HP Provider Relations October 2011 Electronic Health Records (EHR) Incentive Program

Electronic Health Records (EHR) Incentive ProgramOctober 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

Electronic Health Records (EHR) Incentive ProgramOctober Objectives Following this session, providers will: – Know if your provider type is eligible to receive EHR payments – Grasp a basic understanding of Meaningful Use – Understand how to register to receive EHR payments

Explain EHR Incentive Program

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program 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/ehrcertonc-chpl.force.com/ehrcert What is it?

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program EHR incentive payments may be made to: Eligible professionals (EPs) Physicians – Primarily doctors of medicine and doctors of osteopathy Dentists Nurse practitioners Certified nurse midwives Physician assistants practicing in a Federally Qualified Health Center (FQHC) led by a physician assistant Rural Health Clinic (RHC) led by a physician assistant Eligible hospitals (EHs) Acute care hospital (includes cancer and critical access hospitals) Children’s hospitals Who can participate?

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program –EPs must meet patient volume criteria as follows: 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 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 Who can participate?

Understand Meaningful Use

Electronic Health Records (EHR) Incentive ProgramOctober Meaningful Use –Federal law specifies three main components of meaningful use: The use of a certified EHR in a meaningful manner, such as e-prescribing The use of certified EHR technology for electronic exchange of health information to improve quality of healthcare 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: 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 Stage 2 (2013): An expansion of the criteria set in Stage 1 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 ProgramOctober Meaningful Use –To qualify for incentive payments, meaningful use requirements must be met in the following ways: 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 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 Upgraded: Expanded existing technology to meet certification requirements  An example includes adding new functionality to meet the definition of EHR technology

Electronic Health Records (EHR) Incentive ProgramOctober Meaningful Use –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 cms.gov/QualityMeasures/03_ElectronicSpecifications.asp Clinical quality measures

Act EHR Incentive Program Registration

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program Registration 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: – 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 Eligible Professional (EP)

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program Registration 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: – 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 Eligible Hospital (EH)

Electronic Health Records (EHR) Incentive ProgramOctober Click here to register for EHR

Electronic Health Records (EHR) Incentive ProgramOctober Helpful Tools Avenues of resolution

Electronic Health Records (EHR) Incentive ProgramOctober Helpful Tools Avenues of resolution Enter the CMS registration number and click Go

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program Registration –EHR Incentive Program runs from –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

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program –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: (Overall EHR Amount) x (Medicaid Share) Payments are distributed over three years: −Year 1: 50% −Year 2: 40% −Year 3: 10% Eligible Hospital (EH)

Electronic Health Records (EHR) Incentive ProgramOctober 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 ProviderEPEP-Pediatrician Patient Volume30%20-29% Year 1$21,250$14,167 Year 28,5005,667 Year 38,5005,667 Year 48,5005,667 Year 58,5005,667 Year 68,5005,667 Total Incentive Payment $63,750$42,500

Electronic Health Records (EHR) Incentive ProgramOctober EHR Incentive Program 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 EHR statistics

Examine EHR Audits

Electronic Health Records (EHR) Incentive ProgramOctober 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

Certified Technology

Electronic Health Records (EHR) Incentive ProgramOctober 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 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

Electronic Health Records (EHR) Incentive ProgramOctober 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

Find Help Resources Available

Electronic Health Records (EHR) Incentive ProgramOctober Helpful Tools Avenues of resolution –IHCP EHR Manual available at indianamedicaid.com indianamedicaid.com –CMS Information Center –HP EHR Customer Assistance , or (317) in the Indianapolis local area –HP Written Correspondence P.O. Box 7263 Indianapolis, IN –Provider field consultant

Q&A