Post on 31-Dec-2015
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New Jersey Medicaid New Jersey Medicaid EHR Incentive ProgramEHR Incentive ProgramProfessionals OverviewProfessionals Overview
Presentation SummaryPresentation Summary
Medicaid EHR Incentive Program Medicaid EHR Incentive Program OverviewOverview
EligibilityEligibility Adopt, Implement, Upgrade, and Adopt, Implement, Upgrade, and
Meaningful Use DefinitionsMeaningful Use Definitions Payment Amounts and SchedulePayment Amounts and Schedule Registration and AttestationRegistration and Attestation Questions and AnswersQuestions and Answers
Program OverviewProgram Overview The Medicaid EHR Incentive Program will The Medicaid EHR Incentive Program will
provide incentive payments to eligible provide incentive payments to eligible professionals as they adopt, implement, or professionals as they adopt, implement, or upgrade certified EHR technology in their upgrade certified EHR technology in their first year of participation and demonstrate first year of participation and demonstrate meaningful use for five additional years.meaningful use for five additional years.
Program OverviewProgram Overview
Incentive payments to eligible professionals Incentive payments to eligible professionals will begin being distributed in January – will begin being distributed in January – February 2012.February 2012.
Eligible Professionals (EPs) can receive up to Eligible Professionals (EPs) can receive up to $63,750 over six years.$63,750 over six years.
EPs may participate in either the Medicaid or EPs may participate in either the Medicaid or Medicare Incentive Program, but not both.Medicare Incentive Program, but not both.
EPs can switch between the Medicaid and EPs can switch between the Medicaid and Medicare program once, and only once, Medicare program once, and only once, before 12/31/2015.before 12/31/2015.
Program Overview
Each individual EP must separately establish eligibility for their incentive payments
EPs can only receive one payment per calendar year
Eligibility: Provider TypesEligibility: Provider Types
Eligible Provider TypesEligible Provider Types Physicians (generally M.D.s or D.O.s)Physicians (generally M.D.s or D.O.s) PediatriciansPediatricians Dentists (D.D.S. or D.M.D)Dentists (D.D.S. or D.M.D) Certified Nurse MidwivesCertified Nurse Midwives Advanced Practicing NursesAdvanced Practicing Nurses
Hospital-based EPs Hospital-based EPs are not eligibleare not eligible for for incentive paymentsincentive payments 90% of the EP’s services provided in a hospital 90% of the EP’s services provided in a hospital
inpatient or emergency room setting.inpatient or emergency room setting.
Eligibility General Guidelines
Professionals must also meet patient volume and EHR technology requirements to be eligible for a Medicaid Incentive Payment
Eligibility: Patient VolumeEligibility: Patient Volume
To qualify for incentive payments, an To qualify for incentive payments, an EP must meet or exceed one of the EP must meet or exceed one of the following:following: 30% Medicaid (non-CHIP) patient volume 30% Medicaid (non-CHIP) patient volume 20% Medicaid (non-CHIP) patient volume 20% Medicaid (non-CHIP) patient volume
(pediatricians only)(pediatricians only) Practice predominantly in an FQHC and have Practice predominantly in an FQHC and have
30% of their patient volume attributable to 30% of their patient volume attributable to needy individualsneedy individuals
Eligibility: FQHC Providers
Practicing Predominantly 50% of patient encounters over a six month
period in the most recently completed calendar year occurred at an FQHC
Needy Individuals Medicaid and CHIP clients Patients furnished uncompensated care Patients furnished services at either no cost
or on a sliding scale.
Eligibility: Patient EncounterEligibility: Patient Encounter
For the purposes of the Medicaid EHR Incentive For the purposes of the Medicaid EHR Incentive Program, a patient encounter is defined as a Program, a patient encounter is defined as a unique patient, date-of-service, place-of-service unique patient, date-of-service, place-of-service combinationcombination
EPs may count encounters across any number EPs may count encounters across any number of practice locations but must use at least one of practice locations but must use at least one location that has an EHR that meets the AIU or location that has an EHR that meets the AIU or meaningful use requirements.meaningful use requirements.
EPs may include out-of-state encounters in their EPs may include out-of-state encounters in their patient volume calculationpatient volume calculation
Eligibility: Patient EncounterEligibility: Patient Encounter
A Medicaid encounter is any patient encounter A Medicaid encounter is any patient encounter where Medicaid (Title XIX, fee-for-service or where Medicaid (Title XIX, fee-for-service or managed care) paid for part or all of the servicesmanaged care) paid for part or all of the services Includes Medicaid payment of premiums, copays or Includes Medicaid payment of premiums, copays or
other cost sharing.other cost sharing.
