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2014 Annual Medicaid ConferenceNevada Incentive Payment Programfor Electronic Records12014 Annual Medicaid Conference
Objectives To promote an understanding of the Medicaid EHRIncentive Program To determine eligibility criteria To understand program participation criteria To learn how to navigate through to CMS andState Registration page Questions and Answers22014 Annual Medicaid Conference
Overview The American Recovery and Reinvestment Act (ARRA)of 2009 included as much as 27 billion to beexpended over 10 years to support the adoption ofelectronic health records (EHRs). Enacted as part of ARRA, the Health InformationTechnology for Economic and Clinical Health Act(HITECH Act) supports the adoption of electronichealth records by providing financial incentives underMedicare and Medicaid to hospitals and eligibleprofessionals who adopt, implement, upgrade, anddemonstrate "meaningful use" of certified EHRtechnology.32014 Annual Medicaid Conference
Why EHRs? EHRs support complete, accurate, andsearchable health information, available at the pointof diagnosis and care, allowing for more informeddecision-making to enhance the quality and reliability ofhealth care. EHRs support more-efficient and convenientdelivery of care, without having to wait for theexchange of records or paperwork and without requiringunnecessary or repetitive tests or procedures. EHRs support earlier diagnosis andcharacterization of disease, with the potential toimprove health outcomes and reduce costs.42014 Annual Medicaid Conference
Why EHRs? EHRs support reductions in adverse eventsthrough an improved understanding of each patient'sparticular medical history. For example, identification of apatient's potential for drug/drug interactions through theuse of an EHR could decrease the likelihood of apotentially harmful response to a course of treatment. EHRs support increased efficiency inadministrative tasks, allowing for more interaction withand transfer of information to patients, caregivers, andclinical care coordinators. They also improve themonitoring of patient care.52014 Annual Medicaid Conference
EP Program Eligibility Eligible Professionals (EPs) under the Medicaidprogram include:– physicians (doctors of medicine (MDs) and doctors ofosteopathy (ODs));– dentists;– certified nurse midwives;– nurse practitioners; and– physician assistants who practice predominately at aFederally Qualified Health Center, Rural Health Clinic orIndian Heath Programs Clinic that is also led by aphysician assistant.62014 Annual Medicaid Conference
EP Program Eligibility continued To qualify for participation in the Medicaid EHRIncentive Program, an eligible professional must alsomeet one of the following criteria:– Have a minimum 30% Medicaid patient volume– Have a minimum 20% Medicaid patient volume, and be apediatrician EPs can participate only in one program, MedicaidIncentive Program or Medicare Incentive Program. EPs can receive Medicaid Incentive Payment from onlyone state per year. EPs can switch programs only one time.72014 Annual Medicaid Conference
EH Program Eligibility Eligible Hospitals (EHs) under the Medicaidprogram include:– Acute Care Hospitals.– CAHs and cancer hospitals.– Children's Hospitals. To qualify for participation in the Medicaid EHRIncentive Program, an EH must also meet the followingcriteria:– Have an average length of patient stay of 25 days or fewer– Have a CMS Certification Number (CCN) that has the last fourdigits in the series 0001-0879 or 1300-1399.– Meet a 10 percent Medicaid patient volume threshold. There isno Medicaid patient volume requirement for children’s hospitals.82014 Annual Medicaid Conference
Are Hospital Based EPs Eligible? Hospital Based EPs are excluded from receivingincentive payments. If 90% or more of an EP's services take place at asetting of "inpatient hospital" or "emergency room,"the EP is not eligible for the incentive payments.92014 Annual Medicaid Conference
What is an Encounter? An "encounter," for the purpose of calculating patientvolume, is defined as:– Services rendered on any one day to an individual where Medicaidpaid for part or all of the service; or– Services rendered on any one day to an individual where Medicaidpaid all or part of their premiums, co-payments and/or cost-sharing. Medicaid encounter volumes include patients enrolled inNevada Medicaid managed care plans. The Medicaid patient volume calculation can includedenied claims and claims data with zerodollar payments. RQHC/RHC/IHP can also use medically needy patientencounters.102014 Annual Medicaid Conference
