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

occur 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

1

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

15

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

only 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

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MPIP Log In

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Provider NPI and Password

Enter NPI and Password – then click Log In

Enter NPI and Password –

then click Log In

Welcome to MPIP

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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

40

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

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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

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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

45

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

Step 3- MU Status: Menu Measures Summary

46

• 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

of 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

52

Eligible professionals will see an

overview of what they are attesting to

before clicking “Confirm & Submit”.

Step 4- MPIP Payment: Attestation Summary

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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!

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This is the confirmation number

of 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