Presentation on theme: "New Jersey Medicaid EHR Incentive Program Hospital Overview"— Presentation transcript:
1New Jersey Medicaid EHR Incentive Program Hospital Overview
2Presentation Summary Medicaid EHR Incentive Program Overview EligibilityAdopt, Implement, Upgrade, and Meaningful Use DefinitionsPayment Calculation and ScheduleRegistration and AttestationQuestions and Answers
4Program OverviewThe 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.
5Program OverviewIncentive payments to hospitals will begin being distributed in January – FebruaryThe last year a Medicaid eligible hospital may begin the program is 2016.Hospital payments will vary by facility based on hospital size and Medicaid concentrationHospitals may receive payments from BOTH the Medicare and Medicaid EHR Incentive Programs
7Eligibility Acute Care Hospitals Children’s Hospitals General hospitals, cancer hospitals and critical access hospitalsAverage length of patient stay of 25 days or fewerCMS Certification Number (CCN) with the last four digits in the series 0001 – 0879 and10% Medicaid Patient Volume based on encountersChildren’s HospitalsCCN with last four digits in the series 3300 – 3399No patient volume requirement
8Eligibility: Medicaid Encounter A hospital encounter occurs only in a hospital’s inpatient department, or emergency department on any one dayOne Medicaid encounter is tallied:For each inpatient discharge IF Medicaid paid for any part of the patient’s stay, andFor each emergency department visit (no more than one per patient per day), IF Medicaid paid for any part of that ER visit.
9Patient Volume Calculation Medicaid Encounter count for a selected 90 day period divided byTotal inpatient discharges + emergency room visits for the same periodIf the total is greater than 10%, the hospital is eligible for a Medicaid EHR Incentive PaymentNew Jersey Medicaid recommends that hospitals use their Medicare or Medicaid cost reports for all calculations.
11Adopt, Implement or Upgrade (AIU) Hospitals must demonstrate one of these to receive a Year 1 incentive payment:Adopt – Acquire, purchase, or secure access to certified EHR technologyImplement - Install or commence utilization of certified EHR technologyUpgrade - Expand the available functionality of certified EHR technology
12Adopt, Implement or Upgrade (AIU) 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 useSigned contract or financial record indicating the purchase, acquisition or lease of certified EHR technology
13Meaningful UseHospitals must demonstrate meaningful use to receive Year 2 and 3 incentive paymentsMeaningful Use Includes:Compliance with all 14 ONC “Core” Meaningful Use objectivesCompliance with 5 of the 10 “Menu Set” Meaningful Use objectivesAll meaningful use attestations will be subject to audits performed by CMS
15Payment Calculation Basics Payment is calculated once and will be distributed over three years:50% Year 1, 40% Year 2, 10% year 3Complex formula based on projected hospital discharge growth rates and Medicaid patient volumeEHR Incentive Program Payment System will perform the calculationMore detail on the calculation formula is available at
16Payment Calculation: Information Needed Total acute inpatient discharges for the last 4 completed hospital fiscal yearsTotal acute inpatient bed days for the entire hospital fiscal year completed in the most recently completed federal fiscal yearAcute inpatient bed days which Medicaid (Title XIX only, fee-for-service or managed care) paid a share of for the same hospital fiscal yearExcluding Medicaid/Medicare dual eligible days
17Payment Calculation: Information Needed Total charges for the hospital fiscal year completed in the most recently completed federal fiscal yearTotal Charity Care charges for the hospital fiscal year completed in the most recently completed hospital fiscal year
18Payment Calculation: Additional Points Recommended Data Sources:Medicare Cost ReportsMedicaid Cost ReportsFinancial Statements or Accounting RecordsSix page description of the payment calculation process is available at
20Registration and Attestation Timeline November 7, 2011 – National Level Repository registrations launchedDecember 2011 – EHR Incentive Program Attestation System launchesJanuary/February 2012 – Initial EHR Incentive Program payments distributed
21National Level Registration CMS Administered Process with state verificationVerifies that hospital meets the basic eligibility criteria for the Medicaid EHR Incentive ProgramOpened for the New Jersey Medicaid EHR Incentive Program on 11/7/11
22National Level Registration Hospitals that already registered as dually-eligible for the Medicaid and Medicare programs have already completed this processHospitals that have never registered can go to ehrincentives.cms.gov to begin the processRegistration User Guide is available at
23National Level Registration Information Needed to Complete the Process:Name of the eligible hospitalNational Provider Identifier (NPI)Provider Enrollment, Chain, and Ownership System (PECOS) Provider NumberCCN (CMS Certification Number)Business address and phone numberValid addressTaxpayer Identification Number (TIN)
24State Level Attestation Begins once NLR Registration is successfully completedAllows hospitals to enter their Medicaid patient volume information, upload AIU documentation, and enter information needed for payment calculationApplication will be available within the provider portal section ofAll information entered will be subject to audit that could result in recoupment
25State Level Attestation Information Needed to Complete Attestation:Medicaid Provider ID90 day period for patient volume calculationMedicaid Fee-for-Service and Managed Care encounters for the selected 90 day periodTotal encounters for the selected 90 day periodAny out-of-state Medicaid fee-for-service or managed care patient encountersTotal discharges for the four most recently completed hospital fiscal years
26State Level Attestation Information Needed to Complete Attestation:Medicaid fee-for-service and managed care acute inpatient bed days for the most recently completed hospital fiscal yearTotal acute inpatient bed days for the most recently completed hospital fiscal yearTotal Hospital Charges (including Charity Care charges)Charity Care ChargesCMS EHR Certification Number
27State Level Attestation Additional Attestation Information:Once all information is entered, hospitals will have 72 hours to change any information included in the attestationThe attestation system will verify all Medicaid information entered against information available in NJMMISNew Jersey Medicaid recommends using Medicare cost reports to complete the attestation process. The lines that should be used are available at
28Additional Information EHR Incentive Program WebsiteNJMMIS Provider Services, Option 7Have your Medicaid Provider ID numberProgram address