Minnesota EHR Incentive Program (MEIP) Frequently Asked Questions (FAQ)

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1 Frequently Asked Questions (FAQ) Released November 26, 2013

2 General Program Questions General Meaningful Use Questions (New as of NOV 2013) EP Questions EP Meaningful Use Questions (New as of NOV 2013) EH Questions EH Meaningful Use Questions (New as of NOV 2013) General Program Questions G1. Do I need to update my provider affiliations with MHCP Provider Enrollment if I will not qualify for MEIP? The August 1, 2012 Provider Affiliations MHCP Provider Update announcement states that all provider groups review and update, Effective August 1, 2012, Minnesota Health Care Programs (MHCP) requires hospitals and clinic providers to review their professional affiliations with individual providers and report any changes to the MHCP Provider Enrollment unit. This is in preparation for the Minnesota Electronic Health Records (EHR) Incentive Program (MEIP). MHCP requests that all provider groups review and update their provider affiliations by October 15, The message specifies all and does not provide exclusions. Even if the group does not qualify the individual professional may. Individual Eligible Professionals (EPs) who do qualify and decide to participate will attest to a Medicaid Patient Volume (MPV) with one or more clinics and the affiliations associated with each EP need to be accurate. G2. The bigger issue is for the (organization) sites using Meditech [EHR] to identify the qualifying patients. If the other sites are like us, we simply register patients under one plan code if they have state coverage (WEIP, BCPI, etc.). We do not identify which specific program they are covered under and therefore would not be able to use a plan code report to get to the numbers we need. I think what we will need to do is send a full patient listing to DHS so they can match to the specific state program like we did for the DSH projects. Is this an option? In the final rule issued on July 28, 2010 (page 44486), CMS clarified that: where patient volume is a criterion, most providers will be evaluated according to their Medicaid patient volume, while some professionals (those practicing predominantly in an FQHC or RHC) will be evaluated according to their needy individual patient volume. In addition, the Minnesota SMHP clarifies the attestation process: Page 2 of 31

3 Patient volume is met: Providers enter their Medicaid and total patient encounters, and the application calculates the percentage. MEIP requires providers meet Medicaid Patient Volume (MPV) thresholds and have the ability to calculate and attest to these values. MEIP does not support a patient listing process similar to DSH. G3. I cannot access MEIP using Internet Explorer 8 If you currently use IE8 or later and are unable to access MEIP please try the following configuration modification: Step 1: Launch your Internet Explorer Browser (If not already launched) Step 2: Tools V (right side of top menu bar)à Internet Options à Advanced tab Step 3: Scroll to the bottom of the list box in the Settings window. Make sure that you have Use SSL 3.0 selected as indicated by a check mark in the box. If you do not, select that box and press the right mouse button to select. Step 4: Select and click on the Apply button on the bottom right of the window. This should resolve any issues you have. If not, please contact the CGI Business Services Center for further assistance. Page 3 of 31

4 G4. Can an EP or an EH crosswalk the state codes mentioned in the MEIP Guidance Manual to account for Medicaid Patient Volume? The two-character codes listed in the MEIP Guidance Manual were taken directly from the State Medicaid HIT Plan document (SMHP) which details the DHS perspective. A simple list of payers paid by the state is not a solution as underlying complexities exist (which plans under which payers are paid for with stateonly dollars, versus those that have federal funding). Until more defined data is available on a provider s remittance advice DHS recommends the provider keep it simple separate services paid by private insurance plans from those paid by Minnesota Health Care Programs and administered through both feefor-service and managed care plans. When a provider attests, DHS will validate the provider s attestation against the fee-for-service claims data and managed care encounter data that can be pulled according to program codes outlined in the SMHP. If significant discrepancies are found between the attested volumes and the DHS data, additional information will be requested from the provider to conduct a more in-depth analysis of their MPV during the pre-payment verification process. G5. How long will it take to receive a decision on MEIP reimbursement after an EP or an EH completes MEIP enrollment? Page 4 of 31

5 The final rule gives MEIP up to 45 days from the date the EP/EH received a Payment Pending status in MEIP. It is possible that the decision to reimburse or deny would be extended if MEIP is awaiting additional supporting documentation from the EP/EH. DHS cannot provide an opinion on the best timing for your incoming revenue. G6. I completed my CMS registration but I am not recognized when I attempt to log into the MEIP site, why? If an EP or an EH returns to their CMS record and exits without clicking on Submit the CMS system alters your status and MEIP does not receive confirmation that the EP or EH completed CMS registration. To correct, return to the CMS Registration site and submit any changes to trigger the update process and forward the record to MEIP. G7. Does sequestration effect Medicaid EHR incentive payments? (New as of NOV 2013) No. Medicaid EHR incentive payments are exempt from the mandatory reductions Incentive payments made through the Medicare Electronic Health Records (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, Under these mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible hospitals will be reduced by 2%. This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction. G8. Can EPs or EHs round their patient volume percentage when calculating patient volume in the Medicaid EHR incentive program? (New as of NOV 2013) To participate in the Medicaid EHR incentive program, EPs are required to demonstrate a patient volume of at least 30% Medicaid patients over a 90-day period in the prior calendar year or in the 12 months before attestation. The Centers for Medicare and Medicaid Services allow rounding 29.5% and higher to 30% for purposes of determining patient volume. Similarly, pediatric patient volume may be rounded from 19.5% and higher to 20%. Finally, acute care hospitals are required to demonstrate a patient volume of at least 10% Medicaid patients over a 90-day period in the prior fiscal year preceding the hospital's payment year or in the 12 months before attestation. Hospitals' patient volume may be rounded from 9.5% and higher to 10%. For more information, please see CMS FAQ8037. G9. If I participated in the Medicaid EHR Incentive Program last year, am I required to participate in the following year? (New as of NOV 2013) Page 5 of 31

