MUforBH & Qualifacts Presents: Understanding A/I/U


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By now you are very aware that Behavioral Health Providers (psychiatrists, D.O.'s, APRNS, etc) are participating in and successfully collecting the Meaningful Use incentive dollars. Year 1 of the Medicaid EHR Incentive payments alone are $21,250 per eligible provider! But how do you get started? It’s all so overwhelming!

*Exactly what is “patient volume"?
*Do I have to be using the certified EHR in order to participate?
*Is there anything I can do to prepare NOW while I am still looking for the right EHR?

If you have these questions or any others about how to take advantage of the Medicaid EHR Incentive program, be sure and watch this one-hour webinar. Mary Givens, Meaningful Use Program Manager, and her team will also be available to follow up with you about the rules in your state if you want to take advantage of some additional 1-on-1 help with the process of participating in the Medicaid EHR Incentive program.

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MUforBH & Qualifacts Presents: Understanding A/I/U

  1. 1. Presents:The Medicaid EHR Incentive Program for BehavioralHealth Eligible Professionals: Understanding A/I/U
  2. 2. PresenterMary Givens, Chief Contributor and Manager ofMeaningful Usefor Qualifacts Systems, Inc.
  3. 3. Topics for today:• Medicaid vs. Medicare Programs for Eligible Professionals (EPs)• Reassignment of Incentive Dollars• Eligibility for Medicaid EHR Incentive Program -EPs• Rules for attesting to Adopt/Implement /or Upgrade for year 1 of the Medicaid EHR Incentive program
  4. 4. Professionals who are eligible for both programs www.MUforBH.comSlide taken from the CMS website:
  5. 5. A side by side comparison of Medicare and Medicaid EHR Incentive Programs for Eligible Professionals. www.MUforBH.comSlide taken from the CMS website:
  6. 6. Medicaid EP EHR Incentive Program Reimbursement Schedule
  7. 7. Stage 1 – Program Year 1Medicaid EHR Program for Eligible Professionals• For year 1 only, EP can choose to attest to A/I/or U – Adopted > acquired, purchased or secured access to – Implemented > installed or commenced utilization of – Upgraded to certified EHR technology• The meaningful use of an EHR is not required for Stage 1-Year 1
  8. 8. Eligibility requirements for Eligible Professionals-Medicare and Medicaid• Incentive payments for eligible professionals are based on individual practitioners.• If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology.• Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services.• Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting.
  9. 9. Medicaid:Types of Professionals are Eligible• Physicians (primarily doctors of medicine and doctors of osteopathy)• Nurse practitioner• Certified nurse-midwife• Dentist• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.
  10. 10. This Means.. For the Medicaid EHR Incentive Program Year 1,the EP can collect $21,250 for attesting to A/I/U!
  11. 11. Other Eligibility requirements: Patient Volume, licensed professional in good standing• Patient Volume Must Either – have ≥ 30% Medicaid patient volume (≥ 20% for pediatricians only); – or – Practice predominantly in an FQHC or RHC with ≥30% needy individual patient volume• Must be Licensed, credentialed with an individual Medicaid Provider ID• No OIG exclusions, living
  12. 12. In order to determine patient volume, you must understand the definition of an encounter?For purposes of calculating Eligible Professional patientvolume, a Medicaid encounter means services renderedto an individual on any one day where—• Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service; or• Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid all or part of the individual’s premiums, co-payments, and cost-sharing.
  13. 13. Stage 1 Final rule495.306 Establishing Patient Volume forEligible ProfessionalsPatient volume requirement must be metannually for a Medicaid providerEach state has these options fordetermining patient volume:Methodology, patient encounter foreligible professionals:Method (1) To calculate individualMedicaid patient volume, an EP mustdivide:NUMERATOR: The total Medicaidpatient encounters in any representative,continuous 90-day period in thepreceding calendar year; by________________________________DENOMINATOR: The total patientencounters in the same 90-day period.
  14. 14. Methodology, patient encounter for eligible professionals continuedMethod (2) To calculate individual Medicaid patient volumeusing the payer panel, an EP must divide:• Numerator: The total Medicaid patients assigned to the EP’s panel in any representative, continuous 90-day period in the preceding calendar year when at least one Medicaid encounter took place with the Medicaid patient in the year prior to the 90-day period; plus (+) Unduplicated Medicaid encounters in the same 90-day period; by• Denominator: The total patients assigned to the provider in that same 90-day period with at least one encounter taking place with the patient during the year prior to the 90-day period; plus (+) all unduplicated patient encounters in the same 90-day period.
  15. 15. Group practices: Leverage a clinic or group practices patient volume as a proxy for the individuals.Clinics or group practices will be permittedto calculate patient volume at the grouppractice/clinic level, but only inaccordance with all of the followinglimitations:(1) The clinic or group practice’s patientvolume is appropriate as a patient volumemethodology calculation for the EP.(2) There is an auditable data source tosupport the clinic’s or group practice’spatient volume determination.(3) All EPs in the group practice or clinicmust use the same methodology for thepayment year.
  16. 16. Question 4: How are your EPs preparing for Group practices: Leverage a clinic or group practices reportingvolume as aquality for the individuals. 2? patient on clinical proxy measures for stage• (4) The clinic or group practice uses the entire practice or clinic’s patient volume and does not limit patient volume in any way.• (5) If an EP works inside and outside of the clinic or practice, then the patient volume calculation includes only those encounters associated with the clinic or group practice, and not the EP’s outside encounters.FAQ from CMS website that provides a great demonstration of group by proxy method
