New Jersey Medicaid EHR Incentive Program Professionals Overview - PowerPoint PPT Presentation

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New Jersey Medicaid EHR Incentive Program Professionals Overview

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New Jersey Medicaid EHR Incentive Program Professionals Overview Program Overview Each individual EP must separately establish eligibility for their incentive ... – PowerPoint PPT presentation

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Title: New Jersey Medicaid EHR Incentive Program Professionals Overview


1
New Jersey Medicaid EHR Incentive
Program Professionals Overview
2
Presentation Summary
  • Medicaid EHR Incentive Program Overview
  • Eligibility
  • Adopt, Implement, Upgrade, and Meaningful Use
    Definitions
  • Payment Amounts and Schedule
  • Registration and Attestation
  • Questions and Answers

3
Program Overview
4
Program Overview
  • The Medicaid EHR Incentive Program will provide
    incentive payments to eligible professionals as
    they adopt, implement, or upgrade certified EHR
    technology in their first year of participation
    and demonstrate meaningful use for five
    additional years.

5
Program Overview
  • Incentive payments to eligible professionals will
    begin being distributed in January February
    2012.
  • Eligible Professionals (EPs) can receive up to
    63,750 over six years.
  • EPs may participate in either the Medicaid or
    Medicare Incentive Program, but not both.
  • EPs can switch between the Medicaid and Medicare
    program once, and only once, before 12/31/2015.

6
Program Overview
  • Each individual EP must separately establish
    eligibility for their incentive payments
  • EPs can only receive one payment per calendar year

7
Eligibility
8
Eligibility Provider Types
  • Eligible Provider Types
  • Physicians (generally M.D.s or D.O.s)
  • Pediatricians
  • Dentists (D.D.S. or D.M.D)
  • Certified Nurse Midwives
  • Advanced Practicing Nurses
  • Hospital-based EPs are not eligible for incentive
    payments
  • 90 of the EPs services provided in a hospital
    inpatient or emergency room setting.

9
Eligibility General Guidelines
  • Professionals must also meet patient volume and
    EHR technology requirements to be eligible for a
    Medicaid Incentive Payment

10
Eligibility Patient Volume
11
Eligibility Patient Volume
  • To qualify for incentive payments, an EP must
    meet or exceed one of the following
  • 30 Medicaid (non-CHIP) patient volume
  • 20 Medicaid (non-CHIP) patient volume
    (pediatricians only)
  • Practice predominantly in an FQHC and have 30 of
    their patient volume attributable to needy
    individuals

12
Eligibility FQHC Providers
  • Practicing Predominantly
  • 50 of patient encounters over a six month period
    in the most recently completed calendar year
    occurred at an FQHC
  • Needy Individuals
  • Medicaid and CHIP clients
  • Patients furnished uncompensated care
  • Patients furnished services at either no cost or
    on a sliding scale.

13
Eligibility Patient Encounter
  • For the purposes of the Medicaid EHR Incentive
    Program, a patient encounter is defined as a
    unique patient, date-of-service, place-of-service
    combination
  • EPs may count encounters across any number of
    practice locations but must use at least one
    location that has an EHR that meets the AIU or
    meaningful use requirements.
  • EPs may include out-of-state encounters in their
    patient volume calculation

14
Eligibility Patient Encounter
  • A Medicaid encounter is any patient encounter
    where Medicaid (Title XIX, fee-for-service or
    managed care) paid for part or all of the
    services
  • Includes Medicaid payment of premiums, copays or
    other cost sharing.
  • A Needy Individual encounter (for EPs
    practicing predominantly in an FQHC only)
    include
  • Encounters where Medicaid or CHIP paid for part
    or all of the services
  • Encounters furnished at no cost, a sliding scale
    or as uncompensated care

15
Eligibility Patient Volume
  • EPs meeting the 30 Medicaid patient volume
    threshold are eligible for a full incentive
    payment
  • Pediatricians with 20-30 Medicaid patient volume
    are eligible for a 2/3 incentive payment.
  • EPs practicing predominantly in an FQHC and
    meeting the 30 Needy Individual patient volume
    threshold are eligible for a full incentive
    payment.

