Eligible Hospital User Manual Electronic Health Records Incentive Program. Idaho Department of Health and Welfare Division of Medicaid

Transcription

1 Eligible Hospital User Manual Electronic Health Records Incentive Program Idaho Department of Health and Welfare Division of Medicaid July 2013

2 TABLE OF CONTENTS PART I: PROGRAM OVERVIEW... 1 PURPOSE... 1 INTRODUCTION... 1 ELIGIBILITY... 1 Provider Type and Specialty... 1 Patient Volume... 2 Institutional License and Good Standing... 2 Adopt, Implement, or Upgrade... 3 Meaningful Use Stage Getting an EHR Certification ID Number... 4 PAYMENTS... 5 Becoming a Vendor with the State of Idaho... 5 Understanding Timelines... 5 Establishing Eligible Hospital Incentive Payment Amounts... 5 Defining Calculation Inputs for Incentive Payments... 6 Understanding the Calculation... 6 Dispersing Payments... 8 CHIP Encounters for Patient Volume and Payment Calculation... 8 Out of State Providers... 8 Program Integrity and Audit... 9 Administrative Appeals... 9 HOSPITAL ATTESTATION PROCESS AND VALIDATION... 9 Preparing the Documentation Required for Attestation...10 PART II: STEP BY STEP INSTRUCTIONS OVERVIEW...11 LOGGING INTO THE IDAHO INCENTIVE MANAGEMENT SYSTEM...12 Eligible Hospital Landing Page...12 ADOPT, IMPLEMENT, OR UPGRADE ATTESTATION...13 CMS Registration Information (AIU Step 1)...14 Hospital Eligibility Details (AIU Step 2)...15 Incentive Payment Calculations (AIU Step 3)...18 Document Upload (AIU Step 4)...20 Attestation (AIU Step 5)...21 Adopt, Implement, or Upgrade Review Mode...23 MEANINGFUL USE ATTESTATION...24 CMS Registration Information (MU Step 1)...26 Hospital Eligibility Details (MU Step 2)...27 Meaningful Use Questionnaire (MU Step 3)...29 Incentive Payment Calculations (MU Step 4)...31 Document Upload (MU Step 5)...33 Attestation (MU Step 6)...34 Meaningful Use Review Mode...36 OTHER SUPPORTING PAGES...37 Payments...38 Appeals...39 Send E mail...40 APPENDIX A RESOURCES...41 RELATED FAQS FROM CMS S WEBSITE REGARDING GETTING YOUR EHR CERTIFICATION...42 ADDITIONAL INFORMATION...43

3 PART I: PROGRAM OVERVIEW Purpose The purpose of this manual is to provide eligible hospitals (EHs) with an overview of the Idaho Medicaid Electronic Health Records (EHR) Incentive Program, what needs to be done to receive payment, and stepby step instructions about how to enroll and attest. Introduction Through provisions of the American Recovery and Reinvestment Act of 2009 (ARRA), the Centers for Medicare & Medicaid Services (CMS) has implemented incentive payments to EHs that are participating in Medicare and Medicaid programs and are meaningful users of certified EHR technology. The incentive payments are not a reimbursement, but are intended to encourage EHs to adopt, implement, or upgrade (AIU) certified EHR technology and use it in a meaningful manner. Use of certified EHR systems is required to qualify for incentive payments. The Office of the National Coordinator (ONC) for Health Information Technology has issued rules defining certified EHR systems and has identified entities that may certify systems. More information about this process is available at Goals for the national program include: 1) enhance care coordination and patient safety; 2) reduce paperwork and improve efficiencies; 3) facilitate electronic information sharing across hospitals, payers, and state lines; and 4) enable data sharing using the state Health Information Exchange (HIE) and the National Health Information Network (NHIN). Achieving these goals will improve health outcomes, facilitate access, simplify care, and reduce the costs of health care nationwide. Idaho Medicaid will work closely with federal and state partners to ensure the Idaho Medicaid EHR Incentive Program fits into the overall strategic plan for the HIE exchange, thereby advancing national and Idaho goals for HIE. Eligibility A hospital s eligibility to receive EHR incentive payments is based on the hospital s provider type and specialty, patient volume, state of licensure and good standing, and verification that a qualifying EHR system is in place. Provider Type and Specialty The first tier of provider eligibility for the Idaho Medicaid EHR Incentive Program is based on provider type and specialty. At this time, CMS has determined that the following hospitals are potentially eligible to enroll in the Idaho Medicaid EHR Incentive Program: Acute Care Hospitals Critical Access Hospitals Children s Hospitals (none in Idaho) Cancer Hospitals (none in Idaho) 1

