Vermont Medicaid EHR Incentive Program - VITL · 2013-04-26 · 4/26/2013 VT Medicaid EHRIP Webinar...
Transcript of Vermont Medicaid EHR Incentive Program - VITL · 2013-04-26 · 4/26/2013 VT Medicaid EHRIP Webinar...
Vermont Medicaid EHR
Incentive Program
Progress and Updates
April 26, 2013
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 1
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 2
Agenda
• Vermont Medicaid EHRIP status
• Overview of EHRIP changes
• MAPIR 5.0
• Resources for EHRIP applicants
• Q & A
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 3
Agenda
• Vermont Medicaid EHRIP status
• Overview of EHRIP changes
• MAPIR 5.0
• Resources for EHRIP applicants
• Q & A
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 4
VT EHRIP Status
Program Team Activities
• Maintain CMS guidelines for EHRIP functions
• Maintain the technical functioning of attestation system
• Develop Vermont program websiteand other information resources
• Process attestations
• Pre-payment validation
• Develop audit plan, conduct program audits
• Comply with CMS EHRIP reporting requirements
Program Team Members
Terry BequetteState of Vermont HIT Coordinator
Lorraine SicilianoMedicaid Operations Administrator
Timothy TremblayMedicaid Operations Administrator
Heather Kendall, PhDProgram and Operations Auditor
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 5
VT EHRIP Status
EPs
595 Individual EPs
737 Payments
Total$23,458,217
EHs
11 Individual EHs
15 Payments
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 6
VT EHRIP Status
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 7
Agenda
• Vermont Medicaid EHRIP status
• Overview of EHRIP changes
• MAPIR 5.0
• Resources for EHRIP applicants
• Q & A
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 8
Overview of EHRIP Changes
Changes as of Program Year 2013
• Medicaid Encounter definition for EPs
• Patient volume threshold reporting period
• FQHC/RHC ‘Practicing Predominantly’ calculation
• Measures and objectives for certain Meaningful Use
Stage 1 reporting
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 9
Overview of EHRIP Changes
New Definition of ‘Medicaid Encounter’ for EPs
Medicaid Encounter = services rendered on any one day to a
Medicaid-enrolled individual, regardless of payment
liability
Expands the types of services to count toward determining
whether a provider meets the threshold for qualifying for a
Medicaid EHR incentive payment.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 10
Overview of EHRIP Changes
New Definition of ‘Medicaid Encounter’ for EPsExamples of encounters that may now be included
• Claims denied due to service limitation audits
• Claims denied due to non-covered service
• Claims denied due to timely filing
• Services rendered on Medicaid members that were not
billed due to the provider’s understanding of Medicaid
billing rules
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 11
Overview of EHRIP Changes
New Definition of ‘Medicaid Encounter’ for EPs
This does NOT include claims denied due to the provider or
patient being ineligible for the date of service.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 12
Overview of EHRIP Changes
New Definition of ‘Medicaid Encounter’ for EPs
• Medicaid encounter definition does not change for
Eligible Hospitals
• EHs cannot include unpaid claims in their calculations
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 13
Overview of EHRIP Changes
Patient Volume Threshold Reporting Period
As of Program Year 2013, EPs and EHs have the option to
choose their patient volume threshold reporting period:
• Any consecutive 90-day period within the prior program
year
OR
• Any consecutive 90-day period within the preceding 12-
month period from the date of attestation.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 14
Overview of EHRIP Changes
Patient Volume Threshold Reporting Period
Program Year 2012
EPs
January 1, 2012
to
December 31, 2012
EHs
October 1, 2011
to
September 30, 2012
EPs
January 1, 2011
to
December 31, 2011
EHs
October 1, 2010
to
September 30, 2011
PY2012 90-day reporting period dates
EP attestation date of 12/1/12: Only had the option to choose a 90-day patient
volume reporting period from 2011.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 15
Overview of EHRIP Changes
Patient Volume Threshold Reporting Period
Program Year 2013
EPs
January 1, 2013
to
December 31, 2013
EHs
October 1, 2012
to
September 30, 2013
Example: EP attestation date 12/1/13Now has the option to choose a 90-day period
from 2012 OR a 90-day period from
11/30/2012 - 11/30/2013.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 16
Overview of EHRIP Changes
Patient Volume Threshold Reporting Period
It is possible that using the preceding 12-month period and
choosing a 90-day period ending close to the date of the
attestation submission could delay the application processing.
If the state has not yet received claims or encounter data for that
period, the EHR Incentive Program Team may hold the attestation
in pre-payment status until the necessary encounter reporting or
claims information has been received.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 17
Overview of EHRIP Changes
FQHC/RHC Practicing PredominantlyFor EPs to be practicing predominantly at an FQHC/RHC, more than 50 percent of their
patient encounters must be at the qualifying practice. Prior to PY2013, the patient
encounters had to be during 6-month period within the
previous calendar year
from the Program Year in which they were attesting.
