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					    CMS Update

Rural Health Association of
        Oklahoma
   September 23, 2010
              What’s New?
• Dr. Donald Berwick named as CMS
  Administrator on July 7, 2010

 Former President and CEO of the Institute for
 Healthcare Improvement

 Clinical Professor of Pediatrics and Health Care
 Policy at Harvard Medical School
       RHC Regulation – Soon?
• Balanced Budget Act of 1997 enacted
• February 2000 – First Proposed Rule
• December 2003 – Final Rule issued, but
  suspended due to new statutory requirement
  (MMA of 2003) that no more than 3 years can
  elapse between a proposed and final rule
• June 2008 – New Proposed Rule issued
• MMA 2003 requires Final Reg to be published
  within 3 years of Proposed Rule = June 2011
  Patient Protection and Affordable
  Care Act (PPACA) Enacted 3/23/10
• Preventive Services Changes Beginning
  1/1/2011:
  Coverage of Annual Wellness Visit Providing a
  Personalized Prevention Plan (initial and
  subsequent visits)
• Elimination of Beneficiary Cost-Sharing for
  Preventive Services for Annual Wellness Visit,
  Initial Preventive Physical Exam (IPPE), and
  other Medicare preventive services
  recommended by USPSTF with a grade of A or B
 Coinsurance and Deductible Waived
         Beginning in 2011
• Annual Wellness Exam, IPPE, Abdominal Aortic
  Aneurysm Ultrasound Screening, screening lab
  tests for diabetes and cardiovascular disease,
  PAP test, screening pelvic exam, screening
  mammography, bone mass measurement, PSA
  test, colorectal cancer screenings (except
  barium enema), HIV screening lab tests,
  vaccine and administration for flu,
  pneumococcal and hepatitis B, medical
  nutrition therapy
 Preventive Cost Sharing Still Applies
• Diabetes Self-Management Training (DSMT) –
  coinsurance and deductible apply
• Barium Enema as colorectal cancer screening
  – coinsurance applies, deductible is waived
• Digital rectal exam as prostate cancer
  screening – coinsurance and deductible apply
• Glaucoma screening for high risk patients –
  coinsurance and deductible apply
   PPACA Primary Care Incentive
• 1/1/11 - 10% bonus for primary care
  physicians, NPs, CNSs, PAs for whom primary
  care services = at least 60% of allowed Part B
  charges in a prior period (first time will use CY
  2009 PFS claims data processed through
  6/30/10), paid quarterly for primary care
  services furnished during that quarter

  Paid in addition to usual 10% HPSA bonus
      PPACA Surgical Incentive
• 1/1/11: 10% bonus to general surgeons when
  furnishing a major surgery (10 or 90 day
  global) in a geographic HPSA, paid quarterly

• Paid in addition to usual HPSA bonus payment
   Patient Protection and Affordable
            Care Act (PPACA)
• Changes timely filing deadline to one year, beginning
  with services provided on or after 1/1/10,
  Services provided from 10/1/09 to 12/31/09 must be
  filed by 12/31/10.
  At this point, there are no exceptions to the new
  requirement.