Program Incentives Eligible professionals incentives:– Up to 63,750 over the six years– First year payment of 21,250– Must begin by 2016 to receive all payments Eligible hospitals incentives:– Based on volume– NV hospitals have received from 31,000 to 2.9million. Incentives available through 2021112014 Annual Medicaid Conference
Maximum Incentive Payments per ProfessionalAdoption YearPayment Year30% Professional20% PediatricianYear 1 21,250 14,167Year 2 8,500 5,667Year 3 8,500 5,667Year 4 8,500 5,667Year 5 8,500 5,666 8,500 5,666 63,750 42,500Year 6(up to 2021)Total122014 Annual Medicaid Conference
Applying for Incentive Payments How do I apply:– Must apply online and be approved through theMedicare & Medicaid EHR Incentive ProgramRegistration and Attestation System before Stateapplication can proceed– Registration received within 48 hours from CMS– Must apply through the Nevada State Level Process132014 Annual Medicaid Conference
Applying for Incentive Payments What do I need to apply:National Provider Identifier (NPI)Tax Identification Number (TIN) or Social Security NumberNPI and TIN of payee if assigning incentive payment to a group practiceAIU – Copy of Contract, Invoice, or Purchase OrderEHR Certification Number (2011 or 2014)2014 CEHRT required for Program Year 201530% Medicaid patient volume for chosen reporting period (20% forPediatricians)– Patient Encounters detailed information (Patient and Provider Name, Date,Location and Payer)– A list of all insurance payers used for Medicaid patient volume calculation– Professional License number and Licensing Board name––––––– CMS registration and MMIS enrollment information mustmatch. Please update your provider enrollment to include themost recent information.142014 Annual Medicaid Conference
CMS Registration 52014 Annual Medicaid Conference
NIPPER Program Registration162014 Annual Medicaid Conference
Nevada Attestationhttp://www.medicaid.nv.gov/172014 Annual Medicaid Conference
NIPPER Program RegistrationEnrollment00000000000182014 Annual Medicaid Conference00000000
NIPPER Program RegistrationEnrollment192014 Annual Medicaid Conference
Confused about“Meaningful Use”?202014 Annual Medicaid Conference
Meaningful Use Meaningful Use is using certified EHR technology ina meaningful manner; ensuring that the certified EHRtechnology is connected in a manner that provides forthe electronic exchange of health information to improvethe quality of care. Goals of Meaningful Use:–––––21Engage patients and families in their health careImprove quality of careImprove care coordinationImprove population and public healthAll the while maintaining privacy and security2014 Annual Medicaid Conference
MU Stage 1 vs. MU Stage 2 Throughout the program, EPs and EHs must demonstrateincreasing levels of meaningful use.– Eligible Professionalsmust complete: 13 core objectives 5 objectives out of 9from menu setobjectives– Hospitals mustcomplete: 11 core objectives 5 objectives out of10 from menu set222014 Annual Medicaid Conference– Eligible Professionalsmust complete: 17 core objectives 3 menu objectivesout of 6 from menuset objectives– Hospitals mustcomplete: 16 core objectives 3 objectives out of 6from menu set
Meaningful Use for Professionals232014 Annual Medicaid Conference
Program Participation Timeline Adopt, Implement or Upgrade (AIU) or 90 daysMeaningful Use (MU) Stage 1 90 Days Meaningful Use (MU) Stage 1 365 Days Meaningful Use (MU) Stage 2 365 Days MU Stage 2 365 Days MU Stage 3 365 Days MU**Year 2014 MU requirement is 90 days242014 Annual Medicaid Conference
Program Data System/Program Implementation 8/6/2012 EH’s Paid– 28 EP’s Paid– 365 Total Dollars Paid YTD– 35,122,447.90252014 Annual Medicaid Conference
ProgramData Statewide262014 Annual Medicaid Conference
Program Data – Southern Nevada272014 Annual Medicaid Conference
ProgramData –NorthernNevada282014 Annual Medicaid Conference
EHR Program Information and Contacts DHHS - Division of Health Care Financing and r.Milicevic@dhcfp.nv.gov Tel: 775-684-3733or NevadaHIT@dhcfp.nv.gov CGI Business ServicesNV Support@NVEHRSupport.com Tel: 888-639-3452 CMS EHR Information slation/EHRIncentiveProgramsTel: 888-734-6433 Regional Extension : 702-385-9933292014 Annual Medicaid Conference
EH Program Eligibility Eligible Hospitals (EHs) under the Medicaid program include: -Acute Care Hospitals. -CAHs and cancer hospitals. -Children's Hospitals. To qualify for participation in the Medicaid EHR Incentive Program, an EH must also meet the following criteria: -Have an average length of patient stay of 25 days or fewer
