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New Jersey Medicaid EHR Incentive Program Hospital Overview.

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Presentation on theme: "New Jersey Medicaid EHR Incentive Program Hospital Overview."— Presentation transcript:

1 New Jersey Medicaid EHR Incentive Program Hospital Overview

2 Presentation Summary Medicaid EHR Incentive Program Overview Medicaid EHR Incentive Program Overview Eligibility Eligibility Adopt, Implement, Upgrade, and Meaningful Use Definitions Adopt, Implement, Upgrade, and Meaningful Use Definitions Payment Calculation and Schedule Payment Calculation and Schedule Registration and Attestation Registration and Attestation Questions and Answers Questions and Answers

3 Program Overview

4 The Medicaid EHR Incentive Program will provide incentive payments to eligible hospitals as they adopt, implement, or upgrade certified EHR technology in their first year of participation and demonstrate meaningful use for two additional years. The Medicaid EHR Incentive Program will provide incentive payments to eligible hospitals as they adopt, implement, or upgrade certified EHR technology in their first year of participation and demonstrate meaningful use for two additional years.

5 Program Overview Incentive payments to hospitals will begin being distributed in January – February Incentive payments to hospitals will begin being distributed in January – February The last year a Medicaid eligible hospital may begin the program is The last year a Medicaid eligible hospital may begin the program is Hospital payments will vary by facility based on hospital size and Medicaid concentration Hospital payments will vary by facility based on hospital size and Medicaid concentration Hospitals may receive payments from BOTH the Medicare and Medicaid EHR Incentive Programs Hospitals may receive payments from BOTH the Medicare and Medicaid EHR Incentive Programs

6 Eligibility

7 Eligibility Acute Care Hospitals Acute Care Hospitals General hospitals, cancer hospitals and critical access hospitals General hospitals, cancer hospitals and critical access hospitals Average length of patient stay of 25 days or fewer Average length of patient stay of 25 days or fewer CMS Certification Number (CCN) with the last four digits in the series 0001 – 0879 and CMS Certification Number (CCN) with the last four digits in the series 0001 – 0879 and % Medicaid Patient Volume based on encounters 10% Medicaid Patient Volume based on encounters Childrens Hospitals Childrens Hospitals CCN with last four digits in the series 3300 – 3399 CCN with last four digits in the series 3300 – 3399 No patient volume requirement No patient volume requirement

8 Eligibility: Medicaid Encounter A hospital encounter occurs only in a hospitals inpatient department, or emergency department on any one day A hospital encounter occurs only in a hospitals inpatient department, or emergency department on any one day One Medicaid encounter is tallied: One Medicaid encounter is tallied: For each inpatient discharge IF Medicaid paid for any part of the patients stay, and For each inpatient discharge IF Medicaid paid for any part of the patients stay, and For each emergency department visit (no more than one per patient per day), IF Medicaid paid for any part of that ER visit. For each emergency department visit (no more than one per patient per day), IF Medicaid paid for any part of that ER visit.

9 Patient Volume Calculation Medicaid Encounter count for a selected 90 day period divided by Medicaid Encounter count for a selected 90 day period divided by Total inpatient discharges + emergency room visits for the same period Total inpatient discharges + emergency room visits for the same period If the total is greater than 10%, the hospital is eligible for a Medicaid EHR Incentive Payment If the total is greater than 10%, the hospital is eligible for a Medicaid EHR Incentive Payment New Jersey Medicaid recommends that hospitals use their Medicare or Medicaid cost reports for all calculations. New Jersey Medicaid recommends that hospitals use their Medicare or Medicaid cost reports for all calculations.

