Virginia Medicaid EHR Incentive Program Overview

Transcription

1 Virginia Medicaid EHR Incentive Program Overview Virginia HIT Regional Extension Center Pamela Delo, BSN, RN, CPHIMS Program Operations Manager Anna Adam Outreach Manager

2 About Virginia HIT (VHIT) Regional Extension Center Part of a national network of select non-profit organizations designated by DHHS to assist providers with adopting certified EHRs, achieving meaningful use, and receiving EHR incentive payments Maintains strong connections and healthy relationships with the Virginia healthcare provider community Provides direct, rapid and reliable access to key information on health IT and EHR meaningful use Has already helped approximately 600 eligible providers reach meaningful use and receive EHR incentives 2

3 Meaningful Use Goals Meaningful Use has five health-related goals: 3

4 Free Services from VHIT Under our contract with DMAS, we offer FREE services to eligible Medicaid providers to help them adopt/implement/upgrade (A/I/U) certified EHR technology, achieve meaningful use, and receive Virginia Medicaid EHR incentive payments. 4

5 Medicaid Incentive Payouts 5

6 Eligibility Requirements Who is an Eligible Professional (EP) under the Virginia Medicaid EHR Incentive Program? Under the Virginia Medicaid EHR Incentive Program, EPs include: Physicians (primarily doctors of medicine and doctors of osteopathy) Nurse practitioners Certified nurse-midwives Dentists Optometrists Physician assistants who furnish services in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a physician assistant 6

7 Patient Volume Requirements 7

8 Definition of Medicaid Patient Encounter CFR defines a Medicaid patient encounter: (1) For purposes of calculating EP patient volume, a Medicaid encounter means services rendered to an individual on any one day where (i) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service; or (ii) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid all or part of the individual s premiums, co-payments, and cost-sharing. 8

9 Eligibility Formula Individual EP selects a 90-day period in the prior calendar year in which he/she meets the 30% encounter threshold (starting at 20% for pediatricians) Medicaid patient encounters X 100 Total patient encounters 90-day period must begin on the first day of a month Data must be from an auditable data source FAMIS encounters cannot be included 9

10 Eligibility Formula Group Select a 90-day period from the prior calendar year in which the group meets the 30% encounter threshold Group Medicaid patient encounters X 100 Total group patient encounters The 90-day period must begin on the first day of a month Data must be from an auditable data source and will need to show the percentage each EP contributes to the threshold 10

11 Group Eligibility Details All EPs in the group practice/clinic must use the same eligibility method. No EPs in the group can qualify as individuals while others join the group. All Medicaid encounters provided by anyone in the practice and billed from the practice, including those where a non-ep provided the service For example, an RN giving allergy shots or immunizations, diabetic teaching, etc., can be included Hospital-based encounters such as EP consults or visits to patients hospitalized for surgery can also be included. Services billed through the hospital are not included. 11

12 Eligibility Formula Needy Patient Section 1903(t)(3)(F) of the Social Security Act defines needy individuals as individuals meeting any of the following three criteria: (1) They are receiving medical assistance from Medicaid or the Children s Health Insurance Program* (CHIP); (2) they are furnished uncompensated care by the provider; (3) they are furnished services at either no cost or reduced cost based on a sliding scale determined by the individual s ability to pay. * In Virginia, this is FAMIS. 12

13 Needy Patient Details Applies only to EPs practicing in FQHCs and RHCs Patient encounter volume includes: Medicaid encounters FAMIS encounters Client services provided as uncompensated care; client services provided at either no cost or reduced cost based on a sliding scale determined by the individual s ability to pay. If you use uncompensated care instead of charity care, you must subtract bad debt 13

14 EHR Incentive Registration and Enrollment Process 1. EPs register as individuals at the CMS site, as the Virginia Medicaid EHR Incentive Enrollment System does not allow proxy registration and will require EPs to attest that they are enrolling only for themselves. EPs designate their payee at the CMS site, and that data is sent to Virginia. Any change to the payee must be made at the CMS site. 2. Within 48 hours, EPs will receive an with instructions for enrolling in the Virginia Medicaid EHR Incentive System to attest for A/I/U. 14

15 Limited Enrollment Process After registering at the CMS site, EPs will be notified by with instructions if they need to complete the limited enrollment process to be entered in the DMAS payment system. This must be completed before they can complete attestation for EHR incentives. EPs should contact the enrollment help line approximately 2 weeks after submitting the form to verify their limited enrollment is complete. 15

16 A/I/U Documents During the enrollment process, providers will be prompted to upload documents demonstrating they meet patient encounter volume. EPs will also upload documentation to show they have acquired certified EHR technology. Examples of acceptable documents include: 1. Purchase Order 2. Contract 3. Receipts 4. EHR Software License 5. Maintenance agreements 6. Upgrade documentation 7. Data exchange agreement 16

17 Receiving Your Incentive Payments Within 2 to 4 weeks after successful attestation to AIU, you should receive your incentive payment. Call the enrollment help line to check the status of your payment. DMAS has already issued 3.5 million in EHR incentive payments for EPs and eligible hospitals. 17

18 REC Resources Website Overview of VHIT A/I/U and meaningful use services for Medicaid EPs Links to free resources to support EHR selection, eligibility calculators and registration and enrollment information for Virginia Medicaid EHR incentives E-newsletter and EHR Learning Network webinar archive, EHR success stories 18

19 Learn More To log in to the Virginia Medicaid EHR Incentive Enrollment System Virginia Medicaid EHR Incentive Enrollment System Help Line For VHIT assistance with adopting an EHR system and achieving meaningful use, please contact: