Vermont Medicaid EHR Incentive Program

Transcription

1 Vermont Medicaid EHR Incentive Program Progress and Updates April 26, /26/2013 VT Medicaid EHRIP Webinar 1

2 Agenda Vermont Medicaid EHRIP status Overview of EHRIP changes MAPIR 5.0 Resources for EHRIP applicants Q & A 4/26/2013 VT Medicaid EHRIP Webinar 2

4 VT EHRIP Status Program Team Members Terry Bequette State of Vermont HIT Coordinator Lorraine Siciliano Medicaid Operations Administrator Timothy Tremblay Medicaid Operations Administrator Heather Kendall, PhD Program and Operations Auditor Program Team Activities Maintain CMS guidelines for EHRIP functions Maintain the technical functioning of attestation system Develop Vermont program website and other information resources Process attestations Pre-payment validation Develop audit plan, conduct program audits Comply with CMS EHRIP reporting requirements 4/26/2013 VT Medicaid EHRIP Webinar 4

5 VT EHRIP Status EPs 595 Individual EPs 737 Payments EHs 11 Individual EHs 15 Payments Total $23,458,217 4/26/2013 VT Medicaid EHRIP Webinar 5

6 VT EHRIP Status 4/26/2013 VT Medicaid EHRIP Webinar 6

8 Overview of EHRIP Changes Changes as of Program Year 2013 Medicaid Encounter definition for EPs Patient volume threshold reporting period FQHC/RHC Practicing Predominantly calculation Measures and objectives for certain Meaningful Use Stage 1 reporting 4/26/2013 VT Medicaid EHRIP Webinar 8

9 Overview of EHRIP Changes New Definition of Medicaid Encounter for EPs MedicaidEncounter = services rendered on any one day to a Medicaid-enrolled individual, regardless of payment liability Expands the types of services to count toward determining whether a provider meets the threshold for qualifying for a Medicaid EHR incentive payment. 4/26/2013 VT Medicaid EHRIP Webinar 9

10 Overview of EHRIP Changes New Definition of Medicaid Encounter for EPs Examples of encounters that may now be included Claims denied due to service limitation audits Claims denied due to non-covered service Claims denied due to timely filing Services rendered on Medicaid members that were not billed due to the provider s understanding of Medicaid billing rules 4/26/2013 VT Medicaid EHRIP Webinar 10

11 Overview of EHRIP Changes New Definition of Medicaid Encounter for EPs This does NOT include claims denied due to the provider or patient being ineligible for the date of service. 4/26/2013 VT Medicaid EHRIP Webinar 11

12 Overview of EHRIP Changes New Definition of Medicaid Encounter for EPs Medicaid encounter definition does not change for Eligible Hospitals EHs cannot include unpaid claims in their calculations 4/26/2013 VT Medicaid EHRIP Webinar 12

13 Overview of EHRIP Changes Patient Volume Threshold Reporting Period As of Program Year 2013, EPs and EHs have the option to choose their patient volume threshold reporting period: Any consecutive 90-day period within the prior program year OR Any consecutive 90-day period within the preceding 12- month period from the date of attestation. 4/26/2013 VT Medicaid EHRIP Webinar 13

14 Overview of EHRIP Changes Patient Volume Threshold Reporting Period EPs January 1, 2012 to December 31, 2012 Program Year 2012 EHs October 1, 2011 to September 30, 2012 EP attestation date of 12/1/12: Only had the option to choose a 90-day patient volume reporting period from PY day reporting period dates EPs January 1, 2011 to December 31, 2011 EHs October 1, 2010 to September 30, /26/2013 VT Medicaid EHRIP Webinar 14

15 Overview of EHRIP Changes Patient Volume Threshold Reporting Period EPs January 1, 2013 to December 31, 2013 Program Year 2013 EHs October 1, 2012 to September 30, 2013 Example: EP attestation date 12/1/13 Now has the option to choose a 90-day period from 2012 ORa 90-day period from 11/30/ /30/ /26/2013 VT Medicaid EHRIP Webinar 15

16 Overview of EHRIP Changes Patient Volume Threshold Reporting Period It is possible that using the preceding 12-month period and choosing a 90-day period ending close to the date of the attestation submission could delay the application processing. If the state has not yet received claims or encounter data for that period, the EHR Incentive Program Team may hold the attestation in pre-payment status until the necessary encounter reporting or claims information has been received. 4/26/2013 VT Medicaid EHRIP Webinar 16

17 Overview of EHRIP Changes FQHC/RHC Practicing Predominantly For EPs to be practicing predominantly at an FQHC/RHC, more than 50 percent of their patient encounters must be at the qualifying practice. Prior to PY2013, the patient encounters had to be during 6-month period within the previous calendar year from the Program Year in which they were attesting. Old Calculation: PY 2012 Example 4/26/2013 VT Medicaid EHRIP Webinar 17