4 The EHR incentive payments will only be made to Idaho Medicaid providers (EHs with an Idaho Medicaid Provider Agreement). Eligible hospitals must also have a CMS Certification Number range of and and the average length of stay must be 25 days or fewer. Patient Volume To qualify for an EHR incentive payment for each year the EH seeks the incentive payment, the EH must have a minimum of 10 percent Medicaid patient volume attributable to individuals receiving Medicaid funded services as their patient volume requirement. Patient volume thresholds must be established every year a provider applies for an incentive payment. Patient volume is calculated by dividing the number of unduplicated Medicaid discharges and emergency department (ED) encounters during any representative and continuous 90 day period in the preceding fiscal year by the total number of unduplicated discharges and ED encounters in that same period. In other words, patient volume is a percentage derived from a fraction: the numerator is Medicaid discharges and ED encounters and the denominator is total discharges and ED encounters. The equation for the patient volume calculation is: The number of inpatient discharges for which Medicaid paid for any part of the patient's stay + The number of ER visits on any one day for which Medicaid paid any part of the visit (divided by) The total number of inpatient discharges, plus the total number of ER visits on any one day Hospitals will be asked to enter their Medicaid discharges, Medicaid Emergency Department (ED) encounters, and total discharges including total ED visits for the previous federal fiscal year. Note: The ED must be part of the hospital. Total discharge information is listed on the EH s cost reports. Idaho Medicaid will take these numbers from the cost reports in order to verify the information entered by the hospitals. Idaho Medicaid defines "encounter" as a service provided to one patient from admission to discharge for inpatient stay and service provided to one participant by one service provider in one day. Please see p. 10 for additional information about patient volume calculations and Children s Health Insurance Program (CHIP) encounters. Institutional License and Good Standing All participating EHs must have a current institutional license and must be free of both state and federallevel sanctions and exclusions to be eligible for incentive payments. 2

5 Adopt, Implement, or Upgrade All EHs must verify that they have adopted, implemented, or upgraded to a certified EHR system. Below are the criteria for each: Adopt: acquire, purchase, or secure access to certified EHR technology. There is evidence that an EH demonstrated actual installation prior to the incentive, rather than efforts to install. This evidence serves to differentiate between activities that may not result in installation (for example, researching EHRs or interviewing EHR vendors) and actual purchase/acquisition or installation. Implement: install or commence utilization of certified EHR technology. The EH has installed certified EHR technology and has started using the certified EHR technology in clinical practice. Implementation activities would include staff training in the certified EHR technology, the data entry of their patients demographic data into the EHR, or establishing data exchange agreements and relationships between the EH s certified EHR technology and other EPs, such as laboratories and pharmacies. Upgrade: expand the available functionality of certified EHR technology. The EH has added clinical decision support, electronic prescribing functionality, or other enhancements that facilitate the meaningful use of certified EHR technology. An example of upgrading that would qualify for the EHR incentive payment would be upgrading from an existing EHR to a newer version that is certified according to the EHR certification criteria promulgated by the ONC related to meaningful use. Upgrading may also mean expanding the functionality of an EHR in order to render it certifiable according to the ONC s EHR certification criteria ( Meaningful Use Stage 1 When a dually eligible EH successfully attests to the Medicare EHR Incentive Program, CMS sends their meaningful use attestation information to the states as a reference to establish meaningful use for the Medicaid EHR Incentive Program. Dually eligible EHs will not have to repeat their meaningful use attestation in the Idaho Incentive Management System (IIMS) if they have attested for meaningful use through Medicare first. The EHR reporting period will be pre loaded with the EH s dates from their Medicare meaningful use attestation record from CMS. Note: If the EH has not yet attested for meaningful use through the Medicare EHR Incentive Program for payment year 2 and beyond, the EH will not be allowed to proceed further with their attestation and will be advised to contact the Idaho Medicaid EHR Incentive Program Help Desk for further instructions. Eligible hospitals entering meaningful use stage 1 need to meaningfully use a certified EHR technology to improve quality, safety, efficiency, and reduce health disparities. By using EHR technology, EHs will engage their patients and families in their health care and improve care coordination. The EHs can also improve population and public health all the while maintaining privacy and security. The following are the three main components of meaningful use: Use of certified EHR technology in a meaningful manner (e.g., e prescribing). Use of certified EHR technology for electronic exchange of health information to improve the quality of health care. Use of certified EHR technology to submit clinical quality measures and other such measures. 3

6 Getting an EHR Certification ID Number The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. Standards, implementation specifications, and certification criteria for EHR technology have been adopted by the Secretary of the Department of Health and Human Services. The EHR technology in use by the EH must be tested and certified by an ONC Authorized Testing and Certification Body (ATCB) in order for the EH to qualify for EHR incentive payments. Once certified, the product is listed on the ONC website, often referred to as the Certified Health IT Product List (CHPL), where an EH can obtain the product s unique CMS EHR Certification ID Number. This certification number must be provided as part of the CMS attestation and registration process for either the Medicare or Medicaid incentive program. Eligible hospitals can obtain a CMS EHR Certification ID Number for their EHR product by following these steps: 1. Go to the ONC CHPL website: 2. Select the practice type by selecting the Ambulatory or Inpatient button. 3. Search for EHR products by browsing all products, searching by product name, or searching by criteria met. 4. Add products to the cart to determine if they meet 100 percent of the CMS required criteria. 5. Request a CMS EHR Certification ID Number for CMS attestation (this number should contain 15 alphanumeric characters). Note: The "Get CMS EHR Certification ID" button will not be activated until the products in the cart meet 100 percent of the CMS required criteria. If the EHR products don t meet 100 percent of the CMS required criteria to demonstrate meaningful use, a CMS EHR Certification ID Number will not be issued. Important Clarifications The ONC CHPL Product Number issued to a vendor for each certified technology is different than the CMS EHR Certification ID Number issued to a hospital for attestation purposes. Only a CMS EHR Certification ID Number (also obtained from the CHPL site) that is unique to the practice will be accepted at attestation. It is not enough for a hospital s EHR product to be certified by the Certification Commission for Health Information Technology (more commonly known as CCHIT certification). The product must be certified by an ONC ATCB specifically for the Medicare and Medicaid EHR Incentive Programs and listed on the ONC website. A hospital doesn t need to have a certified EHR technology in place to register with CMS for the Medicare and Medicaid EHR Incentive Programs. However, the hospital must adopt, implement, or upgrade to a certified EHR system under the Medicaid EHR Incentive Program or successfully demonstrate meaningful use of certified EHR technology under the Medicare EHR Incentive Program before it can receive an EHR incentive payment. The ONC s website of certified products has the final rules related to certification standards, fact sheets, frequently asked questions, a list of ONC ATCBs, and a wealth of information about certified products and obtaining certification. 4

