Medicaid EHR Incentive Program Eligible Hospitals. New Hampshire Department of Health and Human Services Office of Medicaid Business and Policy

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1 Medicaid EHR Incentive Program Eligible Hospitals New Hampshire Department of Health and Human Services Office of Medicaid Business and Policy

2 NH Medicaid EHR Team Andrew Chalsma (Chief, Office of Medicaid Business and Policy, New Hampshire Department of Health and Human Services) Eve Fralick (Project Director, UNH Institute for Health Policy and Practice) Kristen Lynch (Program Administrator, UNH Institute for Health Policy and Practice) 2

3 Training Overview Medicaid EHR Incentive Program Resources Eligible Hospital (EH) Types Eligibility Requirements Supporting Documentation Payment Schedule Registration and Attestation Information 3

4 Medicaid EHR Website New Hampshire Medicaid EHR Incentive Program: This training presentation EH Eligibility Worksheet (Excel) EH Payment Worksheet (Excel) EH List of Supporting Documentation EH Process Diagram EH Reference Guide Registration tips Link to epip, the NH registration and attestation system (will be enabled when the program opens) Medicaid EHR Incentive Program contact information 4

5 EH Payment Worksheet Medicare Cost Report Reference Payment Data Component Scroll cursor over data entry box to get helpful information and tips 15

6 Medicaid EHR Resources New Hampshire Medicaid EHR staff: send to CMS website: Office of National Coordinator Certified Health IT Product List: chpl.force.com/ehrcert 6

7 Eligible Hospital Types EH Type Hospital Criteria Patient Volume General Acute Care Hospitals (including critical access hospitals) Average Length of Stay 25 days or less CMS Certification Number or Medicaid Patient Encounters: 10% A multi site hospital with one CMS Certification Number is considered one hospital for purposes of calculating the Medicaid EHR Incentive Program payment 7

8 Medicaid Patient Volume Payment Year 1 Reporting Period Any continuous 90 days during the prior hospital fiscal year Exact start and end dates needed for registration Inpatient Hospital Discharges and Emergency Department Discharges included in both numerator and denominator Patient Volume Calculation Total Number of Medicaid Patient Encounters Total Patient Encounters X 100 8

9 Medicaid Patient Encounter All unique inpatient hospital discharges and unique emergency department discharges (from the denominator) provided to an individual in a day by a specific provider in which: Medicaid (including the program formerly known as Healthy Kids Gold and out ofstate Medicaid and Medicaid managed care programs) paid for part or all of the services (including premiums, co payments, and/or cost sharing) An auditable report that documents encounter data is required. Retrieve this from your billing system OR EHR system (with non billable visits excluded). 9

10 Reporting Encounters If you use your billing system to generate an auditable encounters report: It should at the CLAIM level, not the DETAIL level EXAMPLE A patient with a lacerated finger visits the Emergency Department. The doctor does an examination; sutures the finger; administers a tetanus shot; and discharges the patient. This scenario would result in one encounter. 10

11 Medicaid Patient Volume Example Hospital A has 100 Medicaid inpatient hospital discharges and 200 Medicaid emergency department discharges out of 1,870 total inpatient and emergency department discharges in a continuous 90 day period during the prior hospital fiscal year Patient Volume Calculation 300 Medicaid Patient Encounters 1,870 Total Patient Encounters X 100 = 16% With 16% patient volume, Hospital A meets the 10% patient volume threshold 11

12 Dually Eligible Hospitals (Medicare and Medicaid) A hospital that is a meaningful EHR user under the Medicare EHR Incentive Program is deemed to be a meaningful user for the Medicaid EHR Incentive Program CMS will audit dually eligible hospitals for compliance with meaningful use requirements under the Medicare program New Hampshire Medicaid will audit other requirements for receiving a Medicaid EHR incentive payment Patient Volume EHR certification Payment components 12

13 EH Reporting Periods CMS FAQ 3575: Hospital Participating In: Payment Year Medicaid Incentive Program Only Medicaid 1 st, then Medicare in same FY Medicaid 1 st, then Medicare in later FY Medicare and Medicaid Simultaneously / Medicare 1 st, then Medicaid in a later FY 1 st payment year AIU AIU (Medicaid); MU, 90 day reporting period (Medicare) AIU MU, 90 day reporting period 2 nd payment year MU, 90 day reporting period MU, 12 month reporting period MU, 90 day reporting period MU, 12 month reporting period 3 rd payment year MU, 12 month reporting period MU, 12 month reporting period MU, 12 month reporting period MU, 12 month reporting period 13

14 Registration and Attestation STEP 1 Complete the EH Eligibility Worksheet and the EH Incentive Payment Worksheet. They are located on the Medicaid EHR Incentive Program website ( These will really help you with the registration and attestation process. 14