6 No. Medicaid providers are not required to participate in consecutive years of the EHR Incentive Program. Providers who skip years of participation will resume the progression of Meaningful Use (MU) where they left off. All providers are required to meet two years of Stage 1 in their first two years of MU and then proceed to Stage 2, regardless of not participating in consecutive years. (Note that there is an exception to that general rule for providers who demonstrated MU in These providers need not move to Stage 2 until 2014.) Note that eligible professionals who wish to maximize their incentive payments must qualify for an incentive payment for six years, but they can begin receiving payments no later than 2016, and may not receive payments after Also note that after 2016, eligible hospitals must have participated in the previous year in order to receive a payment. For more information on what your meaningful use and incentive payment timeline will be, please see the CMS timeline widget. For more information, please see CMS FAQ9220. G10. If I am participating in the Medicaid EHR Incentive Program but also provide care to Medicare patients, am I subject to the Medicare Payment adjustments? (New as of NOV 2013) Yes. While there are no payment adjustments under the Medicaid EHR Incentive Program, those Medicaid EPs who are also paid under Medicare could be subject to payment adjustments if they are not meaningful EHR users for an applicable reporting period. Adopting, implementing and upgrading EHR technology is not considered meaningful use for these purposes. We encourage you to familiarize yourself with the details of the Medicare payment adjustment by reviewing the Stage 1 and 2 final rules, regulations at 42 C.F.R. Part 495. For more information, please see CMS FAQ7727. G11. Do I have to be a meaningful user each year to avoid the payment adjustments or can I avoid the payment adjustments by achieving meaningful use only once? (New as of NOV 2013) You must demonstrate meaningful use every year according to the timelines detailed above in order to avoid Medicare payment adjustments. For example, an EP who demonstrates meaningful use for the first time in 2013 will avoid the payment adjustment in 2015, but will need to demonstrate meaningful use again in 2014 in order to avoid the payment adjustment in Page 6 of 31

7 General Meaningful Use Questions GMU1. If multiple eligible professionals or eligible hospitals contribute information to a shared portal or to a patient's online personal health record (PHR), how is it counted for meaningful use when the patient accesses the information on the portal or PHR? (New as of NOV 2013) This answer is relevant to the following meaningful use measure: For Eligible Professionals: More than 5 percent of all unique patients seen by the eligible professional during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information. For Eligible Hospitals and Critical Access Hospitals: More than 5 percent of all unique patients (or their authorized representatives) who are discharged from the inpatient or emergency department (Place of Service 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the EHR reporting period. If an eligible professional sees a patient during the EHR reporting period, the eligible professional may count the patient in the numerator for this measure if the patient (or an authorized representative) views online, downloads, or transmits to a third party any of the health information from the shared portal or online PHR. The same would apply for an eligible hospital or CAH if a patient is discharged during the EHR reporting period. The respective eligible professional, eligible hospital, or CAH must have contributed at least some of the information identified in the Stage 2 final rule to the shared portal or online PHR for the patient. However, the respective provider need not have contributed the particular information that was viewed, downloaded, or transmitted by the patient. Although availability varies by state and geographic location, some Health Information Exchanges (HIEs) provide shared portal or PHR services. If a provider uses an HIE for these services to make information available to patients, in order to meet meaningful use requirements the provider must use an HIE that is certified as an EHR Module for that purpose. The HIE must be able to verify whether a particular provider actually contributed some of the information identified in the Stage 2 final rule to the shared portal or PHR for a particular patient. If a provider elects to use the HIE for these shared portal or PHR services, the provider must include the HIE s certification number as part of their attestation. For more information, please see CMS FAQ7735. GMU2. What documentation should be retained during attesting to 90 or 365 days MU? Preparing and Maintaining Documentation It is the provider s responsibility to maintain documentation that fully supports the meaningful use and clinical quality measure data submitted during attestation. To ensure you are prepared for a potential audit, save any electronic or paper documentation that supports your attestation. Also save the documentation that supports the values you entered in the Attestation Module for clinical quality measures. Hospitals should also maintain documentation that supports their payment calculations. Page 7 of 31