7 Payments Becoming a Vendor with the State of Idaho In order to receive EHR incentive payments from Idaho Medicaid, the entity receiving the payment must be enrolled as a vendor with the state of Idaho. If an EH is unsure of prior vendor enrollment, they may call the Idaho Medicaid EHR Incentive Program Help Desk at (208) to see if they have previously enrolled. To enroll as a vendor who receives paper warrants and paper remittance advices (RAs), the EH must complete a W 9 form ( pdf/fw9.pdf) and submit it to the Idaho Medicaid EHR Incentive Program using one of three methods: Mail: EHR Incentive Payments Fax: (208) Division of Medicaid PO Box Boise, ID EHRIncentives@dhw.idaho.gov To enroll as a vendor who receives direct deposits (EFT), the hospital must complete the Combined Substitute W 9/EFT Direct Deposit Authorization Form (on the Idaho Office of the State Controller s website). This form must be mailed in along with a voided check (originals only, please. Copied, scanned, or faxed documents will not be accepted) to: EHR Incentive Payments Division of Medicaid PO Box Boise, ID Processing the completed EFT form includes verifying the vendor s tax identification number (TIN) and name with the IRS to make sure they match, and verifying the vendor s financial institution. This process usually takes a couple of weeks. Once the submitted EFT paperwork and voided check have been processed, the controller s office sends the hospital a letter or with their logon information, password, and instructions for accessing the state controller s vendor website so they can view their RAs. Note: EHs who sign up for EFT will not receive paper warrants or paper RAs. Understanding Timelines Payments to EHs will be made in alignment with the federal fiscal year. The EH must reapply for each year it wishes to receive a Medicaid incentive payment, and it must be determined that the EH was a meaningful user of EHR technology during that year. Medicaid EHs are not required to participate on a consecutive, annual basis before 2016, however, the last year an EH may begin receiving payments is 2016, and the last year the EH can receive payments is Participation must be consecutive starting in Establishing Eligible Hospital Incentive Payment Amounts Federal parameters placed on Idaho Medicaid incentive payments to hospitals are largely based on the methodology applied to Medicare incentive payments. The specifications described in this section are the limits that all states must adhere to when developing aggregate EHR hospital incentive amounts for Medicaid EHs. States will calculate hospital aggregate EHR hospital incentive amounts. 5

8 Acute care hospitals may be paid up to 100 percent of an aggregate EHR hospital incentive amount provided over a three year period. The aggregate EHR hospital incentive amount is calculated using an overall EHR amount multiplied by the Medicaid share. Idaho is responsible for using auditable data sources to calculate Medicaid aggregate EHR hospital incentive amounts, as well as determining Idaho Medicaid incentive payments to those hospitals. Auditable data sources include: Hospitals' Medicare cost reports. State specific Medicaid cost reports. Payment and utilization information from the Idaho Medicaid Management Information System (or other automated claims processing systems or information retrieval systems). Hospital financial statements and hospital accounting records. Defining Calculation Inputs for Incentive Payments Base amount: This is $2 million per year for each of the three payment years. Transition factor: This is multiplied by the base amount for each payment year: per rule, year one is set at 100 percent, year two at 75 percent, year three at 50 percent, and year four at 25 percent. Discharge related amount: This is an add on to the base amount for each hospital equaling $200 per discharge for the 1,150 th through the 23,000 th discharge. Discharges before the 1,150 th or after the 23,000 th receive $0. Discharge growth factor: This is determined by taking the average annual number of discharges for a given hospital over the last four years, the most recent year being the last certified cost report year. This factor is used to trend discharges for purposes of calculating future discharge related add on amounts. Initial EHR amount: This is the base amount, plus the discharge related add on amount, multiplied by the transition factor for each year of the incentive program. Overall EHR amount: This is the sum of the initial EHR amounts for each of the four years. Medicaid share: This is derived by dividing total Medicaid bed days by the total inpatient hospital bed days, multiplied by the total charity care (uncompensated care bad debt) ratio for each hospital. Aggregate EHR incentive payment amount: This is derived by multiplying the Medicaid share by the overall EHR amount. Aggregate EHR incentive payment amount by year: This is derived by dividing the aggregate EHR incentive payment amount into the distribution of proportions 50 percent, 40 percent, and 10 percent for the first three years. Understanding the Calculation The aggregate hospital incentive payment calculation will be used to determine the incentive payment amount for each individual hospital. The equation, as determined by CMS rule, includes: 6

