Patient Volume Threshold (PVT) Massachusetts Medicaid EHR Incentive Program April 25, 2017 Today’s presenters: Thomas Bennett , MeHI Technical Assistance Team Elisabeth Renczkowski , Content Specialist
Disclaimer This presentation was current at the time it was presented, published or uploaded onto the web. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage attendees to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 2 Massachusetts eHealth Institute
Agenda Purpose of This Webinar What is Medicaid Patient Volume Threshold (PVT)? Selecting Your Strategy • PVT Prep Work Refining Your Strategy • Methodology – Individual vs. Group Proxy • Defining and Selecting Your PVT Reporting Period • Defining an Encounter – Paid Claims vs. Enrollees Calculating Your Patient Volume Threshold Data Entry and Supporting Documentation List of Data Elements Required Reassessing Your Strategy Common Issues Questions 3
Purpose of This Webinar
Purpose of This Webinar We want to help you: save time by getting it right the first time ensure the accuracy of your PVT data At the end of this session, participants will understand: the purpose of Medicaid PVT options and strategies to optimize PVT while minimizing headaches how to clean up and organize PVT data to eliminate errors 5
What is Patient Volume Threshold (PVT)?
What is Medicaid Patient Volume Threshold (PVT)? Medicaid patient volume determines if a provider is eligible for the Medicaid EHR Incentive Program • Ensures payments go only to providers who serve the target Medicaid population Eligible Professionals (EPs) must bill at least 30% of their encounters to Medicaid over a consecutive 90-day period • Includes Fee-For-Service (FFS) and Managed Care Organization (MCO) – see the Medicaid 1115 Waiver Population Grid for a complete list • Board-certified pediatricians can meet a 20% threshold and receive a reduced incentive • EPs who work at a Federally Qualified Health Center (FQHC) can include both needy individuals and Medicaid patients to meet the 30% threshold Patient volume eligibility must be demonstrated each year of participation; EPs must select a new reporting period every year PVT does not require use of the CEHRT; organizations may use their billing system to extract their volume 7
Selecting Your Strategy
Selecting Your Strategy Conduct a self-assessment to decide the most advantageous method for the Eligible Professional to meet the required eligibility threshold Learn about the options: The choices may seem confusing at first, but having a variety of options gives you a better chance of meeting the threshold • Individual vs. Group Proxy • Paid Claims vs. Enrollees • PVT reporting period options Try the simplest way first • Are there more than two EPs attesting for an incentive? • Can the EP satisfy the 30% threshold using volume from one site? • Can you extract the volume from your billing system? Pediatricians – try for 30% first 9
PVT Prep Work More than just data entry Several things to consider before reporting in MAPIR: How is the data extracted and compiled? EHR, separate system, 3 rd party biller, etc. • Assigning tasks – • Who is assigned to attest on behalf of the EP? - Acts as point of contact for MeHI staff - Completes MAPIR application - Uploads supporting documentation via MAPIR • Who verifies the accuracy of the patient volume detail? - Retrieves raw data and exports to Excel Organizes, formats, and “cleans up” data - - Confirms accurate numerator and denominator - Calculates PVT 10
Refining Your Strategy
Methodology: Individual vs. Group Proxy To determine Medicaid Patient Volume eligibility, EPs may use either individual data or the Group Proxy Methodology. Individual data: each EP uses only his/her own patient encounters to establish Medicaid PVT Group Proxy Methodology: all providers in the practice (including those not eligible for the Medicaid EHR Incentive Program) aggregate their data to determine the group’s Medicaid PVT • A group is defined as two or more EPs practicing at the same site • Please see our Group Proxy Guide for more information 12