A “Needy Individual” encounter (for EPs A “Needy Individual” encounter (for EPs practicing predominantly in an FQHC only) practicing predominantly in an FQHC only) include:include: Encounters where Medicaid or CHIP paid for part or Encounters where Medicaid or CHIP paid for part or
all of the servicesall of the services Encounters furnished at no cost, a sliding scale or as Encounters furnished at no cost, a sliding scale or as
uncompensated careuncompensated care
Eligibility: Patient VolumeEligibility: Patient Volume EPs meeting the 30% Medicaid patient volume EPs meeting the 30% Medicaid patient volume
threshold are eligible for a full incentive paymentthreshold are eligible for a full incentive payment
Pediatricians with 20-30% Medicaid patient Pediatricians with 20-30% Medicaid patient volume are eligible for a 2/3 incentive payment.volume are eligible for a 2/3 incentive payment.
EPs practicing predominantly in an FQHC and EPs practicing predominantly in an FQHC and meeting the 30% Needy Individual patient volume meeting the 30% Needy Individual patient volume threshold are eligible for a full incentive payment.threshold are eligible for a full incentive payment.
Eligibility: Patient Volume
A group practice or clinic may use a single patient volume calculation for all of its providers, given these conditions:
Each attesting individual provider has at least one Medicaid encounter
The single patient volume calculation must be from an auditable data source
The data from the entire group (not just certain providers) is used to perform the calculation
All provider attesting for the group use the same patient volume calculation
Patient Volume CalculationPatient Volume Calculation Medicaid or Needy Individual encounter count Medicaid or Needy Individual encounter count
for a selected 90 day period in the most recently for a selected 90 day period in the most recently completed calendar year divided bycompleted calendar year divided by
Total patient encounters visits for the same 90 Total patient encounters visits for the same 90 day periodday period
If the result is greater than 30% (20% for If the result is greater than 30% (20% for pediatricians), the professional is eligible for a pediatricians), the professional is eligible for a Medicaid EHR Incentive PaymentMedicaid EHR Incentive Payment
All information used in calculating patient volume All information used in calculating patient volume is subject to audit that could result in payment is subject to audit that could result in payment recoupmentrecoupment
Adopt, Implement or Upgrade (AIU)Adopt, Implement or Upgrade (AIU)
EPs must demonstrate one of the EPs must demonstrate one of the following to receive a Year 1 incentive following to receive a Year 1 incentive payment:payment:
AdoptAdopt – Acquire, purchase, or secure – Acquire, purchase, or secure access to certified EHR technologyaccess to certified EHR technology
ImplementImplement - Install or commence utilization - Install or commence utilization of certified EHR technologyof certified EHR technology
UpgradeUpgrade - Expand the available - Expand the available functionality of certified EHR technologyfunctionality of certified EHR technology
Adopt, Implement or Upgrade (AIU)Adopt, Implement or Upgrade (AIU)
Documentation proving AIU should be Documentation proving AIU should be uploaded into the attestation system, and uploaded into the attestation system, and should include the following:should include the following: Identification of the EHR technology being Identification of the EHR technology being
adopted or already in useadopted or already in use Signed contract or financial record indicating Signed contract or financial record indicating
the purchase, acquisition or lease of certified the purchase, acquisition or lease of certified EHR technologyEHR technology
Meaningful UseMeaningful Use Eligible Professionals must demonstrate Eligible Professionals must demonstrate
meaningful use of certified EHR meaningful use of certified EHR technology to receive Year 2 - 6 incentive technology to receive Year 2 - 6 incentive paymentspayments
Meaningful Use Includes:Meaningful Use Includes: Compliance with all 15 ONC “Core” Meaningful Use Compliance with all 15 ONC “Core” Meaningful Use
objectivesobjectives Compliance with 5 of the 10 “Menu Set” Meaningful Compliance with 5 of the 10 “Menu Set” Meaningful
Use objectivesUse objectives
All MU attestations may be subject to auditAll MU attestations may be subject to audit
Registration and Attestation TimelineRegistration and Attestation Timeline
November 7, 2011 – National Level November 7, 2011 – National Level Repository registrations launchedRepository registrations launched
December 2011 – EHR Incentive Program December 2011 – EHR Incentive Program Attestation System launchesAttestation System launches
January/February 2012 – Initial EHR January/February 2012 – Initial EHR Incentive Program payments distributedIncentive Program payments distributed
