lists those attachments that have already been added to the section in three columns: 1. Filename column: the name of the uploaded file. Selecting the filename will open the file for viewing, provided your PC has an application that can open the file. 2. Subject column: the subject of the uploaded file selected by the user when the file was attached. 3. Selecting a checkbox in the unnamed column and clicking the Remove Selected button will remove the file from the list and delete the file from CO R&A. Clicking the Add Files button opens the Add Files pop-up window. 1. Close icon: clicking the blue X in the upper right-hand corner closes the Add Files window without attaching a file. 2. Subject pull-down menu: select an option to identify what type of document or documents you are attaching. These will be restricted to subjects that are appropriate for the section of CO R&A you are viewing. 3. File text field: the file name will display once it is selected. 4. Select button: allows you to select the file you would like to attach from a local drive. 5. Add button: adds another File field and Select button to allow the user to attach another file. The file will be added under the same subject as the file above it. 6. Remove icon: clicking this removes file reference from the window. It will not be imported. 7. Attach button: adds the document or documents that were selected. 8. File(s) Attached {X} message: allows you to know the number of files currently attached for this specific page. Up to 10 files of up to 10 MB apiece can be added to the Attach Documentation component of each section. CO R&A Eligible Hospital User Guide 70

71 Timing Out CO R&A pages have a session timeout occur at 9 minutes and 30 seconds. If no field has been modified or a page accessed during that time, a pop-up window shall appear asking if you wish to log out or continue to use CO R&A. The pop-up window itself will disappear in 30 seconds if no action is taken. Troubleshooting Accessing Help For general Help, all CO R&A web pages have a Help Link that opens up a copy of this User Manual. For CO R&A Web application assistance, you can contact the SLR Help Desk designated to support the CO R&A. Phone: (866) SLRHelpdesk@xerox.com Help Text Displays Located throughout the CO R&A Web application, there are tool tips, help text, and more info links that should help to complete the pages. 1. Tool Tips: A tool tip is text that displays when you hover your mouse over an area on the page. 2. The more info link of this field opens the following help window: CO R&A Eligible Hospital User Guide 71