Registration and Attestation

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1 Registration and Attestation Presented by: Deb Anderson, HTS Consultant and Sarah Leake, HTS Consultant HTS, a division of Mountain Pacific Quality Health Foundation 1

2 About Health Technology Services - HTS EHR Incentives for Eligible Professionals EPs EHR Incentives for Eligible Hospitals EHs Medicaid Eligibility for EHs and EPs EHR Incentive Registration Identity and Access (I&A) System CMS Registration Wyoming SLR Montana SLR 2

3 EHR Incentive Attestation CMS Attestation Wyoming Medicaid Attestation Montana Medicaid Attestation Q&A Links, upcoming webinars and HTS Regional Extension Center contacts 3

4 HTS is a division of Mountain Pacific Quality Health Foundation. We are the Regional Extension Center (REC) for MT/WY. We assist healthcare facilities with utilizing Health Information Technology (HIT) to improve health care, quality, efficiency and outcomes. Our staff has expertise in HIT, Meaningful Use, PQRS, PCMH, Project Management, LEAN, HIPAA Privacy and Security Consulting as well as Health Information Exchange. 4

5 The Office of the National Coordinator created the Regional Extension Centers (REC) to serve as a support resource to assist Eligible Providers and Eligible Hospitals with EHR implementation and Health Information Technology needs. RECs "bridge the technology gap" and help navigate the EHR adoption process from vendor selection and workflow analysis to implementation and meaningful use attestation. 5

6 The maximum incentive payment amount for Eligible Professionals in the Medicare EHR program is now $43,720 over five years due to sequestration. The maximum incentive for EPs in the Medicaid EHR program is $63,750 over six years. Hospitals can receive incentive payments from both programs if they meet eligibility requirements. Providers and Hospitals must continue to demonstrate meaningful use each year to avoid the payment adjustments from Medicare. There are no payment adjustments from Medicaid. 6

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8 Incentive payments for eligible professionals are based on individual practitioners. If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology. Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provides services. Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting. 8

9 Medicare EHR incentive payments made are subject to the mandatory reductions in federal spending known as sequestration. This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, Incentive amounts decrease dramatically in 2014 ** CMS has announced it s intent to extend Stage 2 through 2016 and start Stage 3 in

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11 Providers are Eligible for EITHER Medicare or Medicaid Medicaid Eligibility requirements Must meet >30% Medicaid Patient Volume 20% Medicaid Patient Volume for Pediatrician FQHC and RHC may include Needy Individuals Adopt/Implement/Upgrade (AIU) Year 1 AIU is not recommended in 2014 Must meet MU Measures from Year 2 forward to avoid Medicare payment adjustments 11

12 Hospitals may be dually eligible to receive both Medicaid and Medicare incentives is the last year for a CAH to request Medicare Reasonable Cost reimbursement. 12

13 Hospitals MAY be eligible for both Medicare and Medicaid incentive payments Hospital must have >10% Medicaid Patient Volume Adopt/Implement/Upgrade (AIU) - Year 1 Must meet MU Measures Year 2 and after to receive payments There are no penalties from Medicaid Payments made through 2021 Medicaid Incentive based on Medicaid Share Calculation 13

14 Identity and Access Management System CMS EHR Registration (NLR) Accessing Medicaid State Level Registries (SLR) 14

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22 NPI Registry Search Home Individual or Organizational Provider NPI 22

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31 Valid I&A login Tax ID (TIN OR SSN) NPI Incentive type (Medicare/Medicaid/both) Eligible Provider Type Payee Information (NPI) Business Address, Zip +4, Phone number address for confirmation Optional EHR Certification Number CCN (Hospital) Medicaid hospital type and state/territory Medicare hospital type 31

32 Login at the bottom of the page. 32

33 Select the Registration Tab 33

34 Click the Register button of the appropriate EP 34

35 Step 1 35

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40 Medicare EPs are now finished with registration! 40

41 Wyoming and Montana CMS National Level Registry - Registration information State Level Registry Registration and MU Data downloads from NLR to SLR 41

42 NPI CMS Registration Identifier Randall "Rick" Hunter HIT Outreach Coordinator Linda Cramer HIT Manager Wyoming Dept. of Health Medicaid (o) (c)

43 MT Medicaid Site: Must Set up an Account in MT SLR Randy Haight MT Medicaid Incentive Contact MT Dept of Health - Medicaid office: Camie Zufelt HIT Manager MT Dept of Health - Medicaid office: cell:

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45 Please enter your questions in the chat box at this time. 45

46 Sarah Leake, HTS Consultant 46

47 Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html 47

48 Worksheets illustrate how Core and Menu items are input into the site. No CQMs or other information is covered. 48

49 Very Helpful Guides 49

50 Must Select the Provider that you are attesting on behalf of. 50

51 Key Information to Prepare for Attestation 1) CMS EHR Certification Number 2) 90 or 365 Day Period for Reporting 3) MU Report generated from EHR with measures Numerator/Denominator and CQMs 4) Hospital: Method for Reporting - ED Visits or Observation Method 51

52 Provider Screen Hospital Screen 52

53 Stage Core Menu CQMs Year Hospital Stage of Hospital Stage of of 29 Year Year core are not reported. (CQM and Electronic Exchange) CQMs thru Attestation Hospital Stage of 6 16 of and on CQMs thru ereporting Provider Stage of 10 6 (3/3) Year core are not reported. (CQM and Electronic Exchange) Provider Stage of 10 9 of 64 Year CQMs thru Attestation Provider Stage of 6 9 of and on CQMs thru ereporting ** All Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. CQMs Requirements = Stage of Meaningful Use 53

54 Differences Stage 1 or Stage 2 Hospital or Provider Core Measure Sample: Numerator/Denominator Y/N 54

55 Patient Records: At the eligible hospital s or provider s discretion, the numerators and denominators of certain measures may be calculated using only the patient records maintained in certified EHR technology. The eligible hospital or provider may also elect to calculate the numerators and denominators of these measures using ALL patient records. Eligible hospitals or providers must indicate which method they used in their calculations. 55

56 Exclusion: Eligible hospitals or providers can be excluded from meeting an objective if they meet the requirements of the exclusion. If the eligible hospital or provider cannot meet the specific exclusion requirements, then they cannot answer Yes to the exclusion question. (If no exclusion is indicated, the eligible hospital or provider must report on that measure.) 56

57 For Stage 1 MU Reporting: Two Core Measures require no input rather you just click on Save and Continue. Clinical Quality Measure Reporting (10 of 15 for Provider Measures) Capability to Exchange Clinical Information (14 of 15 for Provider Measures) 57

58 Know how the client s EHR is reporting these measures; CPOE choose which one the data represents: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Optional Alternate: More than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE. Vital Signs choose which one the data represents: For more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data. New Measure (Optional 2013; Required 2014 and beyond): For more than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. 58

59 Stage 1: Can only report on 5 Menu Measures. 1) One must be a Public Health Measure. 2) Select 4 others. Stage 2: Report on 3 of 6 Menu Measures. 59

60 For 2013: Providers report on 3 Core CQM Measures plus 1-3 Alternate Core CQM Measures for any Core CQM that is zeros and 3 Additional CQM Measures. (a minimum of 6 CQMs or maximum of 9 CQMs) The performance % must now be typed. (does not calculate automatically.) 60

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62 From 2014 Regardless of Stage! Providers: Report on 9 of 64 CQMs. If the first year of MU can report CQMs through Attestation. If in 2 nd or later year hospitals must report CQMs electronically. CQMs Requirements = Stage of Meaningful Use Hospital: Report on 16 of 29 CQMs. If the first year of MU can report CQMs through Attestation. If in 2 nd or later year hospitals must report CQMs electronically. Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalQuality MeasuresTipsheet.pdf 62

63 Review of Attestation Measures Summary Option to Modify if not Correct CONTINUE with ATTESTATION Attestation Statements Agree Confirmation Page Provider/Hospital, TIN/EIN, CCN/NPI, Cert number and Reporting Period Disclaimer SUBMIT Submission Receipt with Attestation Number Attestation Tab Accepted 63

64 Medicare EPs Must Attest by February 28 at 11:59 pm ET to Receive 2013 Incentive 64

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66 AIU Attestation Patient Volume Yes Yes Every Year must meet. Documentation showing methodology and calculation EHR Details Yes Yes ONC-ATCB EHR Certification Number Documentation showing exact name and version. Vendor Contract Yes Yes Documentation showing binding agreement with vendor. Reporting Period No Yes 90 days Year 1, 365 days Year 2 and after. PY 2014: only 90 days reporting required. HOSPITAL ONLY: Medicaid Share Yes No Financial or Cost Report Data: Used to calculate overall incentives. (WY requires cost report data on S3 or S5) Growth Rate Yes No Financial or Cost Report Data: Used to calculate overall incentives. 66