• Watch Medicare contractor listserv for earliest news
  on other changes as they become known
   2011 Physician Fee Schedule
  Regulation – Proposed 7/13/10
• Propose to add to telehealth benefit:
• Individual and group kidney disease education
  services (G0420-1)
• Individual and group DSMT services (G0108-9)
• Group MNT and Health and Behavior
  Intervention services (97804, 96153-4)
• Subsequent hospital care services (99231-3)
• Subsequent SNF/NF services (99307-10)
       2011 PFS Proposed Rule
• Affordable Care Act (PPACA) requires PPS
  system be developed for FQHCs by 2014
• PFS proposes to begin collecting data to
  develop new PPS on 1/1/2011
• 1/1/2011 FQHCs will be required to file claims
  using HCPCS codes (not currently required)
       2011 PFS Proposed Rule
• ACA reinstates physician work geographic
  floor, protection of frontier states, payment of
  technical component of physician pathology
  services, ambulance add-on, reasonable cost
  for lab in rural hospitals <50 beds
• ACA changes payment for certified nurse
  midwife services to the same as physicians on
  Medicare fee schedule (80% of allowable
  charge)
  Inpatient Prospective Payment
    System Final Rule Effective
            10/1/2010
• Acute care transfer policy will now apply to
  patients discharged to critical access hospitals
  and non-participating hospitals (not VA or
  DoD)
• Payment adjustments for low volume
  hospitals in 2011-12 if hospital is more than
  15 mi. from another subsection (d) hospital
  and has fewer than 1,600 discharges for
  patients entitled to Part A in the fiscal year
             IPPS Final Rule
• Medicare Dependent Hospital – extended
  through FY 2012 (ending 10/1/12) and will
  count all days/discharges of patients entitled
  to Medicare Part A beginning 10/1/10
• CRNA Services furnished in rural hospitals and
  CAHs – for cost reporting periods beginning on
  or after 10/1/10, CAHs and hospitals
  reclassified according to 1886(d)(8)(E) and
  Sec. 412.103 are also rural and can be paid
  reasonable cost for CRNA services (Lugar N/A)
              IPPS Final Rule
• $400 million in Payments for Qualifying
  Hospitals with Lowest Per Enrollee Medicare
  Spending – subsection (d) hospital located in
  an eligible county, paid in FY 2011 and FY 2012
• Rural Community Hospital Demo extended to
  20 states with low population density and to
  20 more hospitals
             IPPS Final Rule
• PPACA changes 3-day payment window
  implementation for non-CAH hospitals –
  hospitals must include on inpatient bill the
  diagnoses, procedures, and charges for all
  outpatient preadmission diagnostic services
  and all outpatient preadmission nondiagnostic
  services (except ambulance and maintenance
  renal dialysis) provided by the subsection (d)
  hospital or entity that is wholly owned or
  operated by the hospital
              IPPS Final Rule
• Services on date of admission are deemed
  related and also services provided on the first,
  second and third calendar day prior to the
  admission are also deemed related to the
  admission unless the hospital attests that the
  services are not related to the admission
• A “Related” outpatient service is one that is
  clinically associated with the reason for a
  patient’s inpatient admission
             IPPS Final Rule
• CAHs electing Method 2 no longer required to
  make annual re-election, unless wish to
  terminate election 30 days before cost report
  period end
• If CAH CR period begins in October 2010 or
  November 2010 and elected Method 2 in
  2009 and wish to terminate Method 2, you
  have until 12/1/2010 to do so
              IPPS Final Rule
• PPACA made conforming change for CAHs to
  make 101% of reasonable cost for Method 2
  and to make 101% of reasonable cost for CAH-
  based ambulances, retro to 1/1/2004, but no
  reprocessing since contractors paid the claims
  this way anyway
• CAHs can claim provider taxes as allowable
  costs only to the extent the assessed taxes are
  actually incurred
 Outpatient Prospective Payment
  System Proposed Rule 8/3/10
• Hold Harmless Transitional Payments expires
  on 1/1/2011
• Physician Supervision Policy for Outpatient
  diagnostic services: hospitals (but not CAHs)
  must follow MPFS physician supervision
  requirements for individual tests (general,
  personal, or direct) for services provided
  directly or under arrangement for services
  provided onsite in hospital, provider-based
  department or nonhospital location
          OPPS Proposed Rule
• For outpatient therapeutic services in
  hospitals and CAHs, proposing changes and
  requesting comments: for a limited set of
  services with a significant monitoring
  component that are not surgical and typically
  have a low risk of complication, would require
  direct physician supervision for the initiation
  of the service followed by general supervision
  for the remainder of the service (list does not
  include chemo and blood transfusions)
         OPPS Proposed Rule
• Proposing to revise the MPFS to apply a
  multiple procedure reduction to payment for
  all outpatient physical and occupational
  therapy services
• Proposing changes to whole hospital and rural
  provider exceptions to the physician self-
  referral prohibition
     Ordering/Referring Update
• CMS is delaying implementation of CR 6417 and
  CR 6421 until January 3, 2011 to give all
  physicians and practitioners time to update their
  enrollment information in PECOS. Applies to
  physicians, PA, NP, CNM, CNS, CP and CSW.
  Once implemented, Part B CMS 1500 claims for
  services that were ordered/referred will need to
  include ordering/referring NPI information. If the
  ordering/referring physician is not in PECOS, the
  claim will be rejected and later denied.
 Regulation Implementing PPACA
• 5/5/10 Interim Final Regulation implements
  provision of law to permit only a Medicare
  enrolled physician/eligible professional to certify
  or order home health, DMEPOS supplies and
  other Part B services, and applies to orders,
  referrals and certifications on and after 7/1/10,
  comment period closes 7/6/10.
• CMS will not implement automatic rejection of
  claims for services ordered by providers whose
  PECOS applications have not been approved by
  7/6/10 – (CMS Press Release 6/30/10)
   Ordering/Referring PECOS File
• www.cms.hhs.gov/MedicareProviderSupEnroll

