Texas Medicaid EHR Incentive Program: Dentists

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1 Texas Medicaid EHR Incentive Program: Dentists Julia Alejandre / Medicaid HIT Team July 27, 2012

2 The Program in a Nutshell Incentives of up to $63,750 are available for the adoption and meaningful use of certified electronic health record (EHR) technology: AIU (Adopt, Implement, or Upgrade) in the first year of participation Meaningful Use (MU) in up to 5 subsequent participation years. Eligible Professionals (EPs) include dentists, along with 4 other provider types. First year payment can be received in 2011 through Final payment can be received up to 2021 for EPs. At least 50% of all encounters must be at a site or sites with certified EHR technology. 451 dentists have participated in program, as of June 26,

3 Certified EHR Technology Office of National Coordinator (ONC) publishes standards for software vendors. Vendors submit software for certification. Software receives an ONC certification number ( Vendor must recertify for each MU phase. 3

4 Patient Volume Threshold Payment Year by EP Type Medicaid Patient Volume * Incentive Amount Year 1 for most EPs 30% or higher $21,250 Years 2-6 for most EPs 30% or higher $8,500 Year 1 for pediatricians and pediatric dentists 20% to 30% $14,167 Years 2-6 for pediatricians and pediatric dentists 20% to 30% $5,667 Max. cumulative incentive over 6 years $63,750 $42,500 Pediatric dentists are eligible for the lower patient volume threshold of 20%. Pediatric dentists attesting to 20-30% Medicaid patient volume will be required to upload documentation that they are either board certified in pediatric dentistry, or they completed a pediatric dentistry residency. * If the EP practices predominantly in an FQHC or RHC, patient volume threshold is 30% Needy Individual volume (Medicaid, CHIP, uncompensated care, sliding scale). 4

5 Skipping Years in the Program Skipping years is permissible in the Medicaid incentive program. You may skip one or more years. Example: a provider enters the program in 2011 with AIU and then skip two years. S/he re-enters the program in 2014 with Stage 1 (other providers might be in Stage 2 at that point). Keep in mind that the program ends in 2021, so if you start in 2016 (the last year you can begin the program), you would need to participate in consecutive years if you want all 6 payments. Skipping is still allowed, but you wouldn t receive all 6 payments. 5

6 Reporting Periods There are two reporting periods that apply for the Medicaid EHR Incentive Program: For patient volume, an eligible professional (EP) should use any continuous, representative 90-day period in the prior calendar year. For demonstrating meaningful use, EPs should use the EHR reporting period associated with that payment year: o First payment year that an EP is demonstrating meaningful use, the reporting period is a continuous 90-day period within the calendar year. o In subsequent years, it is the full calendar year. 6

7 EPs: AIU and Stage 1 Requirements First year of program participation: Upload documentation that shows AIU (purchase order, contract, or subscription) Stage 1 Meaningful Use: 20 MU measures 15 from the core set and 5 of 10 from menu set. 6 Clinical Quality Measures (CQMs) 3 Core or Alternate Core plus 3 from list of clinical measures of the provider s choice. MU: Must include at least one Public Health measure: 1) Immunizations 2) Reportable Labs 3) Syndromic Surveillance 7

8 How to Register and Attest 1. Register at CMS: 2. Verify enrollment as a Texas Medicaid provider, with an active TPI. If you assign payment to yourself, your SSN must be listed in your TMHP profile. 3. Gather required information and documentation: EHR certification number. Group or individual attestation choice. Patient volume information (numerator and denominator). AIU documentation. 4. Log into the portal and attest. Go to and log in. Scroll down to Manage Provider Account and select Texas Medicaid EHR Incentive Program. For the full checklist of steps: Go to and select Providers; go to the Health IT page and select EHR Program Information from the list on the left; click on Getting Started with EHR Incentive Program 8

9 Important Notes on Attestation Attestations: All self-reported information (e.g., patient volume, provider types, etc.) are legally binding. Information entered into the portal should come from auditable sources in case you are selected for an audit. For each year of program participation, providers must maintain auditable records related to incentive program attestations for six years. Providers can file an appeal for any of the following reasons: Incentive payment amount. Provider eligibility determination. Support for adopt, implement, or upgrade to a certified EHR. Achievement of meaningful use requirements. 9

10 Additional Resources Learn about the Texas Medicaid EHR Incentive Program through a selfguided e-learning tool: Get technical assistance through the Regional Extension Centers at Review program information on the CMS website: Review additional Texas Medicaid EHR Incentive Program information at: ( Learn about a recent study on EHRs and healthcare outcomes: Sign up for updates at and enter your address. On the subscription topics page, go to the Projects section and select Health Information Technology. Submit questions by sending an to [email protected] or calling , option 4. 10