18 Overview of EHRIP Changes FQHC/RHC Practicing Predominantly The updated requirement allows EPs to use a 6-month period within the prior calendar year or within the preceding 12-month period from the date of attestation for their practicing predominantly period calculation New Calculation: PY 2013 Example Example: EP attestation date 12/1/13 Now has the option to choose a 6-month period from 2012 ORa 6-month period from 11/30/ /30/2013 4/26/2013 VT Medicaid EHRIP Webinar 18

19 Overview of EHRIP Changes Meaningful Use Stage 1 Changes Changes to measures and objectives for certain Meaningful Use Stage 1 (MU1) reporting requirements Changes to MU Core Measures #1, #4 and #8 include optional exclusions and alternate measures. MU Core Measures #10 reporting ambulatory clinical quality measures and #14 exchanging key clinical information are removed as separate reporting requirements. These changes are optionalin PY2013, but will become mandatory for PY2014. Providers attesting for PY2013 will see these options presented on the MAPIR screens for Core Measures #1, #4 and #8. 4/26/2013 VT Medicaid EHRIP Webinar 19

21 MAPIR 5.0 The MAPIR Collaborative Medical Assistance Provider Incentive Repository application A group of 13 states with Hewlett-Packard as their common Medicaid Information technology partner Arkansas Connecticut Delaware Florida Georgia Indiana Kansas Massachusetts Oregon Pennsylvania Rhode Island Vermont Wisconsin 4/26/2013 VT Medicaid EHRIP Webinar 21

22 MAPIR 5.0 Attesting for Program Year 2013 Current screenshot for version a WARNING! DO NOT PROCEED with a Program Year 2013 EHRIP attestation in MAPIR before reading the information here. 4/26/2013 VT Medicaid EHRIP Webinar 22

24 Resources for EHRIP Applicants Information, Guidance, Answers The MAPIR User Guides for EPs and EHs The Vermont Medicaid EHRIP Website Vermont Information Technology Leaders (VITL) REC Services MyVITL Helpdesk CMS EHRIP Website 4/26/2013 VT Medicaid EHRIP Webinar 24

25 Resources MAPIR User Guide 4/26/2013 VT Medicaid EHRIP Webinar 25

26 Resources MAPIR User Guide Introduction Page 1 IMPORTANT: If an Eligible Professional s Vermont Medicaid enrollment lapses at any time after an application is started and BEFORE A PAYMENT IS RECEIVED, the application will automatically ABORT from the MAPIR system. All saved data for the application will be eliminated. The attestation must then be restarted from the beginning in MAPIR after the EP becomes fully re-enrolled in Vermont Medicaid. 4/26/2013 VT Medicaid EHRIP Webinar 26

27 Resources MAPIR User Guide Introduction Page 3 TO INSURE YOU ARE PREPARED FOR A POTENTIAL AUDIT, SAVE ANY ELECTRONIC OR PAPER DOCUMENTATION THAT SUPPORTS YOUR ATTESTATION. 4/26/2013 VT Medicaid EHRIP Webinar 27

28 Resources MAPIR User Guide Patient Volume Page 26 PLEASE NOTE: If there are multiple lines for multiple locations, EACH LINE must have either a Yes or No answer in the column Utilizing Certified EHR Technology (Must Select One). At least one practice location where you are utilizing certified EHR technology must be selected as a location for which you will provide patient volume information. 4/26/2013 VT Medicaid EHRIP Webinar 28

29 Resources MAPIR User Guide Patient Volumes - Group PLEASE NOTE UPDATED DOCUMENTATION REQUIREMENTS FOR ALL GROUP ATTESTATIONS 4/26/2013 VT Medicaid EHRIP Webinar 29

30 Resources MAPIR User Guide Patient Volumes - Group Group Attestation Documentation For each provider attesting as part of a group, please document the following and upload the information in a PDF file as part of each provider s attestation: Applicant s name and individual NPI The set of Group Practice IDs (billing NPIs) used to define the group A complete list of all individual provider names and individual NPIs for all attending or rendering providers associated with the group, regardless of whether they are Eligible Professionals attesting for an incentive payment. 4/26/2013 VT Medicaid EHRIP Webinar 30

31 Resources MAPIR User Guide A/I/U Documentation Please note that for each provider attesting to Adoption, Implementationor Upgrade, you must upload a copy of an invoice, contract, purchase order, license agreement or similar document related to your EHR system. Upload instructions are on page 214 in the Submitsection of the attestation instructions. 4/26/2013 VT Medicaid EHRIP Webinar 31