8 An audit may include a review of any of the documentation needed to support the information that was entered in the attestation. The level of the audit review may depend on a number of factors, and it is not possible to detail all supporting documents that may be requested as part of the audit. However, the following will outline the minimum supporting documentation that providers should maintain: Source document(s) The primary documentation that will be requested in all reviews is the source document(s) that the provider used when completing the attestation. This document should provide a summary of the data that supports the information entered during attestation. Ideally, this would be a report from the certified EHR system, but other documentation may be used if a report is not available or the information entered differs from the report. Providers should retain a report from the certified EHR system to validate all clinical quality measure data entered during attestation, since all clinical quality measure data must be reported directly from the certified EHR system. Providers who use a source document other than a report from the certified EHR system to attest to meaningful use data (e.g., non-clinical quality measure data) should retain all documentation that demonstrates how the data was accumulated and calculated. This primary document will be the starting point of most reviews and should include, at minimum: The numerators and denominators for the measures The time period the report covers Evidence to support that it was generated for that EP, eligible hospital, or CAH (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.) Because some certified EHR systems are unable to generate reports that limit the calculation of measures to a prior time period, CMS suggests that providers download and/or print a copy of the report used at the time of attestation for their records. Although the summary document is the primary review step, there could be additional and more detailed reviews of any of the measures, including review of medical records and patient records. The provider should be able to provide documentation to support each measure to which he or she attested, including any exclusions claimed by the provider. SOURCE: CMS EHR Incentive Programs Supporting Documentation For Audits Last Updated: February 2013 GMU3. Can EPs and EHs report CQMs in 2013 CEHRT Certified to the 2014 Certification Criteria? Page 8 of 31

9 Yes. EPs, eligible hospitals, and CAHs have the flexibility to implement CEHRT certified to the 2014 Edition certification criteria finalized by the Office of the National Coordinator for Health IT (ONC) for the 2013 EHR reporting period. EPs, eligible hospitals, and CAHs can report via attestation CQMs included in both Stage 1 and Stage 2 final rules. For eligible hospitals and CAHs, this includes all 15 CQMs included in the Stage 1 final rule. Therefore, all 15 CQMs could be available to the eligible hospitals and CAHs for reporting for FY2013 if the CEHRT certified to the 2014 Edition certification criteria has been certified for each of those 15 CQMs. For EPs, only 32 of the 44 CQMs included in the Stage 1 final rule are included in the Stage 2 final rule. Therefore, EPs who implement CEHRT certified to the 2014 Edition certification criteria in CY2013 have 12 fewer CQMs from which to select. Therefore, EPs can only select from the 32 CQMs that are included in both the Stage 1 and Stage 2 final rules, and the CEHRT must be specifically certified for each CQM that the EP will report. The 12 CQMs that will not be available in CY2013 for EPs that implement CEHRT certified to the 2014 Edition certification criteria are: NQF 0013, 0027, 0084 (retired) NQF 001, 0012, 0014, 0047, 0061, 0067, 0073, 0074, 0575 (not finalized) Since NQF 0013 is a core CQM in the Stage 1 final rule, an alternate core CQM must be reported instead since it will not be certified based on 2014 Edition certification criteria. Page 9 of 31

10 EP Questions EP1. Are Clinical Nurse Specialists potentially eligible to receive incentive payments under the MN EHR Incentive Program (MEIP)? In the final rule issued on July 28, 2010 (page 44490), CMS clarified that: "States would need to refer to their own scope of practice rules to determine whether an individual qualifies as providing dental, nurse practitioner, physician assistant, or certified nurse midwife services." "States will have a Medicaid State Plan (and often State regulations) that designates how each provider is eligible to participate in the Medicaid program by practice type," "...so long as an EP qualifies as a practitioner within the State's scope of practice rules for each of the five EP types, they are eligible for this program." "Advanced practice nurses who meet their State's criteria for qualifying as a nurse practitioner would qualify as nurse practitioners." After reviewing the federal definition of nurse practitioner services found in 42 CFR , Minnesota's Medicaid State Plan, and scope of practice rules, DHS determined that clinical nurse specialists would meet the federal definition of nurse practitioner and are treated similarly in the Minnesota Medicaid State Plan and as such were included in the State Medicaid HIT Plan (SMHP) as professionals who are potentially eligible for incentives under the Minnesota EHR Incentive Program. Minnesota's SMHP was approved by CMS on November 3, EP2. Would Physicians Assistants (PAs) practicing in an IHS qualify for the incentive payments language is specific to FQHCs and RHCs, but does not specifically list IHS? Yes EP3. Would EPs practicing in an IHS be able to qualify for the MPV using the needy individual encounters, or would they need to use Medicaid only encounters? Yes EP4. Am I required to update my affiliations with DHS? From the MHCP Provider Update MHP Provider Affiliations update, Eligible Professionals (EPs) affiliated with a clinic or group practice can choose to attest their MPV as a group, as long as the affiliations are correct and current in the DHS provider enrollment system. MHCP suggests that individual providers be aware of all of their provider group affiliations and understand whether EPs in those groups are planning to use the group MPV option. Page 10 of 31

