Meaningful Use Registration & Attestation

1. Meaningful Use Registration & Attestation WV HFMA / WVHIMSS Fall Conference The Changing Seasons of Healthcare September 26-28, 2012

2. Objectives • Understand steps to register – EH & EP • Understand steps to attest – EH & EP • Understand differences between Medicare and Medicaid for registration & attestation • Understand resources available to assist you Kimberly F. Clarke, FHIMSS, CPHIMS

3. Kimberly F. Clarke, FHIMSS, CPHIMS Registration – Eligible Hospital(EH)

4. Registration - EH • Obtain registration guide from CMS http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html • There is a separate registration guide for EH’s & EP’s • You will need your hospital NPI number • You can apply for an NPI # through NPPES • You will need your hospital CCN (CMS Certification Number Kimberly F. Clarke, FHIMSS, CPHIMS

5. Registration - EH • You must have an I&A (Identity & Access Mgmt) user web account to register. • You can register for one through the I&A website • A link is available in the CMS EH Registration Guide • EHR Certification Number. This is optional for the registration but is required during attestation. http://oncchpl.force.com/ehrcert Kimberly F. Clarke, FHIMSS, CPHIMS

6. Registration - EH • You can register for Medicare and Medicaid incentive programs at the same time if: • You are a sub-section(d) hospital in the 50 U.S. States or the District of Columbia or CAH; and • You have a CMS Certification Number ending in 0001-0879 or 1300-1399; and • You have at least 10% Medicaid patient volume • Email address – the address entered during registration is where the registration confirmation will be sent. Kimberly F. Clarke, FHIMSS, CPHIMS

7. Registration - EH • Print the registration confirmation receipt – retain for your records • EHR Incentive Program Information Center at 888-734-6433 Kimberly F. Clarke, FHIMSS, CPHIMS

8. Kimberly F. Clarke, FHIMSS, CPHIMS Registration – Eligible Providers(EP)

9. Registration - EP • Obtain registration guide from CMS http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html • There is a separate EP registration guide for Medicare & Medicaid • Medicare EPs • Doctor of Medicine or Osteopathy • Doctor of Dental Surgery or Dental Medicine • Doctor of Podiatric Medicine • Doctor of Optometry • Chiropractor Kimberly F. Clarke, FHIMSS, CPHIMS

10. Registration - EP • Medicaid EPs • Physicians • Nurse Practitioner • Certified Nurse Midwife • Dentist • PAs who practice in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) PLUS… • 20% Medicaid volume if Pediatric based • 30% Medicaid volume – all others Kimberly F. Clarke, FHIMSS, CPHIMS

11. Registration - EP • A provider can attest for the Medicare OR Medicaid incentive program - not both • Medicaid – NLR & State • Delay of ~48 hours for registration to flow to state registration system for approval • Email address – the address entered during registration is where the registration confirmation for the provider will be sent. Kimberly F. Clarke, FHIMSS, CPHIMS

12. Registration - EP Steps to determine EP Incentive Program Eligibility • Identify timeframe to Attest • Run claims data for the same time period but from the previous year. • Determine if provider is hospital based • If => 90% activity hospital based, do not qualify as EP • Based on place of service (POS) code on claims (21-Inpatient, 23-Emergency Dept) Kimberly F. Clarke, FHIMSS, CPHIMS

13. Registration - EP • Calculate percent Medicare volume • Calculate percent Medicaid volume • Identify incentive program for provider • To register you will need • Provider PECOS / NPPES login • Provider NPI • Group practice NPI • I&A web account (each provider) Kimberly F. Clarke, FHIMSS, CPHIMS

14. Registration – Lessons Learned • Save EVERYTHING! • Registration Confirmations • Data to determine program eligibility for providers • All information used to register • Provider consent to register/attest on his/her behalf • EH registration – easy; straightforward Kimberly F. Clarke, FHIMSS, CPHIMS

15. Registration – Lessons Learned • EP Registration – not so easy  • Begin collecting all PECOS logins EARLY • Character length of PECOS passwords changed so may have to log in to I&A system to reset password • Provider must do this – it takes time! • Obtain signed consent from provider to register and attest on provider’s behalf • Audits… Kimberly F. Clarke, FHIMSS, CPHIMS

16. Registration – Lessons Learned • EP Registration – continued • Register all EPs as soon as possible. You can register as Medicare until you have your claims data • Validates provider PECOS login • Once provider incentive program determined, update registration to the correct program • Prior to attestation, you can change between Medicaid and Medicare as many times as you need to • After attestation, you can only switch the program ONE TIME • Easier to identify a specific timeframe to attest so claims data can be run – streamlines process Kimberly F. Clarke, FHIMSS, CPHIMS

17. Registration – Lessons Learned • EP Registration – continued • Implement a process to track data and progress for each provider Kimberly F. Clarke, FHIMSS, CPHIMS