9 Overall EHR Amount = {Sum over 4 year of [(Base Amount plus Discharge Related Amount Applicable for Each Year) times Transition Factor Applicable for Each Year]} Medicaid Share = Medicaid inpatient bed days (total inpatient bed days x (estimated total charges charity care charges) estimated total charges) Mathematically, the aggregate hospital incentive payment is the product of the Overall EHR Amount multiplied by the Medicaid Share. The Overall EHR Amount and Medicaid Share are described below: The Overall EHR Amount has been determined as the Initial Amount multiplied by the Transition Factor. The Initial Amount is calculated in four steps: 1. The discharge growth factor was compiled using data for a four year period to arrive at a figure for average growth, or negative growth, for each hospital. 2. For the first payment year, discharges are equal to the number of discharges in the last filed costreport year; for year two, discharges equal this same number multiplied by the discharge growth factor; for year three, discharges equal the calculated discharges for year two multiplied, again, by the same discharge growth factor; and for year four, discharges equal the calculated discharges for year three multiplied by the discharge growth factor once again. 3. The discharge related amount for each year was determined by multiplying the number of discharges for each year by $200 as calculated above. Note: This means discharge numbers between (but not including) the 1,149 th and the 23,001 st discharge. 4. Each of these four discharge related amounts, so derived for each of the four years, is added to the $2 million annual base amount. Taken together, these four amounts equal the Initial Amount. Transition Factor: o The four sums from step four above, are then multiplied by the appropriate transition factors (1.0 for year one,.75 for year two,.5 for year three, and.25 for year four). o The sum of these four annual amounts equals the Overall EHR Amount. Medicaid Share is a fraction determined as follows: o Numerator The estimated number of inpatient bed days attributable to Medicaid patients plus the estimated number of inpatient bed days in the same period attributable to individuals who are enrolled in a managed care organization and a pre paid inpatient health plan, or a pre paid ambulatory health plan. Both of these numbers are from the latest certified hospital cost report data. o Denominator The estimated total number of inpatient bed days during the same period, multiplied by another fraction involving: 1. The numerator the estimated total amount of the EH s charges during that period, excluding charges attributable to charity care. 2. The denominator the estimated total amount of the EH s charges during the same period. 7

10 Dispersing Payments Idaho intends to pay the aggregate hospital incentive payment amount over a period of three annual payments, contingent on the hospital's annual attestations and registrations for the annual Idaho Medicaid payments. The reason for this approach is that most of Idaho s numerous rural hospitals operate on a very thin margin and need the money as soon as possible to offset their EHR system costs. If all conditions for payment are met each year, the EH will receive the following payments: Year One 50 percent of the aggregate amount. Year Two 40 percent of the aggregate amount. Year Three 10 percent of the aggregate amount. IMPORTANT: If Idaho Medicaid determines that monies have been paid inappropriately, incentive funds will be recouped and refunded to CMS. CHIP Encounters for Patient Volume and Payment Calculation For purposes of calculating patient volume, only Title XIX Medicaid encounters may be counted; Title XXI CHIP encounters, or encounters funded through other state programs, cannot be included. Because hospitals cannot always distinguish between these different funding sources, the state is providing a multiplier that deducts an estimation of non Medicaid encounters from the general medical assistance totals maintained by the hospital. Hospital CHIP encounters will be calculated by Medicaid for each hospital soon after that hospital has registered at the Medicare and Medicaid EHR Incentive Program Registration and Attestation System (often referred to as the CMS R&A System). When the state receives notice from the CMS R&A System that a hospital has registered, Idaho Medicaid will contact that hospital using the contact information provided on the registration. The hospital representative will be asked to identify the start date for the 90 day period (from the previous federal fiscal year) to be used to meet the 10 percent Medicaid patientvolume threshold. Idaho Medicaid staff will use the start date and run a report for that 90 day period to determine how many patient discharges (encounters are based on discharges) and ED encounters at that hospital were with Medicaid recipients, and how many discharges and ED encounters were with CHIP recipients. Idaho Medicaid staff will provide that data to the hospital along with the web address to the IIMS where the hospital is to complete the Idaho Medicaid EHR application/attestation process. The hospital is expected to verify that the numbers provided match their data, and input the encounter information into the IIMS when attesting. If the hospital disagrees with the numbers provided, the hospital representative should contact the Idaho Medicaid EHR Incentive Program Help Desk at (208) to get it resolved. Hospitals need to provide specific calculations like charity care and patient discharges so staff can populate a Hospital EHR Incentive Payment Workbook for you, which will include the CHIP encounters. Out-of-State Providers The EHR incentive payments will only be made to Idaho Medicaid providers (EHs with an Idaho Medicaid Provider Agreement). Idaho must be the only state the EH is requesting an incentive payment from during that participation year. 8

