PENNSYLVANIA MEDICAL ASSISTANCE EHR INCENTIVE PROGRAM ELIGIBLE PROFESSIONAL PROVIDER MANUAL

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1 HIT Initiative PENNSYLVANIA MEDICAL ASSISTANCE EHR INCENTIVE PROGRAM ELIGIBLE PROFESSIONAL PROVIDER MANUAL UPDATED: JULY 2,

2 HIT Initiative Table of Contents Table of Contents... 2 Part I: Pennsylvania Electronic Health Record Incentive Program Background Introduction Purpose of the Eligible Professional Provider Manual Who is Eligible? Overview of the EHR Incentive Program Application Process Patient Volume Calculation Provider Incentive Payments Adopt, Implement or Upgrade (AIU) and Meaningful Use Attestations and Audits Overpayments Appeals Part II: Application Assistance MAPIR Overview Pennsylvania s PROMISe Provider Portal Completing the MAPIR Application Appendix Definitions per Final Rule and/or Pennsylvania State Useful Acronym List Resources MU Criteria: Core, Menu and Clinical Quality Measures Auto-generated Provider Responses (MAPIR Application) Manually Generated Provider Responses (MAPIR Application)

3 HIT Initiative Part I: Pennsylvania Medical Assistance Electronic Health Record Incentive Program Background 3

4 HIT Initiative 1 Introduction Pennsylvania, like other states, recognizes the value of having real-time medical information when providers care for their patients. The use of health information technology (HIT) including electronic health records (EHR) to make this information available at the point-of-care has the potential to improve patient outcomes and the efficiency of the healthcare system as a whole. The American Recovery and Reinvestment Act of 2009 (ARRA) established a program to provide incentive payments to eligible providers who adopt, implement, upgrade, or meaningfully use federally-certified EHR systems. Under ARRA, states are responsible for identifying professionals and hospitals that are eligible for Medicaid EHR incentive payments, making payments, and monitoring payments. The Pennsylvania Health Information Technology Initiative (MAHITI) will oversee the EHR Incentive Program in Pennsylvania. The incentive payments are not a reimbursement, but are intended to encourage adoption and meaningful use of EHRs. The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing the provisions of the Medicare and Medicaid EHR Incentive Programs. CMS issued the Final Rule on the Medicaid EHR Incentive Program on July 28, 2010: For more information on CMS EHR requirements, go to CMS FAQ s at: CMS requires states requesting Federal funds for the EHR Incentive Program to submit a State Medicaid Health Information Technology Plan (SMHP). The Pennsylvania Department of Public Welfare s Office of Programs (OMAP) received CMS approval for its initial SMHP on December 28, 2010 and an updated SMHP on December 20, The SMHP will be updated on a regular and as needed basis. To review a copy of the Pennsylvania Commonwealth s SMHP refer to the following link: 4

5 HIT Initiative Pennsylvania Department of Public Welfare s Office of Programs (OMAP) For many years, Pennsylvania has been a national leader in healthcare, pursuing a variety of strategies to improve access to affordable quality care. Pennsylvania s Medicaid program,, has implemented a long list of initiatives to improve the quality of care delivered to Pennsylvania consumers. The Department of Public Welfare s Office of Programs (OMAP), Pennsylvania s agency, has recognized health information technologies (HIT) as essential tools for achieving long-term transformation of the healthcare delivery system. Pennsylvania s HIT Initiatives Vision: To improve the quality and coordination of care by connecting providers to patient information at the point of care through the meaningful use of EHRs. Goals: Pennsylvania will achieve this vision by actively encouraging the adoption of HIT through a variety of means, including the EHR Incentive Program. Our HIT goals for the Pennsylvania program center on: Increased Awareness Education enables providers and consumers to understand the benefits of HIT adoption. Increased Quality Better information to support clinical decisions by providers increases quality for consumers while reducing costs. Increased Coordination Eliminating duplicative services and identifying gaps in care increases administrative efficiencies and results in better care coordination. System Redesign Data capture and analysis provides opportunities to enhance and improve current quality initiatives for both providers and consumers. 5

6 HIT Initiative 2 Purpose of the Eligible Professional Provider Manual The Pennsylvania EHR Incentive Program Eligible Professional Provider Manual is a resource for healthcare professionals who wish to learn more about the Pennsylvania EHR Incentive Program including detailed information and resources on eligibility and attestation criteria, as well as instructions on how to apply for incentive payments. The Eligible Professional Provider Manual also provides information on how to apply to the program via the Provider Incentive Repository (MAPIR), which is the Department s web-based EHR Incentive Program application system. The best way for a new user to orient themselves to the EHR Incentive Program requirements and processes is to read through each section of this Provider Manual in its entirety, prior to starting the application process. Due to the length, you may not want to print the entire document. In the event this provider manual does not answer your questions or you are unable to navigate MAPIR or complete the registration and application process, you should contact the Department either by at or by phone at (855) Other Resources There are a number of resources available to assist providers with the Pennsylvania Medical Assistance EHR Incentive Program application process. These resources can be found at: For example, there are webinars describing various aspects of the application and attestation process, frequently asked questions, and a patient volume calculator. There is also a list of additional resources at the end of this manual. 6

7 HIT Initiative 3 Who is Eligible? The CMS Final Rule outlines the following mandatory criteria for an Eligible Professional (EP) to be considered for the Pennsylvania EHR Incentive Program: 1. EPs must be licensed physicians, dentists, pediatricians, certified registered nurse practitioners, certified nurse midwives, and physician assistants enrolled in the Pennsylvania Program. a. Note: While physician assistants are not eligible to be compensated for services provided to Pennsylvania recipients, physician assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is so led by a physician assistant may be eligible for Pennsylvania EHR incentive payments. However, physician assistants who are eligible for incentive payments will be required to enroll in Pennsylvania s MMIS provider internet portal, PROMISe. See additional instructions below. b. For the purposes of this Program, the Department defines a pediatrician as a physician who is either board-certified as a pediatrician or has received 12 months of training with children under the age of 21 years old. 2. EPs cannot be hospital-based, meaning the EP does not provide substantially all of their professional services in a hospital setting. Substantially all is defined to mean EPs who conduct more than 90 percent of their covered professional services in either the inpatient hospital (Place of Service code: 21) or hospital emergency department (Place of Service code: 23). 3. EPs must be enrolled as a Pennsylvania provider without sanctions or exclusions. Providers who are not enrolled will need to enroll with Pennsylvania prior to applying for Pennsylvania Medical Assistance EHR Incentive Program. 7

8 HIT Initiative INSTRUCTIONS FOR PHYSICIAN ASSISTANTS Physician assistants applying for the incentive payment must meet the CMS-defined criteria of practicing at an FQHC/RHC that is so led by a physician assistant. So led is defined by CMS to mean the following: When a physician assistant is the primary provider in an FQHC/RHC; When a physician assistant is a clinical or medical director at a clinical site of practice at an FQHC/RHC; or, When a physician assistant is an owner of an FQHC/RHC. Physician assistants applying for the incentive payment will be required to provide the signed FQHC/RHC Attestation Form, ( echnologyinitiative/maprovincentiverepos/index.htm), as one source of supporting documentation to validate the above criteria. The FQHC/RHC Attestation Form must be completed and signed by either the chief executive officer, president, vice president or other senior organizational lead. Additionally, the physician assistant will be asked to provide other supporting documentation such as an organizational chart to complement the FQHC/RHC Attestation Form. Physician assistants predominately practicing in an FQHC/RHC so led by a Physician Assistant who think they may be eligible for EHR Incentive Program payments should contact the Department by at or by phone at (855) The Department will help you determine if you meet the criteria for the EHR Incentive Program. If the Department determines you are eligible to participate with the EHR incentive program as a Physician Assistant, you will be directed to complete the PROMISe application at the following link: To expedite processing of your PROMISe application: When completing Question 5, please indicate Provider Type of 10 and leave the description field blank; 8

9 HIT Initiative When completing Question 6, indicate Specialty Code Number of 100 and leave the specialty description field blank; When completing Question 16L, indicate a Provider Eligibility Program (PEP) of ENP ; If the fields above are not completed as instructed the PROMISe application will be returned; To expedite your request, please the completed PROMISe application to the following address: (Subject line: Physician Assistant ); and, If the applicant chooses to either fax or mail their PROMISe Application to the Department, please send it to the fax number or postal address provided below: To submit via fax: (717) (Attention: EHR Incentive Unit) To submit via postal mail: Room MT (Attention: EHR Incentive Unit) P.O. Box 8045 Harrisburg, PA INSTRUCTIONS FOR PEDIATRICIANS For the purposes of the Pennsylvania EHR Incentive Program, pediatricians are defined as physicians who are either board-certified as pediatricians, or who have received 12 months of training with children under the age of 21 years old. Pediatricians applying for an incentive payment must be able to provide supporting documentation to demonstrate that they meet CMS and Department criteria as a pediatrician for the EHR Incentive Program. The Department may audit and validate pediatricians to verify that they meet the criteria for receiving an incentive payment. Supporting documentation may include, but is not limited to: a copy of the board certification, or verification of 12 months of training or practice in pediatrics. 9

