American Dental Education Association Medicaid EHR Incentives Program Christopher Kenny King & Spalding, LLP 202-626-9253; ckenny@kslaw.com March 15, 2014
Agenda Quick overview of Stage 1 Meaningful Use criteria Summary of changes in Stage 2 Meaningful Use Rule Lessons Learned Next Steps King & Spalding, 2 LLP 2
Overview of the Current Meaningful Use Rule Meaningful Use criteria for Stage 1 in effect for dentists through December 31, 2013. Meaningful Use criteria for Stage 2 began in 2014. Dentists can receive up to $63,750 in Medicaid EHR incentives (residents may be eligible; students are not) Adopt, implement, upgrade option for first year No direct EHR incentives for Dental Schools or Academic Dental Institutions Dentists can reassign their Medicaid EHR incentives to their Dental Schools/Dental Academic Institutions King & Spalding, 3 LLP 2
Overview of Stage 1 Qualification Criteria for Dentists State HIT Plan requirements vary from State to State (cms.gov/ehrincentiveprograms) Medicaid patient population requirements 30% (20% for pediatricians, as defined under each State s Medicaid Program) Pre-October 1, 2012: Based on Medicaid-payable encounters (CMS has changed its definition to include all encounters with Medicaid patients regardless of payment. Effective October 1, 2012) Measured over a representative consecutive 90-day period in the prior calendar year King & Spalding, 4 LLP 3
Overview of Stage 1 Qualification Criteria for Dentists Medicaid patient population requirements Clinic/group-wide measurement of Medicaid patient population is permitted Must be appropriate for each clinic/group dentist Part-time dentists are included Exclude outside encounters for clinic/group dentists with private practices See your State s HIT Plan for any restrictions King & Spalding, 5 LLP 4
Overview of Stage 1 Qualification Criteria for Dentists Functionality/Clinical Quality Measures Must comply only with Measures that are applicable to dentistry (most are not) No minimum performance thresholds for any Clinical Quality Measures in Stage 1 (i.e., reporting only) Use of Certified EHR Technology Full EHR functionality required Adopt, implement, upgrade option requires at least a signed contract (operational EHR not required) King & Spalding, 6 LLP 5
Overview of Stage 2 Meaningful Use Requirements Final Rule issued in September 2012 Key changes: Stage 1 extended through 2013. Stage 2 extended through 2017 Extension for attesting for 2013 payment year to March 31, 2014 (Medicare) Improved Medicaid Population Calculation - All encounters with Medicaid patients are counted, even if no Medicaid-payable services are furnished. Check your Medicaid State HIT Plan to verify methodology King & Spalding, 7 LLP 6
Overview of Stage 2 Meaningful Use Requirements Key Changes (con t) New limitation on the adopt, implement, upgrade option - must have a Certified EHR at a minimum of one site where the dentist practices Two new Clinical Quality Measures concerning dentistry (no performance threshold; reporting only): Record whether patients ages 0-20 have had cavities or tooth decay within the reporting period. Record whether patients under age 20 have had a fluoride varnish applied within the reporting period. King & Spalding, 8 LLP 7
Overview of Stage 2 Meaningful Use Requirements Key changes (con t) Computer Provider Order Entry ( CPOE ) requirement: Expanded to include orders for medications, radiology services, and lab services (dental lab orders excluded). Patient record access requirement - view, download, transfer 5% of patients must access 5% of patients must send dentist an electronic message through the EHR s web portal King & Spalding, 9 LLP 8
Lessons Learned When is a group/clinic s patient volume appropriate? States may require one Medicaid patient encounter per dentist in order to use the group/clinic s patient volume. Other States permit a dentist to rely on the clinic s patient volume if he/she is available to treat Medicaid patients in the clinic. Must maintain documentation. Must each dentist have a patient encounter during the 90- day reporting period, or just the prior calendar year form which the 90-day period is drawn? New dentists? What about encounters performed off-site but using the NPI/billing number for the clinic (e.g., health fairs, schools, etc.)? King & Spalding, 10 LLP 8
Next Steps Certified EHR Technology - options for obtaining Review the reassignment provisions in your dentists employment/independent contractor agreements Register your dentists to participate in your State s Medicaid EHR Incentives Program - see your State s HIT Plan Identify the 90-day period with the highest % of : Encounters with Medicaid patients (regardless of services) Coordinate with your State s Medicaid Agency (and HIT REC) King & Spalding, 11 LLP 9