11 Program Integrity and Audit Idaho Medicaid will be conducting regular reviews of attestations and incentive payments. These reviews will be selected as part of the current audit selection process, including risk assessment, receipt of a complaint, or incorporation into reviews selected for other objectives. All EHs should be sure to keep their supporting documentation for six years after each incentive payment has been received. Please direct all audit questions directly to Figliozzi and Co., the certified public accountant firm selected by CMS to conduct the audits, for faster response time. Administrative Appeals EHs can choose to appeal the determination made by the Idaho Medicaid EHR Incentive Program about the incentive payment application. All contested cases are governed by the provisions of IDAPA , Rules Governing Contested Case Proceedings and Declaratory Rulings. Hospital Attestation Process and Validation Idaho Medicaid will use the IIMS to process EH s attestations. The attestation itself will be electronic and will require the EH to attest to meeting all requirements defined in the federal regulations. Documentation must be provided to support specific elements of attestation. All hospitals will be required to submit supporting documentation for patient volume claimed in the attestation. If an EH registers at CMS and doesn t receive an from Idaho Medicaid within 2 to 10 business days, the EH s representative should contact the Idaho Medicaid EHR Incentive Program Help Desk at (208) Here is an overview of the steps involved in applying/attesting for a Medicaid EHR incentive payment: 1. Access the CMS EHR R&A System at and register with CMS for the Medicaid incentive, if not already done. Dual EHs that have already registered with CMS don t need to re register in the CMS R&A System to register for the Medicaid incentive. All EHs must provide their name, National Provider Identifier (NPI), business address, phone number, and TIN of the entity receiving the payment. The registration information will be automatically sent to Idaho Medicaid where staff will complete a preliminary check of the information provided. Important Note: An EH must revisit the CMS website to make changes to its information or choices, such as changing the program from which they want to receive an incentive payment. After the initial registration, the EH doesn t need to return to the CMS website before seeking annual payments unless information needs to be updated. As EHs make changes at the CMS website, they must remember to go through the screens, selecting SAVE AND CONTINUE, until they get to the Verify Registration page where they ll select SUBMIT. The updated data will not be sent to Idaho and the payment will be delayed unless SUBMIT is selected. 2. Idaho Medicaid will contact the EH to get specific calculations like charity care and patient discharges so a Hospital EHR Incentive Payment Workbook can be populated and sent to an EH. 3. Once the workbook is complete, Medicaid will send the EH the workbook, send the link to the IIMS, and notify the EH that it is time to apply/attest for the Idaho Medicaid incentive. 4. After the EH is notified that it s time to apply/attest, the EH must log into the IIMS and provide the NPI and CMS EHR Certification ID Number. Step by step instructions are included in Part II of this handbook. The EH will also be asked to upload documentation to prove that it meets AIU criteria. 9

12 5. Once the application/attestation is complete and submitted in the IIMS, Idaho Medicaid will initiate eligibility determination. The EH will be contacted if there are any questions. 6. Once payment is disbursed to the EH, CMS will be notified by Idaho Medicaid that a payment has been made. Providers can check the hospital status in the IIMS at any time to determine their status in this process. If the EH has any questions about their status, the EH can contact the Idaho Medicaid EHR Incentive Program Help Desk at (208) to find out why no payment was made. During the first year of the program, EHs will only be able to attest to adopting, implementing, or upgrading to certified EHR technology for the Idaho Medicaid EHR program. Documentation dated any time before the attestation is acceptable if the system and version of EHR technology has been certified by the ONC (the Certified Health IT Product List is on the ONC s website at Preparing the Documentation Required for Attestation The following is a description of the documentation that an EH must upload to the IIMS ( during attestation: Proof of AIU to certified EHR technology This must be a document showing a binding agreement between the EH and the vendor, such as a contract between entities. o Idaho Medicaid only needs the most current documents for proof, not all historical documents relating to the EHR system. o If the EH has already been approved for payment and declared a meaningful user for the Medicare EHR Program, the EH does not have to include the AIU documentation when it applies to Medicaid. o If the EH has registered for a Medicare incentive payment as well as a Medicaid payment but has not yet completed the attestation process for Medicare and been approved for payment, the EH MUST submit AIU documentation to Idaho Medicaid. An invoice showing payment for the certified EHR system (actual numbers may be blacked out). A purchase order. Note A vendor letter is not acceptable unless submitted with additional binding documentation. The documentation submitted must include the exact name of the EHR system purchased including the software version number. A Hospital EHR Incentive Payment Worksheet. o Key in your charity care, total discharges, and ED encounters. o Review your calculations for accuracy. Note: You must save the calculation worksheet as a PDF file format. 10

13 PART II: STEP-BY-STEP INSTRUCTIONS Overview Idaho has implemented a web based interface, called the Idaho Incentive Management System (IIMS), for providers to apply and attest at the state level. To successfully use the IIMS to apply and attest, you must: Be successfully registered on the Centers for Medicare and Medicaid Services (CMS) website for the Incentive Management Program. Have the following information available: o National Provider Identifier (NPI) you used to register at the CMS website. o CMS Registration Identification Number that is associated with your NPI (provided by CMS during registration). o Medicaid Calculation Worksheet and the Hospital Data for IIMS Worksheet (included in the Idaho Electronic Health Records (EHR) Program Hospital Payment Calculation Workbook) available for reference. Steps to complete your application/attestation in the IIMS include: Log into the IIMS. Enroll for a new year of attestation, if this is not the eligible hospital s (EH) first year. Review the CMS registration data. Enter the hospital eligibility details. Review the incentive payment calculation. Upload supporting documentation. Submit the application/attestation. The log in process and step by step instructions for application, attestation, and information verification are discussed on the following pages. 11