10 HIT Initiative Pediatricians must have 20 percent Medicaid patient volume when they do not practice predominantly in an FQHC or RHC and must have 30 percent and needy patient volume when they do practice predominantly in an FQHC or RHC. If you would like to submit this documentation so that it is on file with the Department, please send your information by or fax to the contacts below: To submit via (Subject line: Pediatrician ) To submit via fax: (717) , (Attention: EHR Incentive Unit) Note: Please include your name and NPI number on all correspondence. 10

11 HIT Initiative 4 Overview of the EHR Incentive Program Application Process The following steps describe the Pennsylvania EHR Incentive Program application process (if you are applying for a second year payment, please forego the CMS R&A steps unless you need to modify your registration): In the first participation year, applicants must register with the Centers for Medicare & Medicaid Services (CMS) at the CMS Medicare and Medicaid EHR Incentive Program Registration and Attestation System (also known as the R&A) website ( After the first participation year, applicants can go directly into the MAPIR system to begin the application process. If you do go back to the CMS R&A website to make an update or review the information, you must submit the application before exiting. Failure to re-submit will result in a delay of the processing of your application. For the CMS R&A registration, applicants will need to provide information such as: o o o o Individual and Payee NPI and Tax Identification Number (TIN); Note: if reassigning payment to another entity the applicant must make sure they have the necessary fee assignment in place. This information can be confirmed through PROMISe s epeap application; Incentive Program option of Medicare or Pennsylvania Medical Assistance (referred to as Medicaid in the R&A), Note: If Medicaid, indicate the state for which you are applying; CMS EHR Certification Number (applicants will need to provide documentation to verify a certified EHR system is being used); and, contact information. Once successfully registered with the R&A, eligible applicants will receive a notification that they can register in MAPIR, which is accessed through the Pennsylvania MMIS provider internet portal. This may take up to two business days following successful registration with the R&A. MAPIR is the Department s webbased system that will track and act as a repository for information related to applications, attestations, payments, appeals, oversight functions, and interface with the CMS R&A. 11

12 HIT Initiative Applicants will use their individual PROMISe Internet Portal User ID and password to log into the Pennsylvania MMIS provider internet portal. If they are an eligible professional type then a MAPIR application link will be displayed. By clicking on the link, the MAPIR application will search for a registration record received from the R&A. Once a match is found, the application process can begin. If an application is not found within three days after an applicant registered with the R&A, the applicant should contact the Department for assistance either by at or by phone at: (855) Applicants will need to verify the information displayed in MAPIR, enter additional required data elements, and make attestations about the accuracy of data elements entered in MAPIR. Applicants will need to demonstrate they meet: o Medicaid patient volume thresholds; They are adopting, implementing, upgrading or meaningfully using a federally-certified EHR systems; The EP will be required to provide documentation verifying the provider has adopted, implemented, upgraded to or is meaningfully using the certified EHR system that was attested to in the MAPIR application. Below is a list of documents we will accept to verify EHR attestation is sufficient. The Department will determine if the validation of the attestation is met after review of the documentation(s): o Proof of purchase with CMS EHR system certification number o Signed contract with CMS EHR system certification number o Signed lease with CMS EHR system certification number o Receipt with CMS EHR system certification number o Cancelled check with CMS EHR system certification number o User or license agreement with CMS EHR system certification number o Signed vendor letter with CMS EHR system certification number (to supplement one of the above, if the CMS EHR system certification is not identified on one of those documents). These documents can be uploaded during the MAPIR application process or they can be ed to They meet all other federal program requirements. 12

13 HIT Initiative Applicants may use the patient volume calculator on the Department s website ( prior to entering MAPIR to estimate eligibility based on patient volume for a continuous 90-day period within the previous calendar year. Applicants may refer to Meaningful Use resources on the Department s website ( prior to entering MAPIR to attest to meaningful use. All MU data is done at the individual EP level and cannot be done at the group level like patient volume. In addition, MU data is taken from the current calendar year. The Department will review applications submitted in MAPIR and make approval decisions. The Department will inform all applicants whether they have been approved or denied via . All approvals and denials are based on EHR Incentive Program rules set forth by the federal government. Payments will be issued via the standard PROMISe payment system that runs once a week. Applicants will see approved payments on their remittance advices and their annual 1099 s. It is possible the Department may need to contact applicants during the application process before a decision can be made to approve or deny an application. Applicants are encouraged to contact the Department if they have questions about the process, by at: or by phone at (855) Applicants have appeal rights available to them; for example, if an applicant is denied an EHR incentive payment. The Department will convey information on the appeals process to all applicants denied. Appeals will be processed by the Department s Bureau of Hearings and Appeals. Applicants 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 applicant s covered professional services. Applicants should feel free to contact the Department for more assistance with the application process. Applicants can contact the Department by at or by phone at (855) Please include your name and NPI number on all correspondence. 13

14 HIT Initiative Application Readiness for Providers Applicants can take a number of steps to expedite the processing of their applications: Applicants must provide a valid address during the CMS registration process so that the Department can inform them, by , that their registration has been received from CMS and that they can begin the MAPIR application process; Applicants must obtain a PROMISe Internet Portal User ID and password for the PROMISe provider portal if they do not already have one. For registration information click on the following link: The NPI and TIN provided to CMS must match the NPI and Payee TIN information within the PROMISe system. This combination should be the same NPI/TIN combination that is used for claim payment purposes; A fee assignment relationship needs to be established in the PROMISe system between the individual provider and the group they are assigning payment to. In other words the provider needs to be fee assigned to the payee NPI and TIN they are registering at CMS. Applicants can work through the MAPIR application process through Sample Eligible Professional MAPIR applications on the Department s website: ehealthinformationtechnologyinitiative/maprovincentiverepos/index.htm. 14

15 HIT Initiative Year One Process Flow: Medicaid EHR Incentive Program The following figure describes the overall application, registration, attestation, and monitoring process for the EHR Incentive Program, (see Figure 1 below). Figure 1: Year One Process Flow: Medicaid EHR Incentive ATTENTION! EPs and EHs cannot apply prior to receiving an from OMAP confirming their ability to enroll. Note: MAPIR icon will not appear in PROMISe until provider receives this The Department conducts education and outreach strategy for providers and stakeholders Providers will enroll in the R&A CMS Centers for Medicare & Medicaid Services MAPIR Provider Incentive Repository R&A Medicare and Medicaid EHR Incentive Program Registration and Attestation System The Department Pennsylvania Department of Public Welfare 3 The R&A will provide information to The Department through MAPIR interfaces about providers who have applied for the Incentive Program 8 Provider application clears MAPIR system reviews and MAPIR generates approval with program information to provider 4 MAPIR runs reviews on info from the R&A to determine which providers to contact for the application process 9 MAPIR supplies list of providers who pass reviews on to the R&A for final confirmation 5 6 Providers submit application and attestation form in MAPIR system and MAPIR concurrently runs system reviews The Department reviews pended provider applications and attestations and determines eligibility or addresses reasons for suspension The Department sends approval to provider with program and payment information MMIS issues payment and MAPIR submits payment information to the R&A Post-payment oversight and outreach activities 7 The Department denies provider s application 13 Ongoing technical assistance for adoption, implementation, upgrade and meaningful use of EHR 14 Notification of meaningful use requirements for Year 2 and beyond Provider Appeal/ Questions Submitted No Provider Appeal 15 Meaningful use payment request or renewal * Providers include Eligible Professionals and Eligible Hospitals as defined by the EHR Incentive Program rules. 15

16 HIT Initiative Years Two through Six Process Flow: Medicaid EHR Incentive Program The following figure describes the overall application, registration, attestation, and monitoring process for the EHR Incentive Program years two through six (see Figure 1 below). Year 2 Once an EP has registered at the CMS R&A site it is not necessary to reregister UNLESS the NPI or payee assignment information has changed or if EP changes from Medicare to Medicaid. 1 The Department continues to conduct education and outreach strategy for providers and stakeholders. 2 When EPs are ready to apply for payment year two and subsequent years, go directly into the application through the MAPIR system and complete the required fields and submit. 3 The Department reviews the EPs application and attestations to determine eligibility for payment. The Department will request additional information if it is needed to determine eligibility for payment. 4 When all information is obtained from the EP, the Department will make a payment determination. If requested information is not received within 60 days, the application will not be processed. This determination is either to approve or to deny the application. 5 Approval: MAPIR generates an notifying the EP of the approval. 5 Denial: EPs are notified of the denial and the reason. The EP may file a formal appeal or resubmit their application with updated or corrected data. 6 MAPIR generated records and transmits to CMS for final eligibility check. CMS provides final payment approval and PROMISe generates a payment to the EP. 7 After payment is generated, MAPIR generates a final notification of the payment. MAPIR retains payment information for EPs next incentive application. 8 The Department completes a post payment audit to validate payment. The Department continues to provide notifications and updates on the EHR Incentive program. 16

