NY Medicaid EHR Incentive Program. Eligible Professionals Program Eligibility and AIU Webinar

Transcription

1 Eligible Professionals Program Eligibility and AIU Webinar May 2015

2 2 Program Eligibility and AIU Overview of EHR Eligibility and Medicaid Patient Volume Adopt / Implement / Upgrade (AIU) MEIPASS Walkthrough Closing Comments

3 3 EHR Background Original Legislation The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH Act Established: Medicaid EHR Medicare EHR Office of the National Coordinator for Health Information Technology (ONC) Certified EHR Technology Goals of the HITECH Act: Improve patient quality of care Promote the adoption and meaningful use of health information technology Increase health information exchange Standardize health information technology

4 4 Medicaid EHR Provides incentive payments to: Eligible Professionals Eligible Hospitals as these providers: Adopt, Implement, or Upgrade and subsequently, demonstrate Meaningful Use of ONC certified EHR technology.

6 6 Eligible Professional Types Physicians (M.D. or D.O. ) Nurse practitioners Certified nurse-midwives Dentists Physician assistants, who practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a physician assistant

7 7 What are the patient volume criteria? Eligible Professionals must meet one of the following conditions throughout all participation years: Demonstrate a minimum 30% Medicaid patient volume, or Be a pediatrician* and demonstrate a minimum 20% Medicaid patient volume, or Practice predominantly in a Federally Qualified Health Center or Rural Health Center and demonstrate a minimum 30% patient volume attributable to needy individuals *Pediatricians have the reduced option of demonstrating 20-30% Medicaid patient volume but will only receive 2/3 the incentive payment when their percentage is below 30%. For the purposes of the Medicaid EHR, NY defines a pediatrician as an M.D. or D.O. who satisfies at least one of the following: 1. Has a current board certification in pediatrics or a pediatric subspecialty from the American Board of Pediatrics (ABP) or the American Osteopathic Board of Pediatrics (AOBP) 2. Focuses on treating patients 18 years old and younger, and attests that the majority of care (at least 50% of encounters) were for patients 18 years old or younger

8 8 Patient Volume Methodology Patient volume is calculated over a 90-day period (of the provider s choice) from the prior calendar year or preceding 12 month period from the date of attestation New York will allow providers to select either of two methods of calculating patient volume: 1. Standard patient volume: number of Medicaid encounters divided by number of total patient encounters 2. Alternate method: accounts for managed care patient panel as well as encounters with patients not on managed care panel Group practices and clinics may use their aggregate patient volume (standard or alternate method) as a proxy for all individual providers Providers at FQHCs/RHCs may substitute needy patient encounters in any method (standard/alternate and individual/aggregate)

9 9 Needy Patient Volume Requirements To qualify eligible professionals must: Practice predominantly in a FQHC or RHC Have a minimum 30% patient volume attributable to needy individuals Needy Individual must meet one of the following conditions: 1. Receives medical assistance from Medicaid or Children's Health Insurance Program(CHIP) 2. Furnished uncompensated care by the provider 3. Furnished services at either no cost or reduced cost based on a sliding scale determined by the individual's ability to pay Practice predominantly definition: Clinical location for more than 50% of the eligible professional s total patient encounters over a period of six months is an FQHC or RHC in the prior calendar year or preceding 12 month period from the date of attestation

10 10 Medicaid / Needy Encounter Type of Service Medicaid Encounter Needy Encounter Medicaid Fee-for-Service Medicaid Managed Care Family Health Plus Child Health Plus Uncompensated Care Sliding Scale

11 11 Aggregate Patient Volume Group practices and clinics with more than one eligible provider will be allowed to use the aggregate Medicaid and overall patient volume for the entire practice/clinic as a proxy for each provider's individual patient volume. Requirements and Restrictions Applies to all providers who render service in the practice or clinic, regardless of how much of their overall practice is within the practice or clinic. Each provider will be required to attest that use of the aggregate value is appropriate for that provider. Aggregate values must represent the entire practice's patient volume and not limit it in any way (including not limiting it to only patients seen by eligible professionals).

12 12 Group Provider Definition Group Provider The group/organizational National Provider Identifier (NPI) that the eligible professional has a contractual arrangement allowing the employer or entity to bill and receive payment for the EP's covered professional services. Group NPI / Aggregate Patient Volume Requirements The aggregate patient volume must be representative of the group NPI. Providers within that group must all use the same aggregate patient volume methodology. If a providers works under multiple group NPI s, it as the discretion of the provider and clinic to choose which group NPI to report aggregate patient volume from. Organizational NPI is required in MEIPASS when a provider is choosing to use the aggregate patient volume.

13 13 Attestation Reporting Periods Hospital-Based Status Eligible professionals must render less than 90% of covered Medicaid services in the inpatient and emergency department (ED) settings Measured per individual EP over the entire prior calendar year Practice predominantly in an FQHC or RHC In order to use the needy patient volume, more than 50% of the EP s total patient encounters must have taken place in an FQHC or RHC Measured per individual provider over a six-month period in the prior calendar year or preceding 12 month period from the date of attestation Medicaid Patient Volume All EPs must meet minimum patient volume requirements (30% Medicaid for most EPs, 20% Medicaid for pediatricians, 30% needy for EPs at FQHCs/RHCs) Measured per individual provider or using group/clinic aggregate values over a 90-day period in the prior calendar year or preceding 12 month period from the date of attestation

14 14 Support Services Support offers services to assist providers with calculation of their Medicaid patient volume: Numerator Requests Providers may request a summary of their Medicaid claims. Please be advised that this report may only be used as guidance for calculation purposes and that it does not suffice supporting documentation requirements for audit. Pre-Validation Individual EPs and group providers may utilize the pre-validation services if they already know the following information that they intend to submit with their attestation: 90-day reporting period for Medicaid Patient Volume Medicaid encounter data Total patient encounter data Pre-validation prior to submitting the complete attestation may subsequently reduce the time of state review. For more information about these services, please contact hit@health.ny.gov.