11 EP5. The clinic that employs me and I disagree on who is eligible to receive the MEIP payment. Who is eligible to receive the MEIP payment and how the payment may be assigned? An Eligible Professional (EP) is given the option to designate a payee after the EP attests to their Medicaid Patient Volume (MPV) as an individual or within a group/clinic. The EP can designate themselves as the payee. CMS clarifies in 42 CFR of the final rule published on July 28, 2010 (page 44572), (f) Limitations on incentive payment reassignments. (1) EPs are permitted to reassign their incentive payments to their employer or to an entity with which they have a contractual arrangement allowing the employer or entity to bill and receive payment for the EP s covered professional services. (2)(i) Assignments in Medicare must be consistent with Section 1842(b)(6)(A) of the Act and 42 CFR part 424 subpart F. (ii) Medicaid EPs may also assign their incentive payments to a TIN for an entity promoting the adoption of EHR technology, consistent with subpart D of this part. (3) Each EP may reassign the entire amount of the incentive payment to only one employer or entity. CMS clarifies on page of the final rule EHR incentive payments and contractual agreements, Title IV, Division B of the HITECH Act establishes incentive payments under the Medicare and Medicaid programs for certain professionals and hospitals that meaningfully use certified EHR technology. The provisions are not focused solely upon the costs associated with the EHR technology. Rather, as we stated in the proposed rule (75 FR 1849), it focuses upon the adoption, implementation, upgrade, or meaningful use of the technology. However, we do agree that some entities may have to review and/or negotiate current contractual arrangements to address the transfer of the incentive payments. The first payment year for the incentive payment is CY 2011, which we believe should afford parties sufficient time to reach a new agreement. For Medicaid, a discussion of reassignment of the incentive payment is found in section II.D.3.e of this final rule Entities Promoting the Adoption of Certified EHR technology. DHS will administer the program consistent with the federal regulations. This assignment issue is a contract issue between you and your employer, it is inappropriate for DHS to be involved with this issue. We recommend you review your current contractual arrangements with your employer. You may need to discuss this with an attorney if you and your employer cannot come to an agreement. EP6. How does MEIP define a group/clinic? When determining whether you are attesting to a group/clinic volume or an individual volume consider that MEIP defines an EHR Incentive Program attestation group as a MHCP enrolled group practice under a common Tax Identification Number (TIN) and National Provider Identifier (NPI). EP7. How do we determine Medicaid Patient Volume (MPV) for procedures that are billed globally or in a packaged manner such as obstetrician (OB) visits? Page 11 of 31

12 When determining your total Medicaid encounters for the MPV, DHS will count global billing, or packaged services, encounters as the service line dates paid by DHS. EP8. Can I allow the administrative staff at my clinic to act as a proxy to complete the MEIP attestaton for me? Access to MEIP requires a CMS confirmation number. The EP can decide to complete the enrollment on their own or share their CMS confirmation number with the clinic administrative staff for the staff to act as a proxy. The name of the administrator can be entered in the attestation page to indicate a proxy was used. EP9. We have a provider at our office who works 6 hours per week. Is there a minimum number of hours that a provider has to work in order to qualify for the incentive payment? This provider does not work at any other location. There is not a minimum number of hours an EP must work to qualify. Patient volume is determined by a percentage of Medicaid patients so theoretically if an EP sees one Medicaid patient out of three total, they will qualify. The EP must meet all other eligibility requirements. EP10. I thought there weren't "Proxy" capabilities in (MEIP) It is the responsibility of the EP to control their user account access in MEIP, which requires the CMS Confirmation Number. If the EP provides someone with the information required to access their MEIP account, MEIP is assuming that the EP has delegated that authority accordingly. EP11. In CMS, we are setting up the proxy approvals, to assure we are covered, but will it be a problem in MN system if I use the proxy in CMS to enter our EP's registration / AIU / attestation (which I have their online approval to do)? The CMS Registration User Guide for Eligible Professionals describes that Eligible Professionals (EPs) may authorize surrogate users to work on behalf of the EP in the EHR Incentive Program Registration & Attestation system and that you need to navigate to the Identity and Access Management (I&A) section to create a login account. The I&A section requires you enter the NPI s of the EPs you are representing. For more information on the CMS EHR process, see the CMS EHR Incentive Programs site. EP12. When we are entering the registration at CMS, for Payee TIN type, it provides three options: My Billing TIN, Provider SSN or Group Reassignment. Could you clarify which to use if the provider has provided us authorization to reassign to the organization? Page 12 of 31