Old Calculation: PY 2012 Example
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 18
Overview of EHRIP Changes
FQHC/RHC Practicing PredominantlyThe updated requirement allows EPs to use a
6-month period within the prior calendar year
or within the preceding 12-month period
from the date of attestation
for their practicing predominantly period
calculation
Example: EP attestation date 12/1/13Now has the option to choose a 6-month
period from 2012 OR a 6-month period from
11/30/2012 - 11/30/2013
New Calculation: PY 2013 Example
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 19
Overview of EHRIP Changes
Meaningful Use Stage 1 Changes
• Changes to measures and objectives for certain Meaningful
Use Stage 1 (MU1) reporting requirements
• Changes to MU Core Measures #1, #4 and #8 include optional
exclusions and alternate measures.
• MU Core Measures #10 – reporting ambulatory clinical quality
measures – and #14 – exchanging key clinical information – are
removed as separate reporting requirements.
• These changes are optional in PY2013, but will become
mandatory for PY2014.
• Providers attesting for PY2013 will see these options presented
on the MAPIR screens for Core Measures #1, #4 and #8.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 20
Agenda
• Vermont Medicaid EHRIP status
• Overview of EHRIP changes
• MAPIR 5.0
• Resources for EHRIP applicants
• Q & A
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 21
MAPIR 5.0
The MAPIR Collaborative
• Medical Assistance Provider Incentive Repository application
• A group of 13 states with Hewlett-Packard as their common
Medicaid Information technology partner
Arkansas
Connecticut
Delaware
Florida
Georgia
Indiana
Kansas
Massachusetts
Oregon
Pennsylvania
Rhode Island
Vermont
Wisconsin
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 22
MAPIR 5.0
Attesting for Program Year 2013
WARNING! DO NOT PROCEED
with a Program Year 2013
EHRIP attestation in MAPIR
before reading the information
here.
Current screenshot for version 4.3.1.a
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 23
Agenda
• Vermont Medicaid EHRIP status
• Overview of EHRIP changes
• MAPIR 5.0
• Resources for EHRIP applicants
• Q & A
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 24
Resources for EHRIP Applicants
Information, Guidance, Answers
• The MAPIR User Guides for EPs and EHs
• The Vermont Medicaid EHRIP Website
http://hcr.vermont.gov/hit/ehrip
• Vermont Information Technology Leaders (VITL)
http://www.vitl.net
─ REC Services
─ MyVITL Helpdesk
• CMS EHRIP Website
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 25
Resources – MAPIR User Guide
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 26
Resources – MAPIR User Guide
IMPORTANT: If an Eligible
Professional’s Vermont Medicaid
enrollment lapses at any time after an
application is started and BEFORE A
PAYMENT IS RECEIVED, the application
will automatically ABORT from the
MAPIR system. All saved data for the
application will be eliminated. The
attestation must then be restarted
from the beginning in MAPIR after the
EP becomes fully re-enrolled in
Vermont Medicaid.
Introduction – Page 1
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 27
Resources – MAPIR User Guide
TO INSURE YOU ARE PREPARED FOR
A POTENTIAL AUDIT, SAVE ANY
ELECTRONIC OR PAPER
DOCUMENTATION THAT SUPPORTS
YOUR ATTESTATION.
Introduction – Page 3
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 28
Resources – MAPIR User Guide
PLEASE NOTE: If there are multiple
lines for multiple locations, EACH LINE
must have either a “Yes” or “No”
answer in the column “Utilizing
Certified EHR Technology (Must Select
One).” At least one practice location
where you are utilizing certified EHR
technology must be selected as a
location for which you will provide
patient volume information.
Patient Volume – Page 26
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 29
Resources – MAPIR User Guide
PLEASE NOTE UPDATED
DOCUMENTATION
REQUIREMENTS FOR ALL GROUP
ATTESTATIONS
Patient Volumes - Group
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 30
Resources – MAPIR User Guide
Group Attestation Documentation
For each provider attesting as part of a group, please
document the following and upload the information in a
PDF file as part of each provider’s attestation:
• Applicant’s name and individual NPI
• The set of Group Practice IDs (billing NPIs) used to
define the group
• A complete list of all individual provider names and
individual NPIs for all attending or rendering
providers associated with the group, regardless of
whether they are Eligible Professionals attesting for
an incentive payment.
Patient Volumes - Group
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 31
Resources – MAPIR User Guide
Please note that for each provider
attesting to Adoption,
Implementation or Upgrade, you
must upload a copy of an invoice,
contract, purchase order, license
agreement or similar document
related to your EHR system.
Upload instructions are on page
214 in the Submit section of the
attestation instructions.