10 Adopt, Implement, Upgrade and Meaningful Use

11 Adopt, Implement or Upgrade (AIU) Hospitals must demonstrate one of these to receive a Year 1 incentive payment: Hospitals must demonstrate one of these to receive a Year 1 incentive payment: Adopt – Acquire, purchase, or secure access to certified EHR technology Adopt – Acquire, purchase, or secure access to certified EHR technology Implement - Install or commence utilization of certified EHR technology Implement - Install or commence utilization of certified EHR technology Upgrade - Expand the available functionality of certified EHR technology Upgrade - Expand the available functionality of certified EHR technology

12 Adopt, Implement or Upgrade (AIU) Documentation proving AIU should be uploaded into the attestation system, and should include the following: Documentation proving AIU should be uploaded into the attestation system, and should include the following: Identification of the EHR technology being adopted or already in use Identification of the EHR technology being adopted or already in use Signed contract or financial record indicating the purchase, acquisition or lease of certified EHR technology Signed contract or financial record indicating the purchase, acquisition or lease of certified EHR technology

13 Meaningful Use Hospitals must demonstrate meaningful use to receive Year 2 and 3 incentive payments Hospitals must demonstrate meaningful use to receive Year 2 and 3 incentive payments Meaningful Use Includes: Meaningful Use Includes: Compliance with all 14 ONC Core Meaningful Use objectives Compliance with all 14 ONC Core Meaningful Use objectives Compliance with 5 of the 10 Menu Set Meaningful Use objectives Compliance with 5 of the 10 Menu Set Meaningful Use objectives All meaningful use attestations will be subject to audits performed by CMS All meaningful use attestations will be subject to audits performed by CMS

14 Payment Calculation and Schedule

15 Payment Calculation Basics Payment is calculated once and will be distributed over three years: Payment is calculated once and will be distributed over three years: 50% Year 1, 40% Year 2, 10% year 3 50% Year 1, 40% Year 2, 10% year 3 Complex formula based on projected hospital discharge growth rates and Medicaid patient volume Complex formula based on projected hospital discharge growth rates and Medicaid patient volume EHR Incentive Program Payment System will perform the calculation EHR Incentive Program Payment System will perform the calculation More detail on the calculation formula is available at More detail on the calculation formula is available at

16 Payment Calculation: Information Needed Total acute inpatient discharges for the last 4 completed hospital fiscal years Total acute inpatient discharges for the last 4 completed hospital fiscal years Total acute inpatient bed days for the entire hospital fiscal year completed in the most recently completed federal fiscal year Total acute inpatient bed days for the entire hospital fiscal year completed in the most recently completed federal fiscal year Acute inpatient bed days which Medicaid (Title XIX only, fee-for-service or managed care) paid a share of for the same hospital fiscal year Acute inpatient bed days which Medicaid (Title XIX only, fee-for-service or managed care) paid a share of for the same hospital fiscal year Excluding Medicaid/Medicare dual eligible days Excluding Medicaid/Medicare dual eligible days

17 Payment Calculation: Information Needed Total charges for the hospital fiscal year completed in the most recently completed federal fiscal year Total charges for the hospital fiscal year completed in the most recently completed federal fiscal year Total Charity Care charges for the hospital fiscal year completed in the most recently completed hospital fiscal year Total Charity Care charges for the hospital fiscal year completed in the most recently completed hospital fiscal year

18 Payment Calculation: Additional Points Recommended Data Sources: Recommended Data Sources: Medicare Cost Reports Medicare Cost Reports Medicaid Cost Reports Medicaid Cost Reports Financial Statements or Accounting Records Financial Statements or Accounting Records Six page description of the payment calculation process is available at Six page description of the payment calculation process is available at

19 Registration and Attestation

20 Registration and Attestation Timeline November 7, 2011 – National Level Repository registrations launched November 7, 2011 – National Level Repository registrations launched December 2011 – EHR Incentive Program Attestation System launches December 2011 – EHR Incentive Program Attestation System launches January/February 2012 – Initial EHR Incentive Program payments distributed January/February 2012 – Initial EHR Incentive Program payments distributed