17 HIT Initiative 5 Patient Volume Calculation In order to be eligible for the Pennsylvania EHR Incentive Program, EPs must meet eligible patient volume thresholds. The basic formula for calculating the Medicaid Patient Volume is illustrated below: Patient Encounters (includes Medicaid encounters in and out of Commonwealth of Pennsylvania) Total Patient Encounter Volume in and out of Commonwealth of Pennsylvania = % Medicaid Patient Volume EPs must meet annual patient volume thresholds. The general rule is that EPs must meet the Medicaid patient volume thresholds which is typically a minimum of 30 percent but can be 20 percent or higher for pediatricians. Medicaid patient volume calculations are based on encounters for which Medicaid paid any part. Medicaid patient volume is measured over a continuous 90-day period in the previous calendar year. For example, if requesting payment for 2012, the volume must be achieved and reported for a continuous 90-day period in Providers are encouraged to upload documents supporting their patient volume into their incentive application. Documentation can also be ed to and include the subject line MA patient volume report. A sample volume report can be found here: DEFINITION OF ENCOUNTER For purposes of calculating EP patient volume, a Medicaid encounter means services rendered to an individual on any one day where Medicaid paid for part or all of the service; or paid all or part of the individual s premiums, copayments, and cost-sharing. There is no minimum number of patient encounters. Patient volume calculations can include managed care/healthchoices encounters and dual Medicaid/Medicare eligible encounters. Please note that you cannot include encounters that were not paid (at least in part) by Medical Assistance. Please note that your internal practice management system or billing software may list the payment or insurance type by visit but you must make sure paid 17

18 HIT Initiative some part of the encounter in order to include it in your patient volume calculation. For example, if denied the claim, the individual paid out-of-pocket or the service was not a Medicaid-covered service, then the associated encounter cannot be included in your patient volume numerator. Exceptions: EPs that practice predominantly at a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC) have different criteria, (see Figure 2 below for additional details). Pediatricians have special rules and are allowed to participate with a reduced eligible patient volume threshold (20 percent instead of 30 percent). If pediatricians have greater than 20 percent but less than a 30 percent eligible patient volume, their annual incentive cap is reduced to 2/3. Pediatricians who achieve 30 percent eligible patient volume are eligible to receive the full incentive amount for which they qualify. Figure 2: Patient Volume Thresholds per the CMS Final Rule Provider Type Requirements Threshold Eligible Professionals EPs Applying as Individuals EPs Applying as a Group Pediatrician EPs Practicing Predominantly in an FQHC/RHC Can use encounters from multiple locations. MAPIR will provide information for each location with Medicaid claims or provider enrollment data. Numerator: Includes totals for the entire group. Will require use of the group NPI(s) for verification. The group volume is then applied to all individual providers in the group. The payments are for the individual providers, thus when the group volume calculation is used, it must be applied to all individual providers in the group. Must be a physician who is either board-certified as a pediatrician or has received 12 months of training with children under the age of 21 years old. Other EPs in a pediatric group must meet the 30% threshold. Please note that pediatricians practicing predominantly in FQHC/RHCs must meet the 30% Medicaid patient volume threshold (including Medical Assistance and Needy patient encounters). Numerator: Can also include needy individuals in the numerator totals. Needy individuals are those who receive services paid by Medicaid, CHIP or some other auditable reduced payment scale. 30% 30% 20% (30% FQHC/ RHC) 30% 18

19 HIT Initiative Needy Patient Volume Applies only to EPs Who Practice Predominantly in an FQHC/RHC Needy population encounter means services performed where: or Children s Health Insurance Program paid for all or part of the service; or individual s premiums, copayments, or cost-sharing; The services were furnished at no cost; or, The services were paid for at a reduced cost based on a sliding scale determined by the individual s ability to pay. Practices predominantly means that more than 50 percent of your patient encounters occur at a federally qualified health center or rural health clinic. The calculation is based on a period of 6 months in the most recent calendar year. Group Volume Calculation Incentive payments are for individual providers, however, individual providers practicing in clinics and group practices (including FQHCs and RHCs) are allowed to use the practice or clinic Medicaid patient volume (or needy population patient volume, insofar as it applies) for their patient volume. Note: The group NPI must define the group and all members of the group must apply in an identical manner. EPs should enter the group NPIs in the group practice provider ID field. The following conditions apply to group practice calculations: 1. There must be an auditable data source to support the group s patient volume determination. Providers are encouraged to upload documents supporting their patient volume into their incentive application. Documentation can also be ed to and include the subject line MA patient volume report. A sample volume report can be found here: 3.pdf 2. The group methodology is not appropriate for eligible professionals who see commercial, Medicare, or self-pay exclusively. The Pennsylvania EHR incentive program will verify that EPs are currently and actively seeing medical assistance (or needy individuals if the EP practices predominately in a FQHC or RHC) by reviewing claims history for the EP. 3. EPs have the capability to enter four (4) group NPIs. If there are more than four (4) group NPIs please indicate by checking the box in MAPIR described as additional 19

20 HIT Initiative group practice provider IDs. Please send all additional group NPI numbers and provider names by to: 4. If you are an eligible professional in a group that practices predominantly in an FQHC or RHC then you can include needy population encounters as part of your patient volume. For additional information on calculating patient volume, please review the Patient Volume Webinar that OMAP presented on February 15, 2011: A patient volume calculator to help estimate EP patient volume before applying in MAPIR is available on the Department s website: chnologyinitiative/maprovincentiverepos/index.htm A sample volume report that outlines how encounters should be captured is available on the Department s website and it is recommended you upload as a PDF with your MAPIR app.: For FQHC/RHC clinics, you may send us a report matching the MAPIR application information in a slightly different format as outlined below: Column 1: Medicaid & CHIP Encounter Volume This is all Pennsylvania Medicaid and Pennsylvania CHIP encounters Column 2: Other Needy Individual Encounter Volume This is Pennsylvania sliding scale and Pennsylvania uncompensated encounters Column 3: Total Needy Encounter Volume This is 1 plus 2 plus out of state Medicaid, sliding and uncompensated Column 4: Total Encounter Volume This is all encounters regardless of payer and regardless of state (this should always be larger than 3) This report would still include 90-day consecutive period the data represents. However, it WILL need to be signed and dated by an authorizing official (CEO, CFO, COO) of the health center. In addition, just wanted to remind that you cannot include Medicare/Medicaid dually eligible if Medicaid did not pay some portion or all of the encounter. See FAQ from CMS below: 20

21 HIT Initiative 6 Provider Incentive Payments The federal rules also set forth the EP EHR incentive payments. EPs may receive up to $63,750 in six incentive payments by participating in 6 program years over the life of the incentive program. It is not necessary for EPs to participate in 6 consecutive years, unless joining the program in 2016, to receive the full incentive payment of $63,750, (see Figure 3 below). Eligible pediatricians that reach the 20 percent of their total patient volume but not 30 percent may receive up to $42,500 through six incentive payments over the life of the program. The pediatrician incentive payments table, (see Figure 4 below), provides an overview of incentive payments over the life of the Pennsylvania EHR Incentive Program. Note: Pediatricians who receive the lower incentive payment in year one still have the opportunity to receive the higher incentive payment in subsequent years if their MA patient volume increases to over 30%. Figure 3: Maximum Incentive Payments for Pennsylvania CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY 2011 $21,250 CY 2012 $8,500 $21,250 CY 2013 $8,500 $8,500 $21,250 CY 2014 $8,500 $8,500 $8,500 $21,250 CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250 CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500 CY 2018 $8,500 $8,500 $8,500 $8,500 CY 2019 $8,500 $8,500 $8,500 CY 2020 $8,500 $8,500 CY 2021 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 21

22 HIT Initiative Figure 4: Pediatrician Pennsylvania EHR Incentive Payments (Between Percent) CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY 2011 $14,167 CY 2012 $5,667 $14,167 CY 2013 $5,667 $5,667 $14,167 CY 2014 $5,667 $5,667 $5,667 $14,167 CY 2015 $5,667 $5,667 $5,667 $5,667 $14,167 CY 2016 $5,665 $5,667 $5,667 $5,667 $5,667 $14,167 CY 2017 $5,665 $5,667 $5,667 $5,667 $5,667 CY 2018 $5,665 $5,667 $5,667 $5,667 CY 2019 $5,665 $5,667 $5,667 CY 2020 $5,665 $5,667 CY 2021 $5,665 TOTAL $42,500 $42,500 $42,500 $42,500 $42,500 $42,500 22

23 HIT Initiative 7 Adopt, Implement or Upgrade (AIU) and Meaningful Use The goal of the Pennsylvania EHR Incentive Program is to promote the adoption, implementation, upgrade, and meaningful use of certified EHRs. In their first payment year, professionals will be able to attest to and demonstrate that they have: Adopted: Acquired, purchased or secured access to certified EHR technology. Implemented: Installed or commenced utilization of certified EHR technology capable of meeting meaningful use requirements. Upgraded: Expanded the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to a federally-certified EHR system. Meaningfully Used: Utilized a certified EHR technology to obtain meaningful use measures for a minimum of 90 continuous days within the current calendar year. All providers will fall into one of the four groups listed above. The CMS Final Rule describes multiple stages for determining meaningful use (MU), each with its own separate measurements and criteria. The stages represent a graduated approach to arriving at the ultimate goal. Only Stage 1 was described in detail in the 2010 Final Rule: Stage 1 Criteria was implemented in 2011 for Medicare and 2012 for the Pennsylvania Program. Stage 1 requires providers to capture health information in a structured format, using the information to track key clinical conditions (for care coordination purposes), implementing clinical decision support tools to facilitate disease and medication management and using EHRs to engage patients and families and reporting clinical quality measures and public health information. The criteria for stages 2, 3, and beyond will be described in future rulemaking. Stage 1 includes a series of core and menu measures, (see Appendix for Meaningful Use Criteria: Core, Menu, and Clinical Quality Measures ). 23

