Electronic Health Records (EHR) HP Provider Relations October 2012
Agenda Session Objectives Electronic Health Record (EHR) EHR Incentive Program Certified Technology EHR Meaningful Use EHR Incentive Program Registration EHR Audits Helpful Tools Questions 2
Objectives Following this session, providers will: Learn what an EHR system is and does Know if your provider type is eligible to receive EHR payments Grasp a basic understanding of Meaningful Use Understand how to register to receive EHR payments 3
Define Electronic Health Record
Electronic Health Record (EHR) What is an EHR? An electronic health record (EHR) sometimes called an electronic medical record (EMR) allows healthcare providers to record, capture, and share patient information electronically in place of the standard paper method The EHR Incentive Program asks providers to use the capabilities of EHR technology whose ultimate goal is to achieve benchmarks that can lead to improved patient care and treatment 5
Explain EHR Incentive Program
EHR Incentive Program What is it? The American Recovery and Reinvestment Act (Recovery Act) of 2009 provides for incentive payments for eligible professionals (EPs) and eligible hospitals (EHs) for efforts to adopt, implement and upgrade certified EHR technology in their first year of participation in the program and successfully demonstrate meaningful use in subsequent years. Meaningful use is not a requirement for the first year of participation. 7
EHR Incentive Program Who can participate? EHR incentive program is available for: Eligible professionals (EPs) Physicians Primarily doctors of medicine and doctors of osteopathy Dentists Nurse practitioners Certified nurse midwives Physician assistants practicing in a Federally Qualified Health Center (FQHC) led by a physician assistant Rural Health Clinic (RHC) led by a physician assistant Eligible hospitals (EHs) Acute care hospital (includes cancer and critical access hospitals) Children s hospitals 8
EHR Incentive Program EP participant criteria EPs must meet patient volume criteria as follows: Minimum 30% patient volume attributable to Medicaid-funded services For pediatricians, the patient volume minimum requirement is 20% EPs that practice at an FQHC or RHC must demonstrate that more than 50% of their clinical encounters occurred at an FQHC or RHC over a sixmonth period, and that they had a minimum 30% patient volume attributable to needy individuals, which are: Those receiving medical assistance from Medicaid or the Children s Health Insurance Program (CHIP) Individuals who are furnished uncompensated care by the provider Individuals furnished services at either no cost or reduced cost based on a sliding scale determined by the individual s ability to pay 9
EHR Incentive Program EP participant criteria Hospital-based providers are not eligible for the EHR incentive program An EP is considered to be hospital-based when 90% of the services provided are furnished in a hospital inpatient or emergency room setting 10
EHR Incentive Program EH participant criteria Acute care hospitals including critical access hospitals (CAHs) must have a minimum of 10% Medicaid patient volume for each year that the hospital seeks an EHR incentive payment Certified children s hospitals Do not require a patient volume threshold Per federal rule, EHs must register for EHR incentive payments no later than federal fiscal year (FFY) 2016 September 30, 2016 for EHs The FFY begins October 1 and ends September 30 of the following year 11 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program Medicare and Medicaid EHR program payment structures, in contrast for EPs 12 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program The maximum Medicare incentive payment to an EP is $44,000 over a five year period EPs must begin receiving payment no later than CY 2014 The last year an EP can receive payment is CY 2016 13 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program The maximum Medicaid incentive payment to an EP is $63,750 over a six-year period ($42,500 for pediatricians) EPs must begin receiving payment no later than CY 2016 The last year an EP can receive payments is 2021 Provider EP EP-Pediatrician Patient Volume 30% 20-29% Year 1 $21,250 $14,167 Year 2 8,500 5,667 Year 3 8,500 5,667 Year 4 8,500 5,667 Year 5 8,500 5,667 Year 6 8,500 5,667 Total Incentive Payment $63,750 $42,500 14 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program EH Medicaid payment structure States may pay children s hospitals and ACHs up to 100 percent of an aggregate EHR hospital incentive amount provided over a minimum of