Embed Size (px)
DESCRIPTION
Vermont Medicaid EHR Incentive Payment Program. Update and Status August 18, 2011. Today’s agenda. Vermont’s Incentive Payment Program Requirements for incentive payments Registration and attestation Payment and appeals Help Schedule Q&A. Requirements. - PowerPoint PPT Presentation
Citation preview
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 1
Vermont Medicaid EHR Incentive Payment Program
Update and Status
August 18, 2011
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 2
Today’s agenda
Vermont’s Incentive Payment Program Requirements for incentive payments Registration and attestation Payment and appeals Help Schedule
Q&A
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 3
Requirements
To qualify for a Vermont Medicaid EHR incentive payment you must: Be an eligible professional (EP) Using a federally certified EHR system for your patient
encounters Where you have at least Acquired, Implemented, or
Upgraded (AIU) that system With a Medicaid patient encounter ratio that satisfies
the federal requirement. You must register at the CMS Registration &
Attestation (R&A) web portal and then enter your status and attestation data into the Vermont MAPIR web portal.
For payment year 2011, VT will only accept AIU and cannot accept a MU filing.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 4
Eligibility: What is a Medicaid Eligible Provider? Eligible Professionals (EPs)
Physicians Pediatricians have special eligibility & payment rules Clarified physician for Medicaid = MDs; DOs
Nurse practitioners (NPs) Certified Nurse Midwives (CNMs) Dentists Physician Assistants (PAs) when practicing at an
FQHC/RHC that is so led by a PA Eligible Hospitals
Acute Care hospitals (including CAHs and cancer hospitals)
Children’s hospitals
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 5
Who is Eligible?
EPs cannot be hospital based, meaning that not “substantially all” (more than 90%) of covered professional services are conducted in either the inpatient hospital or hospital emergency department.
EPs must be enrolled as a Vermont Medicaid provider without sanctions or exclusions. If not currently enrolled, do so before applying for an incentive.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette
6
Hospital-based EP
Hospital-based EP is an EP who furnishes 90 percent or more of his or her covered professional services in a hospital setting in the year preceding the payment year…a setting is considered a hospital setting if it is a site of service that would be identified by the codes used in the HIPAA standard transactions as an inpatient hospital, or emergency room setting.
Codes 21, 23.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 7
More on Eligibility: Practices Predominantly & Needy Individuals EP is also eligible when practicing predominantly in
FQHC/RHC providing care to needy individuals Practicing predominantly is when FQHC/RHC is the
clinical location for over 50% of total encounters over a period of 6 months in the most recent calendar year
Needy individuals (specified in statute) include: Medicaid or CHIP enrollees; Patients furnished uncompensated care by the
provider; Furnished services at either no cost or on a sliding
scale
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 8
More on Eligibility: Physician Assistants Physician Assistants are eligible when
working at an FQHC or RHC that is so led by a physician assistant
In response to comments, CMS clarified “so led” to mean:
1. When a PA is the primary provider in a clinic
2. When a PA is a clinical or medical director at a clinical site of practice
3. When a PA is an owner of an RHC
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 9
Federally Certified EHR System
ONC Certified Health IT Product List (CHPL): http://onc-chpl.force.com/ehrcert
CHPL site provides ID number for each certified EHR ID number needed on MAPIR (Medical Assistance
Provider Repository) for attestation Make sure your system is certified by an Authorized
Testing and Certification Body (ATCB)
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 10
AIU and MU: Overview
Adopt, Implement, Upgrade (AIU) First participation year only No EHR reporting period
Meaningful Use (MU) Successive participation years; and Early adopters and some dually-eligible hospitals in
year 1 Medicaid Providers’ AIU/MU does not have to be
over six consecutive years States may propose to CMS for approval of limited
revisions to MU as it pertains to 4 public health related objectives (VT proposed no revisions)
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 11
AIU and MU: AIU
Adopted: Acquired and installed ‘Acquired’ can mean ordered ‘Installed’ – e.g., some evidence of installation prior to
incentive Implemented: Commenced utilization of
e.g., staff training, data entry of patient demographic information into EHR
Upgraded: Expanded e.g., upgraded to certified EHR technology or added
new functionality to meet the definition of certified EHR technology
Vermont expects some proof of purchase: a receipt, invoice, contract, purchase order; etc.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 12
Eligibility: Patient Volume
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 13
Eligibility: Patient Volume
General approach:
Total (Medicaid) patient encounters
In any 90-day period in the preceding
Calendar year
________________________________ x 100
Total patient encounters in
That same 90-day period
- May also be used to calculate needy individual patient volume
- May be used for hospitals and EPs
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette
14
Patient Encounters
Generally stated, a patient encounter is any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums for the service…In general, the same concept applies to needy individuals.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 15
Overview of the EHR Incentive Program (EHRIP) Process 1. Register with the CMS Incentive Program
Registration and Attestation System (R&A) website https://ehrincentives.cms.gov/hitech/login.action
Provide information such as: Individual and Payee NPI and TIN Option of Medicare or Vermont Medicaid If Medicaid, pick the state from the drop down menu
(Only states that have launched their programs are in the list; Vermont is not yet there)
You won’t be able to register for Medicaid until Vermont is ready to launch its program – on or near October 3, 2011 as currently planned!
