Eligible Professionals Ohio Association of Community Health Centers - - PowerPoint PPT Presentation

Medicaid Provider Incentive Program

Presenters Emma Esmont, Management Analyst John Mack, Project Manager Elbony McIntyre, Project Manager

July 18, 2012

Meaningful Use for Eligible Professionals

Ohio Association of Community Health Centers

Agenda Topics

 RECAP

 Eligibility  Patient Volume  AIU

 Meaningful Use Overview  Meaningful Use in MPIP System

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RECAP

RECAP: MPIP Eligibility

 Eligible Professionals: physicians, optometrists,

dentists, certified nurse midwives, nurse practitioners and physician assistants (when practicing at an FQHC/RHC so led by a PA)

 An eligible professional cannot be hospital-based 

An eligible professional is hospital-based if 90% or more of his/her Medicaid encounters are furnished in an inpatient hospital (POS 21) or an emergency room (POS 23) setting in the calendar year prior to the payment year

 This exclusion does not apply to the eligible professional

qualifying as practicing predominantly through an FQHC or RHC

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RECAP: Patient Volume

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Eligible Participants Medicaid Patient Volume Requirements OR The eligible professional practices predominantly through an FQHC or RHC — 30% needy individual patient volume threshold Physicians 30%

• Pediatricians

20% Optometrist 30% Dentists 30% Certified Nurse Midwives 30% Nurse Practitioners 30% Physician Assistants (PAs) when practicing at an FQHC/RHC that is so led by a PA 30% An eligible professional practices predominantly if over 50% of an eligible professional’s total patient encounters over a period of six months in the most recent calendar year

• ccur through an FQHC/RHC.

 Any continuous 90-day period in the preceding calendar year

 Medicaid Patient Volume

Medicaid Patient Encounters – (Medicaid Patient Encounters * County SCHIP Factor) Total Patient Encounters

 Needy Individual Patient Volume

 Medicaid Patient Volume for eligible professionals practicing

predominantly through an FQHC/RHC

Needy Individual Patient Encounters Total Patient Encounters

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RECAP: Patient Volume Calculation

Reminder! Patient Volume Selection

 Pediatricians that do not have a Medicaid Patient Volume of

30%, but have a Medicaid Patient Volume of at least 20%, may attest as a Pediatrician.

 Eligible professionals practicing predominantly through an

FQHC/RHC that do not have a Medicaid Patient Volume of 30%, but have a Needy Individual Patient Volume of at least 30%, may attest as an eligible professional practicing predominantly through an FQHC/RHC.

 MPIP allows eligible professionals to enroll as part of a group

practice/clinic in order to meet Patient Volume thresholds

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

Eligible professionals must attest to adopting, implementing, or upgrading to certified EHR technology to be eligible for MPIP



Adopt: Acquiring, purchasing, or securing access to certified EHR technology



Implement: Installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements



Upgrade:



Expanding the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or



Upgrading from existing EHR technology to certified EHR technology per the EHR certification criteria published by the ONC

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RECAP: Year 1 AIU Requirement

Meaningful Use

What is Meaningful Use?

 To be eligible for incentives, eligible professionals must be

able to demonstrate that they are using certified EHR technology for three fundamental purposes:

 Meaningful use: e-prescribing, electronic patient health histories,

clinical decision support tools, and other meaningful uses

 Connectivity: connecting to other providers through a health

information exchange to improve access to the full view of a patient’s health history

 Reporting: Submitting information on clinical quality measures

and other measures in accordance with federal standards

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What is Meaningful Use?

 Meaningful use is using certified EHR technology to:

 Improve quality, safety, efficiency, and reduce health

disparities

 Engage patients and families in their health care  Improve care coordination  Improve population and public health  Maintain privacy and security

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Meaningful Use: A Staged Approach

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https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf

What is Meaningful Use: A Staged Approach

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Stage 2 implementation changed to 2014

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Meaningful Use Criteria – Stage 1

 Eligible professionals must complete:

 15 core objectives  5 of 10 menu set objectives  1 of 5 must be a public health measure  6 clinical quality measures (CQMs)  3 core or alternate core, 3 of 38 from menu set

 All measures have been pre-selected and defined

by CMS in collaboration with ONC

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15+ 5+ 6= MU

EHR Reporting Periods

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Payment Year Medicaid Incentive Program Only 1st payment year AIU 2nd payment year MU, 90 day reporting period 3rd payment year and subsequent MU, 12 month reporting period

Note: To be considered a meaningful EHR user, at least 50 percent of an eligible professional’s patient encounters during the EHR reporting period must occur at a practice/location or practices/locations equipped with certified EHR technology.

