Texas Medicaid EHR Incentive
Program:
Dentists
Julia Alejandre / Medicaid HIT Team
The Program in a Nutshell
• Incentives of up to $63,750 are available for the adoption and
meaningful use of certified electronic health record (EHR)
technology:
• AIU (Adopt, Implement, or Upgrade) in the first year of participation
• Meaningful Use (MU) in up to 5 subsequent participation years. • Eligible Professionals (EPs) include dentists, along with 4 other
provider types.
• First year payment can be received in 2011 through 2016.
Final payment can be received up to 2021 for EPs.
Certified EHR Technology
• Office of National Coordinator (ONC)
publishes standards for software vendors.
• Vendors submit software for certification.
• Software receives an ONC certification
Patient Volume Threshold
• Pediatric dentists are eligible for the lower patient volume threshold of 20%. • Pediatric dentists attesting to 20-30% Medicaid patient volume will be required
to upload documentation that they are either board certified in pediatric dentistry, or they completed a pediatric dentistry residency.
Payment Year by EP Type
Medicaid Patient Volume * Incentive Amount Max. cumulative incentive over 6 years Year 1 for most EPs 30% or higher $21,250
$63,750
Years 2-6 for most EPs 30% or higher $8,500 Year 1 for pediatricians and pediatric
dentists 20% to 30% $14,167
$42,500
Years 2-6 for pediatricians and pediatric
dentists 20% to 30% $5,667
Skipping Years in the
Program
• Skipping years is permissible in the Medicaid incentive
program.
•
You may skip one or more years.
•
Example: a provider enters the program in 2011 with AIU
and then skip two years. S/he re-enters the program in
2014 with Stage 1 (other providers might be in Stage 2 at
that point).
• There are two reporting periods that apply for the
Medicaid EHR Incentive Program:
•
For patient volume, an eligible professional (EP)
should use any continuous, representative 90-day
period in the prior calendar year.
•
For demonstrating meaningful use, EPs should use
the EHR reporting period associated with that
payment year:
o
First payment year that an EP is demonstrating
meaningful use, the reporting period is a continuous
90-day period within the calendar year.
• First year of program participation: Upload documentation
that shows AIU (purchase order, contract, or subscription)
• Stage 1 Meaningful Use:
• 20 MU measures – 15 from the “core set” and 5 of 10
from “menu set”.
• 6 Clinical Quality Measures (CQMs) – 3 Core or
Alternate Core plus 3 from list of clinical measures of the
provider’s choice.
MU: Must include at least one Public Health measure:
1) Immunizations 2) Reportable Labs
3) Syndromic Surveillance
1. Register at CMS: https://ehrincentives.cms.gov.
2. Verify enrollment as a Texas Medicaid provider, with an active TPI. If you assign payment to yourself, your SSN must be listed in your TMHP profile.
3. Gather required information and documentation:
• EHR certification number.
• Group or individual attestation choice.
• Patient volume information (numerator and denominator). • AIU documentation.
4. Log into the portal and attest. Go to www.tmhp.com and log in. Scroll down to “Manage Provider Account” and select “Texas Medicaid EHR Incentive Program.”
How to Register and Attest
Important Notes on
Attestation
• Attestations:• All self-reported information (e.g., patient volume, provider types, etc.) are legally binding.
• Information entered into the portal should come from auditable sources in case you are selected for an audit. • For each year of program participation, providers must
maintain auditable records related to incentive program attestations for six years.
• Providers can file an appeal for any of the following reasons:
• Incentive payment amount.
• Provider eligibility determination.
Learn about the Texas Medicaid EHR Incentive Program through a
self-guided e-learning tool: www.texasehrincentives.com.
Get technical assistance through the Regional Extension Centers at
www.txrecs.org.
Review program information on the CMS website:
http://www.cms.gov/ehrincentiveprograms/.
Review additional Texas Medicaid EHR Incentive Program information at:
(http://www.tmhp.com/Pages/HealthIT/HIT_EHR.aspx).
Learn about a recent study on EHRs and healthcare outcomes:
http://www.nejm.org/doi/full/10.1056/NEJMsa1102519.
Sign up for e-mail updates at
https://public.govdelivery.com/accounts/TXHHSC/subscriber/new and
enter your email address. On the subscription topics page, go to the Projects section and select “Health Information Technology”.
Submit questions by sending an email to [email protected] or calling