15 Worksheet Instructions Tab Start with the Instructions Tab in each Worksheet 15

16 EH Eligibility Worksheet then complete the Eligibility Worksheet in Tab A 16

17 EH Payment Worksheet and Tab A on the Payment Worksheet 17

18 Registration and Attestation After the NH system launches (expected on October 1), register with CMS ( Wait 24 to 48 hours for CMS to transmit data to NH Then navigate to the NH Medicaid EHR website ( Click on the Register and Attest in NH link in the menu box on the right This takes you to the Register and Attest in NH webpage Click on the epip (Electronic Provider Incentive Payment System) logo to navigate to the NH registration and attestation system 18

19 Registration and Attestation epip does NOT save partially completed registration or attestation data. You will need to have all of your data ready to submit when you log on. However, you can upload supporting documentation at a later time. 19

20 EH Payment Process NH Register and attest on epip epipusername = NH Medicaid Provider ID. (If you have re enrolled in the new system, use your OLD ID, not your new.) Check epip for status Payment NH Medicaid EHR staff have 5 months to verify provider attestations CMS approves payment NH has 45 days to process payment 20

21 EH Registration Information National Provider Identifier (NPI) CMS Identity and Access Management (I&A) Username and Password (same as PECOS) CMS Certification Number (CCN) Tax Identification Number (TIN) Users working on behalf of an EH need an Identity and Access Management System (I&A) web user account (User ID/Password) associated with the organization s NPI CMS Registration ID EHR Certification Number NH Medicaid Provider Number 21

22 epip Supporting Documentation To facilitate timely payments, please ensure that: Documents are uploaded into the state system (epip Electronic Provider Incentive Payment System) with file names that reflect their content (for ease in identifying them) Example: Medicare_Cost_Report_Total_Discharges_Reed_Hospital Reports include data exactly as is requested so Medicaid EHR Incentive Program eligibility criteria can easily be verified Files should be pdf and no larger than 2 MB There are no restrictions on the number that can be uploaded 22

23 AIU Documentation (Dually Eligible Hospitals) Year 1: Adopt, Implement, Upgrade Certified EHR EHR system must be listed on Office of the National Coordinator Certified Health IT Product List ( EHR Certification ID required to attest Years 1, 2, and 3: Meaningful Use (MU) Submission Receipt from the CMS registration website as proof that the hospital successfully attested for the Medicare EHR Incentive Program 23

24 AIU Documentation (Medicaid Only Hospitals) Year 1: Adopt, Implement, Upgrade (AIU) of certified EHR EHR system must be listed on Office of the National Coordinator Certified Health IT Product List ( chpl.force.com/ehrcert) EHR Certification ID required to attest Proof of AIU (retain for three years following first payment year): Signed vendor contract; or Paid invoice; or Signed purchase order; or Document showing legal contractual obligation Proof of payment such as: Bank invoice; or Credit card slip that matches the invoice Contracts must be fully executed with signatures from both parties (the EP/Practice and vendor) and clearly indicate that it represents an EHR system 24

25 Meaningful Use Documentation (Medicaid only Hospitals) Years 2 and 3: Meaningful Use (MU) Available on epip in 2013 Clinical and other quality measures 90 day MU reporting period in payment year 2; full year for payment year 3 More information will be provided in the future 25

26 Medicare Cost Report Documentation Four years of Medicare Cost Report (MCR) data needed Most current filed hospital fiscal year report (base year) Previous three hospital fiscal year reports Upload copies of applicable pages that support attestation data onto epip Specific MCR references are included in the EH Eligibility Worksheet and EH Payment Worksheet Example: Medicaid Inpatient Bed Days is taken from CMS , Worksheet S 3, Part 1, Column 7, Add lines 1 2 and 8 12 (for Line 2, only include Medicaid HMO days) 26

27 Other Supporting Documentation NH Medicaid may request other documentation on an as needed basis to verify patient volume encounters, payment data, etc. 27

28 EH Payment Schedule NH Medicaid EHR incentive payments will be paid over three years Year 1: 50% Year 2: 40% Year 3: 10% Complete the EH Payment Worksheet (on the New Hampshire Medicaid EHR website) to determine your estimated incentive payment amount Use the same data to attest in epip 28

29 Program Acronyms AIU: Adopt, Implement, Upgrade CMS: Centers for Medicare and Medicaid Services EHR: Electronic Health Record EH: Eligible Hospital epip: Electronic Provider Incentive Payment System MU: Meaningful Use ONC: Office of National Coordinator 29

30 Questions? New Hampshire Medicaid EHR Incentive Program Website: NH Medicaid EHR staff: send to CMS website: 30