24 HIT Initiative 8 Attestations and Audits CMS requires states to ensure that payments are being made to the right person, at the right time, for the right reason. In order to receive an incentive payment, eligible professionals will be attesting to, among other things, whether they are using a certified EHR, demonstrating adopting, implementing or upgrading (AIU) certified EHR technology, demonstrating meaningful use, etc. States will be required to look behind provider attestations which will require audits both pre- and post-payment. CMS believes a combination of pre-payment and post-payment reviews will result in accurate payments and timely identification of overpayments. In particular, with meaningful use, the Department will use pre- and post-audit opportunities to combat fraud and abuse, encourage meaningful use of certified EHR systems, and assist with promoting HIT initiatives to increase affordable access to quality healthcare. The Department will confirm that EHR incentive payments were appropriately disbursed by ensuring that meaningful use eligibility requirements are met, and reflect their attestations in the MAPIR application. Along with fraud and abuse detection practices, the Department will facilitate providers with meaningful use of Certified EHR systems, which will ultimately assist with patients and medical professional s decision making. The Department will also determine how eligible provider s Certified EHR systems will increase the likelihood that the systems can align with other HIT initiatives that support the exchange of information, care coordination, improved quality of care, safety, efficiency, and reduction in health disparities. All information submitted in the MAPIR application is subject to review. Applicants have the option to submit additional information, (e.g., copies of receipts, contracts, and other documentation related to adopt, implement, upgrade and meaningful use), as part of the application process by uploading the documentation directly into the MAPIR application or by to: MAPIR Attestations Professionals will need to verify the information displayed in MAPIR and will also need to enter additional required data elements and make attestations about the accuracy of data elements entered in MAPIR. For example, applicants will need to demonstrate that they meet Medicaid patient volume thresholds, that they are adopting, implementing, upgrading or meaningfully using federally-certified EHR systems, and that they meet all other federal 24

25 HIT Initiative program requirements. If additional documentation is requested, the EP has 60 days from the time of the request to submit the documentation to validate the attestation requirements. The MAPIR system design is based on the CMS Final Rule for the EHR Incentive Program and Pennsylvania s specific eligibility criteria. A series of reviews will identify applicants who do not appear to be eligible, for example: Hospital-based providers Providers who do not meet patient volume thresholds Those who are ineligible provider types Providers with current sanctions These MAPIR system reviews help ensure providers meet all requirements of the program and reduce incorrect payments and overpayments. 25

26 HIT Initiative Post-Payment Reviews MAHITI and the MAPIR Operations team members, after discussion with the Department of Program Integrity (BPI) Liaison, will refer issues related to fraud with program requirements to BPI and work directly with the BPI Liaison to resolve the issue. In the case of abuse, MAHITI and the Operations team will reach-out to the applicant to correct the issue, (this is performed during the application process as part of the pre-payment audit). In the case where abuse is identified after the payment is processed, MAHITI and the Operations team will refer the issue to BPI. Abuse is characteristically an innocent mistake, while fraud consists of an event that was knowingly and willingly incorrect, and that was purposely executed to obtain a benefit. The Department will perform a multitude of different post-payment audit strategies. The department has categorized higher risk type applications for potential fraud or abuse for review such as professionals that had Medicaid sanctions in the past. In the case of meaningful use auditing, the Department will use pre- and post-payment audit opportunities to combat fraud and abuse. MAPIR will have system checks to ensure that providers are meeting meaningful use standards. Along with these system checks, manual reviews will be used to look behind the attestations. Risk categories developed by the Department or by CMS, along with sampling techniques can be used for audit selection. These manual reviews can take place by means of primary and secondary data analysis and comparison, ultimately leading to desk and field audits to ensure proper access and use of EHRs. According the Final Rule, a state must comply with federal requirements to ensure the program qualifications of the provider, detect improper payments, and refer suspected cases of fraud and abuse to the Medicaid Fraud Control Unit for that state. The Bureau of Program Integrity will refer all cases of suspected provider fraud to the Medicaid Fraud Control Section (MFCS) found in the Pennsylvania Attorney General's Office. Electronic Health Record (EHR) Incentive Program Post-payment Audit Request Policy The Program requires the provider thirty (30) business days to submit the required documentation that was requested. The auditor can authorize a fifteen (15) business day 26

27 HIT Initiative extension if requested, and appropriately justified, by the provider. If the provider needs more than forty-five (45) business days to produce the documents, approval from the HIT Coordinator is required. 27

28 HIT Initiative 9 Overpayments MAPIR will be used to store and track records of incentive payments for all participating EPs. The Department will regularly monitor payments to ensure overpayments are not made. Once an overpayment is identified, MAPIR will be used to determine the amount of payments that have been made and that must be returned by EPs. When overpayments are identified, the Department will initiate the payment recoupment process and communicate with CMS on repayments. The Department will recover any overpayments from instances of abuse; however, overpayments identified as a result of a fraud conviction are handled in conjunction with the Medicaid Fraud Control Unit. The Department will request that providers submit overpayments by check. If a provider fails to submit a payment by check within 90 calendar days of the notice to return the overpayment, the Department will take other measures to recoup the overpayment. Federal law requires the Department to return overpayments within one (1) year of identification. 28

29 HIT Initiative 10 Appeals EPs will have the right to appeal certain Department decisions related to the Medical Assistance EHR Incentive Program. Appeals are not related to disputes between providers and practices. Examples of appeal reasons include, but are not limited to, the following: Applicant is determined ineligible for the EHR Incentive Program; Applicant has received an overpayment for the EHR Incentive Program; or, Appeal of incentive payment amount, (e.g., pediatrician payment). You will receive a notice of denial via and a follow-up denial letter with specific instructions on how to submit an appeal. Appeals related to this program will be processed like all other provider appeal issues. Providers should submit appeals to the Department s Bureau of Hearings and Appeals copying the Bureau of Program Integrity and the Office of HIT Coordinator. 29

30 HIT Initiative Part II: Application Assistance 30

31 HIT Initiative 11 MAPIR Overview This section of the Pennsylvania EHR Incentive Program Eligible Professional Provider Manual, describes how users apply for incentive payments through the Provider Incentive Repository (MAPIR). MAPIR is the state-level information system for the EHR Incentive Program that will both track and act as a repository for information related to payment, applications, attestations, oversight functions, and interface with the Medicare and Medicaid EHR Incentive Program Registration and Attestation System (R&A). MAPIR is intended to streamline and simplify the provider enrollment process by interfacing with other systems to verify data. EPs will enter data into MAPIR and attest to the validity of data thus improving the accuracy and quality of the data. The MAPIR system will be used to process provider applications, including: Interfacing between the Department and the R&A to: o Receive initial registration information from professionals o Report eligibility decisions to CMS o Report payment on formation (payment date, transaction number, etc.) to CMS Verify information submitted by applicant Determine eligibility of professionals Allow professionals to submit: o Attestations o Payee information o Submission confirmation/digital signature Communicate Payment Determination In addition, MAPIR will contain a series of validation checks that will be used during the application process (e.g., confirmation of R&A information, patient volume, and attestations) to confirm a professional s eligibility for the program. 31

32 HIT Initiative To begin in the MAPIR application process, professionals must: 1. Enroll at the R&A (first year only or if there have been changes since your first payment year, i.e. changing payee assignment); 2. Be enrolled in ; and, 3. Be free of sanctions or exclusions. Note: In some cases, professionals will be re-directed to the R&A to correct discrepant data. In other cases, providers will be deemed ineligible for participation in the Pennsylvania Medical Assistance EHR Incentive Program. The Department will provide an notification to applicants in these instances. 32

33 HIT Initiative 12 Pennsylvania s PROMISe Provider Portal Providers can access MAPIR through Pennsylvania s MMIS provider internet portal, PROMISe : To access PROMISe, the user must first be an enrolled provider. To enroll as a provider, applicants must complete the enrollment process as defined in our online information: 33

34 HIT Initiative It is important to note that there are no specific applications for Physician Assistants or Pediatricians. Instead, they should use the application for individual practitioners (PT31). To review the individual practitioners PT31 application, click on the following link: Upon receipt of notification (via ) from the Department, applicants will be able to access MAPIR from the PROMISe provider portal using their PROMISe TM Internet Portal User ID. In order to apply for the EHR incentive payment via MAPIR, the individual provider who registered at the R&A must have a PROMISe Internet account ID; even if the applicant has elected someone else to enroll for them. A group practice internet account ID will not display the MAPIR link. If the EP does not already have an individual PROMISe Internet account ID, you may register for one at If you need assistance, you may access the PROMISe Internet elearning course ( or call the Provider Assistance Center at Note: You must use the same PROMISe Internet Portal User ID throughout the application process including if you start and then have to restart the application. The same PROMISe Internet Portal User ID will need to be used in subsequent years as well. If you need to change that User ID, please contact the Department at 34