13 TIN is a unique identification number used by IRS in the administration of tax law known as the Taxpayer Identification Number. TIN Types are taxpayer identification numbers classified as a Social Security Number (personal) or Employer Identification Number (organization). SSN is a unique 9 digit number used to identify a person for tax filing and other purposes EIN is a unique 9 digit number used to identify an organization for tax filing and other purposes Page 16 of the CMS Registration guide clarifies to select where your payment will go in the Payee TIN Type: SSN Payee TIN Type indicates that the provider receives the payment EIN Payee Tin Type indicates the group receives the payment When assigning payment during CMS registration, please ensure that: If you are assigning the payment to a group (even if you are sole proprietor), select Employer Identification Number (EIN) as the payee TIN type, and then enter the organization s TIN. Ensure that group name, payee TIN, and payee NPI match the registration information for the group in the National Plan and Provider Enumeration System (NPPES). If you are assigning payment to yourself rather than your clinic or group, select SSN as the payee TIN type. Ensure that your SSN is on file with MHCP and linked to your MHCP NPI record. The assigned payee information entered during this step is sent to MEIP. This choice can only be changed at the CMS registry level. The TIN or SSN provided during the CMS registration will be used for IRS purposes. EP13. Does the incentive program apply to both full-time AND part-time? If not, what are the hours and/or production amount that a provider has to reach to be eligible, and in what time frame? Eligibility is not based on full-time or part-time. The part-time EP must be an actively enrolled provider in good standing with MHCP and meet the same criteria as a full-time EP. EP14. Once a provider is enrolled, can they drop out later, or are they required to participate? To enroll for a 2012 incentive payment the EP attests a to A/I/U of a certified EHR system and to a Medicaid Patient Volume (MPV) over any contiguous 90-day period in The EP is required to attest again for Year Two if the EP is interested in receiving the Year Two incentive payment. EP15. What is the procedure for when we lose a provider due to attrition so how do I terminate their participation so it doesn t throw our percentages off? Page 13 of 31

14 The MHCP Provider affiliation file for the group is used to tie a set of EP Medicaid Patient Volume (MPV) attestations. The group completes a MHCP Provider Profile Change Form to update the MHCP Group Affiliations records when a EP discontinues their employment with the group. EP16. When we have new providers join the group, do I enroll them right away? Does the whole program start over again for the new provider, or do they jump in where the others are? Each EP must register at CMS s EHR Incentive Program registration site before enrolling with MEIP. The MEIP group enrollment process is an EP all-in or EP all-out at the time you are enrolling in MEIP. EPs that are employed by the group after the group has completed the MEIP process would not be eligible as part of the group that year. The EP could attest as an individual to their MPV for 2012 payment if the EP A/I/U under a separate EHR system outside of the group. EP17. What does MEIP deem appropriate source documentation for both our patient volumes per EP and the accuracy of AIU? The MEIP Reference Material page includes a MEIP Guidance Manual which provides more detail on supporting documentation. Acceptable AIU supporting documentation comes in many forms and MN reserves the right to request additional supporting documentation as necessary. Supporting documentation for Medicaid Patient Volume (MPV) may include: An internal systems report that breaks out by month the MPV from the total volume Group - A break out by EP and by location if attesting as a group A break out by state if including out-of state encounters in the MPV Group - A list of the EPs, whether they intend to attest as part of the group, and documenting their consent to include their patient volume included in the group Supporting documentation for AIU may include: A document like a purchase order that establishes a relationship between the vendor, purchaser and user(s) (if different) If attesting as a group and users are not specifically listed on the initial AIU supporting documentation the purchaser can sign a document on company letterhead listing the product, the date purchased, the users and their NPI s. As noted on the supporting documentation appendix, documentation must clearly show the relationship between the certified EHR vendor, the entity that adopted, implemented or upgraded to the system, and the licensed user. EP18. Is a group sent form required and is the MEIP Group Consent Form is the only acceptable group consent form? Page 14 of 31

15 The MEIP Group Consent form is intended as a template to assist the provider if they do not have one to use or are looking for suggestions Consent should be from the current members only, not from the members that are included in the PV period but no longer with the group The provider may participate if they are part of a group and it s appropriate to include their encounters (i.e. you see Medicaid patients), even if they weren t in the group last year when the group patient volume proxy was calculated If the group is an FQHC/RHC and using needy individual patient volume, the provider can only be added to their group proxy if they practiced predominately at an FQHC/RHC for six months in the prior CY EP19. Are screen shots from the American Board of Pediatrics an acceptable pediatric upload document? The screen shots from the American Board of Pediatrics website and an upload of an EP s license (albeit it does not mention their specialty) would generally be sufficient for the MEIP Pediatrician documentation requirement. MN reserves the right to request additional supporting documentation if necessary. While a screen shot can be easily modified a license is readily available and supports the ABP screen shot. EP20. Can EP Jones, who recently joined Clinic ABC, attest to a group consisting of employees from Clinic ABC even though he provided no encounters in the previous year? The provider may participate if they are part of a group and it s appropriate to include their encounters (i.e. you see Medicaid patients), even if they weren t in the group last year when the group patient volume proxy was calculated The only caveat is if the group is an FQHC/RHC and using needy individual patient volume, the provider can only be added to their group proxy if they practiced predominately at an FQHC/RHC for six months in the prior CY. EP21. What is the last day that an EP can attest to A/I/U for the calendar year 2012? DHS has been granted authority to grant a 120-day extension for the application of Medicaid dollars through April 28, Page of the final rule clarifies: For all EPs in the Medicare and Medicaid EHR incentive programs, we are proposing a common definition for both payment year and year of payment, as any calendar year beginning with 2011 at EP22. What year would an EP attest if the EP switches from the Medicare EHR Incentive Program to the Medicaid EHR Incentive Program after being reimbursed for Medicare Year One in 2011? Page 15 of 31