National Level RegistrationNational Level Registration
CMS Administered Process with state CMS Administered Process with state verificationverification
Verifies that the professional meets the Verifies that the professional meets the basic demographic criteria to participate in basic demographic criteria to participate in the Medicaid EHR Incentive Programthe Medicaid EHR Incentive Program
Process begins at Process begins at ehrincentives.cms.gov Registration User Guide is available at Registration User Guide is available at
www.nj.gov/njhit/ehr
National Level RegistrationNational Level Registration
Information Needed to Complete the Information Needed to Complete the National Level Registration Process:National Level Registration Process: Name of the eligible professional Name of the eligible professional National Provider Identifier (NPI) National Provider Identifier (NPI) Business address and phone numberBusiness address and phone number Valid Email address Valid Email address Taxpayer Identification Number (TIN) to which Taxpayer Identification Number (TIN) to which
the professional would like their incentive the professional would like their incentive payment madepayment made
State Level AttestationState Level Attestation Begins once National Level Registration is Begins once National Level Registration is
successfully completedsuccessfully completed Allows professionals to enter their Allows professionals to enter their
Medicaid or Needy Individual patient Medicaid or Needy Individual patient volume information and upload AIU volume information and upload AIU documentationdocumentation
Web-based application will be available Web-based application will be available within the provider portal section of within the provider portal section of www.njmmis.com
All information entered may be subject to All information entered may be subject to audit that could result in recoupmentaudit that could result in recoupment
State Level AttestationState Level Attestation Information Needed to Complete Attestation:Information Needed to Complete Attestation:
Medicaid Provider IDMedicaid Provider ID 90 day period for patient volume calculation90 day period for patient volume calculation Medicaid or Needy Individual encounters for the Medicaid or Needy Individual encounters for the
selected 90 day periodselected 90 day period Total encounters for the selected 90 day periodTotal encounters for the selected 90 day period Out-of-state Medicaid or Needy Individual encounters Out-of-state Medicaid or Needy Individual encounters
for the selected 90 day periodfor the selected 90 day period Total out-of-state encounters for the selected 90 day Total out-of-state encounters for the selected 90 day
periodperiod CMS EHR Certification NumberCMS EHR Certification Number
State Level AttestationState Level Attestation Attestations must be completed for each year Attestations must be completed for each year
the EP wishes to receive an incentive paymentthe EP wishes to receive an incentive payment Once all information is entered, professionals Once all information is entered, professionals
will have 72 hours to change any information will have 72 hours to change any information included in the attestationincluded in the attestation
The attestation system will verify all Medicaid The attestation system will verify all Medicaid information entered against information available information entered against information available in NJMMISin NJMMIS
Once all attestation information is verified, Once all attestation information is verified, payment will be electronically distributed in 2-4 payment will be electronically distributed in 2-4 weeksweeks
State Level AttestationState Level Attestation EPs can designate another person to EPs can designate another person to
attest on their behalf attest on their behalf
Payment InformationPayment Information
$63,750 for most EPs, as follows:$63,750 for most EPs, as follows: $21,250 in Year 1$21,250 in Year 1 $8,500 for all remaining program years$8,500 for all remaining program years Pediatricians with patient volumes of 20-30% Pediatricians with patient volumes of 20-30%
will receive 2/3 of the amounts shown abovewill receive 2/3 of the amounts shown above Eligibility must be maintained for each Eligibility must be maintained for each
payment yearpayment year Payments to EPs can be assigned to a Payments to EPs can be assigned to a
group practice or clinicgroup practice or clinic Payments can be used to offset amounts Payments can be used to offset amounts
owed to the Medicaid programowed to the Medicaid program
Additional InformationAdditional Information
EHR Incentive Program WebsiteEHR Incentive Program Website www.nj.gov/njhit/ehr
NJMMIS Provider ServicesNJMMIS Provider Services 1-800-776-6334, Option 71-800-776-6334, Option 7 Have your Medicaid Provider ID number Have your Medicaid Provider ID number
readyready
Program e-mail addressProgram e-mail address MAHS.ehrincentives@dhs.state.nj.usMAHS.ehrincentives@dhs.state.nj.us