M edicaid P rovider I ncentive P rogram Meaningful Use for Eligible Professionals Ohio Association of Community Health Centers Presenters Emma Esmont, Management Analyst John Mack, Project Manager Elbony McIntyre, Project Manager July 18, 2012
Agenda Topics RECAP Eligibility Patient Volume AIU Meaningful Use Overview Meaningful Use in MPIP System 2
RECAP
RECAP: MPIP Eligibility Eligible Professionals : physicians, optometrists, dentists, certified nurse midwives, nurse practitioners and physician assistants (when practicing at an FQHC/RHC so led by a PA) An eligible professional cannot be hospital-based An eligible professional is hospital-based if 90% or more of his/her Medicaid encounters are furnished in an inpatient hospital (POS 21) or an emergency room (POS 23) setting in the calendar year prior to the payment year This exclusion does not apply to the eligible professional qualifying as practicing predominantly through an FQHC or RHC 4
RECAP: Patient Volume Eligible Participants Medicaid Patient OR Volume Requirements The eligible Physicians 30% professional - Pediatricians 20% practices predominantly Optometrist 30% through an FQHC or Dentists 30% RHC Certified Nurse Midwives 30% — 30% needy Nurse Practitioners 30% individual patient Physician Assistants (PAs) when 30% volume threshold practicing at an FQHC/RHC that is so led by a PA An eligible professional practices predominantly if over 50% of an eligible professional’s total patient encounters over a period of six months in the most recent calendar year occur through an FQHC/RHC. 5
RECAP: Patient Volume Calculation Any continuous 90-day period in the preceding calendar year Medicaid Patient Volume Medicaid Patient Encounters – (Medicaid Patient Encounters * County SCHIP Factor) Total Patient Encounters Needy Individual Patient Volume Medicaid Patient Volume for eligible professionals practicing predominantly through an FQHC/RHC Needy Individual Patient Encounters Total Patient Encounters 6
Reminder! Patient Volume Selection Pediatricians that do not have a Medicaid Patient Volume of 30%, but have a Medicaid Patient Volume of at least 20%, may attest as a Pediatrician. Eligible professionals practicing predominantly through an FQHC/RHC that do not have a Medicaid Patient Volume of 30%, but have a Needy Individual Patient Volume of at least 30%, may attest as an eligible professional practicing predominantly through an FQHC/RHC. MPIP allows eligible professionals to enroll as part of a group practice/clinic in order to meet Patient Volume thresholds 7
RECAP: Year 1 AIU Requirement Eligible professionals must attest to adopting, implementing, or upgrading to certified EHR technology to be eligible for MPIP Adopt: Acquiring, purchasing, or securing access to certified EHR technology Implement: Installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements Upgrade: Expanding the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or Upgrading from existing EHR technology to certified EHR technology per the EHR certification criteria published by the ONC 8
Meaningful Use
What is Meaningful Use? To be eligible for incentives, eligible professionals must be able to demonstrate that they are using certified EHR technology for three fundamental purposes: Meaningful use: e-prescribing, electronic patient health histories, clinical decision support tools, and other meaningful uses Connectivity: connecting to other providers through a health information exchange to improve access to the full view of a patient’s health history Reporting: Submitting information on clinical quality measures and other measures in accordance with federal standards 10
What is Meaningful Use? Meaningful use is using certified EHR technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Maintain privacy and security 11
Meaningful Use: A Staged Approach https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf 12
What is Meaningful Use: A Staged Approach 1 Stage 2 implementation changed to 2014 13
Meaningful Use Criteria – Stage 1 15+ 5+ 6= MU Eligible professionals must complete: 15 core objectives 5 of 10 menu set objectives 1 of 5 must be a public health measure 6 clinical quality measures (CQMs) 3 core or alternate core, 3 of 38 from menu set All measures have been pre-selected and defined by CMS in collaboration with ONC 14
EHR Reporting Periods Medicaid Incentive Payment Year Program Only 1 st payment year AIU 2 nd payment year MU, 90 day reporting period 3 rd payment year and MU, 12 month reporting period subsequent Switching Between the Medicare EHR incentive program and MPIP An eligible professional who switches to MPIP from the Medicare EHR incentive program is placed in the payment year that the eligible professional would have been in had the eligible professional begun in, and remained in, the Medicare EHR incentive payment program. Note: To be considered a meaningful EHR user, at least 50 percent of an eligible professional’s patient encounters during the EHR reporting period must occur at a practice/location or practices/locations equipped with certified EHR technology. 15
Applicability of Meaningful Use Objectives Some meaningful use objectives are not applicable to every eligible professional’s clinical practice. In these cases, the eligible professional would be excluded from meeting that specific objective e.g. a dentist who does not perform immunizations, or a certified nurse mid-wife who does not e-prescribe 16
Meaningful Use Denominators Two types of percentage based measures are included in demonstrating meaningful use: Denominator = all patients seen during the EHR 1. reporting period. The denominator is all patients whether or not their records are kept using the EHR technology. Denominator = actions or subsets of patients seen 2. during the EHR reporting period. The denominator only includes patients, or actions taken on behalf of those patients, whose records are kept using the EHR technology. 17
Important Definition Unique Patient If a patient is seen by an eligible professional more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure 18
Meaningful Use MPIP System
Meaningful Use in the MPIP System Enrollment Attestation- 4 Steps (1) Registration Verification Status (2) Patient Volume Status (3) Meaningful Use Status (4) MPIP Payment Status Confirmation Number 20
MPIP – Helpful Hints NPI # and Password Make a note of this information Save & Continue Make sure to select after entering information (e.g. after completing each screen) Entered data will be saved prior to completing entire attestation, which may be completed at a later date Always select & then Logout before exiting MPIP 21
MPIP Log In Provider NPI and Password Enter NPI and Password – then click Log In Enter NPI and Password – then click Log In 22
Welcome to MPIP Click Enrollment to begin Click Enrollment to Page has the same look as AIU begin Page similar to AIU Page has the same look as AIU 23
Enrollment Home Click Enroll to start MU Note : ‘ Paid ’ status is from Payment Year 1 attestation for calendar The top record will begin the MU attestation process year 2012 24
Step 1- Registration Verify all Registration Information To update your National Provider Information, go to the CMS web site at the following link: https://ehrincentives.cms.gov/hitech/login.action Basic questions, same questions as AIU 25
Step 1- Registration Click “Yes” if enrolling as a group Same questions asked as in AIU Who the payment is assigned to If using needy individual patient volume, select “yes” and select affiliated FQHC/RHC 26
Step 1- Registration: Group Practice Click “Yes” if enrolling as a group Who the payment is assigned to Click the Radio button “Yes” if enrolling as a group 27
Step 1- Provider Registration: Group Selection This will show the groups associated with this NPI or an eligible professional can create a group 28
Step 1- Registration: Payment Assignment The Payee ID selected for the previous payment year will be displayed by default. Click Select Medicaid ID if you want to change/update the Payee. Click the radio button to select a payee and then click Select & Continue to save the payee ID and return to the Enrollment Status page 29
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