New Jersey Medicaid EHR Incentive Program Professionals Overview

1. New Jersey Medicaid EHR Incentive ProgramProfessionals Overview

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

3. Program Overview

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

5. Program Overview Incentive payments to eligible professionals will begin being distributed in January – February 2012. Eligible Professionals (EPs) can receive up to $63,750 over six years. EPs may participate in either the Medicaid or Medicare Incentive Program, but not both. EPs can switch between the Medicaid and Medicare program once, and only once, before 12/31/2015.

6. Program Overview • Each individual EP must separately establish eligibility for their incentive payments • EPs can only receive one payment per calendar year

7. Eligibility

8. Eligibility: Provider Types • Eligible Provider Types • Physicians (generally M.D.s or D.O.s) • Pediatricians • Dentists (D.D.S. or D.M.D) • Certified Nurse Midwives • Advanced Practicing Nurses • Hospital-based EPs are not eligible for incentive payments • 90% of the EP’s services provided in a hospital inpatient or emergency room setting.

9. Eligibility General Guidelines • Professionals must also meet patient volume and EHR technology requirements to be eligible for a Medicaid Incentive Payment

10. Eligibility: Patient Volume

11. Eligibility: Patient Volume • To qualify for incentive payments, an EP must meet or exceed one of the following: • 30% Medicaid (non-CHIP) patient volume • 20% Medicaid (non-CHIP) patient volume (pediatricians only) • Practice predominantly in an FQHC and have 30% of their patient volume attributable to needy individuals

12. Eligibility: FQHC Providers • Practicing Predominantly • 50% of patient encounters over a six month period in the most recently completed calendar year occurred at an FQHC • Needy Individuals • Medicaid and CHIP clients • Patients furnished uncompensated care • Patients furnished services at either no cost or on a sliding scale.

13. Eligibility: Patient Encounter For the purposes of the Medicaid EHR Incentive Program, a patient encounter is defined as a unique patient, date-of-service, place-of-service combination EPs may count encounters across any number of practice locations but must use at least one location that has an EHR that meets the AIU or meaningful use requirements. EPs may include out-of-state encounters in their patient volume calculation

14. Eligibility: Patient Encounter • A Medicaid encounter is any patient encounter where Medicaid (Title XIX, fee-for-service or managed care) paid for part or all of the services • Includes Medicaid payment of premiums, copays or other cost sharing. • A “Needy Individual” encounter (for EPs practicing predominantly in an FQHC only) include: • Encounters where Medicaid or CHIP paid for part or all of the services • Encounters furnished at no cost, a sliding scale or as uncompensated care

15. Eligibility: Patient Volume EPs meeting the 30% Medicaid patient volume threshold are eligible for a full incentive payment Pediatricians with 20-30% Medicaid patient volume are eligible for a 2/3 incentive payment. EPs practicing predominantly in an FQHC and meeting the 30% Needy Individual patient volume threshold are eligible for a full incentive payment.

16. Eligibility: Patient Volume • A group practice or clinic may use a single patient volume calculation for all of its providers, given these conditions: • Each attesting individual provider has at least one Medicaid encounter • The single patient volume calculation must be from an auditable data source • The data from the entire group (not just certain providers) is used to perform the calculation • All provider attesting for the group use the same patient volume calculation

17. Patient Volume Calculation • Medicaid or Needy Individual encounter count for a selected 90 day period in the most recently completed calendar year divided by • Total patient encounters visits for the same 90 day period • If the result is greater than 30% (20% for pediatricians), the professional is eligible for a Medicaid EHR Incentive Payment • All information used in calculating patient volume is subject to audit that could result in payment recoupment

18. Eligibility: EHR Technology

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

20. Adopt, 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 use • Signed contract or financial record indicating the purchase, acquisition or lease of certified EHR technology

21. Meaningful Use • Eligible Professionals must demonstrate meaningful use of certified EHR technology to receive Year 2 - 6 incentive payments • Meaningful Use Includes: • Compliance with all 15 ONC “Core” Meaningful Use objectives • Compliance with 5 of the 10 “Menu Set” Meaningful Use objectives • All MU attestations may be subject to audit

22. Registration and Attestation

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

24. National Level Registration CMS Administered Process with state verification Verifies that the professional meets the basic demographic criteria to participate in the Medicaid EHR Incentive Program Process begins at ehrincentives.cms.gov Registration User Guide is available at www.nj.gov/njhit/ehr

25. National Level Registration • Information Needed to Complete the National Level Registration Process: • Name of the eligible professional • National Provider Identifier (NPI) • Business address and phone number • Valid Email address • Taxpayer Identification Number (TIN) to which the professional would like their incentive payment made

26. State Level Attestation • Begins once National Level Registration is successfully completed • Allows professionals to enter their Medicaid or Needy Individual patient volume information and upload AIU documentation • Web-based application will be available within the provider portal section of www.njmmis.com • All information entered may be subject to audit that could result in recoupment

27. State Level Attestation • Information Needed to Complete Attestation: • Medicaid Provider ID • 90 day period for patient volume calculation • Medicaid or Needy Individual encounters for the selected 90 day period • Total encounters for the selected 90 day period • Out-of-state Medicaid or Needy Individual encounters for the selected 90 day period • Total out-of-state encounters for the selected 90 day period • CMS EHR Certification Number

28. State Level Attestation • Attestations must be completed for each year the EP wishes to receive an incentive payment • Once all information is entered, professionals 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 • Once all attestation information is verified, payment will be electronically distributed in 2-4 weeks

29. State Level Attestation EPs can designate another person to attest on their behalf

30. Payment Amounts and Schedule

31. Payment Information • $63,750 for most EPs, as follows: • $21,250 in Year 1 • $8,500 for all remaining program years • Pediatricians with patient volumes of 20-30% will receive 2/3 of the amounts shown above • Eligibility must be maintained for each payment year • Payments to EPs can be assigned to a group practice or clinic • Payments can be used to offset amounts owed to the Medicaid program

32. Additional Information • EHR Incentive Program Website • www.nj.gov/njhit/ehr • NJMMIS Provider Services • 1-800-776-6334, Option 7 • Have your Medicaid Provider ID number ready • Program e-mail address • MAHS.ehrincentives@dhs.state.nj.us