• Over 800,000 names and NPIs on file in PECOS
  of physicians and non-physician practitioners
  eligible to order/refer

• Sorted in alpha order by last name, with NPI
         Ordering/Referring for
       RHC/FQHC/CAH Physicians
• Physicians/NPPs who would not be sending
  claims to Medicare Part B can still enroll for the
  sole purpose of ordering or referring
• Paper form CMS-855I, complete only certain
  sections, and attach a cover letter stating
  provider is only enrolling to order and refer
  services for a beneficiary and cannot be
  reimbursed for services performed
• Mail application to designated Part B MAC
  provider enrollment address (see TrailBlazer
  website www.trailblazerhealth.com for details)
Internet-Based PECOS Enrollment
• Available to Part B individuals, groups,
  organizations and Part A providers

• https://pecos.cms.hhs.gov

• RHCs, FQHCs not allowed to use the Internet-
  based PECOS
• All providers use paper 855 for filing changes of
  ownership, acquisition, mergers, consolidations,
  changes in tax ID, changes in legal business name
 Rejection of Enrollment Application
• CMS contractors may reject a provider’s or
  supplier’s enrollment application if they fail to
  furnish complete information on the application
  within 30 calendar days from the date of the
  contractor’s request for the missing information
• After rejection, a provider or supplier must
  complete and submit a new enrollment
  application and documentation for review and
  approval
       Recent Enrollment Changes
• Establishes an effective date of billing for
  physicians, non-physician practitioners and
  physician and NPP organizations as the later
  of
  1) the filing of an enrollment application that
  is subsequently approved or
  2) the date an enrolled physician or NPP first
  started furnishing services at a new practice
  location
       Recent Enrollment Changes
• Permits physicians and non-physician
  practitioners to retrospectively bill for services
  rendered up to 30 days prior to the effective
  date, if they met all program requirements or
  services rendered up to
  90 days prior when there is a Presidentially-
  declared disaster

• No longer unlimited retroactive billing
       Recent Enrollment Changes
• Requires all providers and suppliers, including
  individual practitioners, to maintain ordering
  and referring documentation for 7 years from
  the date of service
      Enrollment Reportable Events –
            30 Day Timeframe
• All providers/suppliers must report a change
  in ownership or control on CMS 855 form
  within 30 days
• Physicians and non-physician practitioners are
  required to report the following changes on
  CMS 855 form within 30 days of these events:
• 1. Change of ownership
• 2. Change in practice location
• 3. Final adverse action
   Penalties for Not Meeting 30-Day
           Reportable Events
• Failure to notify the Medicare contractor of
  these changes may result in a revocation
  (termination of billing privileges) and/or
  overpayment from the date of the reportable
  change
• Providers/suppliers whose billing privileges
  are revoked may be barred from re-enrolling
  in Medicare for 1-3 years
  Enrollment Reportable Events – 90 Day
               Timeframe
• Physician and non-physician practitioners are
  required to report on CMS 855 form the following
  changes no later than 90 days after the event:
• 1) Change in practice status (e.g., retirement)
• 2) Change of business structure, legal business name
  or taxpayer ID Number
• 3) Change of banking arrangements or payment
  information
• 4) A change in the correspondence or special
  payments address
    Enrollment Reportable Events – 90
             Day Timeframe
• All providers/suppliers must report on CMS
  855 form within 90 calendar days of the
  following changes:

•   Change in practice location
•   Change of any managing employee
•   Change in billing services
•   Other changes
   Penalties for Not Meeting 90-Day
           Reportable Events
• Medicare contractors may deactivate a
  provider or supplier’s Medicare billing
  privileges for failure to report changes within
  90 days of the event, and providers/suppliers
  must complete and submit a new enrollment
  application to reactivate Medicare billing
  privileges
   Periodic Revalidation of Medicare
        Enrollment Information
• Providers/suppliers (other than DMEPOS and
  ambulance) must resubmit and recertify the
  accuracy of its enrollment information every 5
  years
• CMS Medicare contractors will contact providers
  and suppliers directly when it is time to revalidate
  their information
• Providers/suppliers must submit complete
  application and documentation within 60
  calendar days of the notification
   Penalty for Failure to Respond to
        Revalidation Request

• Providers who fail to respond to the CMS
  Medicare contractor’s revalidation request
  may have billing privileges revoked and may
  be barred from re-enrolling in Medicare for
  one year
      More Information on Medicare
               Enrollment
• Go to CMS website
  www.cms.gov/MedicareProviderSupEnroll

• CMS Internet Only Manual 100-08, Chapter 10

• Federal Regulations 42 CFR 424.500
        A/B MAC Implementation
• MMA 2003 requires geographic assignment of providers

• All new Part A or Part B providers enroll with the Medicare
  Administrative Contractor (MAC) serving their state, or with the
  legacy contractor serving the state if there is no MAC yet
•
  New freestanding RHCs and FQHCs (including FQHC satellites) are
  no longer assigned to regional or national FIs (only HHA/hospice
  and DMEPOS are still assigned to regional MACs)
• New Freestanding RHCs now enroll with the MAC for their state, or
  if the MAC has not been awarded yet, it will enroll with the local
  Medicare fiscal intermediary in their state

• New Provider-Based RHCs and other provider-based entities
  continue to enroll with the FI/MAC that serves the parent provider
       A/B MAC Implementation
• Existing Out-of-jurisdiction providers (e.g., those
  with Mutual/WPS, and providers with former
  regional or national FIs that are not the MACs for
  the state where they are located) will not
  transition to the MAC for their state until after all
  the MAC contracts are fully implemented

• WPS/Mutual providers in J4 jurisdiction are in
  the process of being transitioned to J4 by October
  18, 2010
 Medicare Advantage Payment Guide


• CMS guidance to MA plans regarding original
  Medicare payments to providers (for PFFS
  plan payments and out-of-network provider
  payments):
  http://www.cms.hhs.gov/MedicareAdvtg
  SpecRateStats/downloads/oon-payments.pdf
Be Prepared – New X12 Standards
• HIPAA Version 5010 Level I Compliance by
  12/31/10 (covered entities demonstrate they
  can create and receive compliant transactions)
  and Level II Compliance by 1/1/12 (covered
  entities complete testing with all trading
  partners and are able to operate in production
  mode with new version of the standards)
• http://www.cms.hhs.gov/Versions5010
  andD0 (note the last is a zero)
        Be Prepared – ICD-10
• 1/16/09 HIPAA Final Rule to adopt ICD-10-CM
  and ICD-10-PCS by October 1, 2013 for all
  covered entities

• http://www.cms.hhs.gov/ICD10 for info on
  educational resources, code tables and
  descriptions, mappings, etc.
      PS&R Reports via Internet
• Must establish an IACS account and be approved
  for PS&R access
• IACS verification process includes the submission
  of supporting documentation and may take
  several weeks to complete the entire process, so
  start in advance of when you need it for cost
  report preparation
• CMS PS&R Redesign Web page has user manuals,
  guides, etc. (link on TrailBlazer website, and CMS
  website CR 6519)
      CMS/HHS Rural Resources
• CMS Open Door Forum Calls:
  http://www.cms.hhs.gov/OpenDoorForums for
  information on signing up for Rural Open Door
  listserv

• CMS Web site Rural Health Clinic Center
  http://www.cms.hhs.gov/center/rural.asp

• HRSA Office of Rural Health Policy Rural Assistance
  Center – one-stop shopping for all Department of
  HHS rural info
  http://raconline.org
          CMS Rural Resources
• Medicare Learning Network:
  http://www.cms.hhs.gov/MLNGenInfo

