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Vermont EHR Incentive Program

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Vermont EHR Incentive Program

  1. 1. Vermont Electronic Health Record Incentive Program (EHRIP) Medicaid EHR Incentive Program for Eligible Professionals Presenter: Mary Givens, Program Manager of Meaningful Use and Chief Contributor to www.MUforBH.com
  2. 2. •Agenda Eligibility Rules and A/I/U Item 1 Patient Volume Item 2 Reassignment of Incentive Dollars Item 3 Item 4 Item 5 Register at CMS Attest at Vermont Medicaid EHRIP using MAPIR system Copyright 2009
  3. 3. •Eligibility • • Medicaid EHR Incentive Program Eligible Professionals under the Medicaid EHR Incentive Program include: • Physicians • Nurse Practitioners • Certified Nurse-Midwives • Dentists • Physician assistants who furnish services in a Federally Qualified Health Center or Rural • Health Center that is led by a physician assistant Copyright 2009 3
  4. 4. •Eligibility • Medicaid EHR Incentive Program • Incentive payments for the EHR Incentive Program for Eligible Professionals (EP) are based on individual practitioners. • If the EP is part of a practice, each EP may qualify for an incentive payment. • An EP must have an Individual Vermont Medicaid provider ID to participate in meaningful use. • 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. Copyright 2009 4
  5. 5. •Adopt/Implement/or Upgrade • To a certified EHR Incentive Program *In the Medicaid EHR Incentive program only, 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 EP does not have to be using the CEHRT to attest for year 1. Copyright 2009 5
  6. 6. •Patient Volume To qualify for an incentive payment under the Medicaid EHR Incentive Program, an Eligible Professional must meet one of the following criteria: • • • • • • Have a minimum 30% Medicaid patient volume Have a minimum 20% Medicaid patient volume, and is a pediatrician Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals For payment year 2013 and all subsequent payment years, at least one clinical location used in the calculation of patient volume must have Certified EHR Technology— (1) During the payment year for which the EP attests to having adopted, implemented or upgraded Certified EHR Technology (for the first payment year); or (2) During the payment year for which the EP attests it is a meaningful EHR user. Copyright 2009
  7. 7. •Patient Volume-methodology Sec. 495.306 of the final rules, Establishing patient volume. (c) Methodology, patient encounter. (1) EPs. To calculate Medicaid patient volume, an EP must divide: (i) The total Medicaid patient encounters in any representative, continuous 90-day period in the calendar year preceding the EP's payment year, or in the 12 months before the EP's attestation; by (ii) The total patient encounters in the same 90-day period. (3) Needy individual patient volume. To calculate needy individual patient volume, an EP must divide— (i) The total needy individual patient encounters in any representative, continuous 90-day period in the calendar year preceding the EP's payment year, or in the 12 months before the EP's attestation; by (ii) The total patient encounters in the same 90-day period. Copyright 2009
  8. 8. •Definition of an encounter (for purposes of calculating patient volume) A Medicaid encounter means services rendered to an individual on any one day where: (i) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service. (ii) 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. (iii) The individual was enrolled in a Medicaid program (or a Medicaid demonstration project approved under section 1115 of the Act) at the time the billable service was provided. Calculating needy individual patient volume, a needy patient encounter means services rendered to an individual on any 1 day if any of the following occur: (i) Medicaid or CHIP (or a Medicaid or CHIP demonstration project approved under section 1115 of the Act) paid for part or all of the service. (ii) Medicaid or CHIP (or a Medicaid or CHIP demonstration project approved under section 1115 of the Act) paid all or part of the individual's premiums, co-payments, or cost-sharing. (iii) The individual was enrolled in a Medicaid program (or a Medicaid demonstration project approved under section 1115 of the Act) at the time the billable service was provided. (iv) The services were furnished at no cost; and calculated consistent with Sec. 495.310(h). (v) The services were paid for at a reduced cost based on a sliding scale determined by the individual's ability to pay. Copyright 2009
  9. 9. •Using the Group Method for Patient Volume CLINICS OR GROUP PRACTICES WILL BE PERMITTED TO CALCULATE PATIENT VOLUME AT THE GROUP PRACTICE/CLINIC LEVEL, BUT ONLY IN ACCORDANCE WITH ALL OF THE FOLLOWING LIMITATIONS: • • • • • (1) The clinic or group practice's patient volume is appropriate as a patient volume methodology calculation for the EP. (2) There is an auditable data source to support the clinic's or group practice's patient volume determination. (3) All EPs in the group practice or clinic must use the same methodology for the payment year. (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. Copyright 2009
  10. 10. •Reassignment of 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. • TIP: We suggest the EPS voluntary reassignment of the incentive dollars to the agency be documented for audit purposes. Copyright 2009
  11. 11. •Medicaid EPs must Register at CMS Program year 1 only. • Each EP will need the following information to register at CMS: • An NPI • An NPPES I&A ID and Password • A Payee TIN • A Payee NPI** • EHR Certification Number • For EPs who will be reassigning their incentive dollars to the group/clinic, they will need the following information: • Individual NPI • Agency's legal name • Payee NPI • Payee TIN Copyright 2009
  12. 12. •Attesting with the VT Medicaid EHRIP Using the MAPIR System • At approximately 48 hours after the EP registers at CMS, he/she will receive an email that they are invited to participate in the VT Medicaid EHRIP program for Eligible Professionals. • • • The agency should identify one individual who will be responsible for completing the MAPIR application and attestation information. This person can also serve as a contact point for state Medicaid communications. This person should download the MAPIR user guide and familiarize themselves with the process beforehand. • • Once the EP has received the email welcoming him/her to the VT EHRIP , the agency point person can complete the attestation process for each EP using the MAPIR system. The final step is to wait for the incentive payments. Copyright 2009
  13. 13. •Important Links for Vermont Medicaid Eligible Professionals • Vermont MA Provider Incentive Repository User Guide for Eligible Professionals • Vermont EHRIP Patient Volume Data Tool • CMS EHRIP Webpage • CMS Registration Checklist • Access the CMS Registration and Attestation (R&A) System here: https://ehrincentives.cms.gov/hitech/login.action • Vermont EHRIP User Guide for Eligible Professionals • CMS FAQs www.MUforBH.com the only resource built specifically for behavioral health Eligible Professionals • Copyright 2009
  14. 14. QUESTIONS?? You can also submit questions at www.MUforBH.com or by emailing me at MeaningfulUse@qualifacts.com Copyright 2009

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