a three-year period and a maximum of a six-year period. The aggregate EHR incentive amount is the total amount the hospital could receive in Medicaid payments over a theoretical four years of the program. The Medicaid incentive payment is a product of 2 factors: The overall EHR amount An Initial Amount The Medicare Share A Transition Factor applicable to each of a theoretical four years The Medicaid Share 15 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program EH Medicaid payment structure The complete Medicaid incentive payment calculation is available at: http://www.cms.gov/outreach-and-education/medicare-learning- Network- MLN/MLNProducts/downloads/Medicaid_Hosp_Incentive_Payments_ Tip_Sheets.pdf The last year a EH can first receive a Medicaid incentive program payment is FY 2016. 16 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program Statistical Data Application during the period May 2011 through December 2011 Applications Received Applications Approved Money Paid EP 742 EP 739 $15,597,505.00 EH 59 EH 59 $37,997,031.67 TOTALS: 801 798 $53,594,536.67 17 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program Statistical Data During the period January 2012 through August 2012 Applications Received Applications Approved Money paid EP 566 EP 499 $8,909,002.00 EH 36 EH 24 $12,813,916.09 TOTALS: 602 453 $21,722,918.09 18 Electronic Health Records (EHR) Program October 2012
Inform Certified Technology
Certified EHR Technology EHR technologies that meet the certification requirements for the Medicaid EHR incentive programs are listed on the Office of the Nat l Coordinator (ONC) website: onc-chpl.force.com/ehrcert Providers can register to become eligible to participate in the Medicaid EHR incentive programs. 20
Certified EHR Technology - CEHRT To meet EHR certified criteria, EHR technology must be certified by: The Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) Visit http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objid=3120 to view a list of ONC ATCBs Vendors found in the ONC ATCB list are authorized to perform EHR and/or EHR Module certification Certification by an ATCB signifies that an EHR technology product has the capabilities necessary to support efforts to meet the goals and objectives of meaningful use 21
Understand EHR Meaningful Use
Meaningful Use To qualify for incentive payments, meaningful use requirements must be met in the following ways: EPs and EHs must adopt, implement, upgrade, or demonstrate meaningful use after their first year of participation in the incentive program Meaningful use must be successfully demonstrated during subsequent participation years Adopted: Acquired and installed certified EHR technology Provider must be able to show evidence of installation Implemented: Began using certified EHR technology Can include staff training and data entry of patient demographics into EHR Upgraded: Expanded existing technology to meet certification requirements An example includes adding new functionality to meet the definition of EHR technology 23
Meaningful Use Federal law specifies three main components of meaningful use: The use of certified EHR in a meaningful manner e-prescribing Computerized provider order entry (CPOE) The use of certified EHR technology for electronic exchange of health information to improve quality of healthcare The use of certified EHR technology to submit clinical quality data and other measures 24
Meaningful Use Criteria for meaningful use is defined in three stages over the next five years: Stage 1 (began 2011-2013): Sets the baseline for electronic data capture and information sharing EPs must meet at least 20 of the 25 objectives to qualify for EHR payment EHs must meet at least 19 of the 24 objectives to qualify for EHR payment 25
Meaningful Use Stage 2 (2014): Demonstrate use of advanced clinical processes and procedures EPs must meet at least 20 of the 25 objectives to qualify for EHR payment EHs must meet at least 19 of the 24 objectives to qualify for EHR payment Stage 2 Core and Menu objectives are available at CMS.gov, at the Stage 2 Overview Tipsheet Stage 3 (2016): Demonstrate improved outcomes along with continued expansion of criterion set in Stages 1 and 2 Development of future stage criterion will be communicated through future rule making 26
Meaningful Use Stage 2 Clinical quality measures To demonstrate meaningful use successfully, EPs and EHs are required to report clinical quality measures EPs must report on six total clinical quality measures EHs must report on all 15 of their clinical quality measures Providers must demonstrate to CMS that they are using their EHRs in ways that positively impact patient care Must do more than simply own certified EHR materials To review the list of clinical quality measures, providers may access cms.gov/qualitymeasures/03_electronicspecifications.asp 27