35 HIT Initiative EHR Incentive Program 13 Completing the MAPIR Application The next section of the Eligible Professional Provider Manual consists of instructions on how to complete each screen component within seven electronic MAPIR application tabs that comprise the registration document: Get Started R&A and Contact Info Eligibility Patient Volume Attestation Review Submit As applicants move through the various screens, MAPIR will display key information about completing each tab through information pages which display information needed to complete the fields in the tab and guidance on what to include in the response. More information to help you with the application will be available in hover bubbles which are indicated by a question mark. To view this information, simply move your mouse over the symbol shown in the example below. 35

36 HIT Initiative EHR Incentive Program HOVER BUBBLES HOVER BUBBLES Many MAPIR screens contain help icons to give the provider additional details about the information being requested. Moving your cursor over the will reveal additional text providing more details. In this screen, the hover bubble explains what it means to be a Hospital-based eligible professional. 36

37 HIT Initiative DASHBOARD PROGRAM PARTICIPATION DASHBOARD This dashboard will show the options for the EP Incentive program. It shows the status of the application (current and previous), the payment year, the program year and the incentive amount from previous years. Your available options will be bolded. In this specific example, the EP has begun the application for Program Year

38 HIT Initiative DASHBOARD (cont.) PROGRAM PARTICIPATION DASHBOARD Once you choose the application you want to complete, you will then see this page. Doc Mapir Please verify that the Payment Year and the Program Year listed at the top of the page are the ones you chose to complete. If the Payment Year and Program Year are correct, press Get Started. Otherwise press Exit, log back into your application and at the dashboard select the correct Payment Year/Program Year Combination. 38

39 HIT Initiative GET STARTED (cont.) If the applicant elects to start over, MAPIR will display a Confirmation Screen confirming this is how the applicant chooses to proceed. The applicant can either: Select Cancel and return to the Get Started screen; or, Select Confirm, and will be prompted to initiate the application from the beginning. 39

40 HIT Initiative GET STARTED (cont.) CONTACT US Clicking on the Contact us link in the upper right hand corner of most [not all] screens within MAPIR will display the following contact information. 40

41 HIT Initiative GET STARTED INFORMATION PAGE There are information pages/splash screens (see screen to the left) throughout the MAPIR Application that include guidance on how to complete the MAPIR Application. For example, this first splash screen includes general information about MAPIR and how the provider should navigate through the MAPIR Application. 41

42 HIT Initiative PROFESSIONAL R&A AND CONTACT INFORMATION 42

43 HIT Initiative PROFESSIONAL R&A AND CONTACT INFORMATION (cont.) Check your information carefully to make sure all of it is accurate. Compare the R&A Registration ID you received when you registered with the R&A against the R&A Registration ID displayed. After reviewing the information click Yes or No. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. If you chose No, any discrepancies must be updated directly in the R&A before you can proceed in the MAPIR application. NOTE: Any time you go to the R&A system to review your account, you must re-submit and then will need to come back into this application to re-verify the data entered. This delays the processing of the application. 43

44 HIT Initiative PROFESSIONAL R&A AND CONTACT INFORMATION (cont.) Enter a Contact Name and Contact Phone. Enter a Contact Address twice for verification. All correspondence about your application will be sent to this address. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 44

45 HIT Initiative PROFESSIONAL R&A AND CONTACT INFORMATION (cont.) This screen confirms you successfully completed the R&A and Contact Info section. See check box in the right hand corner of the R&A and Contact Info tab. Click Continue to proceed to the Eligibility tab. 45

46 HIT Initiative ELIGIBILITY 46

47 HIT Initiative ELIGIBILITY (cont.) The questions on this screen are required fields that must be answered. Move your mouse over to find out additional information. Select Yes or No to the eligibility questions. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. For additional information on the definition of a Hospitalbased Eligible Professional, please click here. 47

48 HIT Initiative ELIGIBILITY (cont.) The Eligibility Questions (Part 2 of 3) screen asks for information about your practice type and general eligibility questions. The questions on this screen are required fields that must be answered. Indicate your responses to the eligibility questions by choosing your provider type and selecting Yes or No. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 48

49 HIT Initiative ELIGIBILITY (cont.) This Eligibility screen asks for information about your CMS EHR Certification ID. The requested information on this screen is required and must be completed. Enter the 15-character CMS EHR Certification ID without spaces or dashes. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. Note: The system will perform an online validation of the number you entered. A CMS EHR Certification ID can be obtained from the ONC Certified Health IT Product List (CHPL) website ( 49

50 HIT Initiative ELIGIBILITY (cont.) This screen confirms that you have successfully entered your CMS EHR Certification ID. Click Save & Continue to proceed; Previous to return. Q l0C

51 HIT Initiative ELIGIBILITY(cont.) This screen confirms that you have successfully completed the Eligibility section. See check box in the right hand corner of the Eligibility tab. Click Continue to proceed to the Patient Volumes section. 51

52 HIT Initiative PATIENT VOLUME 52

53 HIT Initiative PATIENT VOLUME (cont.) The questions on this screen are required fields that must be answered. Your answers here will determine which information screen will appear next. Please click on the appropriate link below to navigate through the Provider Manual screens for how to complete this section: Individual Patient Volume click here Group Patient Volume click here FQHC/RHC Individual Patient Volume click here FQHC/RHC Group Patient Volume click here 53

54 HIT Initiative PATIENT VOLUME INDIVIDUAL 54

55 HIT Initiative PATIENT VOLUME - INDIVIDUAL (cont.) This screen shows an Eligible Professional who does not practice predominantly in a FQHC/RHC and is using Individual Volume calculations. Select the appropriate answers using the buttons. The questions on this screen are required fields that must be answered. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 55

56 HIT Initiative PATIENT VOLUME - INDIVIDUAL (cont.) The information on this screen is required and must be completed. Enter a Start Date or select one from the calendar icon located to the right of the Start Date field. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 56

57 HIT Initiative PATIENT VOLUME INDIVIDUAL (cont.) The 90 Day End Date has been calculated for you. Review the Start Date and systemcalculated End Date information for accuracy. Click Save & Continue to proceed; Previous to return. 57

58 HIT Initiative PATIENT VOLUME INDIVIDUAL (cont.) You must select at least one practice location that you will be reporting Medicaid Patient Volumes and Utilizing Certified EHR Technology. Add locations by clicking Add Location and enter the requested information. Click Save & Continue to precede, Previous, or Reset to clear all unsaved data. 58

59 HIT Initiative PATIENT VOLUME INDIVIDUAL (cont.) If you clicked Add Location on the previous screen, you will see the screen to the left. The fields on this screen marked with the red asterisk are required fields that must be completed. Enter the requested practice location information. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 59

60 HIT Initiative PATIENT VOLUME INDIVIDUAL (cont.) Enter Patient Volumes for all locations. The fields on this screen marked with the red asterisk are required fields that must be completed. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 60

61 HIT Initiative PATIENT VOLUME INDIVIDUAL (cont.) Review the information for accuracy. Click Save & Continue to proceed or Previous to return. 61

62 HIT Initiative PATIENT VOLUME INDIVIDUAL This screen confirms that you have successfully completed the Patient Volumes tab. Note the check box in the right corner of the Patient Volumes tab. Click Continue to proceed to the Attestation tab. Please click here to move onto the Attestation section in the Provider Manual. 62

63 HIT Initiative PATIENT VOLUME - GROUP 63

64 HIT Initiative PATIENT VOLUME - GROUP (cont.) This screen shows an Eligible Professional who does not practice predominantly in a FQHC/RHC and is using Group Volume calculations. Select the appropriate answers using the buttons. The questions on this screen are required fields that must be answered. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 64

65 HIT Initiative PATIENT VOLUME - GROUP (cont.) The information on this screen is required and must be completed. Enter a Start Date or select one from the calendar icon located to the right of the Start Date field. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 65

66 HIT Initiative PATIENT VOLUME - GROUP (cont.) The 90 Day End Date has been calculated for you. Review the Start Date and systemcalculated End Date information for accuracy. Click Save & Continue to proceed; Previous to return. 66

67 HIT Initiative PATIENT VOLUME - GROUP (cont.) You must select at least one practice location that you will be reporting Medicaid Patient Volumes and Utilizing Certified EHR Technology. Add locations by clicking Add Location and enter the requested information. Click Save & Continue to proceed, Previous, or Reset to clear all unsaved data. 67

68 HIT Initiative PATIENT VOLUME - GROUP (cont.) If you clicked Add Location on the previous screen, you will see the screen to the left. The fields on this screen marked with the red asterisk are required fields that must be completed. Enter the requested practice location information. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 68

69 HIT Initiative PATIENT VOLUME GROUP (cont.) Enter Group Practice Provider IDs (also referred to as Group NPIs). If you listed four (4) Group NPIs and the patient volume numbers at the bottom reflect more than the four IDs you listed, please check the box directly below the Group NPIs. The fields on this screen marked with the red asterisk are required fields that must be completed. Enter Patient Volumes for the Group NPIs entered. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 69