16 16 What is Adopt / Implement / Upgrade (AIU)? Adopt: Acquire, purchase, or secure access to certified EHR technology Requires either installation of the certified EHR technology, OR a financial commitment to purchasing or using the EHR Does NOT require that the technology be in use in the clinical setting Implement: Install or commence utilization of certified EHR technology Qualifying activities include integration, training, and data transfer Upgrade: Expanding functionality of existing certified EHR, or moving from non-certified to certified version Requires installation OR a financial commitment to purchase or use the certified version Important: The attestation and supporting documentation must accurately reflect the AIU activity performed by the provider during the payment year.

17 ONC Certified EHR Technology Standards, implementation specifications, and certification criteria for EHR technology have been adopted by the Secretary of Health and Human Services EHR technology is tested and certified by ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) ONC-ATCBs certify EHR technology for one or more meaningful use criteria To be eligible for the EHR s, providers must have a complete EHR system certified to 2014 ONC standards To find a list of certified EHR systems and modules, consult the ONC Certified HIT Product List (CHPL):

18 18 AIU Attestation and Preparing to Attest Attest: To authenticate officially In the first year of program participation, providers may legally attest that they have successfully adopted, implemented or upgraded (A/I/U) 2014 ONC Certified EHR Technology during the chosen payment year. Attestation begins in MEIPASS but requires a physical signature to complete the process. Providers must print, sign, and return (by mail) an attestation form before payment may be issued

19 19 AIU Attestation and Preparing to Attest Eligible Professionals must: Be one of the eligible practitioner types Be actively enrolled in NY Medicaid as a fee-for-service provider in good standing Meet minimum patient volume criteria (Medicaid/needy) Adopt, implement or upgrade to a 2014 ONC Certified EHR system in the first participation year Not be hospital-based (i.e., render less than 90% of covered Medicaid services in the inpatient and emergency department settings) Meet the meaningful use criteria and submit clinical quality measures as required in the second and subsequent participation years Register using the CMS Medicare & Medicaid EHR Registration and Attestation System Attest using the New York Medicaid EHR Administrative Support Service (MEIPASS)

20 20 MEIPASS Submitter Registration Providers must be enrolled in the Electronic Provider Assisted Claim Entry System (epaces) to access MEIPASS. If you are not enrolled in epaces, contact the emedny Call Center at 1 (800) for assistance. Prior to logging in to MEIPASS, all providers are required to specify the ETIN of the epaces account that will be used to log in to MEIPASS to perform their attestation. For assistance with MEIPASS Submitter Registration, contact the EHR Support Team at 1 (877) Opt.1, or refer to provider support materials available at

21 21 Preparing to Attest Where do I start? Recommendations: Review CMS webinar and user guide regarding registration at the national level EHR: Medicare, Medicaid EHR Webinar for Eligible Professionals EHR Medicaid EP Registration User Guide Review NYS webinars and user guides regarding attestation and meaningful use MEIPASS Resource Webpage o Eligible Professional Webinar Schedule o MEIPASS Walkthroughs o Frequently Asked Questions (FAQs)

22 22 Application Prerequisites Eligible Professionals must: Have an individual National Provider Identifier (NPI) Have a National Plan and Provider Enumeration System (NPPES) account associated with the individual NPI Be enrolled in epaces and have the original enrollment user ID and password Have a valid ETIN, or designate a third party submitter who has a valid ETIN to perform the attestation on the EP s behalf Have an ONC certified EHR Certification ID (EHR) Have a CMS Registration ID (RID) Other information needed: Taxpayer Identification Number (TIN): SSN or EIN Name / EP Type / Group Name (if EIN) / Address / Phone # /

24 24 Login

25 25 CMS Registration ID

26 26 Provider Information Review

27 27 Eligibility FQHC / RHC

28 28 Eligibility Information (1/4)

32 32 Submission

33 33 Attestation Document

35 35 Details and Deadlines 2016 is the last year that an eligible professional can begin participation in the. Providers must attest to the Medicaid patient volume to maintain eligibility in the. Numerator requests and Pre-Validation Services are available. Contact for more information. Providers must use 2014 Edition CEHRT. AIU activity must be within the payment year. Please verify that your contact information shown in MEIPASS is accurate. If it needs to be changed, please update your record in the CMS Registration and Attestation System.

36 36 Details and Deadlines Attestations must be submitted online via MEIPASS. Providers must print, sign, and return (by mail) the complete attestation before payment may be issued. After attesting in MEIPASS, please do not log back into the CMS Registration and Attestation System during the attestation review process or else your attestation will have to be resubmitted. Attestation deadline is 90 days after the given payment year, i.e. March 31. For payment year 2015, the attestation deadline for EPs is March 31, 2016.

37 37 Resources State Resources website MEIPASS emedny LISTSERV New York State Medicaid HIT Plan (NY-SMHP) Other Resources CMS Website for the Medicare and Medicaid EHR s ONC Home Page

38 CMS Help Desk phone: Program Registration, Meaningful Use, Medicare Program Support Teams phone: Option 1: epaces, ETIN, MEIPASS, Enrollment, General Questions Option 2: Calculation, Eligibility, Reviews, Rejections Option 3: Public Health Registrations, Status Updates, Guidance Version