14 Logging Into the Idaho Incentive Management System The person completing the hospital s application/attestation begins the Idaho Medicaid EHR Incentive Program application and attestation process by accessing the IIMS at The following page is displayed: When this page appears: Enter the NPI used when registering at the CMS EHR Incentive Program site and the 10 digit CMSassigned Registration ID Number. If the data entered here does not match the NPI or the CMSassigned Registration ID Number on file, the message, Invalid NPI/Registration ID combination will be displayed. If you do not remember your CMS assigned Registration Identification Number, you must return to the CMS EHR Incentive Program Registration and Attestation System to reference it. Select Submit to log in and proceed to the CMS Registration Information page. If you encounter the message Application is in process at Idaho Medicaid. You can expect to receive an in 7 10 days informing you of your application status, this indicates that Idaho Medicaid is conducting a preliminary review of the registration record received from CMS. Once this preliminary review is completed you will be allowed to log in and begin attestation for year 1. Eligible Hospital Landing Page The EH will be presented with a landing page upon successfully logging in that will show their current status. The first page in the adopt, implement, or upgrade (AIU) and meaningful use (MU) sections below is what they will see when they first log in which will be slightly different depending on the payment year for AIU or MU. 12

15 Adopt, Implement, or Upgrade Attestation The current status of the payment year will be displayed in the Provider Status Flow section of the page. To start the attestation, the EH must select Begin/Modify Attestation and it will bring them to the CMS Registration Information Page. 13

16 CMS Registration Information (AIU Step 1) When this page appears: Review this information carefully. This information is populated directly from your CMS registration information. You cannot update the information on this page. If you need to make updates to this information, return to the CMS website and make your changes. Once you have completed your update on the CMS website, your information will again be sent to Idaho and this page will be updated. Please allow 24 hours for the update to be received by Idaho. Important Note: As you make your changes at the CMS website, make sure you go through the screens, selecting Save and Continue, until you get to the Verify Registration page and select Submit. Unless you select Submit, your updated data will not be sent to Idaho and your payment will be delayed. Before moving to the next screen, open the Payment Calculation Workbook provided to you by Medicaid and click on the worksheet/tab at the bottom of the page titled, Hospital Data for IIMS. You may want to print the worksheet for easy reference as you will use it on the next page. Select Next to go to the Hospital Eligibility Details page. 14

17 Hospital Eligibility Details (AIU Step 2) Two graphics are shown below: The first is a graphic of the of the Hospital Eligibility Details page of the IIMS. The second is a comparison between what is on the Hospital Eligibility Details page and what is on the Hospital Data for IIMS worksheet that was already completed. The Hospital Data for IIMS worksheet that hospitals receive from Idaho Medicaid is designed to mimic exactly what is on the Hospital Eligibility Details page of the IIMS. Use the worksheet and the step by step instructions below to complete the Hospital Eligibility Details page. 15

18 Program Year Select the program year. This selection is only available if the current date is between October 1 and the end of November. This allows you to choose the previous program year during the two month period where it is allowed to attest for either the previous or current program year. After the end of November, the program year will be defaulted to the current federal fiscal year (October 1 September 30), which will be equal to the current active program year. For example, on December 1, 2013, the federal fiscal year is 2014 and is equal to the current active program year of Patient Volume: 1. Select the starting date of the 90 day period to calculate the Medicaid encounter volume percentage. The date format is month, day, and year separated by forward slashes. If you enter a two or four digit year it will convert to the two digit year. 2. Enter the total Medicaid patient discharges from the Hospital Data for IIMS worksheet. 3. Enter the total patient discharges during this period from the Hospital Data for IIMS worksheet. 4. Medicaid patient volume percentage (calculated for you). When items #2 and #3 are entered and the cursor is moved to the next entry, the patient volume percentage will display. Note: If the hospital patient volume percentage is less than the 10 percent threshold, a message will be displayed that says, "This is below the 10% of patient volume and you should meet the threshold of 10% to get the EHR Incentive Payment." 16

19 EHR Details: 5. Enter the CMS EHR Certification ID of your EHR: This is your CMS EHR Certification ID, which will be auto populated from your CMS registration information, if it was provided there. If not, the EHR Certification ID must by input here. This ID will be checked against valid certified EHR IDs from the Office of the National Coordinator (ONC) for Health Information Technology. 6. Select the status of your EHR Adopt, Implement, or Upgrade. Growth Rate: 7. Enter the total number of discharges in the previous year, which corresponds to the same item on the Hospital Data for IIMS worksheet. 8. Enter the total number of discharges one year prior to the program year, which corresponds to the same item on the Hospital Data for IIMS worksheet. 9. Enter the total number of discharges two years prior to the program year, which corresponds to the same item on the Hospital Data for IIMS worksheet. 10. Enter the total number of discharges three years prior to the program year, which corresponds to the same item on the Hospital Data for IIMS worksheet. Medicaid Share: 11. Enter the total Medicaid inpatient bed days (exclude nursery bed days), which corresponds to the same item on the Hospital Data for IIMS worksheet. 12. Enter the total Medicaid HMO inpatient bed days (exclude nursery bed days), which corresponds to the same item on the Hospital Data for IIMS worksheet. 13. Enter the total inpatient bed days, which corresponds to the same item on the Hospital Data for IIMS worksheet. 14. Enter the total hospital charges, which correspond to the same item on the Hospital Data for IIMS worksheet. 15. Enter the total charity care charges, which correspond to the same item on the Hospital Data for IIMS worksheet. After entering your data, you must select one of the following buttons from the bottom of the screen: Previous If you have not saved your entries, this will cancel your entries and take you to the previous page. Next will save your entries and take you to the Incentive Payment Calculations page. Save will save your current entries on the page and you will remain on that page. Cancel will replace any changes you made with data retrieved from the last time you saved your information. For example, if you never entered anything into the page before selecting Cancel you will see blank fields. 17

