Working Together With MassHealth. Presented by Tarsha Weaver MeHI Medicaid Operations Director September 26, 2011

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1 Working Together With MassHealth Presented by Tarsha Weaver MeHI Medicaid Operations Director September 26, 2011

2 Presentation Outline MeHI Medicaid EHR Incentive Operations Overview Key Functions that MeHI will be Administering High Level Overview of the Registration & Attestation Process High Level Overview of the Special Enrollment Process 2

3 MeHI Medicaid Operations Overview Staff: Hiring and training 15 FTEs & 3 Temps Address: MeHI Medicaid EHR Incentive Operations Department 100 North Drive Westborough, MA Call Center Telephone Number effective October 3, 2011: MASSEHR Hours of Operations: 8:30 am 5:00 pm Expanded Hours for Outreach Activities Inquiry Address & to Request a Workshop, Site Visit, or MAPIR Workbook: MassEHR@masstech.org 3

4 Key Functions that MeHI will be Administering Program Planning and Administration; Provider Outreach and Education; Provider Enrollment and Eligibility Verification; Provider Attestation and Pre-Payment Verification; Provider Verification and Payment Authorization; Provider Reconsideration; Program Reporting and Analysis. 4

5 Massachusetts Medicaid EHR Incentive Payment Program High Level Registration and Attestation Overview 5

6 Medicaid EHR Incentive Payment Program Registration Introduction Three systems working together to support the Medicaid EHR Incentive Payment Program. CMS Registration & Attestation System (CMS R& A) Medical Assistance Provider Incentive Repository (MAPIR ) Medicaid Management Information System/Provider Online Service Center (MMIS/POSC) 6

7 CMS R&A for EPs In order to participate in the Massachusetts Medicaid EHR Incentive Payment Program, all Eligible Professionals (EPs) must register with CMS Registration & Attestation System and select Massachusetts to initiate their EHR incentive payment application. Once the EP has submitted their CMS Registration, CMS will send the information to MMIS by way of MAPIR, which is the incentive payment program application system. 7

8 MassHealth Provider Online Service Center 8

9 MAPIR Homepage 9

10 MAPIR Welcome Page 10

11 Special Enrollment Process EPs that have completed their CMS registration but are not recognized as a provider in MassHealth s MMIS/POSC system will be required to complete a special enrollment process for the purpose of participating in the Massachusetts Medicaid EHR Incentive Payment Program. MeHI Medicaid Provider Enrollment & Verification Analysts will contact all EPs that need to complete the special enrollment process to participate. EPs or their designees will receive an with instructions and an attached PDF file, which includes the following: Cover letter W9 directions & forms (if EP is requesting payment directly) Data Collection Form Request for copy of license and/or license # Electronic Funds Transfer EHR Provider Agreement 11

12 Special Enrollment Process In order to expedite the special enrollment process, EPs will be requested to complete and return all required forms with 7 business days. All special enrollment forms will be reviewed and processed within 14 business days. Upon successful completion, the EP will receive a Welcome to MAPIR notification with instructions to log into MMIS/POSC to complete their attestation. 12

13 Key Reminders for EPs Practicing in a FQHC/RHC Practices Predominantly & Needy Individuals: Practices predominantly is defined for an EP when the FQHC/RHC is the clinical location for over 50% of their total encounters over a period of six months in the most recent calendar year. Needy individuals include: Medicaid, CHIP (includes: individual premiums, co-pays, or cost sharing); Patient furnished uncompensated care by the eligible professional; or Furnished services at either no cost or a sliding scale. Note: Please reference the Medicaid 1115 Waiver Guide. 13

14 Definition of Patient Encounter For the purpose of participating in the Massachusetts Medicaid EHR Incentive Payment Program, the definition of a patient encounter is: a service, per day, per patient, where: Medicaid or CHIP or a Medicaid 1115 waiver project paid for all or part the service; Medicaid or CHIP or a Medicaid 1115 waiver project paid for all or part of the individual s premiums, co-payments or cost sharing; or The services were furnished as no cost; or The services were paid for at a reduced cost based on a sliding scale determined by the individual s ability to pay 14

15 Key Reminders for EPs not affiliated with an FQHCs/RHC EP qualifications to participate in the Medicaid EHR Incentive Payment Program: The provider is: A Medicaid Eligible Professional; Is not hospital based; Registers with the CMS R & A and selects Medicaid & Massachusetts; Attest to a minimum of 30% of Medicaid patient encounters for a selected continuous 90 day period in the previous calendar year. Exception: Pediatricians minimum Medicaid patient threshold is 20%. 15

16 Scenario A: Group Reporting Eligibility Example: Patient Volume The following EPs practice at Roxbury Central Health Center, which is an FQHC: Physician 1: has 40% Medicaid/Needy Individual Encounters (80/200) Physician 2: has 50% Medicaid/Needy Individual Encounters (50/100) Nurse Practitioner: has 10% Medicaid/Needy Individual Encounters (30/300) Pharmacist: has 75% Medicaid/Needy Individual Encounters (150/200) In total, there are 800 encounters within the 90 day selected reporting period (previous CY); 310 are Medicaid/Needy Individual Encounters. Roxbury Central Health Center s Medicaid/Needy Individual Encounters would be as follows: 310/800 =.3875 x 100 = 38.75% Based upon this scenario 3 of the 4 would be eligible to participate in the Medicaid Incentive Program. The Pharmacist is not considered EP but their volume must be included to report at the group level. 16

17 Scenario B: Multiple Practice Locations Eligibility Example: Patient Volume Dr. Green, Internal Medicine provider, practices at 2 locations; Roxbury Central Health Center and Central West Medical Associates. Both are using a federally certified EHR system. At Roxbury Central Health Center, Dr. Green has 500 total patient encounters for the 90 day selected reporting period (prior CY), 95 of his patient encounters are Medicaid/Needy Individual. 95/500 =.19 x 100 = 19% (not eligible) At Central West Medical Associates, Dr Green has 95 total patient encounters for the 90 day selected reporting period (prior CY), 35 of his patient encounters are Medicaid/Needy Individual. 35/95 =.368 x 100 = 36.8% (eligible) 17

18 Reference Material The following reference material will be available within the next few weeks: Fact Sheets; MAPIR User Guides; Medicaid 1115 Waiver Project Grid; Registration Checklist. The MassHealth and MeHI website will be updated with reference material and other helpful resources within the upcoming weeks. 18

19 Massachusetts Medicaid EHR Incentive Payment Program will commence a soft launch on October 3, 2011 For More Information Please Contact Us: MassEHR MassEHR@masstech.org 19