MUforBH & Qualifacts Presents: Understanding A/I/U
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MUforBH.com Presents: The Medicaid EHR Incentive Program for Behavioral Health Eligible Professionals: 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.
Transcript of MUforBH & Qualifacts Presents: Understanding A/I/U
MUforBH.com Presents: The Medicaid EHR Incentive Program for Behavioral Health Eligible Professionals: Understanding A/I/U
Presenter
Mary Givens, Chief Contributor for www.MUforBH.com and Manager of Meaningful Use for Qualifacts Systems, Inc.
www.MUforBH.com
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
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Professionals who are eligible for both programs
Slide taken from the CMS website: https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html
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A side by side comparison of Medicare and Medicaid EHR Incentive Programs for Eligible Professionals.
Slide taken from the CMS website: https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html
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Medicaid EP EHR Incentive Program Reimbursement Schedule
Stage 1 – Program Year 1 Medicaid 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
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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.www.MUforBH.com
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.
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This Means..
For the Medicaid
EHR Incentive
Program Year 1,
the EP can collect
$21,250 for
attesting to A/I/U!www.MUforBH.com
• 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
Other Eligibility requirements: Patient Volume, licensed
professional in good standing
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In order to determine patient volume, you must understand the definition of an encounter?
For purposes of calculating Eligible Professional patient volume, a Medicaid encounter means services rendered to 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.
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Stage 1 Final rule § 495.306 Establishing Patient Volume for
Eligible ProfessionalsPatient volume requirement must be met annually for a Medicaid provider
Each state has these options for determining patient volume:
Methodology, patient encounter for eligible professionals:
Method (1) To calculate individual Medicaid patient volume, an EP must divide:
NUMERATOR: The total Medicaid patient encounters in any representative, continuous 90-day period in the preceding calendar year; by
________________________________
DENOMINATOR: The total patient encounters in the same 90-day period.
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Methodology, patient encounter for eligible professionals continued
Method (2) To calculate individual Medicaid patient volume using 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.
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Group practices: Leverage a clinic or group practices patient volume as a proxy for the individuals.
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. www.MUforBH.com
• (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 https://questions.cms.hhs.gov/app/answers/detail/a_id/10362/kw/patient%20volume
Question 4: How are your EPs preparing for reporting on clinical quality measures for stage 2?
Group practices: Leverage a clinic or group practices patient volume as a proxy for the individuals.
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• 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 professional's 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.
Question 4: How are your EPs preparing for reporting on clinical quality measures for stage 2? Register or Attest on behalf of the EP
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• 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
The reassignment of Incentive Dollars
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• 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.
Looking forward to program years two,
three, four, five, and six
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• 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
The Meaningful Use of an EHR
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Ambulatory Measures of Meaningful Use
CORE1. *CPOE2. Drug : drug and drug : allergy checks3. Up to date problem list4. *eRx5. Active Medication list6. Active Medication Allergy list7. Demographics8. *Vital Signs9. *Smoking Status10. Clinical Quality Measures11. Clinical Decision support rule12. *Electronic copy of Health Info upon
request13. *Clinical Summaries after each visit14. Exchange Key Clinical Information15. Protect Health Information
MENU1. *Implement drug formulary
checks2. *Incorporate Lab test results3. Generate patient lists4. *Patient Reminders5. *Provide patients Electronic
Access6. Patient Specific Education
Resources7. *Medication Reconciliation8. *Summary of Care record upon
transition9. *Submit Electronic data to
immunization registry10. *Submit syndromic
surveillance data to public health agency
* Measures that have exclusions
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Want state specific help with A/I/U?
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If you would like a no cost, one to one consultation on the Medicaid A/I/U process in your state, please contact the 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.com
Sean Peratikos: [email protected] 615-386-6755 ex:5503Florida, Maryland, Tennessee, Pennsylvania, Virginia, Washington D.C., Delaware, Kentucky
Sam Huffman: [email protected] 615-386-6755 ex:5522 Alaska, Arkansas, Georgia, Illinois, North Carolina, South Carolina, West Virginia, Texas, Mississippi, Louisiana Alabama Samantha Bunch: [email protected] 615-386-6755 ex:5504Indiana, Michigan, Missouri, Ohio, Wisconsin, Iowa, North Dakota, South Dakota, Nebraska, Oklahoma
Sarah Rawlins: [email protected] 615-386-6755 ex:5496 Connecticut, Massachusetts, New Jersey, New York, Maine, New Hampshire, Vermont, Rhode Island
Aaron Hall: [email protected] 615-386-6755 ex:5501Arizona, Colorado, Kansas, Minnesota, Oregon, Wyoming, California, Utah, Washington, Nevada, Montana, Idaho, New Mexico, Hawaii
• Resource for Behavioral Health Eligible professionals> www.MUforBH.com • List of state specific HIT EHR Incentive program websites>
http://www.cms.gov/apps/files/statecontacts.pdf• Get information, tip sheets and more at CMS’ official website for the EHR incentive
programs: http://www.cms.gov/ehrincentiveprograms/• The Meaningful Use specification Sheets on each of the Core and Menu Measures >
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf • EP eligibility Decision Tool>
https://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp• Department of Health and Human Services (HHS) Frequently Asked Questions>
http://questions.cms.hhs.gov/app/answers/list/p/21,26,1139• Learn about certification and certified EHRs, as well as other ONC programs designed
to support providers as they make the transition: http://healthit.hhs.gov
Links to the sources and authorities on the EHR Incentive Programs
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• HITECH Answers> www.HITECHAnswers.net• TWITTER LINKS: http://twitter.com/ONC_HealthIT http://twitter.com/HITECHAnswers http://twitter.com/CMSGov http://twitter.com/GovHIT http://twitter.com/AHRQNews
Other links you may find helpful
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Please rememberWe do our best to provide you with the most accurate information possible, but it is ultimately your responsibility to fully understand and comply with the final rules and regulations of the Medicaid and Medicare EHR Incentive Programs.
We highly recommend each individual consult the CMS website and the state-specific Medicaid EHR Incentive Program website to confirm the rules and requirements.
Under no circumstances shall anyone associated with Qualifacts Systems Inc. Be liable for any incidental, indirect, consequential or special damages or loss of any kind including those resulting from the expected incentives themselves.
It is important that each Eligible Professional note that CMS views the EP as ultimately responsible for the numerator and denominator and their Medicaid Encounter volume as well as the data used for attestation on the measures of Meaningful Use.
Disclaimer
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Questions?
www.MUforBH.com
A resource for behavioral health professionals seeking advice, guidance, and information on meeting Meaningful Use requirements.
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• FAQso 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 Universityo Meaningful Use Education State by State
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A resource for behavioral health professionals seeking advice, guidance, and information on meeting Meaningful Use requirements.
Would you like more information on meaningful use consulting services?
• If you like to learn more about how you can get assistance with – 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 EPsYou can send an email to [email protected] . 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.