  17. 17. Question 4: How are your EPs preparing for Register or Attest on measures of the EP reporting on clinical quality behalf for stage 2?• CMS allows an eligible professional to designate a third party to register and attest on his or her behalf. – To do so, users working on behalf of an eligible professional must have an Identity and Access Management System (I&A) web user account (User ID/Password), and be associated to the eligible professionals National Provider Identifier (NPI). – If you are working on behalf of one or more eligible professionals and do not have an I&A web user account, please visit I&A Security Check to create one.
  18. 18. The reassignmentof Incentive Dollars• EPs are permitted to reassign their incentive payments to their employer or to an entity with which they have a contractual arrangement allowing the employer or entity to bill and receive payment for the EP’s covered professional services• EPs can only reassign incentive payments to one employer or entity per program year.• Employers should put in place a formal reassignment of incentive dollar agreement
  19. 19. Looking forward to program years two,three, four, five, and six• Eligibility must be met each year (non hospital based, patient volume, etc).• AND for year 2 and beyond, the EP will have to demonstrate the meaningful use of a certified EHR for a designated reporting period – For year two, the reporting period for the meaningful use of an EHR is 90 consecutive days during a calendar year. – For year 3,4,5,6, the reporting period for the meaningful use of an EHR is a calendar year.
  20. 20. The Meaningful Use of an EHR• In order to demonstrate the meaningful use of a certified EHR, an EP must be able to meet the –15 core objectives –5 of the 10 objectives from menu set or, be eligible for an exclusion
  21. 21. Ambulatory Measures of Meaningful UseCORE MENU1. *CPOE 1. *Implement drug formulary checks2. Drug : drug and drug : allergy checks 2. *Incorporate Lab test results3. Up to date problem list 3. Generate patient lists4. *eRx 4. *Patient Reminders5. Active Medication list 5. *Provide patients Electronic Access6. Active Medication Allergy list 6. Patient Specific Education7. Demographics Resources8. *Vital Signs 7. *Medication Reconciliation9. *Smoking Status 8. *Summary of Care record upon transition10. Clinical Quality Measures 9. *Submit Electronic data to11. Clinical Decision support rule immunization registry12. *Electronic copy of Health Info upon 10. *Submit syndromic surveillance request data to public health agency13. *Clinical Summaries after each visit * Measures that have exclusions14. Exchange Key Clinical Information15. Protect Health Information
  22. 22. Want state specific help with A/I/U?If you would like a no cost, one to one consultation on the Medicaid A/I/U process in your state, please contactthe staff associated with your region to set it up. If your state is not incldued in one of the groups below, you can ask for help at www.MUforBH.comSean Peratikos: 615-386-6755 ex:5503Florida, Maryland, Tennessee, Pennsylvania, Virginia, Washington D.C., Delaware, KentuckySam Huffman: 615-386-6755 ex:5522Alaska, Arkansas, Georgia, Illinois, North Carolina, South Carolina, West Virginia, Texas,Mississippi, Louisiana AlabamaSamantha Bunch: 615-386-6755 ex:5504Indiana, Michigan, Missouri, Ohio, Wisconsin, Iowa, North Dakota, South Dakota, Nebraska, OklahomaSarah Rawlins: 615-386-6755 ex:5496Connecticut, Massachusetts, New Jersey, New York, Maine, New Hampshire, Vermont, Rhode IslandAaron Hall: 615-386-6755 ex:5501Arizona, Colorado, Kansas, Minnesota, Oregon, Wyoming, California, Utah, Washington, Nevada, Montana,Idaho, New Mexico, Hawaii
  23. 23. Links to the sources and authorities on the EHR Incentive Programs• Resource for Behavioral Health Eligible professionals>• List of state specific HIT EHR Incentive program websites>• Get information, tip sheets and more at CMS’ official website for the EHR incentive programs:• The Meaningful Use specification Sheets on each of the Core and Menu Measures >• EP eligibility Decision Tool>• Department of Health and Human Services (HHS) Frequently Asked Questions>,26,1139• Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition:
  24. 24. Other links you may find helpful• HITECH Answers>• TWITTER LINKS:
  25. 25. DisclaimerPlease rememberWe do our best to provide you with the most accurate information possible, but it isultimately your responsibility to fully understand and comply with the final rules andregulations of the Medicaid and Medicare EHR Incentive Programs.We highly recommend each individual consult the CMS website and the state-specificMedicaid EHR Incentive Program website to confirm the rules and requirements.Under no circumstances shall anyone associated with Qualifacts Systems Inc. Be liable forany incidental, indirect, consequential or special damages or loss of any kind includingthose resulting from the expected incentives themselves.It is important that each Eligible Professional note that CMS views the EP as ultimatelyresponsible for the numerator and denominator and their Medicaid Encounter volume aswell as the data used for attestation on the measures of Meaningful Use.
  26. 26.
  27. 27. A resource for behavioral health professionals seeking advice, guidance, and information on meeting Meaningful Use requirements.• FAQs o Get quick answers to the most common Meaningful Use questions• Forum o Chat and exchange ideas with others in your community• Play the MU Game o A step-by-step guide to claiming your Meaningful Use dollars• Videos and Webinars o Access past Meaningful Use presentations for additional help or join our free live webinars• MU State University o Meaningful Use Education State by State
  28. 28. Would you like more information onmeaningful use consulting services? A resource for behavioral health professionals seeking advice, guidance, and • If you like to learn more about how youUse requirements. with information on meeting Meaningful can get assistance – Understanding the rules of eligibility – Understanding the rules for what belongs in the numerator/denominator in the patient volume calculation – How to re-engineer your current business process to more easily integrate the meaningful use measures into your business – Or anything else about MU for EPs You can send an email to . Please include a brief description of your anticipated needs. We will contact you within 1 business day so we can set up a call to tell you more about what types of services are available.