21 National Level Registration CMS Administered Process with state verification CMS Administered Process with state verification Verifies that hospital meets the basic eligibility criteria for the Medicaid EHR Incentive Program Verifies that hospital meets the basic eligibility criteria for the Medicaid EHR Incentive Program Opened for the New Jersey Medicaid EHR Incentive Program on 11/7/11 Opened for the New Jersey Medicaid EHR Incentive Program on 11/7/11

22 National Level Registration Hospitals that already registered as dually- eligible for the Medicaid and Medicare programs have already completed this process Hospitals that already registered as dually- eligible for the Medicaid and Medicare programs have already completed this process Hospitals that have never registered can go to ehrincentives.cms.gov to begin the process Hospitals that have never registered can go to ehrincentives.cms.gov to begin the process ehrincentives.cms.gov Registration User Guide is available at Registration User Guide is available at

23 National Level Registration Information Needed to Complete the Process: Information Needed to Complete the Process: Name of the eligible hospital Name of the eligible hospital National Provider Identifier (NPI) National Provider Identifier (NPI) Provider Enrollment, Chain, and Ownership System (PECOS) Provider Number Provider Enrollment, Chain, and Ownership System (PECOS) Provider Number CCN (CMS Certification Number) CCN (CMS Certification Number) Business address and phone number Business address and phone number Valid address Valid address Taxpayer Identification Number (TIN) Taxpayer Identification Number (TIN)

24 State Level Attestation Begins once NLR Registration is successfully completed Begins once NLR Registration is successfully completed Allows hospitals to enter their Medicaid patient volume information, upload AIU documentation, and enter information needed for payment calculation Allows hospitals to enter their Medicaid patient volume information, upload AIU documentation, and enter information needed for payment calculation Application will be available within the provider portal section of Application will be available within the provider portal section of All information entered will be subject to audit that could result in recoupment All information entered will be subject to audit that could result in recoupment

25 State Level Attestation Information Needed to Complete Attestation: Information Needed to Complete Attestation: Medicaid Provider ID Medicaid Provider ID 90 day period for patient volume calculation 90 day period for patient volume calculation Medicaid Fee-for-Service and Managed Care encounters for the selected 90 day period Medicaid Fee-for-Service and Managed Care encounters for the selected 90 day period Total encounters for the selected 90 day period Total encounters for the selected 90 day period Any out-of-state Medicaid fee-for-service or managed care patient encounters Any out-of-state Medicaid fee-for-service or managed care patient encounters Total discharges for the four most recently completed hospital fiscal years Total discharges for the four most recently completed hospital fiscal years

26 State Level Attestation Information Needed to Complete Attestation: Information Needed to Complete Attestation: Medicaid fee-for-service and managed care acute inpatient bed days for the most recently completed hospital fiscal year Medicaid fee-for-service and managed care acute inpatient bed days for the most recently completed hospital fiscal year Total acute inpatient bed days for the most recently completed hospital fiscal year Total acute inpatient bed days for the most recently completed hospital fiscal year Total Hospital Charges (including Charity Care charges) Total Hospital Charges (including Charity Care charges) Charity Care Charges Charity Care Charges CMS EHR Certification Number CMS EHR Certification Number

27 State Level Attestation Additional Attestation Information: Additional Attestation Information: Once all information is entered, hospitals will have 72 hours to change any information included in the attestation Once all information is entered, hospitals will have 72 hours to change any information included in the attestation The attestation system will verify all Medicaid information entered against information available in NJMMIS The attestation system will verify all Medicaid information entered against information available in NJMMIS New Jersey Medicaid recommends using Medicare cost reports to complete the attestation process. The lines that should be used are available at New Jersey Medicaid recommends using Medicare cost reports to complete the attestation process. The lines that should be used are available at

28 Additional Information EHR Incentive Program Website EHR Incentive Program Website NJMMIS Provider Services NJMMIS Provider Services , Option , Option 7 Have your Medicaid Provider ID number Have your Medicaid Provider ID number Program address Program address


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