Methodology: Individual vs. Group Proxy Once a method is selected, all attesting EPs must submit their applications using the same methodology • An organization cannot have some EPs who use individual data and others who use Group Proxy • Payment year and attestation phase (AIU vs. MU) do not impact Group Proxy – providers at different phases of the program can still attest as a group Group Proxy Methodology usually involves less administrative burden and often allows more EPs to participate Dr. Green 25% • Example: using individual data, Dr. Brown 35% Dr. Green would not qualify; Dr. Smith 35% aggregating the group’s data Dr. Jones 35% allows all five EPs to participate Dr. Johnson 35% Group Total 33% 13
Defining Reporting Periods The PVT reporting period is any 90-day period from either the previous calendar year or the 12-month period leading up to attestation • Simplest approach: choose one timeframe and stick to it Previous Calendar Year (CY) is always based on Program Year (PY), not the date of attestation • For example, for PY 2016 applications, the previous CY is 2015, regardless of when you attest (even if you attest in 2017) Meaningful Use (MU) reporting period vs. PVT reporting period • Both are 90 consecutive days* • PVT reporting period is always from either the previous CY or the 12-month period leading up to attestation • MU reporting period is within the Program Year *For Program Year 2016 and 2017, MU reporting period is 90 days; for Program Year 2018, MU reporting period is scheduled to be 365 days 14
Selecting Your PVT Reporting Period Keep in mind the PVT reporting period selected for the previous Program Year Program Attestation Timeframe PVT Reporting Period PVT Reporting Period Year Date Selected Options Selected 12-month period March 31, 2015 – April 1, 2015 – March 31, PY 2015 preceding 2016 March 30, 2016 June 29, 2015 attestation January 1, 2015 – March 31, 2015 July 1, 2015 – Previous CY PY 2016 May 1, 2017 ~~~~~~~~~~~~~~ (2015) September 28, 2015 June 30, 2015 – December 31, 2015 15
Selecting Your PVT Reporting Period, continued Organizations that used individual methodology for the previous Program Year and intend to use Group Proxy for the current Program Year should pay extra attention to reporting period(s) selected previously Program PVT Attestation Timeframe PVT Reporting PVT Reporting Year Method Date Selected Period Options Periods Selected Dr. Jones: March 1, 2015 – 12-month period May 29, 2015 January 20, 2015 – January 20, PY 2015 Individual preceding ~~~~~~~~~~~~~~ 2016 January 19, 2016 Dr. Smith: attestation August 1, 2015 – October 29, 2015 Group May 1, Previous CY PY 2016 None* Proxy 2017 (2015) *In this case, the organization would have to select a PVT reporting period from the 12-month period leading up to attestation (May 1, 2016 – April 30, 2017) 16
Selecting Your PVT Reporting Period – the “No - Fly Zone” 12-month period Month Previous CY preceding attestation January 2015 Yes February 2015 Yes March 2015 Yes April 2015 Yes May 2015 Yes June 2015 Yes July 2015 Yes August 2015 Yes September 2015 Yes October 2015 Yes November 2015 Yes December 2015 Yes January 2016 February 2016 No-Fly Zone March 2016 April 2016 May 2016 June 2016 Yes July 2016 Yes August 2016 Yes September 2016 Yes October 2016 Yes November 2016 Yes December 2016 Yes January 2017 Yes February 2017 Yes March 2017 Yes April 2017 Yes May 2017 Yes 17
Defining an Encounter – Paid Claims vs. Enrollees To determine patient volume eligibility, EPs may use either Medicaid paid claims or Medicaid enrollees. For EPs using paid claims, a patient encounter is defined as: One service, per patient, per day, where Medicaid or a Medicaid 1115 Waiver Population paid for all or part of the service rendered, or paid for all or part of the individual’s premiums, co -payments, or cost-sharing For EPs using the enrollee approach, a patient encounter is defined as: One service rendered to a Medicaid or Medicaid 1115 Waiver enrolled patient, regardless of payment liability. This includes zero-pay encounters and denied claims (excluding denied claims due to the patient being ineligible on the date of service) Please see the Medicaid 1115 Waiver Population Grid for a complete list of payers that are considered Medicaid 18
Calculating Your Patient Volume Threshold
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