Switching Between the Medicare EHR incentive program and MPIP An eligible professional who switches to MPIP from the Medicare EHR incentive program is placed in the payment year that the eligible professional would have been in had the eligible professional begun in, and remained in, the Medicare EHR incentive payment program.

Applicability of Meaningful Use Objectives

 Some meaningful use objectives are not

applicable to every eligible professional’s clinical

• practice. In these cases, the eligible

professional would be excluded from meeting that specific objective

 e.g. a dentist who does not perform

immunizations, or a certified nurse mid-wife who does not e-prescribe

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Meaningful Use Denominators

Two types of percentage based measures are included in demonstrating meaningful use:

1.

Denominator = all patients seen during the EHR reporting period.



The denominator is all patients whether or not their records are kept using the EHR technology.

2.

Denominator = actions or subsets of patients seen during the EHR reporting period.



The denominator only includes patients, or actions taken on behalf of those patients, whose records are kept using the EHR technology.

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Important Definition

 Unique Patient

 If a patient is seen by an eligible professional

more than once during the EHR reporting period, then for purposes of measurement that patient is

• nly counted once in the denominator for the

measure

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Meaningful Use MPIP System

Meaningful Use in the MPIP System

 Enrollment  Attestation- 4 Steps

 (1) Registration Verification Status  (2) Patient Volume Status  (3) Meaningful Use Status  (4) MPIP Payment Status

 Confirmation Number

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 NPI # and Password

 Make a note of this information

 Save & Continue

 Make sure to select after entering

information (e.g. after completing each screen)

 Entered data will be saved prior to completing

entire attestation, which may be completed at a later date

 Always select & then Logout before

exiting MPIP

MPIP – Helpful Hints

21

MPIP Log In

22

Provider NPI and Password

Enter NPI and Password – then click Log In Enter NPI and Password – then click Log In

Welcome to MPIP

23

Page has the same look as AIU

Click Enrollment to begin Page has the same look as AIU Click Enrollment to begin Page similar to AIU

Enrollment Home

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The top record will begin the MU attestation process

Click Enroll to start MU attestation for calendar year 2012 Note: ‘Paid’ status is from Payment Year 1

Step 1- Registration

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Basic questions, same questions as AIU

Verify all Registration Information To update your National Provider Information, go to the CMS web site at the following link: https://ehrincentives.cms.gov/hitech/login.action

Step 1- Registration

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Click “Yes” if enrolling as a group Who the payment is assigned to

Same questions asked as in AIU If using needy individual patient volume, select “yes” and select affiliated FQHC/RHC

Step 1- Registration: Group Practice

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Click “Yes” if enrolling as a group Who the payment is assigned to

Click the Radio button “Yes” if enrolling as a group

Step 1- Provider Registration: Group Selection

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This will show the groups associated with this NPI or an eligible professional can create a group

Step 1- Registration: Payment Assignment

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The Payee ID selected for the previous payment year will be displayed by default. Click Select Medicaid ID if you want to change/update the Payee.

Click the radio button to select a payee and then click Select & Continue to save the payee ID and return to the Enrollment Status page

Completion of Step 1

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The Payee ID selected for the previous payment year will be displayed by default. Click Select Medicaid ID if you want to change/update the Payee. Click the radio button to selected a payee and then Select & Continue to save the payee ID and return to the Enrollment Status page

If all information is correct, select Save & Continue to navigate to Step 2 – Medicaid Patient Volume Determination

Step 2- Medicaid Patient Volume

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Select Start Date for 3-month reporting period – for Patient Volume determination If using out-of-state encounters, select Yes. Identify which States/Territories. Select the county in which your are located to display the applicable SCHIP Percentage.

Step 2- Patient Volume Continued

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Enter Medicaid encounters and Total Patient encounters for 3-month period Upload supporting documentation then click Save & Continue to proceed to Step 3

Step 2- Needy Individual Patient Volume

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If using Needy Individual Patient Volume, the SCHIP factor is not applied Enter Needy Individual Patient encounters and Total Patient encounters for 3-month period Upload supporting documentation then click Save & Continue to proceed to Step 3

Step 3- MU Status: Summary of Measures

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Enter encounters associated with EHR

Select Start MU Info Attestation

Step 3- MU Status: EHR Technology

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90 day reporting period, in current CY Adding EHR location System will EHR Certification ID from previous payment year If using the same certified EHR solution from previous payment year, select Yes then Save & Continue

Step 3- MU Status: EHR Technology cont.