A/I/U Documentation
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 32
Resources – MAPIR User Guide
Page 77 – Core Measure 1
Choose if you would like to attest to the
Original Core Measure 1 or the Optional
Core Measure 1.
(Measure Code EPCMU01)
Old measure: CPOE is based on the number of
unique patients with a medication in their
medication list that was entered using CPOE.
New optional measure: CPOE is based on the total
number of medication orders created during the EHR
reporting period.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 33
Resources – MAPIR User Guide
Page 85 – Core Measure 4
New exclusion added.
(Measure Code EPCMU04)
New additional exclusion: EPs can exclude from this
measure if the EP does not have a pharmacy within
their organization, and there are no pharmacies that
accept electronic prescriptions within 10 miles of the
EP's practice location at the start of his/her EHR
reporting period.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 34
Resources – MAPIR User Guide
Page 90 – Core Measure 8
Choose if you would like to attest to the
Original Core Measure 8 or the Optional
Core Measure 8.
(Measure Code EPCMU08)
Old measure: Vital signs must be recorded for more than
50 percent of all unique patients ages 2 and over.
New optional measure: An EP who sees no patients age 2
or older, or an EP who believes that all three vital signs
(height, weight, blood pressure) are not relevant to their
scope of practice.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 35
Resources – MAPIR User Guide
Supporting documentation is
required to be uploaded with your
attestation …
File Upload – Page 211
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 36
Resources – MAPIR User Guide
Supporting documentation is
required to be uploaded with your
attestation …
Post Submission – Page 228
IMPORTANT: If an Eligible
Professional’s Vermont Medicaid
enrollment lapses at any time after an
application is started and BEFORE A
PAYMENT IS RECEIVED, the application
will automatically ABORT from the
MAPIR system. All saved data for the
application will be eliminated. The
attestation must then be restarted
from the beginning in MAPIR after the
EP becomes fully re-enrolled in
Vermont Medicaid.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 37
Resources – VT Medicaid EHRIP Website
http://hcr.vermont.gov/hit/ehripCurrent
Announcements
Program
Updates
Participation
Timelines
How to
Apply
Help
Topics
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 38
Resources – VT Medicaid EHRIP Website
http://hcr.vermont.gov/hit/ehrip/help/access
Common issues
encountered when
accessing MAPIR, and
suggested steps to
resolve them
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 39
Resources – VITL REC Services
http://www.vitl.net/medicaid
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 40
Resources – VITL Helpdesk
MyVITL.net
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 41
Resources – CMS EHRIP Website
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html
CMS
Frequently Asked
Questions
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 42
Resources – CMS EHRIP Website
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf
CMS Guidance for EHR Incentive Program audits
Providers who receive an EHR
incentive payment for either the
Medicare or Medicaid EHR
Incentive Program potentially
may be subject to an audit.
• Retain ALL relevant supporting documentation
used in the completion of your attestation,
including documentation to support data for
meaningful use objectives and clinical quality
measures (CQMs), for six years post-attestation.
• Retain documentation that is in either paper or
electronic format – to include screenshots.
• Download and/or print a copy your MU report at
the time of attestation for your records.
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 43
Q & A
• Vermont Medicaid EHRIP statusProgram Team Members and Activities
• Overview of EHRIP changesMedicaid Encounter Definition
Patient Volume Threshold Reporting Period
Practicing Predominantly
MU1 Measures
• MAPIR 5.0Attestation begins May 1st, 2013 for EHRIP PY2013 changes
• Resources for EHRIP applicantsMAPIR User Guide
VT EHRIP website
VITL REC Services
MyVITL Helpdesk
CMS EHRIP Website
DEPARTMENT OF VERMONT HEALTH ACCESS
4/26/2013 VT Medicaid EHRIP Webinar 44
Q & A
• A provider can only switch once after receiving a payment. Once the switch occurs, the provider is in the Program to
which he or she switched for the remainder of program participation.
• The switch will only count once the attestation is successfully completed. If the provider started in Medicaid and
switched to Medicare, it will only be considered “switched” with approved attestation and payment.
• A provider is allowed to switch back if no attestation is completed. If the provider tries to attest and is unsuccessful, the
provider may switch back.
• It is the successful attestation that triggers the switch, because that is when the payment process starts.
• The National Level Registry (NLR) is not currently coded to allow this. If a provider is paid by one Program and switches
registration to the other Program, then the provider cannot switch back.
• CMS is working to enhance the system to allow a switch back until a successful attestation is completed. Until that
system enhancement comes online, the provider would have to contact the NLR help desk to have it switched
manually.
• CMS is working on a FAQ that will be added to their website and FAQ documentation.
Q: How do I switch between Medicaid and Medicare EHR
Incentive Programs; What constitutes a switch?