70 HIT Initiative PATIENT VOLUME GROUP (cont.) Review the information you entered on this screen for accuracy. Click Save & Continue to proceed or Previous to return. 70

71 HIT Initiative PATIENT VOLUME GROUP (cont.) This screen confirms that you have successfully completed the Patient Volumes tab. Note the check box in the right corner of the Patient Volumes tab. Click Continue to proceed to the Attestation tab. Please click here to move onto the Attestation section in the Provider Manual. 71

72 HIT Initiative PATIENT VOLUME FQHC/RHC INDIVIDUAL 72

73 HIT Initiative PATIENT VOLUME FQHC/RHC - INDIVIDUAL (cont.) This screen shows an Eligible Professional who does practice predominantly in a FQHC/RHC and is using Individual Volume calculations. Select the appropriate answers using the buttons. The questions on this screen are required fields that must be answered. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 73

74 HIT Initiative PATIENT VOLUME FQHC/RHC - INDIVIDUAL (cont.) The information on this screen is required and must be completed. Enter a Start Date or select one from the calendar icon located to the right of the Start Date field. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 74

75 HIT Initiative PATIENT VOLUME FQHC/RHC - INDIVIDUAL (cont.) The 90 Day End Date has been calculated for you. Review the Start Date and systemcalculated End Date information for accuracy. Click Save & Continue to proceed; Previous to return. 75

76 HIT Initiative PATIENT VOLUME FQHC/RHC - INDIVIDUAL (cont.) You must select at least one practice location that you will be reporting Medicaid Patient Volumes and Utilizing Certified EHR Technology. Add locations by clicking Add Location and enter the requested information. Click Save & Continue to proceed, Previous, or Reset to clear all unsaved data. 76

77 HIT Initiative PATIENT VOLUME FQHC/RHC - INDIVIDUAL (cont.) Enter Patient Volumes for all locations. Note: Pediatricians working at a FQHC/RHC must meet the 30 percent Medicaid patient volume and can include needy patients in that volume. The fields on this screen marked with the red asterisk are required fields that must be completed. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 77

78 HIT Initiative PATIENT VOLUME FQHC/RHC - INDIVIDUAL (cont.) Review the information you entered on this screen for accuracy. Click Save & Continue to proceed or Previous to return. 78

79 HIT Initiative PATIENT VOLUME FQHC/RHC INDIVIDUAL (cont.) This screen confirms that you have successfully completed the Patient Volumes tab. Note the check box in the right corner of the Patient Volumes tab. Click Continue to proceed to the Attestation section. Please click here to move onto the Attestation section in the Provider Manual. 79

80 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP 80

81 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) This screen shows an Eligible Professional who does practice predominantly in a FQHC/RHC and is using Group Volume calculations. Select the appropriate answers using the buttons. The questions on this screen are required fields that must be answered. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 81

82 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) The information on this screen is required and must be completed. Enter a Start Date or select one from the calendar icon located to the right of the Start Date field. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 82

83 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) The 90 Day End Date has been calculated for you. Review the Start Date and systemcalculated End Date information for accuracy. Click Save & Continue to proceed; Previous to return. 83

84 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) You must select at least one practice location that you will be reporting Medicaid Patient Volumes and Utilizing Certified EHR Technology. Add locations by clicking Add Location and enter the requested information. Click Save & Continue to proceed, Previous, or Reset to clear all unsaved data. 84

85 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) Enter Group Practice Provider IDs (also referred to as Group NPIs). If you listed four (4) Group NPIs and the patient volume numbers at the bottom reflect more than the four IDs you listed, please check the box directly below the Group NPIs. The fields on this screen marked with the red asterisk are required fields that must be completed. Enter Patient Volumes for the Group NPIs entered. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 85

86 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) Review the information you entered on this screen for accuracy. Click Save & Continue to proceed or Previous to return. 86

87 HIT Initiative PATIENT VOLUME FQHC/RHC GROUP (cont.) This screen confirms that you have successfully completed the Patient Volumes tab. Note the check box in the right corner of the Patient Volumes tab. Click Continue to proceed to the Attestation section. 87

88 HIT Initiative ATTESTATION 88

89 HIT Initiative ATTESTATION EHR SYSTEM PHASE This Attestation screen requires a selection for your EHR System Phase. After making your selection, the next screen you see will depend on the phase you selected. Please click on the appropriate link below to navigate through the Provider Manual screens for how to complete this section: To select IMPLEMENTATION PHASE click here To select UPGRADE PHASE click here To select MEANINGFUL USE click here Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 89

90 HIT Initiative ATTESTATION FINAL ATTESTATION This screen contains information about the assignment of your incentive payment. Please review it carefully. Select Yes or No regarding assigning your incentive payment. Click Save & Continue to proceed to Final Attestation or Previous to return, or Reset to clear all data. 90

91 HIT Initiative ATTESTATION This screen confirms you successfully completed the Attestation tab. Note the check box in the right hand corner of the Attestation tab. Click Continue to proceed to the Review tab. Please click here to move onto the Review section in the Provider Manual. 91

92 HIT Initiative ATTESTATION IMPLEMENTATION PHASE If you are in the process of implementing a federally certified EHR system, then you would choose the Implementation option. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 92

93 HIT Initiative ATTESTATION IMPLEMENTATION PHASE Select your Implementation Activities by selecting the Planned/ In Progress or Complete button. NOTE: Your responses in this section will not impact your eligibility for an incentive payment but helps us to understand your attestation more completely. At least one activity must be selected to proceed. Click Other to add any additional Implementation Activities you would like to supply. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 93

94 HIT Initiative ATTESTATION IMPLEMENTATION PHASE (cont.) Review the Implementation Activities you selected for accuracy. Click Save & Continue to proceed or Previous to return. 94

95 HIT Initiative ATTESTATION FINAL ATTESTATION This screen contains information about the assignment of your incentive payment. Please review it carefully. Select Yes or No regarding assigning your incentive payment. Click Save & Continue to proceed to Final Attestation or Previous to return, or Reset to clear all data. 95

96 HIT Initiative ATTESTATION This screen confirms you successfully completed the Attestation tab. Note the check box in the right hand corner of the Attestation tab. Click Continue to proceed to the Review tab. Please click here to move onto the Review section in the Provider Manual. 96

97 HIT Initiative ATTESTATION UPGRADE PHASE If you are in the process of upgrading your current EHR system to a federally certified EHR system, then you would choose the Upgrade option. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 97

98 HIT Initiative ATTESTATION UPGRADE PHASE (cont.) Select your Upgrade Activities by selecting the Planned/In Progress or Complete button for each activity. NOTE: Your responses in this section will not impact your eligibility for an incentive payment but helps us to understand your attestation more completely At least one activity must be selected to proceed. Click Other to add any additional Upgrade activities you would like to supply. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 98

99 HIT Initiative ATTESTATION UPGRADE PHASE (cont.) Review the Upgrade Activities you selected for accuracy. Click Save & Continue to proceed or Previous to return. 99

100 HIT Initiative ATTESTATION FINAL ATTESTATION This screen contains information about the assignment of your incentive payment. Please review it carefully. Select Yes or No regarding assigning your incentive payment. Click Save & Continue to proceed to Final Attestation or Previous to return, or Reset to clear all data. 100

101 HIT Initiative ATTESTATION This screen confirms you successfully completed the Attestation tab. Note the check box in the right hand corner of the Attestation tab. Click Continue to proceed to the Review tab. Please click here to move onto the Review section in the Provider Manual. 101

102 HIT Initiative ATTESTATION MEANINGFUL USE PHASE You should select meaningful use if you are utilizing a federally certified EHR System and have completed the meaningful use requirements for the appropriate timeframe. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 102

103 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) Please select the appropriate EHR System Meaningful Use Phase that applies to your situation. Choose the 90 day option if this is your first payment associated with meeting the Meaningful Use requirements. If this is the first year you have participated in the EHR Incentive program (either Medicaid or Medicare) you may choose Meaningful Use (90 days) or you may still choose Adopt, Implement or Upgrade in the previous slides. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 103

104 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) Please enter a start date (or select one from the calendar icon located to the right of the Start Date field) for your 90 day MU attestation. NOTE: Meaningful Use dates need to be dates within the current Calendar Year. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 104

105 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This screen displays an example of a Start Date of January 1, 2012 and a systemcalculated End Date of March 30, 2012 for the period in which you are attesting to meaningful use. NOTE: Meaningful Use dates need to be dates within the current Calendar Year. Click Save & Continue to proceed or Previous to return. 105

106 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This dashboard will display your progress on the various measures as you progress through the application. You may choose which set of measures you wish to begin first as you do not need to go in order. To start a Topic, click the Begin button. Click Save & Continue to proceed or Previous to return. 106

107 HIT Initiative ATTESTATION GENERAL REQUIREMENTS (cont.) This screen is the Meaningful Use General Requirements. Please complete all required fields (*). Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 107

108 HIT Initiative ATTESTATION GENERAL REQUIREMENTS (cont.) This dashboard shows the General Measures are completed by showing the under the Completed column. This checkmark does not necessarily indicate the measure meets the actual requirement associated with the measure. To change one of the measures or to continue with the measures, click the Edit Button. To clear all the data that has been entered, select the Clear All Button. To start a Topic, click the Begin button. Click Save & Continue to proceed or Previous to return. 108

