1. JOHN W BARCH, MHA SR. DIRECTOR OF CLINICAL OPERATIONS JANET M RIVERA MANAGER, PATIENT MANAGEMENT AND BUSINESS OFFICE BRIANNE E PORCHE, BBA SUPERVISOR OF PATIENT ACCOUNTS JULIE M GARZA, BS ACCOUNTS PAYABLE AND RECEIVABLE CLERK San Antonio’s success in obtaining EHR Incentive Funding through CMS and Texas Medicaid

2. Goals  Participate in the American Recovery and Reinvestment Act of 2009  Procure axiUm’s certified version of the EHR  CE 5.10, axiUm Patient Access Module, eRx Why  Efficiency – Gives providers the ability to share information  Effectiveness – Computes information (drug interactions/allergies) and provides “decisions support” for clinicians.  Financial Incentives – Federal Government is encouraging providers to transition to a certified EHR with dollars

3. Authorization/Eligibility  The Health Information Technology for Economic and Clinical Health (HITECH) Act 2009  EHR Incentive Program Period  Runs from 2011-2021  Providers must be enrolled by 2016 to be eligible for any incentives  EHR Incentive Program is run by State Medicaid Agency  Texas-Texas Health and Human Services Commission (HHSC)  Texas Medicaid provides dental services to pediatric patients and limited adult services  Pediatric Dentist must be board certified in Pediatric Dentistry or have completed a residency in Pediatric Dentistry  Must be licensed to practice in the State of Texas  Must be a contracted provider with Texas Medicaid Electronic Health Record (EHR) Incentive Program

4. San Antonio’s success in obtaining EHR Incentive Funding through CMS and Texas Medicaid Select and adopt a certified EHR Provider Eligibility and Centers for Medicare and Medicaid Services (CMS) Registration Obtain EHR Certification code Register at the Texas Medicaid website Receive incentive payment Year two “meaningful use” for 90 days and attest `

5. Step 1 Select and Adopt a certified EHR axiUm 5.10 Certified Edition  Package includes the following: axiUm CE 5.10, axiUm Patient Access v2.00, axiUm eRx v3.25.R2P1.B2  Purchase order obtained September 2012  Implementation scheduled for July 2013

6. Step 2 Provider Eligibility and CMS Registration Identifying Eligible Providers and Calculating Patient Volume  To be an eligible provider, at least 30% of your services furnished to Medicaid patients in an outpatient setting (20% requirement for pediatricians)  This percentage should be an average of 3 consecutive months.  This percentage must be volume by facility by provider.  Volume based on prior calendar year services at treating facility, as required by CMS.  UTHSCSA used 2011 service dates  Pediatric Dentist must be board certified in Pediatric Dentistry or have completed a residency in Pediatric Dentistry Must be licensed to practice in the State of Texas Must be a contracted provider with Texas Medicaid

7. Step 2 Register at the CMS Registration Portal axiUm Info Manager  Valid charge transaction in location where the Treatment Date fell in the month and the Instructor was a faculty provider.  The visits were distinguished by transaction Insurance Company or Insurance Company equal to patient Financial Class identifier.

8. Step 2 Register at the CMS Registration Portal Registering with CMS  Identify the Authorized Official  E-mailed Eligible Providers a notification explaining the enactment of the Medicaid EHR incentive program. Identify the person submitting application on behalf of providers.  Authorized Official required Name, SS#, Affiliation  Registering each Eligible Provider with CMS:  https://ehrincentives.cms.gov https://ehrincentives.cms.gov  Required Items for registering  Individual Provider NPI  Treating Facility Address and NPI (if applicable)  Obtain a CMS EHR certification number

9. Step 2 Register at the CMS Registration Portal  After registration of the Authorized Official on CMS website, an approval was required by each Eligible Provider.  Eligible Provider logged into the NPPES https://pecos.cms.hhs.gov/pecos/login.do to complete this process https://pecos.cms.hhs.gov/pecos/login.do  Authorized Official found this to be the most challenging aspect of this process!  Authorized Official received email acknowledgement and was able to proceed to the state level for application submission.

10. Step 3 Obtain EHR Certification code Obtain EHR certification code  http://oncchpl.force.com/ehrcert/CHPL Home http://oncchpl.force.com/ehrcert/CHPL Home  CMS EHR Certification ID for axiUm 5.10 Certified Edition: A000001CDSBWEAZ

11. Step 4 Register with Texas Medicaid Registration with the Texas Medicaid  The provider’s NPI, treating facility and entity receiving payment was attested, along with the provider’s volume.  In the Texas Medicaid and Healthcare Partnership (TMHP) website, the state of TX had a check mechanism that would prompt the Authorized Official, if volumes did not meet their requirement.  Attach Adoption, Implementation, or Upgrade (AIU) supporting documentation.  Purchase Order was used as our AIU documentation. A letter accompanied this Purchase Order stating our satellite clinics were under the umbrella of UTHSCSA and axiUm agreement.

12. Step 4 Register with Texas Medicaid  Once all information was entered and deemed accurate, the Authorized Official signed electronically and submitted the application. An email confirmation of submission followed.  Application status was monitored via CMS and TMHP websites.  Once the process was started and the first application was submitted, each subsequent application went smoothly and efficiently.

13. Step 5 Receive incentive payment Receiving Payment  The time from application submission to receiving payment was approximately 30 days.  Some of our payments were received in bulk, along with our regular Medicaid claim payments.  Payment status was monitored via CMS and TMHP websites.  Not necessarily to achieve meaningful use to qualify for the first year of EHR incentives.

14. Step 5 Receive incentive payment

15. Step 6 Year two “meaningful use” for 90 days and attest Stage two  UTHSCSA is scheduled for the new release of axiUm 5.10 CE in July 2013  UTHSCSA will be eligible for stage two “meaningful use” in 2015  Incentive Payments Audits  Authorized by the Medicaid/CHIP division of the Texas Health and Human Services Commission, as required by HITECH Act of 2009

16. Center for Oral Health Care & Research Opening in 2015