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New Jersey Medicaid EHR Incentive Program Hospital Overview

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Title: New Jersey Medicaid EHR Incentive Program Hospital Overview


1
New Jersey Medicaid EHR Incentive
Program Hospital Overview
2
Presentation Summary
  • Medicaid EHR Incentive Program Overview
  • Eligibility
  • Adopt, Implement, Upgrade, and Meaningful Use
    Definitions
  • Payment Calculation 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 hospitals as they
    adopt, implement, or upgrade certified EHR
    technology in their first year of participation
    and demonstrate meaningful use for two additional
    years.

5
Program Overview
  • Incentive payments to hospitals will begin being
    distributed in January February 2012.
  • The last year a Medicaid eligible hospital may
    begin the program is 2016.
  • Hospital payments will vary by facility based on
    hospital size and Medicaid concentration
  • Hospitals may receive payments from BOTH the
    Medicare and Medicaid EHR Incentive Programs

6
Eligibility
7
Eligibility
  • Acute Care Hospitals
  • General hospitals, cancer hospitals and critical
    access hospitals
  • Average length of patient stay of 25 days or
    fewer
  • CMS Certification Number (CCN) with the last four
    digits in the series 0001 0879 and 1300-1399
  • 10 Medicaid Patient Volume based on encounters
  • Childrens Hospitals
  • CCN with last four digits in the series 3300
    3399
  • No patient volume requirement

8
Eligibility Medicaid Encounter
  • A hospital encounter occurs only in a hospitals
    inpatient department, or emergency department on
    any one day
  • One Medicaid encounter is tallied
  • For each inpatient discharge IF Medicaid paid for
    any part of the patients stay, and
  • For each emergency department visit (no more than
    one per patient per day), IF Medicaid paid for
    any part of that ER visit.

9
Patient Volume Calculation
  • Medicaid Encounter count for a selected 90 day
    period divided by
  • Total inpatient discharges emergency room
    visits for the same period
  • If the total is greater than 10, the hospital is
    eligible for a Medicaid EHR Incentive Payment
  • New Jersey Medicaid recommends that hospitals use
    their Medicare or Medicaid cost reports for all
    calculations.

10
Adopt, Implement, Upgrade and Meaningful Use
11
Adopt, Implement or Upgrade (AIU)
  • Hospitals must demonstrate one of these 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

12
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

13
Meaningful Use
  • Hospitals must demonstrate meaningful use to
    receive Year 2 and 3 incentive payments
  • Meaningful Use Includes
  • Compliance with all 14 ONC Core Meaningful Use
    objectives
  • Compliance with 5 of the 10 Menu Set Meaningful
    Use objectives
  • All meaningful use attestations will be subject
    to audits performed by CMS

14
Payment Calculation and Schedule
15
Payment Calculation Basics
  • Payment is calculated once and will be
    distributed over three years
  • 50 Year 1, 40 Year 2, 10 year 3
  • Complex formula based on projected hospital
    discharge growth rates and Medicaid patient
    volume
  • EHR Incentive Program Payment System will perform
    the calculation
  • More detail on the calculation formula is
    available at www.nj.gov/njhit/ehr.

16
Payment Calculation Information Needed
  • Total acute inpatient discharges for the last 4
    completed hospital fiscal years
  • Total acute inpatient bed days for the entire
    hospital fiscal year completed in the most
    recently completed federal fiscal year
  • Acute inpatient bed days which Medicaid (Title
    XIX only, fee-for-service or managed care) paid a
    share of for the same hospital fiscal year
  • Excluding Medicaid/Medicare dual eligible days

17
Payment Calculation Information Needed
  • Total charges for the hospital fiscal year
    completed in the most recently completed federal
    fiscal year
  • Total Charity Care charges for the hospital
    fiscal year completed in the most recently
    completed hospital fiscal year

18
Payment Calculation Additional Points
  • Recommended Data Sources
  • Medicare Cost Reports
  • Medicaid Cost Reports
  • Financial Statements or Accounting Records
  • Six page description of the payment calculation
    process is available at http//www.nj.gov/njhit/ho
    spitals/calculation

19
Registration and Attestation
20
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

21
National Level Registration
  • CMS Administered Process with state verification
  • Verifies that hospital meets the basic
    eligibility criteria for the Medicaid EHR
    Incentive Program
  • Opened for the New Jersey Medicaid EHR Incentive
    Program on 11/7/11

22
National Level Registration
  • Hospitals that already registered as
    dually-eligible for the Medicaid and Medicare
    programs have already completed this process
  • Hospitals that have never registered can go to
    ehrincentives.cms.gov to begin the process
  • Registration User Guide is available at
    www.nj.gov/njhit/ehr

23
National Level Registration
  • Information Needed to Complete the Process
  • Name of the eligible hospital
  • National Provider Identifier (NPI)
  • Provider Enrollment, Chain, and Ownership System
    (PECOS) Provider Number
  • CCN (CMS Certification Number)
  • Business address and phone number
  • Valid Email address
  • Taxpayer Identification Number (TIN)

24
State Level Attestation
  • Begins once NLR Registration is successfully
    completed
  • Allows hospitals to enter their Medicaid patient
    volume information, upload AIU documentation, and
    enter information needed for payment calculation
  • Application will be available within the provider
    portal section of www.njmmis.com
  • All information entered will be subject to audit
    that could result in recoupment

25
State Level Attestation
  • Information Needed to Complete Attestation
  • Medicaid Provider ID
  • 90 day period for patient volume calculation
  • Medicaid Fee-for-Service and Managed Care
    encounters for the selected 90 day period
  • Total encounters for the selected 90 day period
  • Any out-of-state Medicaid fee-for-service or
    managed care patient encounters
  • Total discharges for the four most recently
    completed hospital fiscal years

26
State Level Attestation
  • Information Needed to Complete Attestation
  • Medicaid fee-for-service and managed care acute
    inpatient bed days for the most recently
    completed hospital fiscal year
  • Total acute inpatient bed days for the most
    recently completed hospital fiscal year
  • Total Hospital Charges (including Charity Care
    charges)
  • Charity Care Charges
  • CMS EHR Certification Number

27
State Level Attestation
  • Additional Attestation Information
  • Once all information is entered, hospitals 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
  • New Jersey Medicaid recommends using Medicare
    cost reports to complete the attestation process.
    The lines that should be used are available at
    www.nj.gov/njhit/ehr

28
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
  • Program e-mail address
  • MAHS.ehrincentives_at_dhs.state.nj.us
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