16
Eligibility Patient Volume
  • A group practice or clinic may use a single
    patient volume calculation for all of its
    providers, given these conditions
  • Each attesting individual provider has at least
    one Medicaid encounter
  • The single patient volume calculation must be
    from an auditable data source
  • The data from the entire group (not just certain
    providers) is used to perform the calculation
  • All provider attesting for the group use the same
    patient volume calculation

17
Patient Volume Calculation
  • Medicaid or Needy Individual encounter count for
    a selected 90 day period in the most recently
    completed calendar year divided by
  • Total patient encounters visits for the same 90
    day period
  • If the result is greater than 30 (20 for
    pediatricians), the professional is eligible for
    a Medicaid EHR Incentive Payment
  • All information used in calculating patient
    volume is subject to audit that could result in
    payment recoupment

18
Eligibility EHR Technology
19
Adopt, Implement or Upgrade (AIU)
  • EPs must demonstrate one of the following to
    receive a Year 1 incentive payment
  • Adopt Acquire, purchase, or secure access to
    certified EHR technology
  • Implement - Install or commence utilization of
    certified EHR technology
  • Upgrade - Expand the available functionality of
    certified EHR technology

20
Adopt, Implement or Upgrade (AIU)
  • Documentation proving AIU should be uploaded into
    the attestation system, and should include the
    following
  • Identification of the EHR technology being
    adopted or already in use
  • Signed contract or financial record indicating
    the purchase, acquisition or lease of certified
    EHR technology

21
Meaningful Use
  • Eligible Professionals must demonstrate
    meaningful use of certified EHR technology to
    receive Year 2 - 6 incentive payments
  • Meaningful Use Includes
  • Compliance with all 15 ONC Core Meaningful Use
    objectives
  • Compliance with 5 of the 10 Menu Set Meaningful
    Use objectives
  • All MU attestations may be subject to audit

22
Registration and Attestation
23
Registration and Attestation Timeline
  • November 7, 2011 National Level Repository
    registrations launched
  • December 2011 EHR Incentive Program Attestation
    System launches
  • January/February 2012 Initial EHR Incentive
    Program payments distributed

24
National Level Registration
  • CMS Administered Process with state verification
  • Verifies that the professional meets the basic
    demographic criteria to participate in the
    Medicaid EHR Incentive Program
  • Process begins at ehrincentives.cms.gov
  • Registration User Guide is available at
    www.nj.gov/njhit/ehr

25
National Level Registration
  • Information Needed to Complete the National Level
    Registration Process
  • Name of the eligible professional
  • National Provider Identifier (NPI)
  • Business address and phone number
  • Valid Email address
  • Taxpayer Identification Number (TIN) to which the
    professional would like their incentive payment
    made

26
State Level Attestation
  • Begins once National Level Registration is
    successfully completed
  • Allows professionals to enter their Medicaid or
    Needy Individual patient volume information and
    upload AIU documentation
  • Web-based application will be available within
    the provider portal section of www.njmmis.com
  • All information entered may be subject to audit
    that could result in recoupment

27
State Level Attestation
  • Information Needed to Complete Attestation
  • Medicaid Provider ID
  • 90 day period for patient volume calculation
  • Medicaid or Needy Individual encounters for the
    selected 90 day period
  • Total encounters for the selected 90 day period
  • Out-of-state Medicaid or Needy Individual
    encounters for the selected 90 day period
  • Total out-of-state encounters for the selected 90
    day period
  • CMS EHR Certification Number

28
State Level Attestation
  • Attestations must be completed for each year the
    EP wishes to receive an incentive payment
  • Once all information is entered, professionals
    will have 72 hours to change any information
    included in the attestation
  • The attestation system will verify all Medicaid
    information entered against information available
    in NJMMIS
  • Once all attestation information is verified,
    payment will be electronically distributed in 2-4
    weeks

29
State Level Attestation
  • EPs can designate another person to attest on
    their behalf

30
Payment Amounts and Schedule
31
Payment Information
  • 63,750 for most EPs, as follows
  • 21,250 in Year 1
  • 8,500 for all remaining program years
  • Pediatricians with patient volumes of 20-30 will
    receive 2/3 of the amounts shown above
  • Eligibility must be maintained for each payment
    year
  • Payments to EPs can be assigned to a group
    practice or clinic
  • Payments can be used to offset amounts owed to
    the Medicaid program

32
Additional Information
  • EHR Incentive Program Website
  • www.nj.gov/njhit/ehr
  • NJMMIS Provider Services
  • 1-800-776-6334, Option 7
  • Have your Medicaid Provider ID number ready
  • Program e-mail address
  • MAHS.ehrincentives_at_dhs.state.nj.us
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