18. Kimberly F. Clarke, FHIMSS, CPHIMS Attestation – Eligible Hospital(EH)

19. Attestation - EH • Obtain attestation user guide from CMS http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html • Medicare Attestation • If qualify for Medicare & Medicaid, attest for Medicare • Will be deemed meaningful users for Medicaid • Medicare calculates a payment amount; Medicaid calculates a total amount that States may pay eligible hospitals. Kimberly F. Clarke, FHIMSS, CPHIMS

20. Attestation - EH • Numerator & Denominator for Objectives & Quality Measures • Worksheet on CMS website (link on previous page) • Attestation steps through each objective and quality measure (QM) • Summary of attestation for each objective & QM Kimberly F. Clarke, FHIMSS, CPHIMS

21. Attestation - EH • Medicaid Attestation – data required • Workbook on MMIS website http://www.wvmmis.com/welcome.screen • Data from cost reports • Total # of discharges for the past 4 years (FFY) • Does not include Observ, ED or Newborn • Total # of discharges for the most recent fiscal year • Total # of inpatient bed days for most recent fiscal year • Total # Medicaid inpatient (indemnity) days for most recent fiscal year Kimberly F. Clarke, FHIMSS, CPHIMS

22. Attestation - EH • Total # of hospital charges for most recent fiscal year • Total # of Charity care charges for most recent fiscal year • Data from cost reports is used to calculate average annual growth rate and the Medicaid incentive payment calculation • Summary of calculated payments provided Kimberly F. Clarke, FHIMSS, CPHIMS

23. Kimberly F. Clarke, FHIMSS, CPHIMS Attestation – Eligible Provider(EP)

24. Attestation - EP • Obtain attestation user guide from CMS http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html • The more providers, the more complex the process • Medicaid – straightforward for first year AIU Kimberly F. Clarke, FHIMSS, CPHIMS

25. Attestation - EP • Medicare – more prep work involved • Determination of quality measures for provider • If multi-specialty practice, consider QMs that apply to all providers in the specialty practice • Process to track QMs to attest to per provider • Medicaid • First yearAIU • Need claims data – same data gathered to determine if EP eligible for Medicaid incentives Kimberly F. Clarke, FHIMSS, CPHIMS

26. Attestation - EP • Claims data entered as part of attestation • Attest through the WV MMIS (Molina) website • After attestation, takes approximately 48 hrs. to get status on attestation • Must keep checking the website for your list of providers to check their status • If claims data entered differs from the state’s claims data by more than 10%, attestation is rejected Kimberly F. Clarke, FHIMSS, CPHIMS

27. Attestation - EP • WV Medicaid uses total of paid claims + reversed claims • Do not include CHIP • Do not include Carelink • Do not include UniCare • Do not include HealthPlan Kimberly F. Clarke, FHIMSS, CPHIMS

28. Attestation – Lessons Learned • Save EVERYTHING! • Screen shots of attestations • Attestation confirmations • Proof of objectives requiring a yes/no attestation • Data extracted from certified EHR (numerator / denominator) and detail behind the numbers • Test plan/scripts to validate MU data • System design/build required to meet MU • Certified EHR vendor supporting documentation Kimberly F. Clarke, FHIMSS, CPHIMS

29. Attestation – Lessons Learned • Take advantage of the MMIS and CMS help desks • Have cost report data ready prior to starting attestation for Medicaid (EH) • Medicaid Attestation – EPs • Check MMIS incentive attestation site regularly to confirm status of attestation • Use the MMIS “EDI Help Desk” to clarify reasons for rejected attestations Kimberly F. Clarke, FHIMSS, CPHIMS

30. Attestation – Lessons Learned • Medicaid Attestation – Eps (continued) • Check MMIS incentive attestation site regularly to confirm status of attestation • Use the MMIS “EDI Help Desk” to clarify reasons for rejected attestations • If first year, determine the 90 day attestation period for the providers. Streamlines process – alleviates a lot of rework. Kimberly F. Clarke, FHIMSS, CPHIMS

31. Resources • CMS Registration & Attestation Link http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html • NPPES Help Desk (800) 465-3203 https://nppes.cms.hhs.gov/NPPES/Welcome.do • PECOS Help Desk (866) 484-8049 https://pecos.cms.hhs.gov/ • WV Medicaid Molina EDI Help Desk 1-888-483-0793 (have your NPI# ready, then press selection “6”) edihelpdesk@molinahealthcare.com Kimberly F. Clarke, FHIMSS, CPHIMS

32. Resources • CMS FAQs http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/FAQ.html • Sign up for notifications when new FAQs or clarifications are posted! Kimberly F. Clarke, FHIMSS, CPHIMS

33. Kimberly F. Clarke, FHIMSS, CPHIMS QUESTIONS?