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



Agenda

• Vermont Medicaid EHRIP status

• Overview of EHRIP changes

• MAPIR 5.0

• Resources for EHRIP applicants

• Q & A



Agenda



• MAPIR 5.0


• Q & A



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



VT EHRIP Status

EPs

595 Individual EPs

737 Payments

Total$23,458,217

EHs

11 Individual EHs

15 Payments



VT EHRIP Status



Agenda



• MAPIR 5.0


• Q & A



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




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.




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





This does NOT include claims denied due to the provider or

patient being ineligible for the date of service.





• Medicaid encounter definition does not change for

Eligible Hospitals

• EHs cannot include unpaid claims in their calculations




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.





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.





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.





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.




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




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




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.



Agenda



• MAPIR 5.0


• Q & A



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



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



Agenda



• MAPIR 5.0


• Q & A



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



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




TO INSURE YOU ARE PREPARED FOR

A POTENTIAL AUDIT, SAVE ANY

ELECTRONIC OR PAPER

DOCUMENTATION THAT SUPPORTS

YOUR ATTESTATION.

Introduction – Page 3




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




PLEASE NOTE UPDATED

DOCUMENTATION

REQUIREMENTS FOR ALL GROUP

ATTESTATIONS

Patient Volumes - Group




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




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




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.





New exclusion added.


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.





Choose if you would like to attest to the

Original Core Measure 8 or the Optional

Core Measure 8.


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.




Supporting documentation is

required to be uploaded with your

attestation …

File Upload – Page 211




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.



Resources – VT Medicaid EHRIP Website

http://hcr.vermont.gov/hit/ehripCurrent

Announcements

Program

Updates

Participation

Timelines

How to

Apply

Help

Topics



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



Resources – VITL REC Services

http://www.vitl.net/medicaid



Resources – VITL Helpdesk

MyVITL.net



Resources – CMS EHRIP Website

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

CMS

Frequently Asked

Questions



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.



Q & A

• Vermont Medicaid EHRIP statusProgram Team Members and Activities

• Overview of EHRIP changesMedicaid Encounter Definition


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



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?

Vermont Medicaid EHR Incentive Program - VITL · 2013-04-26 · 4/26/2013 VT Medicaid EHRIP Webinar...

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