16 CMS clarifies this question and two related questions on page of the final rule: For the final rule, we are clarifying that the EP is placed in the payment year the EP would have been in had the EP begun in and remained in the program to which he or she has switched. We have modified (e)(5) accordingly. We believe it is self-evident that an EP switching to a new program is subject to the requirements of such new program. We do not believe that the Congress intended for the payment caps to be exceeded under any circumstance, and therefore proposed that no EP should receive more than the maximum incentive available to them under Medicaid, which is the higher of the two caps. The last year incentive payment would be reduced if awarding the EP the full amount would exceed the overall maximum available under Medicaid. This is possible if an EP receives their first two payment years from Medicare and then the last four from Medicaid, as the cap would be exceeded by $250. EP23. Are psychiatrists eligible for the Medicaid MEIP incentive? Yes, Psychiatrists are enrolled with MHCP under the physician provider type which satisfies the MN EHR Incentive Program (MEIP) provider type and enrollment with MHCP requirements. EP24. Is the 30% threshold actually 30% of all patient visits during a year? Please see MEIP Presentation Module 4 Eligible Professionals. For determining Medicaid Patient Volume, a provider will need to select a continuous 3-month reporting period in the previous calendar year. They will then need to enter their total Medicaid Patient Encounters during that time period (numerator); and the total of all patient encounters during that time period (denominator). The following are considered Medicaid encounters: Services rendered on any one day to an individual where Medicaid paid for part or all of the service. Services rendered on any one day to an individual where Medicaid paid for all or part of their premiums, co-payments, and/or cost-sharing. Services rendered on any one day to an individual where Medicaid paid for part or all of the service including services rendered through a Managed Care Organization (MCO). Services rendered on any one day to an individual where Medicaid paid for all or part of their premiums, co-payments, and/or cost-sharing including services rendered through a Managed Care Organization (MCO). EP25. Does Medicaid include CHIP? Does it include MinnesotaCare? Are there other programs it incudes or excludes? Page 16 of 31

17 CHIP enrollees are included in the definition of needy individuals who may be counted toward Medicaid patient volume, but only for eligible professionals practicing predominantly in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or Indian Health Services clinic (IHS). Only MinnesotaCare Products that are eligible for federal financial participation (FFP) are countable for purposes of determining Medicaid Patient Volume under MEIP. These include: MinnesotaCare Basic Plus Two (parents & adult caretakers with income 275% FPL), MinnesotaCare Basic Plus (parents and adult caretakers with income 275% FPL), MinnesotaCare Expanded (MinnesotaCare for children under age 21 and pregnant women), MinnesotaCare Expanded (MinnesotaCare for adults without children up to 250% FPL). Please see MEIP Guidance Manual for full details Section 1.3 EP26. Pediatricians have a 20% threshold. Do pediatric dentists have a similar, lower level? The definition of a pediatrician for purposes of MEIP has been established in law. The statutory definition is listed in M.S. 62J.495, Subd. 8 (f), and is as follows: "Pediatrician" means a physician who is certified by either the American Board of Pediatrics or the American Osteopathic Board of Pediatrics. Only eligible professionals who meet the Minnesota statutory definition of pediatrician in this section are allowed to qualify for the program at the 20% MPV threshold. EP27. Should an EP include out of-state encounters in the Medicaid Patient Volume (MPV) and total patient volume? The defines an "out-of-state" encounter as any encounter that occurred (in MN or outside of MN) that was paid in full or part of by another state's Medicaid program. In considering whether to include out-of-state encounters in your Medicaid patient volume encounter data: a. If an Eligible Professional (EP) can meet the minimum Medicaid Patient Volume (MPV) requirement using Minnesota encounter data only, they do not have to include out-of-state encounters the Total Medicaid Encounters (numerator). The Total Patient Encounters (denominator) of the MPV calculation, however, must still include all encounters for the EP (or group if using a group MPV). b. If an Eligible Professional (EP) cannot meet the minimum Medicaid Patient Volume (MPV) requirement using Minnesota encounter data, an EP is allowed to include encounters from outof-state in the Total Medicaid Encounters (numerator). If out-of-state is included in the numerator an EP should upload a document during MEIP enrollment identifying the number of encounters per month, per state that can be verified. If a group is attesting to out-of-state Page 17 of 31