CMS EHR Certification Number Email contact information
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 16
Overview of the EHRIP Process
2. Vermont Green Mountain Care Internet Portal Following CMS R&A, EP receives an email (a few
business days later) notification that you can register in Vermont’s MAPIR system
MAPIR is a repository of information for attestations, payments, appeals, oversight functions and interface with R&A
Use your GMC Internet Portal user ID and password to log in. If you are an EP type then you will see a MAPIR application link.
An EP can delegate someone to enter data in the portal
MAPIR looks for a registration record from the R&A and the application process can begin.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 17
Overview of the EHRIP Process
3. Vermont GMC Internet Portal (con’t) Verify the data displayed in MAPIR, enter
additional data elements, and attest to the accuracy of the data elements; demonstrate that you meet:
Medicaid patient volume thresholds Adopting, Implementing or Upgrading a federally
certified EHR system, and Meet all other federal program requirements Submit proof of purchase via email attachment
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 18
Overview of the EHRIP Process
4. Department of Vermont Health Access (DVHA) actions Review applications and make approval decisions Inform applications of approval or denial via email
Based on federal rules about the EHRIP. Payments via standard GMC payment system. You will see
approved payments on your remittance advices and your annual 1099’s.
You may be contacted during this process if there are questions
Appeals rights are available (e.g., if payment is denied) and there will be instructions on the website.
Applicants can reassign their payments to their employer or a contractual entity allowed to bill and receive payment for the applicant’s covered professional services.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 19
Preparation
A valid email address for the CMS registration process
A GMC Internet portal User ID and password NPI and TIN provided to CMS must match the NPI
and Payee TIN information in the GMC system (should be same as used for Medicaid claim payment purposes)
Proof of EHR acquisition Can also work through the sample EP MAPIR
applications on our website when that is available.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 20
A Little More MAPIR
Tab-oriented progress flow Get Started R&A Contact Information Eligibility Patient Volumes Attestation Review Submit
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 21
A Little More MAPIR
Attesting to an EHR Phase E.g., Implementation Questions
Workflow Analysis Planned / Complete Workflow Redesign Software Installation Hardware Installation Peripherals Installation Internet Connectivity / Broadband Uploading Patient Data Electronic Prescribing Health Information exchange (labs; pharmacy) Physical Redesign of workspace Training
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 22
A Little More MAPIR
The MAPIR system returns a summary of your entries…
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 23
A Little More MAPIR
As you work through the tabs you can save your work, log out and return to where you were
Very much like Turbo Tax Opportunities to review each section Opportunity to review the overall attestation and get a
printout Once you electronically sign and submit your
attestation, you cannot change the data in MAPIR, but can work with DVHA administrative support to make corrections.
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 24
Schedule
We are currently holding to an October 3, 2011 launch Must be on the first Monday of a month Much to accomplish to make this happen:
Website materials (State and portal websites) Provider Manuals for EPs and Hospitals System testing Administrative procedures
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 25
Request for Early Attesters
If you think you will be ready to attest when we launch, and are counting on an incentive payment for the 2011 payment year, send an email with contact information to
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 26
Helpful Links
ONC (Office of the National Coordinator): http://healthit.hhs.gov
CMS pages: EHR Incentive Payments:
http://www.cms.gov/EHRIncentivePrograms/ CMS EHR FAQs: http://www.cms.gov/EHRIncentivePrograms/95_FAQ.asp#TopOfPage
VITL: http://www.vitl.net/medicaid Vermont pages:
Health Care Reform: http://hcr.vermont.gov/ DVHA: http://ovha.vermont.gov/
GMC Provider Portal: http://www.vtmedicaid.com/
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 27
Contact Information Terry Bequette
Assoc. State HIT Coordinator
Department of Vermont Health Access
289 Hurricane Lane
Williston VT 05495
802.879.5996
Paul ForlenzaVice President, Policy and Special Projects
Vermont Information Technology Leaders, Inc.
Vermont’s Regional Extension Center
144 Main Street, Suite 1
Montpelier VT 05602
802.839.1942
Carol KulczykDirector of Program Implementation
Vermont Information Technology Leaders, Inc.
Vermont’s Regional Extension Center
144 Main Street, Suite 1
Montpelier VT 05602
802.839.1957
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 28
HITECH Legislation: Purpose
Improve outcomes, facilitate access, simplify care and reduce costs by providing: Major financial support to providers and States Learning opportunities created and leveraged
through TA from CMS and others Will establish sustainable data-driven
infrastructure that will create a framework for improving healthcare quality and outcomes
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 29
Payments: EP Incentives
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette30
Payments: EP Adoption Timeline
VITL Meaningful Use Webinar 8/18/2011 - Terry Bequette 31
QUESTIONS
![Cms+ehr incentive program_hospital_training_final[1]](https://img.pdfslide.net/doc/110x75/55936b951a28ab6e138b45f6/cmsehr-incentive-programhospitaltrainingfinal1.jpg)