109 HIT Initiative ATTESTATION CORE MEASURES This screen summarizes the requirements for the Meaningful Use Core Measures. Please read this as it provides details that will make it easier to complete the application. NOTE: Eligible Professionals are required to complete all 15 Core Measures even if you meet the exclusion requirements. Click Begin to start the Core Measure section. 109

110 HIT Initiative ATTESTATION CORE MEASURES (cont.) This screen displays more details on the Meaningful Use Core Measures. Each Measure provides a link to a document that gives additional details about the specific measure. To enter data for any of the measures, click the Edit button by that measure. Click Return to Main to go back to the Meaningful Use Dashboard. 110

111 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 1 CPOE for medication orders. Please complete all required fields (*). NOTE: You are required to enter whole numbers in the numerator and denominator. This screen shows the error you receive when you enter numbers with decimal points. To view more details about this measure, please click this link. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 111

112 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 1 CPOE for medication orders. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 112

113 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is the CMS Information Sheet for MU Core Measure 1 Computerized Provider Order Entry (CPOE). It provides details on what the measure means and what information should be included when completing the measure. You get to this page by selecting the Click HERE to review CMS guidelines for this measure link at the top of each Meaningful Use Measure attestation page. To view the entire document, click this link. 113

114 HIT Initiative ATTESTATION CORE MEASURES (cont.) After completing each Core Measure, you will return to the Meaningful Use Core Measure List Table. To complete another measure, click Edit by that measure. Click Return to Main to go to go back to the Meaningful Use Dashboard. 114

115 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 2 Drug Interaction Checks. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 115

116 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 3 Maintain Problem List. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 116

117 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 4 Generate and Transmit Permissible Prescriptions Electronically. Please complete all required fields (*). To view more details about this measure, please click this link. Note: This screen shows an error because Yes was selected for the exclusion, but the Numerator and Denominator were completed Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 117

118 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 4 Generate and Transmit Permissible Prescriptions Electronically. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 118

119 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 5 Maintain Active Medication List. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 119

120 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 6 Maintain Active Medication Allergy List. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 120

121 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 7 Record Patient Demographics. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 121

122 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 8 Record and Chart Changes in Patient Vital Signs. Please complete all required fields (*). Note: This shows an example of choosing an exclusion. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 122

123 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 9 Record Smoking Status. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 123

124 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 10 Report Ambulatory Clinical Quality Measures. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 124

125 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 11 Implement One Clinical Decision Support Tool. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 125

126 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 12 Electronic Copy of Health Information. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 126

127 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 13 Provide Clinical Summaries. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 127

128 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 14 Exchange Key Clinical Information. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 128

129 HIT Initiative ATTESTATION CORE MEASURES (cont.) This is MU Core Measure 15 Protect Electronic Health Information. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 129

130 HIT Initiative ATTESTATION CORE MEASURES (cont.) This screen summarizes the information entered for the Core measures. You will need to verify that this information is accurate. To change the data, select the EDIT button. Click Return to Main to go back to the Meaningful Use Dashboard. 130

131 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This dashboard shows the Core Measures are completed by showing the under the Completed column. This checkmark does not necessarily indicate the measure meets the actual requirement associated with the measure. To change one of the measures or to continue with the measures, click the Edit Button. To clear all the data that has been entered, select the Clear All Button. To start a Topic, click the Begin button. Click Save & Continue to proceed or Previous to return. 131

132 HIT Initiative ATTESTATION MENU MEASURES (cont.) This screen summarizes the requirements for the Meaningful Use Menu Set Measures. Please read this as it provides details that will make it easier to complete the application. NOTE: Eligible Professionals are required to complete 5 out of 10 Menu Set Measures. At least one Public Health Measure must be included in the 5 choices. You may complete more than 5 even though you are only required to complete 5. Click Begin to move on to the Menu Set Measures. 132

133 HIT Initiative ATTESTATION MENU MEASURES (cont.) This screen displays details on the Menu Set Measures. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 133

134 HIT Initiative ATTESTATION MENU MEASURES (cont.) This screen displays the summary of the Menu Set Measures that you chose to complete. To enter data for any of the measures, click the Edit button by that measure. Click Return to Selection List to go back to the list of the Menu Set Measures. 134

135 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 1 - Drug Formulary Checks. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 135

136 HIT Initiative ATTESTATION MENU MEASURES (cont.) After completing each Menu Measure, you will return to the Meaningful Use Menu Measure List Table. To complete another measure, click Edit by that measure. Click Return to Selection List to go to go back to the List of Menu Measures. 136

137 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 2 Incorporate Clinic Lab Test Results. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 137

138 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 3 Generate Lists of Patients by Specific Conditions. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 138

139 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 4 Send Reminders to Patients. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 139

140 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 5 Timely Electronic Access to Health Information. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 140

141 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 6 Patient Specific Education Resources. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 141

142 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 7 Medication Reconciliation. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 142

143 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 8 Summary of Care. Please complete all required fields (*). To view more details about this measure, please click this link. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 143

144 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 9 Public Health Measure Immunization Registry. Please complete all required fields (*). To view more details about this measure, please click this link. If you would like to upload documents to support this measure, you will be able to do this in the Submit section. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 144

145 HIT Initiative ATTESTATION MENU MEASURES (cont.) This is MU Menu Set Measure 10 Public Health Measure Syndromic Surveillance. Please complete all required fields (*). If you would like to upload documents to support this measure, you will be able to do this in the Submit section. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 145

146 HIT Initiative ATTESTATION MENU MEASURES (cont.) This screen summarizes the information entered for the Menu Measures. You will need to verify that this information is accurate. To change the data, select the EDIT button. 146

147 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This dashboard shows the Menu Set Measures are completed by showing the under the Completed column. This checkmark does not necessarily indicate the measure meets the actual requirement associated with the measure. To change one of the measures or to continue with the measures, click the Edit Button. To clear all the data that has been entered, select the Clear All Button. To start a Topic, click the Begin button. Click Save & Continue to proceed or Previous to return. 147

148 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES This screen summarizes the requirements for the Meaningful Use Clinical Quality Measures (CQM). Please read this as it provides details that will make it easier to complete the application. You may only enter positive whole numbers for numerators/ denominators/ exclusions. For CQM s exclusions are numeric. NOTE: Eligible Professionals are required to complete a minimum of 6 Clinical Quality Measures; 3 from Core or Alternate Core Clinical Quality Measures and 3 from Additional Clinical Quality Measures. You may enter information on more than the minimum number of CQMs required. Click Begin to move on to the Clinical Quality Measures. 148

149 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen displays a listing of the Core Clinical Quality Measures. Click Return to Main to go back to the Meaningful Use Dashboard. 149

150 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Core Clinical Quality Measure 1 Hypertension: Blood Pressure Measurement. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 150

151 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) When you choose the Click here for additional information on completing this measure link, you will first see this screen. Please review this screen and then select Accept at the bottom of the page to view the next screen. 151

152 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) After you accept the CMS Disclaimer, this top window will open. This window displays folders with additional information for the Clinical Quality Measures. Simply choose the measure that you would like additional information and double click on the folder. This will open the 2 nd window. Here you have the option of opening a.pdf file or an excel spreadsheet. The.pdf file is in a format that is easier to view. 152

153 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is the Information Sheet for MU Core Clinical Quality Measure 1 Hypertension: Blood Pressure Measurement. It provides details on what the measure means and what information should be included when completing the measure. 153

154 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) After completing each Clinical Quality Measure, you will return to the Meaningful Use Clinical Quality Measure List Table. To complete another measure, click Edit by that measure. Click Return to Main to go to go back to the Meaningful Use Dashboard. 154

155 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Core Clinical Quality Measure 2 Tobacco Preventive Care and Screening Measure. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 155

156 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Core Clinical Quality Measure 3 Adult Weight Screening. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 156

157 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen summarizes the information entered for the Core Clinical Quality Measures. You will need to verify that this information is accurate. To change the data, select the EDIT button. Click Return to Main to go back to the Meaningful Use Dashboard. 157

158 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This dashboard shows the Core Clinical Quality Measures are completed by showing the under the Completed column. This checkmark does not necessarily indicate the measure meets the actual requirement associated with the measure. To change one of the measures or to continue with the measures, click the Edit Button. To clear all the data that has been entered, select the Clear All Button. To start a Topic, click the Begin button. Click Save & Continue to proceed or Previous to return. 158

159 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen summarizes the requirements for the Meaningful Use Alternate Core Clinical Quality Measures. Please read this as it provides details that will make it easier to complete the application. NOTE: Eligible Professionals are required to complete a minimum of 6 Clinical Quality Measures; 3 from Core or Alternate Core Clinical Quality Measures and 3 from Additional Clinical Quality Measures. Click Begin to move on to the Clinical Quality Measures. 159

160 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen displays a listing of the Alternate Core Clinical Quality Measures. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 160

161 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Alternate Core Clinical Quality Measure 1 Weight Assessment and Counseling. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 161

162 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Alternate Core Clinical Quality Measure 2 Influenza Immunizations Preventive Care and Screening. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 162

163 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Alternate Core Clinical Quality Measure 3 Childhood Immunization Status To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 163

