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Electronic Health
Records (EHR)
Incentive Program
HP Provider Relations
October 2011
Agenda
– Session Objectives
– EHR Incentive Program:
• What is it?
• Eligible Provider Types
• What is Meaningful Use?
• How do you register?
• Audits
– Certified Technology
– Helpful Tools
– Questions
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Electronic Health Records (EHR) Incentive Program
October 2011
Objectives
Following this session, providers will:
–
Know if your provider type is eligible to receive EHR payments
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Grasp a basic understanding of Meaningful Use
–
Understand how to register to receive EHR payments
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Electronic Health Records (EHR) Incentive Program
October 2011
Explain
EHR Incentive Program
EHR Incentive Program
What is it?
• The American Recovery and Reinvestment Act (Recovery Act) of
2009 provides for incentive payments for eligible professionals
(EPs) and eligible hospitals (EHs) for efforts to adopt, implement,
upgrade, or meaningfully use certified EHR technology
– To qualify for EHR payments, EHR technology must be tested and
certified by an Office of the National Coordinator (ONC) Authorized
Testing and Certification Body
– EHR technologies that meet the certification requirements for the
Medicare and Medicaid EHR incentive programs are listed on the
ONC website: onc-chpl.force.com/ehrcert
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Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program
Who can participate?
• EHR incentive payments may be made to:
• Eligible professionals (EPs)
•
Physicians – Primarily doctors of medicine and doctors of osteopathy
•
Dentists
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Nurse practitioners
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Certified nurse midwives
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Physician assistants practicing in a Federally Qualified Health Center (FQHC) led by
a physician assistant
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Rural Health Clinic (RHC) led by a physician assistant
• Eligible hospitals (EHs)
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•
Acute care hospital (includes cancer and critical access hospitals)
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Children’s hospitals
Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program
Who can participate?
– EPs must meet patient volume criteria as follows:
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Minimum 30% patient volume attributable to Medicaid-funded services
For pediatricians, the patient volume minimum requirement is 20%
• EPs that practice at an FQHC/RHC must demonstrate that more than 50% of
their clinical encounters occurred at an FQHC/RHC over a six-month period,
and that they had a minimum 30% patient volume attributable to needy
individuals. Needy individuals are:
Those receiving medical assistance from Medicaid or the Children’s Health
Insurance Program (CHIP)
Individuals who are furnished uncompensated care by the provider
Individuals furnished services at either no cost or reduced cost based on a sliding
scale determined by the individual’s ability to pay
– Hospital-based providers are not eligible for the EHR incentive
program
•
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An EP is considered to be hospital-based when 90% of his or her services are
furnished in a hospital inpatient or emergency room setting
Electronic Health Records (EHR) Incentive Program
October 2011
Understand
Meaningful Use
Meaningful Use
– Federal law specifies three main components of meaningful use:
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The use of a certified EHR in a meaningful manner, such as e-prescribing
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The use of certified EHR technology for electronic exchange of health information to
improve quality of healthcare
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The use of certified EHR technology to submit clinical quality and other measures
– Criteria for meaningful use will be staged in three steps over the next
five years:
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•
Stage 1 (2011 and 2012): Set the baseline for electronic data capture and information
sharing
EPs must meet at least 20 of the 25 Stage 1 objectives to qualify for an EHR
payment
EHs must meet at least 19 of the 24 Stage 1 objectives to qualify for an EHR
payment
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Stage 2 (2013): An expansion of the criteria set in Stage 1
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Stage 3 (2015): A continued expansion of the criterion set in Stages 1 and 2.
Development of future stage criterion will be communicated through future Rule
making
Electronic Health Records (EHR) Incentive Program
October 2011
Meaningful Use
– To qualify for incentive payments, meaningful use requirements
must be met in the following ways:
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EPs and EHs must adopt, implement, upgrade, or demonstrate meaningful use in
their first year of participation in the incentive program
Meaningful use must be successfully demonstrated during subsequent
participation years
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Adopted: Acquired and installed certified EHR technology
Provider must be able to show evidence of installation
•
Implemented: Began using certified EHR technology
Can include staff training and data entry of patient demographics into EHR
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Upgraded: Expanded existing technology to meet certification requirements
An example includes adding new functionality to meet the definition of EHR
technology
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Electronic Health Records (EHR) Incentive Program
October 2011
Meaningful Use
Clinical quality measures
– To demonstrate meaningful use successfully, EPs and EHs are
required to report clinical quality measures
– EPs must report on six total clinical quality measures
– EHs must report on all 15 of their clinical quality measures
– To review the list of clinical quality measures, providers may access
cms.gov/QualityMeasures/03_ElectronicSpecifications.asp
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Electronic Health Records (EHR) Incentive Program
October 2011
Act
EHR Incentive Program Registration
EHR Incentive Program Registration
Eligible Professional (EP)
EPs and EHs register for the incentive program through a two-step