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68 WY Medicaid EHR Incentive Site 68

69 Links: Manuals AIU Provider Manual EP MU Manual EH MU Manual CMS EHR Site WY Medicaid EHR Site NPI CMS Registration Identifier 69

70 New users: If you have not received an EHR Incentive Program payment from Wyoming Medicaid, you first have to register at the CMS Web Site. After approximately 48 hours after successfully registering at the CMS level, you will receive an from Wyoming Medicaid indicating that you are able to complete your application on this site. Return Users: If you have already registered on the CMS site and received an EHR Incentive Program payment from Wyoming Medicaid, you do not need to visit the CMS again. Please proceed with your year two attestation by entering your NPI and CMS Registration Identifier 70

71 EPs tail period is from January 01 to March 31. However, we would prefer ALL of their paperwork be submitted prior to March 15 to allow for any corrections of incomplete packages. If they were to wait until the 31st March deadline and something was not correct, they could quite possibly lose that attestation. EHs run on FFY; so their 'tail period' runs until 31st December, Again, we prefer they have all materials submitted prior to 15th December to allow time for corrections. Hospital deadline already Passed. From WY HIT Coordinator 71

72 Provides Description of Medicaid Program: Eligibility, Patient Volume, Payments, Registration, Attestation 72

73 DETAILED MANUAL Describes the Provider Attestation Process Pages 73

74 Hospital User Manual Describes the Hospital Attestation Process - 26 Pages 74

75 1. Provider Authorization Proxy Any providers allowing another person to complete the registration and attestation process in the Wyoming Medicaid EHR Program is required to complete and submit a Provider Authorization Proxy 2. Proof of EHR Must be a document showing a binding agreement between provider and vendor. (A vendor letter alone is not acceptable.) a. Contract between entities b. Invoice showing payment (actual numbers can be blacked out) c. Purchase Order 3. Exact Name and Version of EHR system 4. Patient Volume Methodology a. Date range must be 90 consecutive days from previous year. b. Total Medicaid encounters / total encounters during same time * Calendar Year for Providers *Federal FY for Hospitals previous FFY that did not end in payment year. 75

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77 Montana providers must register with the CMS registration and attestation system prior to registering with the Montana State Level Registry. Must Set up an Account in MT SLR MT Medicaid Site: 77

78 Account is Set Up! MT Medicaid Site: 78

79 HOW to Set up Account, AIU and Attest The tools in this Provider Outreach Page will help you start collecting and organizing the information you will need in order to register with Montana's SLR. 79

80 Choose Eligible Provider, Hospital or Group Administrator. Helpful List of Steps toward Medicaid AIU/Attestation. Resources 80

81 An eligible professional (EP) must register and attest for the 2013 calendar year by March 31, 2014 Log into the MT State Level Registry 81

82 STEPS in MT Medicaid Payment Information, Reports, Audits 82

83 Step 1: About You Contact Information Step 2: Confirm Montana Medicaid Program Eligibility Medicaid Volume, Representative Period Start and End date, Hospital Total Discharges Hospital Demographics for 1 st Year Documentation. 83

84 Reporting Period Medicaid Volume Data Attach Documents 84

85 Step 1: About You Contact Information Step 2: Confirm Montana Medicaid Program Eligibility Step 3: Attestation of EHR or AIU EHR Certified Version AIU: Verify Adopt, Implement or Upgrade Attest: Input MU Measure Data and CQMs Step 4: Review and Sign Agreement Print, Sign and Upload Step 5: Send Year 2 Attestation (LOCKED) 85

86 Questions? Comments? 86

87 Deb Anderson Health Technology Consultant Sarah Leake Health Technology Consultant

88 Register for our upcoming webinars and check out the resources used today: Upcoming webinars January *Important New Meaningful Use Changes in 2014 *Open MU Q&A (For HTS MU subscribers only) February *Meaningful Use Stage 2 *HIPAA Privacy and Security for 2014 March *Understanding & Reporting 2014 Clinical Quality Measures for EPs and EHs *Open MU Q&A (For HTS MU subscribers only) 88

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