164 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen summarizes the information entered for the Alternate Core Clinical Quality Measures. You will need to verify that this information is accurate. To change the data, select the EDIT button. Click Return to Selection List to go back to the Alternate Core Clinical Quality Measures checklist. 164

165 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This dashboard shows the Alternate Clinical Quality Measures are completed by showing the under the Completed column. This checkmark does not necessarily indicate the measure meets the actual requirement associated with the measure. To change one of the measures or to continue with the measures, click the Edit Button. To clear all the data that has been entered, select the Clear All Button. To start a Topic, click the Begin button. Click Save & Continue to proceed or Previous to return. 165

166 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen summarizes the requirements for the Meaningful Use Additional Clinical Quality Measures. Please read this as it provides details that will make it easier to complete the application. NOTE: Eligible Professionals are required to complete a minimum of 6 Clinical Quality Measures; 3 from Core or Alternate Core Clinical Quality Measures and 3 from Additional Clinical Quality Measures. Click Begin to move on to the Clinical Quality Measures. 166

167 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen displays part of the listing of the Additional Clinical Quality Measures. 167

168 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen displays part of the listing of the Additional Clinical Quality Measures. 168

169 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This screen displays part of the listing of the Additional Clinical Quality Measures. Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 169

170 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 1 Diabetes: Hemoglobin A1c. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 170

171 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 2 Diabetes: Low Density Lipoprotein Management. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 171

172 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 3 Diabetes: Blood Pressure Management. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 172

173 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 4 Heart Failure: Angiotensin- Converting Enzyme (ACE). To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 173

174 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 5 Coronary Artery Disease (CAD): Beta Blocker Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 174

175 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 6 Pneumonia Vaccination Status. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 175

176 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 7 Breast Cancer Screening. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 176

177 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 8 Colorectal Cancer Screening. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 177

178 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 9 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 178

179 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 10 Heart Failure: Beta-Blocker Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 179

180 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 11 Anti- Depressant Medication Management. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 180

181 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 12 Primary Open Angle Glaucoma (POAG) To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 181

182 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 13 Diabetic Retinopathy: Documentation of Presence of Absence of Macular Edema. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 182

183 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 14 Diabetic Retinopathy: Communication with Physician. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 183

184 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 15 Asthma Pharmacologic Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 184

185 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 16 Appropriate Testing for Children with Pharyngitis. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 185

186 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 17 Oncology Breast Cancer: Hormonal Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 186

187 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 18 Oncology Colon Cancer: Chemotherapy for Stage III. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 187

188 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 19 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 188

189 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 20 Smoking and Tobacco Use Cessation, Medical Assistance. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 189

190 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 21 Diabetes: Eye Exam. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 190

191 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 22 Diabetes: Urine Screening. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 191

192 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 23 Diabetes: Foot Exam. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 192

193 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 24 Coronary Artery Disease (CAD): Drug Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 193

194 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 25 Heart Failure: Warfarin Therapy. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 194

195 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 26 Ischemic Vascular Disease (IVD): Blood Pressure Management. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 195

196 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 27 Ischemic Vascular Disease (IVD): Use of Aspirin. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 196

197 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 28 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 197

198 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 29 Asthma Assessment. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 198

199 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 30 Prenatal Care: Screening for Human Immunodeficiency Virus (HIV). To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 199

200 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 31 Prenatal Care: Anti-D Immune Globulin. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 200

201 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 32 Controlling High Blood Pressure. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 201

202 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 33 Cervical Cancer Screening. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 202

203 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 34 Chlamydia Screening for Women. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 203

204 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 35 Use of Appropriate Medications for Asthma. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 204

205 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 36 Low Back Pain: Use of Imaging Studies. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 205

206 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 37 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 206

207 HIT Initiative ATTESTATION CLINICAL QUALITY MEASURES (cont.) This is Additional Clinical Quality Measure 38 Diabetes: Hemoglobin A1c. To view more details about this measure, please click this link Click Save & Continue to proceed; Previous, or Reset to clear all unsaved data. 207

208 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This dashboard shows the Additional Clinical Quality Measures are completed by showing the under the Completed column. This checkmark does not necessarily indicate the measure meets the actual requirement associated with the measure. To change one of the measures or to continue with the measures, click the Edit Button. To clear all the data that has been entered, select the Clear All Button. Click Save & Continue to proceed or Previous to return. 208

209 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 209

210 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 210

211 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 211

212 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 212

213 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 213

214 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 214

215 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 215

216 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 216

217 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 217

218 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 218

219 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 219

220 HIT Initiative ATTESTATION MEANINGFUL USE REVIEW (cont.) This screen displays a continuation of the summary of the data you completed for the Meaningful Use Measures. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click Save & Continue to proceed or Previous to return. 220

221 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This screen asks you to verify that you are either receiving the payment or assigning it to the Payee designated at the top of the page. Additionally, you are asked which address you would like to have your incentive payment sent to, contingent on approval for payment. Click Save &Continue to proceed, Previous to return, or Reset to clear all unsaved data. 221

222 HIT Initiative ATTESTATION MEANINGFUL USE PHASE (cont.) This screen confirms you successfully completed the Meaningful Use Phase of the Attestation tab. Note the check box in the Attestation tab. Click Continue to proceed to the Review section. 222

223 HIT Initiative REVIEW The Review tab displays all the information associated with your application. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click the Submit tab to proceed. NOTE: An application will show as Incomplete until submitted. Click Print to generate a printer-friendly version of this information. 223

224 HIT Initiative REVIEW (cont.) The Review tab displays all the information associated with your application. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click the Submit tab to proceed. Click Print to generate a printerfriendly version of this information. 224

225 HIT Initiative REVIEW (cont.) The Review tab displays all the information associated with your application. Carefully review all of the information to ensure it is accurate. Once you have reviewed all information click the Submit tab to proceed. Click Print to generate a printerfriendly version of this information. 225

226 HIT Initiative REVIEW (cont.) The Review tab displays all the information associated with your application. Carefully review all of the information to ensure it is accurate. NOTE: To may click on the Meaningful Use Measures link to review what you entered. Once you have reviewed all information click the Submit tab to proceed. Click Print to generate a printer-friendly version of this information. Note: Once the Continue button is pressed, it will take the applicant to where they left off on the previous tabs OR, if done with previous tabs, it will take the applicant to the Submit tab. 226

227 HIT Initiative SUBMIT 227

228 HIT Initiative SUBMIT (cont.) This screen lists the current status of your application and any validation messages of concern identified by the system. You can review these identified validation messages for accuracy, or, leave them as is. You can submit this application without making any changes; however, the validation messages identified may impact your eligibility and incentive payment amount. Click Review to be taken to the specific section identified and make any appropriate changes to the entered information. To return to this section at any time click the Submit tab. Click Save & Continue to continue with the application submission. 228

229 HIT Initiative SUBMIT (cont.) This screen presents optional questions that will assist us in improving the program. Answer the questions by selecting Yes or No. Click Save & Continue to proceed, Previous to return, or Reset to clear all unsaved data. 229

230 HIT Initiative SUBMIT (cont.) Applicants can upload supporting documents to accompany their MAPIR Application in this screen. Supporting documents can include information supporting your volume, attestation, validation of certified EHR or information to support your MU attestation. Click Save &Continue to proceed, Previous to return, or Reset to clear all unsaved data. 230

231 HIT Initiative SUBMIT (cont.) Applicants can upload supporting documents to accompany their MAPIR Application in this screen. Files uploaded will be displayed in the chart at the bottom of the page. Click Save &Continue to proceed, Previous to return, or Reset to clear all unsaved data. 231

232 HIT Initiative SUBMIT (cont.) Check the RED BOX (located on the left of the MAPIR screen) to acknowledge that you have reviewed all of your information. Select the Provider or Preparer button, as appropriate. Click Save & Continue to proceed; Previous to return, or Reset to clear all unsaved data. 232

233 HIT Initiative SUBMIT (cont.) This screen depicts the signature screen for a Preparer on behalf of the provider. As the preparer of this application on behalf of the provider, please attest to the accuracy of all information entered. Enter your Preparer Name and Preparer Relationship to the provider. Click Sign Electronically 233

234 HIT Initiative SUBMIT (cont.) This is an example of an application that has a Meaningful Use Measure that does not meet the requirements. This STOP sign alerts you that you may have entered some information incorrectly. To view the measures and to verify the data you entered is accurate, select the Meaningful Use Measures link in the center of the page. Select Save & Continue in order to Submit your application. 234

235 HIT Initiative SUBMIT (cont.) This screen shows what you will see if you selected the Meaningful Use Measures link on the page with the red STOP sign. This is an example of an application that has a Meaningful Use Measure that does not meet the requirements. If you determine that you have entered incorrect information, simply close out of this screen, select the Attestation tab at the top of the page and continue to the measure where you want to enter the correct information. Save this information and then go back to the Submit tab to complete the application. SUBMIT (cont.) 235

236 HIT Initiative SUBMIT (cont.) This is an example of an incentive payment chart for a Non- Pediatric Professional. No information is required on this screen. Note: This is the final step of the Submit process. You will not be able to make any changes to your application after submission. Click Submit Application to continue 236

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