May 2015
Eligible Professionals
Program Eligibility and AIU Webinar
Program Eligibility and AIU
Overview of EHR Incentive Program
Eligibility and Medicaid Patient Volume
Adopt / Implement / Upgrade (AIU)
EHR Incentive Program Background
Original Legislation
The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA).
The HITECH Act Established:
• Medicaid EHR Incentive Program • Medicare EHR Incentive Program
• Office of the National Coordinator for Health Information Technology (ONC) • Certified EHR Technology
Goals of the HITECH Act:
• Improve patient quality of care
• Promote the adoption and meaningful use of health information technology • Increase health information exchange
Medicaid EHR Incentive Program
Provides incentive payments to:
• Eligible Professionals
• Eligible Hospitals
as these providers:
• Adopt,
• Implement, or
• Upgrade
Program Eligibility and AIU
Overview of EHR Incentive Program
Eligibility and Medicaid Patient Volume
Adopt / Implement / Upgrade (AIU)
MEIPASS Walkthrough
Eligible Professional Types
• Physicians
(M.D. or D.O. )
• Nurse practitioners
• Certified nurse-midwives
• Dentists
• Physician assistants,
who practice
What are the patient volume criteria?
Eligible Professionals must meet one of the following
conditions throughout all participation years:
• Demonstrate a minimum 30% Medicaid patient volume, or
• Be a pediatrician* and demonstrate a minimum 20% Medicaid patient
volume, or
• Practice predominantly in a Federally Qualified Health Center or Rural
Health Center and demonstrate a minimum 30% patient volume
attributable to needy individuals
*Pediatricians have the reduced option of demonstrating 20-30% Medicaid patient volume but will only receive 2/3 the incentive payment when their percentage is below 30%.
For the purposes of the Medicaid EHR Incentive Program, NY defines a “pediatrician” as an M.D. or D.O. who satisfies at least one of the following:
1. Has a current board certification in pediatrics or a pediatric subspecialty from the American Board of Pediatrics (ABP) or the American Osteopathic Board of Pediatrics (AOBP)
Patient Volume Methodology
• Patient volume is calculated over a 90-day period (of the provider’s
choice) from the prior calendar year or preceding 12 month period
from the date of attestation
• New York will allow providers to select either of two methods of
calculating patient volume:
1. Standard patient volume: number of Medicaid encounters divided by number of total patient encounters
2. “Alternate” method: accounts for managed care patient panel as well as encounters with patients not on managed care panel
• Group practices and clinics may use their aggregate patient volume
(standard or alternate method) as a proxy for all individual providers
• Providers at FQHCs/RHCs may substitute needy patient encounters
Needy Patient Volume Requirements
To qualify eligible professionals must:
• Practice predominantly in a FQHC or RHC
• Have a minimum 30% patient volume attributable to needy individuals
Needy Individual must meet one of the following conditions:
1. Receives medical assistance from Medicaid or Children's Health Insurance Program(CHIP)
2. Furnished uncompensated care by the provider
3. Furnished services at either no cost or reduced cost based on a sliding scale determined by the individual's ability to pay
Practice predominantly definition:
Medicaid / Needy Encounter
Type of Service Medicaid Encounter Needy Encounter
Medicaid Fee-for-Service
Medicaid Managed Care
Family Health Plus
Child Health Plus
Uncompensated Care
Aggregate Patient Volume
Group practices and clinics with more than one eligible provider will
be allowed to use the aggregate Medicaid and overall patient
volume for the entire practice/clinic as a proxy for each provider's
individual patient volume.
Requirements and Restrictions
• Applies to all providers who render service in the practice or clinic,
regardless of how much of their overall practice is within the practice or
clinic.
• Each provider will be required to attest that use of the aggregate value is
appropriate for that provider.
• Aggregate values must represent the entire practice's patient volume and
not limit it in any way (including not limiting it to only patients seen by
Group Provider Definition
Group Provider
• The group/organizational National Provider Identifier (NPI) that the eligible
professional has a contractual arrangement allowing the employer or entity to bill and receive payment for the EP's covered professional services.
Group NPI / Aggregate Patient Volume Requirements
• The aggregate patient volume must be representative of the group NPI. • Providers within that group must all use the same aggregate patient volumemethodology.
• If a providers works under multiple group NPI’s, it as the discretion of the provider and clinic to choose which group NPI to report aggregate patient volume from.
Attestation Reporting Periods
Hospital-Based Status
• Eligible professionals must render less than 90% of covered Medicaid services in the inpatient and emergency department (ED) settings
• Measured per individual EP over the entire prior calendar year
Practice predominantly in an FQHC or RHC
• In order to use the needy patient volume, more than 50% of the EP’s total patient encounters must have taken place in an FQHC or RHC
• Measured per individual provider over a six-month period in the prior calendar year or preceding 12 month period from the date of attestation
Medicaid Patient Volume
• All EPs must meet minimum patient volume requirements (30% Medicaid for most EPs, 20% Medicaid for pediatricians, 30% needy for EPs at FQHCs/RHCs) • Measured per individual provider or using group/clinic aggregate values over a
Support Services
NY Medicaid EHR Incentive Program Support offers services to assist
providers with calculation of their Medicaid patient volume:
• Numerator Requests
Providers may request a summary of their Medicaid claims. Please be advised that this report may only be used as guidance for calculation purposes and that it does not suffice supporting documentation requirements for audit.
• Pre-Validation
Individual EPs and group providers may utilize the pre-validation services if they already know the following information that they intend to submit with their attestation:
90-day reporting period for Medicaid Patient Volume Medicaid encounter data
Total patient encounter data
Pre-validation prior to submitting the complete attestation may subsequently reduce the time of state review.
