Health Information Technology (MHIT) FQHC/RHC/IHS & Tribal 638 Meeting. Karen Hale, Business Analyst Lisa Parker, Sr. Business Analyst August 4, 2011

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1 Health Information Technology (MHIT) Project FQHC/RHC/IHS & Tribal 638 Meeting Karen Hale, Business Analyst Lisa Parker, Sr. Business Analyst August 4, 2011

2 Medicaid EHR Incentive Program Highlights Up to $63,750 over 6 years for Eligible Professionals (EPs) who meet minimum Medicaid patient volume standards. EPs are: Physician i Nurse practitioner Certified nurse-midwife Dentist Physician assistant in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant Provide annual incentive payments to eligible professionals (EP) as they adopt, implement, upgrade (year 1) or demonstrate meaningful use (years 2-6) of Certified EHR Technology

3 Medicaid EHR Incentive Program: Recent CMS FAQ Can tribal clinics be treated as Federally Qualified Health Centers (FQHCs) for the Medicaid Electronic Health Record (EHR) Incentive Program? CMS previously issued guidance stating that health care facilities owned and operated by American Indian and Alaska Native tribes and tribal organizations ("tribal clinics") with funding authorized by the Indian da Self-Determination ete and Education Assistance sta Act (Public Law , as amended) must be reimbursed as FQHCs in order to be considered FQHCs in the Medicaid EHR Incentive Program. CMS revised this policy and will allow any such tribal clinics to be considered as FQHCs for the Medicaid EHR Incentive Program, regardless of their reimbursement arrangements. 3

4 Medicaid EHR Incentive Program: Eligible Professional (EP) Criteria To qualify for an EHR incentive payment, a Medicaid EP must meet one of the following criteria: Have a minimum 30% Medicaid* patient volume Have a minimum 20% Medicaid* patient volume, and be a pediatrician Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) and have a minimum 30% patient volume attributable to needy individuals: o Needy Individuals are those who receive Medicaid, CHIP, uncompensated care, and fee reduced based on the ability to pay. *In Oregon, Medicaid is calculated using a CHIP proxy. Providers are instructed to adjust their Oregon Health Plan encounters by

5 Medicaid Patient Volume Calculation In any representative continuous 90-day period in the preceding calendar year: Total Medicaid (or needy individual*) patient encounters Total patient encounters *For providers who practice predominantly in a FQHC/RHC/IHC, use Needy Individuals Volume can be calculated by either the individual provider encounters or by all encounters billed for the group Out-of-state patients can be used 5

6 High-Level Group Calculation Example* All encounters for each provider in the group are added together to achieve the patient volume threshold Physician A Nurse Practitioner B Registered Nurse C 100 Medicaid patient encounters 400 Total patient encounters 25% Individual Medicaid volume 100 Medicaid patient encounters 200 Total patient encounters 50% Individual Medicaid volume 100 Medicaid patient encounters 150 Total patient encounters 66% Individual Medicaid volume Group Calculation: Total Medicaid Encounters = 300 Total Patient Encounters = 750 Group Patient Volume = 40% *See Group Calculation appendix

7 Assignment of Payment Payments can be assigned from the eligible professional (EP) to: an employer or other entity with whom a contractual relationship to bill and receive payment for the EP s covered professional services 1099 will follow the TIN that received the EHR Incentive Payment The entire amount of the incentive payment may be reassigned to one employer or entity Physician (EP) works at County Health Clinic A and B & is eligible for a Medicaid EHR Incentive payment Does not reassign (default) Reassigns to Clinic A Reassigns to Clinic B 1099 Physician 1099 Clinic A 1099 Clinic B

8 Year Medicaid EHR Incentive Payments by Calendar Year 2011 $21,250 Medicaid EPs Who Adopted In: $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 8

9 Adopt, Implement, or Upgrade (AIU) and Meaningful Use of Certified EHR Technology AIU Applies in Year one Adopt: Acquire, purchase, or secure access to certified EHR technology Implement: Install or commence utilization of certified EHR technology capable of meeting meaningful use requirements Upgrade: Expand the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, Meaningful Use Applies in all subsequent years Meaningful use means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity Criteria for meaningful use will be staged in three steps, updated every 2 years over the course of the next four years. Stage 1 is comprised of 15 core measures and 10 menu measures. EPs choose to report on 5 of the 10 menu measures 9

10 Getting Started with an EHR Oregon s eligible providers in Tribal communities who need help with selecting an EHR or assessing whether a current system needs to be upgraded can contact: The National Indian Health Board American Indian/Alaska Native National Regional Extension Center (REC) AI/AN REC will help providers select, implement and meaningfully use EHR technology. 10

11 Medicaid EHR Incentive Program: Resources Oregon Medicaid EHR Incentive Program Resources: Main website: Oregon Public Health Meaningful Use Website: eproviders/meaningfuluse Other Resources: CMS EHR Incentives: Tribal REC (TA for providers): O-HITEC (TA for providers):

12 Steps to Take to Prepare to Participate Enroll as an active Oregon Health Plan provider. Sign up for direct deposit with the Oregon Health Plan. The Medicaid id EHR Incentive Program will only use electronic payments as the distribution mechanism of incentive payments. Enroll in the Provider Web Portal. This will be the only mechanism for providers to apply for Oregon Medicaid EHR incentive payments starting in the summer of Register your NPI number with Oregon Medicaid (DMAP). Find out if your EHR meets new certification standards: Seek out EHR assistance as needed. d 12

13 Oregon Medicaid EHR Incentive Program How to Apply 1. Complete all preparation steps with Oregon Medicaid provider enrollment 2. Register with Centers for Medicaid and Medicare Services (CMS) after the Oregon Medicaid EHR Incentive Program is approved by CMS RegistrationandAttestation.asp 3. Complete an application with Oregon s Medicaid EHR Incentive Program Via Oregon DHS Provider Web Portal 13

14 Medicaid Patient Volume Calculation Group Calculation Appendix Conditions: Must be appropriate methodology for the eligible professional; Must have an auditable data source to support the group s patient volume determination; All eligible professionals in the group must use the same methodology for the payment year; Must use the entire practice or clinic s patient volume, including noneligible providers who are billing, rendering and ancillary providers, and does not limit patient volume in any way; and For eligible professionals who work inside and outside of the group, the patient volume calculation includes only those encounters associated with the group, and not the eligible professional s outside encounters. 14