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90 day reporting period, in current CY Adding EHR location

New CMS EHR Certification ID

If using a different EHR from the previous year:

• Enter new CMS EHR Certification ID
• Select No Radio Button
• Check type(s) of Documentation for upload
• Must be legally and/or financially binding
• Upload documents (required)
• Save & Continue after document upload

Step 3- MU Status: EHR Technology cont.

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90 day reporting period, in current CY Adding EHR location Selecting Save & Continue at Step 3 – will initiate the ONC Web Service to validate the CMS EHR Certification ID. If unsuccessful, the user will be prompted to enter a valid Certification ID.

Step 3 MU Status: Reporting Period

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This is the information needed if adding an EHR location

Select Start and End Date for MU EHR reporting period

• Must be at least 90 days for first MU Attestation
• Reporting period for subsequent MU attestations is 365 days

Click to add a location of an EHR

Step 3- MU Status: Adding EHR Location

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Step 3 MU Status: Patient Encounters

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This is the information needed if adding an EHR location

> 80% of Unique Patients is required for certain MU Objectives

Step 3- MU Status: Summary of Measures

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Enter encounters associated with EHR

Select Start MU Info Attestation

Step 3- MU Status: Core Measures- Y/N

42

Example of a YES/NO Measure Select Yes if functionality was enabled for the length of the MU EHR reporting period, then select Save & Continue

Step 3- MU Status: Core Measures- N/D

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Example of a Numerator/Denominator Measure

Step 3- MU Status: Core Measures- Exclusion

44 Exclusion – Example: Eligible professional sees no patients 13 or younger. If exclusion applies – Eligible professional does not report numerator & denominator for the measure.

Example of an Exclusion Measure

Step 3- MU Status: Core Measures Summary

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Click on the “Pencil” icon to edit any of the MU info entered

Step 3- MU Status: Menu Measures Summary

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• Eligible professional must report on at least 5 Menu Set measures
• At least 1 of the 5 must be a Public Health measure:
• Immunization registry
• Syndromic surveillance
• Lab results (EH only)

At least one

• f these

Step 3- MU Status: Menu Measure- Public Health

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Immunizations

Exclusion applies if an eligible professional did not perform immunizations during reporting period

Eligible professionals must perform at least one test of electronic submission to immunization registry

Indicate if the test was successful Follow-up submission is required if test is successful

Step 3- MU Status: Menu Measure

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Select Radio buttons, then enter numerator and

• denominator. Once

entered, click Save & Continue to Proceed.

Step 3- MU Status: CQM Summary

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Clinical Quality Measures (CQMs)

• Eligible professionals must report on 6 (3 from core/3 from a set of 38)
• CQM results must be generated from the certified EHR system
• Zero (0) is an acceptable CQM denominator value if that value was

generated by the certified EHR technology

Step 3- MU Status: CQM Measure

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Enter Numerator and Denominator

Step 4- MPIP Payment Status

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Step 4- MPIP Payment: Overview

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Eligible professionals will see an

• verview of what they are attesting to

before clicking “Confirm & Submit”.

Step 4- MPIP Payment: Attestation Summary

53

Summary of what the eligible professional is attesting to

Step 4- MPIP Payment: Legal Notice

54

Agree & Continue

Step 4- MPIP Payment: Submission

55

One more chance to review Enrollment Summary before submitting attestation

Medicaid MU Attestation Complete!

56

This is the confirmation number

• f the completed attestation

Additional Meaningful Use Resources

 Public Health Reporting ODH websites:

 Immunizations

 https://odhgateway.odh.ohio.gov/impact/

 Electronic Laboratory Reporting

 http://www.odh.ohio.gov/odhPrograms/dis/orbitdis/elr1.aspx

 Syndromic Surveillance

 http://www.odh.ohio.gov/odhPrograms/dis/orbitdis/smedu/

SMEDMainPage.aspx

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Additional Meaningful Use Resources



State Rule



Ohio Administrative Code 5101:3-57



CMS EHR Incentive Programs



https://www.cms.gov/EHRincentivePrograms/



CMS EHR Meaningful Use Overview



https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp#TopOfPage



MU Specification Sheets for Eligible Professionals (Core & Menu Measures)



http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

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Contact Us!

 MPIP Website

 http://www.jfs.ohio.gov/ohp/HIT%20Program.stm

 Send us an email! MPIP@jfs.ohio.gov  Or call us at 1-877-JFS-MPIP

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Questions