18 encounters a document that describes the EP Name/NPI/out-of-state encounter count by state is required to verify with the out-of-state agency. EP28. Is a pediatrician who was still in their residency eligible for MEIP? Residents are not eligible for enrollment with Minnesota Health Care Programs (MHCP) and would not be eligible for MEIP. EP29. Do I need to complete an EP or an EP Group enrollment all at once? The MEIP system does not require an EP to complete the enrollment during one Login session. You can Save an EP enrollment if you cannot complete the process and you can return later. The enrollment of an EP Group is also a work in progress. The Group Lead is the initial EP chosen to set up the group. Once the Group is established then the Group members can enroll in MEIP. EP30. How long does it take MHCP to process a Provider Affiliation request? MHCP Provider Enrollment has up to 30 days to process these requests. The EP is not contacted when the change is completed. The Provider Affiliations list is updated daily on the DHS provider portal MN- ITS. EP31. What does so-led mean when describing an FQHC/RHC/IHS so-led by a Physician Assistant? A PA would be leading an FQHC or RHC or IHS under any of the following circumstances: (1) When a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, we would consider the PA as the primary provider); (2) When a PA is a clinical or medical director at a clinical site of practice; or (3) When a PA is an owner of an RHC. We agree that FQHCs, RHCs and IHS' that have PAs in these leadership roles can be considered PA-led. Furthermore, since RHCs can be practitioner owned (FQHCs cannot), we will allow ownership to be considered PA-led. See also EP32. Am I required to have malpractice insurance as a solo practitioner? Individuals and/or FQHC groups are not required to have Malpractice Insurance to enroll. However, if the provider does have it MHCP Provider Enrollment will add this information to the provider s record. For more information please contact MHCP Provider Enrollment at (651) ; Toll-free line at (800) ; Fax at (651) Page 18 of 31

19 EP33. If I register for MEIP under the so-led FQHC where I work part-time is the FQHC required to receive the payment? When you enroll for the MEIP you will be asked if you practice predominately (>50% during a 6 month period) in a FQHC and if so would select the FQHC that employs you. Eligible Professionals (EPs) have the option to assign the incentive payment to the FQHC or the EP if the EP has reported their SSN to MHCP Provider Enrollment. EP34. Could an EP create a group of 1 with just himself/herself in it? Technically, the MEIP system will allow a group of one assuming the following occurs: 1. MHCP Provider Enrollment has a group affiliation of the EP on file associated with the NPI 2. MHCP has encounters in the Encounter Volume file that combined with the EP put them over the threshold If the EP is enrolled as an individual and not a group practice with MHCP I expect MHCP Provider Enrollment staff would question why an individual is trying to create an affiliation group. If the EP is enrolled as a group with MHCP many providers can be noted in the Affiliated Group list that are either not eligible or not participating in the EHR incentive Program. It is important to remember when calculating patient volume, all Medicaid encounters that are seen at the group locations are included for every practitioner in the group/clinic, even those who are not eligible for the program, or those who are not participating. Do not include outside encounters in your group attestation. If the encounter (numerator/denominator) is outside the group, do not include it in the attestation. EP35. Would we include chiropractors and PAs and would we include Emergency Room physicians to determine the group volume for the practice? It should be noted that when calculating patient volume, all Medicaid encounters that are seen at the group location are included for every practitioner in the group/clinic, even those who are not eligible for the program (i.e. chiropractors), or those who are not participating. Do not include outside encounters in your group attestation. If the encounter (numerator/denominator) is outside the group, do not include it in the attestation. EP36. Can an EP enroll in MEIP under Group A attestation if the EP was recently hired by Group A and did not have any Medicaid Patient Volume (MPV) with Group A in the previous year? The provider may participate if they are part of a group and it s appropriate to include their encounters (i.e. you see Medicaid patients), even if they weren t in the group last year when the group patient volume proxy was calculated The only caveat is if the group is an FQHC/RHC and using needy individual Page 19 of 31

20 patient volume, the provider can only be added to their group proxy if they practiced predominately at an FQHC/RHC for six months in the prior CY. EP37. Is an official letter from United States DHHS appropriate A/I/U supporting documentation for a EP working in an IHS? Yes, MEIP considers this an acceptable A/I/U supporting documentation. See CMS FAQ EP38. Can attestation information submitted for the EHR incentive program be updated, changed canceled or withdrawn after successful submission? (New as of NOV 2013) If an eligible professional (EP) or hospital participating in the Medicaid EHR Incentive Program chooses to change or withdraw their attestation, an attestation amendment form or incentive payment attestation withdrawal form must be completed and sent back along with any incentive payments already received. Medicare Attestation Amendment Form Medicare Incentive Payment Withdrawal Form Please note that the Centers for Medicare and Medicaid Services (CMS) do not require providers who relied on flawed software for their attestation information to submit amended attestation data. For additional information, please see CMS FAQ#6097. EP39. How can an eligible provider (EP) that is new to a practice meet the patient volume/practice predominantly criteria for the Medicaid EHR Incentive Program? (New as of NOV 2013) There a three ways an EP could meet the patient volume/practice predominantly criteria to potentially qualify for an incentive payment. For illustrative purposes, assume the EP in the below example joined the practice in 2013: Next year (2014), after the EP establishes his/her own 90-day patient volume period as an EP from the prior calendar year (2013) or 12-month period prior to attestation, if this option is allowed by his/her state. Page 20 of 31