20 Incentive Payment Calculations (AIU Step 3) Two graphics are shown below: The first is a graphic of the of the Incentive Payment Calculations page of the IIMS. The second is a comparison between what is on the Incentive Payment Calculations page and what is on the Medicaid Calculation worksheet. Open the Medicaid Calculation worksheet included in the Payment Calculation Workbook (provided by Idaho Medicaid) as shown on the next page. 18

21 Verification of Incentive Payment Calculation A simple verification between the Medicaid Calculation worksheet and the Incentive Payment Calculations page is required. The easiest way to do this is to: Make sure the total and first year payment amounts on the screen match the payments calculated in the Medicaid Calculation worksheet (based on the input from the previous page, your payment calculation is shown). On the Medicaid Calculation worksheet Aggregate EHR Incentive Payment Amount First Year Idaho Medicaid EHR Incentive Payment Must match Must match On the Incentive Payment Calculations page in IIMS Total Medicaid Aggregate EHR Incentive Payment First Year Idaho Medicaid Incentive Payment (50%) If the amounts do not match, contact the Idaho Medicaid EHR Incentive Program Help Desk at (208) to get the problem resolved. After verifying your data, you must select one of the following buttons from the bottom of the screen: o Selecting Next will take you to the Document Upload page. o Selecting Previous will take you back to the Hospital Eligibility Details page. 19

22 Document Upload (AIU Step 4) When this page appears: You may not have to do anything. Medicaid should have all the pertinent information to support your attestation; however, you may be instructed to upload additional documentation. Note: only PDF files can be uploaded. You will still be able to upload files even after you have completed your attestation. Selecting Next will take you to the Attestation Statement page of the IIMS. 20

23 Attestation (AIU Step 5) Required: Enter your initials or name and the hospital s NPI at the bottom of the screen. o This will serve as your electronic signature. o By entering this information, you attest to the validity of all data submitted for consideration by the Idaho Medicaid EHR Incentive Program. Select Submit Important: After you select Submit, YOU CANNOT GO BACK AND MAKE ANY CHANGES. o Once you select Submit, it will take you to the first page of your attestation, CMS Registration Information (Step 1), to review. You can select Previous and Next to view the attestation pages in a review mode only. o Selecting Submit will notify Idaho Medicaid that the hospital s attestation is ready for final eligibility review. 21

24 The attestation text is shown here: ATTESTATION FOR PARTICIPATION IN THE IDAHO MEDICAID EHR INCENTIVE PROGRAM This Attestation is required for participation in the Idaho Medicaid Electronic Health Record (EHR) Incentive Payment Program to eligible professionals (EPs) and eligible hospitals who adopt, implement, upgrade (AIU) or meaningfully use (MU) certified EHR technology. Participation must be in accordance with the requirements under United States Department of Health and Human Services, Centers for Medicare & Medicaid Services Final Rule regulations 42 CFR 495, Standards for the Electronic Health Record Incentive Program, revised July 28, These regulations implement the HITECH Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA) (Public Law 111 5). To comply with the above cited regulations, the Idaho Department of Health and Welfare (Department) requires that eligible professionals (EPs) and eligible hospitals submit this Attestation. This Attestation certifies the following is known and understood: 1. EPs are prohibited from seeking payment from another state or from the Medicare EHR incentive program in this payment year (applicable to EP only). 2. The Department can review, verify and/or audit all information provided by the EP or eligible hospital, both prior to and after payment has been made. 3. The Department can request AIU and/or MU supporting information either at the time of attestation or after, and can review, verify and/or audit both prior to and after payment has been made. 4. The EP or eligible hospital is required to retain the documentation that verifies patient volume calculations, AIU, MU, and any other information that validates the appropriateness of the EHR incentive payments received, and do so for 6 years from the date of payment. 5. The submission of any false information in this agreement or this process may result in the EP or eligible hospital being declared ineligible to participate in the Idaho Medicaid EHR Incentive Program. 6. Any incentive payments paid to the EP or eligible hospital, later found to have been made based on fraudulent or inaccurate information or attestation may be recouped by the Department or other appropriate state or federal agency. 7. The EHR incentive payments will be treated like all other income and are subject to federal and state laws regarding income tax, wage garnishment, and debt recoupment. This Attestation also certifies that the following is true and accurate: 1. With awareness and informed consent, this EP or eligible hospital is voluntarily participating in the Idaho Medicaid EHR Incentive Program. 2. The EHR certification number provided is the correct number, and accurately represents the certified EHR system or combination of certified EHR modules adopted and/or in use by this EP, group practice, or eligible hospital. 3. Any reassignment of an EHR incentive payment is made voluntarily, which assumes informed consent, has been given by the EP, who understands that the party so designated not the EP will receive the payment (applicable to EPs only). 4. The person completing this electronic attestation is the EP, or the assigned representative of the EP, group practice or eligible hospital, who has been duly authorized to commit the EP or eligible hospital to the statements set forth in this attestation (applicable to EPs only). 5. If patient volume threshold is derived using encounter data from multiple practice locations, at least one of those locations must have has a certified EHR (applicable to EPs only). 6. If the EP is a physician assistant, they are practicing in a physician assistant led FQHC or RHC. I CERTIFY THAT the information provided in this Attestation and during the registration process, as well as in the documents submitted in support of registration, are true, accurate and complete. I hereby agree to retain such records for six years from the date of payment as are necessary to demonstrate I meet the program requirements, and to furnish those records to the Idaho Department of Health and Welfare, Division of Medicaid or contractor acting on their behalf, upon request before and/or after payment. I have read and understood this entire Attestation. I understand that any Medicaid EHR incentive payment made, in part, or wholly as a result of this Attestation will be from federal funds, and that falsification or concealment of material facts may be prosecuted under federal and state laws. 22