Meaningful Use (Example) Projected time line of stages of meaningful use applications 28
Act EHR Incentive Program Registration
Registration and Enrollment A New Tool Medical Assistance Provider Incentive Repository (MAPIR) Registration and Attestation (R&A) is completed electronically R&A completion must be performed prior to accessing MAPIR function States support the application process MAPIR unifies the EHR registration process No paper forms required MAPIR interfaces with a state Medicaid Management Information System (MMIS) for provider enrollment and claims information, to create transactions for payment, and to store payment information Registration and Attestation Portal now enhanced to allow Medicaideligible providers the ability to attest for Year 2 Meaningful Use (MU) payment incentives A new user manual is available with details about this new functionality for eligible providers (EP or EH) 30 Electronic Health Records (EHR) Program October 2012
EHR Incentive Program Registration Eligible professional (EP) EPs register for the incentive program through a two-step process: 1. Providers must register at the CMS Registration and Attestation system at: https://ehrincentives.cms.gov/hitech/login.action EPs enter: National Provider Identifier (NPI) National Plan and Provider Enumeration System (NPPES) User ID and Password Payee Tax ID (if re-assigning EHR payments) Payee NPI (if re-assigning EHR payments) EPs receive a CMS registration number 2. Register EHR system using the Provider Profile feature of Web interchange 31
EHR Incentive Program Registration Eligible professional (EP) The last day for EPs to register and attest to receive an Incentive Payment for calendar year (CY) 2012 is February 28, 2013 To get the maximum incentive payment, EPs must begin participation by 2016 32
EHR Incentive Program Registration Eligible hospital (EH) EHs register for the incentive program through a two-step process: 1. Providers must register at the CMS Registration and Attestation system at: https://ehrincentives.cms.gov/hitech/login.action EHs enter: National Provider Identifier (NPI) CMS Identity and Access Management (I & A) User ID and Password CMS Certification Number (CCN) Hospital Tax ID EHs receive a CMS registration number 2. Register EHR system using the Provider Profile feature of Web interchange 33
EHR Incentive Program Registration Eligible hospital (EH) The last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for FY 2012 under the Medicare EHR Incentive Program is November 30, 2012 The last year an EH may register to begin the EHR Incentive Program is 2016 34
Click here for EHR registration 35
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EHR Incentive Program Registration Recap EHR Incentive Program runs through 2021 EPs must register for EHR incentive payments no later than calendar year (CY) 2016 EHs must register for EHR incentive payments no later than federal fiscal year (FFY) 2016 September 30, 2016 FFY begins October 1 and ends September 30 of the following year EPs eligible for both the Medicare and Medicaid EHR programs must choose which program they wish to participate EPs may not receive EHR incentive payments from both Medicare and Medicaid programs in the same year Before 2015, an EP may switch one time between Medicare and Medicaid to receive the EHR payment after the first EHR payment is received 38
Examine EHR Audits
EHR Audits Indiana providers receiving EHR incentive payments are subject to audit by CMS (dually eligible) or the Office of Medicaid Policy and Planning Surveillance and Utilization Review Providers that attested to receive EHR incentive payments should retain all supporting documentation (either paper or electronic format) used in the completion of the attestation responses Retain documentation for six years post-attestation Providers should also retain documentation to support the clinical quality measures reported to establish meaningful use 40
Find Help Resources Available
Helpful Tools Avenues of resolution IHCP EHR Manual available at indianamedicaid.com CMS Information Center 1-888-734-6433 HP EHR Customer Assistance 1-855-856-9563, or (317) 488-5137 in the Indianapolis local area Locate area consultant map on: indianamedicaid.com (provider home page> Contact Us> Provider Relations Field Consultants) or Web interchange > Help > Contact Us 42
Q&A