32 Resources MAPIR User Guide Page 77 Core Measure 1 Choose if you would like to attest to the Original Core Measure 1or the Optional Core Measure 1. (Measure Code EPCMU01) Old measure: CPOE is based on the number of unique patients with a medication in their medication list that was entered using CPOE. New optional measure: CPOE is based on the total number of medication orders created during the EHR reporting period. 4/26/2013 VT Medicaid EHRIP Webinar 32

33 Resources MAPIR User Guide Page 85 Core Measure 4 New exclusion added. (Measure Code EPCMU04) New additional exclusion: EPs can exclude from this measure if the EP does not have a pharmacy within their organization, and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. 4/26/2013 VT Medicaid EHRIP Webinar 33

34 Resources MAPIR User Guide Page 90 Core Measure 8 Choose if you would like to attest to the Original Core Measure 8or the Optional Core Measure 8. (Measure Code EPCMU08) Old measure: Vital signs must be recorded for more than 50 percent of all unique patients ages 2 and over. New optional measure: An EP who sees no patients age 2 or older, or an EP who believes that all three vital signs (height, weight, blood pressure) are not relevant to their scope of practice. 4/26/2013 VT Medicaid EHRIP Webinar 34

35 Resources MAPIR User Guide File Upload Page 211 Supporting documentation is requiredto be uploaded with your attestation 4/26/2013 VT Medicaid EHRIP Webinar 35

36 Resources MAPIR User Guide Post Submission Page 228 IMPORTANT: If an Eligible Supporting Professional s documentation Vermont Medicaid is requiredto be uploaded with your attestation enrollment lapses at any time after an application is started and BEFORE A PAYMENT IS RECEIVED, the application will automatically ABORT from the MAPIR system. All saved data for the application will be eliminated. The attestation must then be restarted from the beginning in MAPIR after the EP becomes fully re-enrolled in Vermont Medicaid. 4/26/2013 VT Medicaid EHRIP Webinar 36

37 Program Updates Resources VT Medicaid EHRIP Website Current Announcements Participation Timelines How to Apply Help Topics 4/26/2013 VT Medicaid EHRIP Webinar 37

38 Resources VT Medicaid EHRIP Website Common issues encountered when accessing MAPIR, and suggested steps to resolve them 4/26/2013 VT Medicaid EHRIP Webinar 38

39 Resources VITL REC Services 4/26/2013 VT Medicaid EHRIP Webinar 39

40 Resources VITL Helpdesk MyVITL.net 4/26/2013 VT Medicaid EHRIP Webinar 40

41 Resources CMS EHRIP Website CMS Frequently Asked Questions 4/26/2013 VT Medicaid EHRIP Webinar 41

42 Resources CMS EHRIP Website CMS Guidance for EHR Incentive Program audits Providers who receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program potentially may be subject to an audit. Retain ALL relevant supporting documentation used in the completion of your attestation, including documentation to support data for meaningful use objectives and clinical quality measures (CQMs), for six years post-attestation. Retain documentation that is in either paper or electronic format to include screenshots. Download and/or print a copy your MU report at the time of attestation for your records. 4/26/2013 VT Medicaid EHRIP Webinar 42

43 Q & A Vermont Medicaid EHRIP status Program Team Members and Activities Overview of EHRIP changes Medicaid Encounter Definition Patient Volume Threshold Reporting Period Practicing Predominantly MU1 Measures MAPIR 5.0 Attestation begins May 1st, 2013 for EHRIP PY2013 changes Resources for EHRIP applicants MAPIR User Guide VT EHRIP website VITL REC Services MyVITL Helpdesk CMS EHRIP Website 4/26/2013 VT Medicaid EHRIP Webinar 43

44 Q & A Q: How do I switch between Medicaid and Medicare EHR Incentive Programs; What constitutes a switch? Aprovider can only switch once after receiving a payment. Once the switch occurs, the provider is in the Program to which he or she switched for the remainder of program participation. The switch will only count once the attestation is successfully completed. If the provider started in Medicaid and switched to Medicare, it will only be considered switched with approved attestation and payment. A provider is allowed to switch back if no attestation is completed. If the provider tries to attest and is unsuccessful, the provider may switch back. It is the successful attestation that triggers the switch, because that is when the payment process starts. The National Level Registry (NLR) is not currentlycoded to allow this. If a provider is paid by one Program and switches registration to the other Program, then the provider cannot switch back. CMS is working to enhance the system to allow a switch back until a successful attestation is completed. Until that system enhancement comes online, the provider would have to contact the NLR help desk to have it switched manually. CMS is working on a FAQ that will be added to their website and FAQ documentation. 4/26/2013 VT Medicaid EHRIP Webinar 44