Program Eligibility and AIU
Overview of EHR Incentive Program
Eligibility and Medicaid Patient Volume
Adopt / Implement / Upgrade (AIU)
What is Adopt / Implement / Upgrade (AIU)?
Adopt:
Acquire, purchase, or secure access to certified EHR technology
Requires either installation of the certified EHR technology, OR a
financial commitment to purchasing or using the EHR
Does NOT require that the technology be in use in the clinical setting
Implement:
Install or commence utilization of certified EHR technology
Qualifying activities include integration, training, and data transfer
Upgrade:
Expanding functionality of existing certified EHR, or moving from
non-certified to certified version
Requires installation OR a financial commitment to purchase or use
the certified version
Important: The attestation and supporting documentation must accurately
2014 ONC Certified EHR Technology
• Standards, implementation specifications, and certification criteria
for EHR technology have been adopted by the Secretary of Health
and Human Services
• EHR technology is tested and certified by ONC-Authorized Testing
and Certification Bodies (ONC-ATCBs)
• ONC-ATCBs certify EHR technology for one or more meaningful
use criteria
• To be eligible for the EHR Incentive Programs, providers must
have a complete EHR system certified to 2014 ONC standards
• To find a list of certified EHR systems and modules, consult the
AIU Attestation and Preparing to Attest
• Attest: To authenticate officially
• In the first year of program participation, providers may
legally attest that they have successfully adopted,
implemented or upgraded (A/I/U) 2014 ONC Certified
EHR Technology during the chosen payment year.
• Attestation begins in MEIPASS but requires a physical
signature to complete the process.
AIU Attestation and Preparing to Attest
Eligible Professionals must:
Be one of the eligible practitioner types
Be actively enrolled in NY Medicaid as a fee-for-service provider in good standing Meet minimum patient volume criteria (Medicaid/needy)
Adopt, implement or upgrade to a 2014 ONC Certified EHR system in the first participation year
Not be hospital-based (i.e., render less than 90% of covered Medicaid services in the inpatient and emergency department settings)
Meet the meaningful use criteria and submit clinical quality measures as required in the second and subsequent participation years
Register using the CMS Medicare & Medicaid EHR Incentive Program Registration and Attestation System
MEIPASS Submitter Registration
• Providers must be enrolled in the Electronic Provider
Assisted Claim Entry System (ePACES) to access
MEIPASS. If you are not enrolled in ePACES, contact the
eMedNY Call Center at 1 (800) 343-9000 for assistance.
• Prior to logging in to MEIPASS, all providers are required to
specify the ETIN of the ePACES account that will be used to
log in to MEIPASS to perform their attestation.
• For assistance with MEIPASS Submitter Registration,
contact the EHR Support Team at 1 (877) 646-5410 – Opt.1,
or refer to provider support materials available at
Preparing to Attest – Where do I start?
Recommendations:
Review CMS webinar and user guide regarding registration at the
national level
•
EHR: Medicare, Medicaid EHR Incentive Program Webinar for
Eligible Professionals
•
EHR Medicaid EP Registration User Guide
Review NYS webinars and user guides regarding attestation and
meaningful use
• NY Medicaid EHR Incentive Program MEIPASS Resource Webpage
www.emedny.org/meipass
o Eligible Professional Webinar Schedule
o MEIPASS Walkthroughs
Application Prerequisites
Eligible Professionals must:
Have an individual National Provider Identifier (NPI)
Have a National Plan and Provider Enumeration System (NPPES)
account associated with the individual NPI
Be enrolled in ePACES and have the original enrollment user ID and
password
Have a valid ETIN, or designate a third party submitter who has a valid
ETIN to perform the attestation on the EP’s behalf
Have an ONC certified EHR Certification ID (EHR)
Have a CMS Registration ID (RID)
Other information needed:
Taxpayer Identification Number (TIN): SSN or EIN
Program Eligibility and AIU
Overview of EHR Incentive Program
Eligibility and Medicaid Patient Volume
Adopt / Implement / Upgrade (AIU)
MEIPASS Walkthrough
Login
Program Eligibility and AIU
Overview of EHR Incentive Program
Eligibility and Medicaid Patient Volume
Adopt / Implement / Upgrade (AIU)
MEIPASS Walkthrough
Details and Deadlines
• 2016 is the last year that an eligible professional can begin
participation in the NY Medicaid EHR Incentive Program.
• Providers must attest to the Medicaid patient volume to maintain
eligibility in the NY Medicaid EHR Incentive Program.
• Numerator requests and Pre-Validation Services are available.
Contact
[email protected]
for more information.
• Providers must use 2014 Edition CEHRT.
• AIU activity must be within the payment year.
• Please verify that your contact information shown in MEIPASS is
accurate. If it needs to be changed, please update your record
Details and Deadlines
• Attestations must be submitted online via MEIPASS.
• Providers must print, sign, and return (by mail) the complete
attestation before payment may be issued.
• After attesting in MEIPASS, please do not log back into the CMS
Registration and Attestation System during the attestation review
process or else your attestation will have to be resubmitted.
Resources
State Resources
• NY Medicaid EHR Incentive Program website
www.emedny.org/meipass• MEIPASS
https://meipass.emedny.org/• eMedNY LISTSERV
www.emedny.org/Listserv/EHR_Email_Alert_System.aspx• New York State Medicaid HIT Plan (NY-SMHP)
http://health.ny.gov/regulations/arra/docs/medicaid_health_information_technology_plan.pdf
Other Resources
• CMS Website for the Medicare and Medicaid EHR Incentive Programs
http://www.cms.gov/ehrincentiveprograms/