25 Adopt, Implement, or Upgrade Review Mode After submitting the attestation, you will be place in review mode where you can review the attested pages one at a time by pressing Next and Previous. Logout when finished with review. 23

26 Meaningful Use Attestation After logging on, you will see the MU landing page (see graphic below). The current status of the payment year will be displayed in the Provider Status Flow section of the page. You will see one of the following on the bottom of this page: The Enroll for next year s attestation button You will see this if you are already enrolled with the Idaho Medicaid EHR Incentive Program and have received a payment in the past (see graphic below). The Begin/Modify Attestation button under the Action column of the table shown You will see this link if you have never received a payment from the Idaho Medicaid EHR Incentive Program and your payment year is at least Year 2. This indicates that you are a new registrant to the Idaho Medicaid EHR Incentive Program and your CMS registration information has been reviewed by Idaho Medicaid. To enroll for the next year s attestation: Select the Enroll for next year s attestation button on the bottom of the page (see graphic above) the page will refresh and you will see a new payment year added to the table displayed (see graphic below). 24

27 Select the Begin/Modify Attestation button it will take you to the CMS Registration Information page (MU Step 1) (see graphic below). 25

28 CMS Registration Information (MU Step 1) When this page appears: Review this information carefully. This information is populated directly from your CMS registration information. You cannot update the information on this page. If you need to make updates to this information, return to the CMS website and make your changes. Once you have completed your update on the CMS website, your information will again be sent to Idaho and this page will be updated. Important Note: As you make your changes at the CMS website, make sure you go through the screens, selecting Save and Continue, until you get to the Verify Registration page and select Submit. Unless you select Submit, your updated data will not be sent to Idaho and your payment will be delayed. Before moving to the next screen, open the Payment Calculation Workbook provided to you by Medicaid and click on the worksheet/tab at the bottom of the page titled, Hospital Data for IIMS. You may want to print the worksheet for easy reference as you will use it on the next page. Select Next to go to the Hospital Eligibility Details page. 26

29 Hospital Eligibility Details (MU Step 2) Use the step by step instructions below to complete this page. Program Year Select the program year. This selection is only available if the current date is between October 1 and the end of November. This allows you to choose the previous program year during the two month period where it is allowed to attest for either the previous or current program year. After the end of November, the program year will be defaulted to the current federal fiscal year (October 1 September 30), which will be equal to the current active program year. For example, on December 1, 2013, the federal fiscal year is 2014 and is equal to the current active program year of

30 Patient Volume: 1. Select the starting date of the 90 day period to calculate the Medicaid encounter volume percentage. The date format is month, day, and year separated by forward slashes. If you enter a two or four digit year it will convert to the two digit year. 2. Enter the total Medicaid patient discharges from the Hospital Data for IIMS worksheet. 3. Enter the total patient discharges during this period from the Hospital Data for IIMS worksheet. 4. Medicaid patient volume percentage (calculated for you). When items #2 and #3 are entered and the cursor is moved to the next entry, the patient volume percentage will display. Note: If the hospital patient volume percentage is less than the 10 percent threshold, a message will be displayed that says, "This is below the 10% of patient volume and you should meet the threshold of 10% to get the EHR Incentive Payment." EHR Details: 5. This is your CMS EHR Certification ID, which will be auto populated from your CMS registration information, if it was provided there. If not, the EHR certification ID must by input here. This ID will be checked against valid certified EHR IDs from the ONC. 6. Select the status of your EHR Meaningful User. Growth Rate and Medicaid Share: The Growth Rate and Medicaid Share sections for EHs are not editable after the first year payment from the Medicaid EHR Incentive Program. If there are factors that have changed, you must contact the Idaho Medicaid EHR Incentive Program at EHRincentives@dhw.idaho.gov or call (208) After entering your data, you must select one of the following buttons from the bottom of the screen: Previous If you have not saved your entries, this will cancel your entries and take you to the previous page. Next will save your entries and take you to the Incentive Payment Calculations page. Save will save your current entries on the page and you will remain on that page. Cancel will replace any changes you made with data retrieved from the last time you saved your information. For example, if you never entered anything into the page before selecting Cancel you will see blank fields. 28