21 This year (2013), if he/she is part of a group using the group patient volume proxy and it is appropriate to include him/her (i.e., he/she see Medicaid patients*). It is not a requirement that he/she was in the group for the period that is the basis for the proxy. However, using the group patient volume proxy is distinct from whether an EP practices predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC). To meet the "practice predominantly" criterion, an EP must use individualized data; there is no group proxy (see below bullet). If the EP is working in an FQHC or RHC, next year (2014), after the EP practiced predominately in his/her the FQHC/RHC for at least 6 months. The EP could then use either individual or group proxy needy individual patient volume. FQHCs/RHCs using the group proxy must follow the regulations, including ensuring all EPs in the clinic use the proxy, and counting only encounters associated with the clinic (not an EP's outside encounters). For more information, please see CMS FAQ2993 & FAQ7817 EP40. If I am an EP who is eligible for both the Medicare and Medicaid EHR Incentive Programs, but I register to participate in the Medicaid EHR Incentive Program, do I still have to be a meaningful user to avoid the payment adjustments? (New as of NOV 2013) Yes. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you must demonstrate meaningful use according to the timelines detailed above to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. EP41. If I am an EP who is eligible for both the Medicare and Medicaid EHR Incentive Programs, will I avoid the payment adjustments during a calendar year when I receive an incentive payment for adopting, implementing, or upgrading (AIU) my Certified EHR Technology? (New as of NOV 2013) No. Congress mandated that an EP must be a meaningful user in order to avoid the payment adjustment; therefore receiving a Medicaid EHR incentive payment for adopting, implementing, or upgrading your Certified EHR Technology would not exempt you from the payment adjustments. You must demonstrate meaningful use according to the timelines detailed above to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. EP42. If I am a hospital-based Medicare EP, am I subject to the payment adjustments? (New as of NOV 2013) Page 21 of 31

22 No. If you perform 90% or more of your covered professional services in either the inpatient (Place of Service 21) or emergency department (Place of Service 23) of a hospital, then you will be determined to be hospital-based and are not eligible to receive an EHR incentive and will not be subject to the payment adjustments. However, your hospital-based status can change from year to year. For example, an EP who is determined to be hospital-based for the 2015 program year would not be subject to the payment adjustments in But if that EP is determined not to be hospital-based for the 2016 and the 2017 program year, then he or she could be subject to the payment adjustments in 2018 if the EP does not demonstrate meaningful use. Therefore it is important to check your hospital-based status at the beginning of each year. You can check your hospital-based status by visiting the Medicare EHR Incentive Programs Registration System. Page 22 of 31

23 EP Meaningful Use Questions PMU1.For the Stage 2 meaningful use objective of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs that requires the successful electronic exchange of a summary of care document with either a different EHR technology or the CMS designated test EHR, if multiple eligible professionals (EPs) are using the same certified EHR technology across several physical locations, can a single test meet the measure? The Stage 2 Final Rule (CMS-0044-F) changed the way shared Certified EHR Technologies are handled for the Stage 2 measure option for summary of care records at transitions of care and referrals. Previously, if multiple EPs are using the same certified EHR technology in different physical locations/settings (e.g., different practice locations), there must be a single test performed for each physical location/setting. Under changes made in the Stage 2 Final Rule providers that use the same EHR technology and share a network for which their organization either has operational control of or license to use can conduct one test for the successful electronic exchange of a summary of care document with either a different EHR technology or the CMS designated test EHR that covers all providers in the organization. For example, if a large group of EPs with multiple physical locations use the same EHR technology and those locations are connected using a network that the group has either operational control of or license to use, then a single test would cover all EPs in that group. Similarly, if a provider uses an EHR technology that is hosted (cloud-based) on the developer's network, then a single test would allow all EPs, eligible hospitals, and CAHs using the EHR technology that is hosted (cloud-based) on the developer's network to meet the measure. For more information, please see CMS FAQ7729. PMU2.How should eligible professionals (EPs) select menu objectives for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs? EPs participating in Stage 1 of the EHR Incentive Programs are required to report on a total of 5 meaningful use objectives from the menu set of 10. When selecting five objectives from the menu set, EPs must choose at least one option from the public health menu set. If an EP is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the EP should select and report on the public health menu objective they are able to meet. If an EP can be excluded from both public health menu objectives, the EP should claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set. EPs participating in Stage 2 are required to report 3 meaningful use objectives from the menu set of 6. Page 23 of 31

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