process:
1. Providers must register at the CMS Registration and Attestation
system at: https://ehrincentives.cms.gov/hitech/login.action
–
EPs enter:
• National Provider Identifier (NPI)
• National Plan and Provider Enumeration System (NPPES) User ID and
Password
• Payee Tax ID (if re-assigning EHR payments)
• Payee NPI (if re-assigning EHR payments)
–
EPs receive a CMS registration number
2. Register EHR system using the Provider Profile feature of Web
interChange
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Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program Registration
Eligible Hospital (EH)
EPs and EHs register for the incentive program through a two-step
process:
1. Providers must register at the CMS Registration and Attestation
system at: https://ehrincentives.cms.gov/hitech/login.action
–
EHs enter:
• National Provider Identifier (NPI)
• CMS Identity and Access Management (I & A) User ID and Password
• CMS Certification Number (CCN)
• Hospital Tax ID
–
EHs receive a CMS registration number
2. Register EHR system using the Provider Profile feature of Web
interChange
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Electronic Health Records (EHR) Incentive Program
October 2011
Click here to register for EHR
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Electronic Health Records (EHR) Incentive Program
October 2011
Helpful Tools
Avenues of resolution
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Electronic Health Records (EHR) Incentive Program
October 2011
Helpful Tools
Avenues of resolution
Enter the CMS registration
number and click Go
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Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program Registration
– EHR Incentive Program runs from 2011-2021
– EPs must register for EHR incentive payments no later than calendar
year (CY) 2016
– EHs must register for EHR incentive payments no later than federal
fiscal year (FFY) 2016
•
FFY begins October 1 and ends September 30
– EPs eligible for both the Medicare and Medicaid EHR programs must
choose which program they wish to participate
– EPs may not receive EHR incentive payments from both Medicare
and Medicaid programs in the same year
– Before 2015, an EP may switch one time between Medicare and
Medicaid to receive the EHR payment after the first EHR payment is
received
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Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program
Eligible Hospital (EH)
– Per federal rule, EHs must register for EHR incentive payments no
later than federal fiscal year (FFY) 2016
– FFY begins October 1 and ends September 30
– Acute care hospitals – including critical access hospitals (CAHs) –
must have a minimum of 10% Medicaid patient volume for each year
that the hospital seeks an EHR incentive payment
– Children’s hospitals do not have a patient volume threshold
– Payment calculation for EHs:
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•
(Overall EHR Amount) x (Medicaid Share)
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Payments are distributed over three years:
− Year 1: 50%
− Year 2: 40%
− Year 3: 10%
Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program
– The maximum incentive payment to an EP is $63,750 over a six-year
period ($42,500 for pediatricians)
– EPs must begin receiving payment no later than CY 2016
– The last year an EP can receive payments is 2021
Provider
EP
EP-Pediatrician
Patient Volume
30%
20-29%
Year 1
$21,250
$14,167
Year 2
8,500
5,667
Year 3
8,500
5,667
Year 4
8,500
5,667
Year 5
8,500
5,667
Year 6
8,500
5,667
$63,750
$42,500
Total Incentive
Payment
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Electronic Health Records (EHR) Incentive Program
October 2011
EHR Incentive Program
EHR statistics
During the period, May through October 19, 2011:
– 424 EHR applications were processed
– 269 EHR applications have been paid
– HP has paid $9,503,881 million
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Electronic Health Records (EHR) Incentive Program
October 2011
Examine
EHR Audits
EHR Audits
– Indiana providers receiving EHR incentive payments are subject to
audit by CMS (dually eligibles) or the Office of Medicaid Policy and
Planning Surveillance and Utilization Review
– Providers that attested to receive EHR incentive payments should
retain all supporting documentation (either paper or electronic format)
used in the completion of the attestation responses
• Retain documentation for six years post-attestation
– Providers should also retain documentation to support the clinical
quality measures reported to establish meaningful use
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Electronic Health Records (EHR) Incentive Program
October 2011
Certified
Technology
Certified Technology
– To qualify for EHR Incentive payments EHR technology must be
tested and certified by:
– The Office of the National Coordinator (ONC) Authorized Testing
and Certification Body (ATCB)
– Visit
http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3
120 to view a list of ONC ATCBs
– Vendors found in the above link are authorized to perform EHR
and/or EHR Module testing and certification
– Certification by an ATCB signifies that an EHR technology product
has the capabilities necessary to support efforts to meet the goals
and objectives of meaningful use
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Electronic Health Records (EHR) Incentive Program
October 2011
Certified Technology
– The ONC ATCBs test and certify EHRs to the certification criteria
adopted by the Secretary of the Department of Health and Human
Services
– EHR certification criteria is found under subpart C of Part 170 Part II
and Part III as stipulated in the Standards and Certification Criteria
Final Rule
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Electronic Health Records (EHR) Incentive Program
October 2011
Find Help
Resources Available
Helpful Tools
Avenues of resolution
– IHCP EHR Manual available at
indianamedicaid.com
– CMS Information Center
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1-888-734-6433
– HP EHR Customer Assistance
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1-855-856-9563, or
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(317) 488-5137 in the Indianapolis local area
– HP Written Correspondence
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P.O. Box 7263
Indianapolis, IN 46207-7263
– Provider field consultant
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Electronic Health Records (EHR) Incentive Program
October 2011
Q&A