• Medlearn Matters Listserv:
  https://list.nih.gov

• Sign up for your Medicare contractor’s listserv:
  http://www.cms.hhs.gov/MLNProducts/
  downloads/CallCenterTollNumDirectory.zip to
  get web address of your contractor’s homepage
Medicare & Medicaid EHR
  Incentive Program
      A Short History of MU
• American Recovery & Reinvestment Act
  (Recovery Act) – February 2009
• Medicare & Medicaid Electronic Health
  Record (EHR) Incentive Program Notice of
  Proposed Rulemaking (NPRM)
  • Publication – January 13, 2010
     • NPRM Comment Period Closed – March 15, 2010
     • CMS received 2,000+ comments
• Final Rule on Display – July 13, 2010
• Final Rule Published – July 28, 2010
                Three-Legged Stool



Meaningful Use
       • Final Rule released by CMS in July, 2010
Standards
       • Final Rule released by ONC in July, 2010
Certification
       • Temporary Program Final Rule released by ONC in June,
         2010
      Standards and Certification
• Standards & Certification IFR
  – Establishes the required capabilities and related
    standards that certified EHR technology will need to
    include in order to, at a minimum, support the
    achievement of proposed Stage 1 Meaningful Use
• Certification Program NPRM
  – Provides assurance to purchasers and other users that
    HIT offers the necessary technological capability,
    functionality, and security to help them meet the
    Meaningful Use criteria established for a given phase
        EHR Incentive Program
• The EHR Incentive Programs provide incentive
  payments to eligible professionals, eligible
  hospitals, and critical access hospitals (CAHs)
  for adopting and meaningfully using certified
  EHR technology
• EHR Incentive Programs
  – Medicare
  – Medicare Advantage
  – Medicaid
    Meaningful Use: Process of
            Defining
• National Committee on Vital and Health
  Statistics (NCVHS) hearings
• HIT Policy Committee (HITPC)
  recommendations
• Listening Sessions with providers/organizations
• Public comments on HITPC recommendations
• Comments received from the Department and
  the Office of Management and Budget (OMB)
• Revised based on public comments on the
  NPRM
Office of the National Coordinator for
            Health IT (ONC)
• Resource for the entire U.S. health system
• Supports and coordinates efforts to
  improve health care through:
  – Adoption of health information technology (HIT)
  – Nationwide health information exchange (HIE)
• Created in 2004, then mandated in 2009 in
  the Health Information Technology for
  Economic and Clinical Health (HITECH) Act
 How HITECH Addresses Barriers to Adoption
Obstacle                       Intervention                                                Lead Agency

                                              •   Medicare and Medicaid EHR
Market Failure, Need for
                                                  Incentive Programs for “Meaningful   •    CMS
Financial Resources                               Use”

Addressing Adoption                           •   Regional Extension Centers
                                                                                       •    ONC
Difficulties                                  •   Health IT Research/Resource Center


Workforce Training                            •   Workforce Training Programs          •    ONC


                                              •   Strategic Health Information
Addressing Technology
                                                  Technology Advanced Research
Challenges and Providing                                                               •    ONC
                                                  Projects
Breakthrough Examples                         •   Beacon Communities Programs

                                              •   Policy Framework
Privacy and Security                          •   New Privacy and Security Policies    •     OCR


                                              •   NHIN, Standards and Certification
Need for Platform for Health                                                           •    ONC
                                              •   State Cooperative Agreement
Information Exchange                              Program (HIE)
Regional Extension Centers (RECs)
• Goal: Assist at least 100,000 primary care providers in
  achieving Meaningful Use by 2012
• Funded through 4-year Cooperative Agreements
• 60 RECs, covering 98% of the USA
• RECs Support Primary Providers in these priority settings:
   – Individual and small group practices focused on primary
     care (10 or fewer care providers)
   – Public and Critical Access Hospitals
   – Community Health Centers and Rural Health Clinics
   – Other settings (medically underserved populations)
State Health Information Exchange
 • Goal: Give every provider options for meeting health
   information exchange (HIE) Meaningful Use requirements
 • 4-year program to support state programs to ensure the
   development of HIE within and across their jurisdictions
 • 56 states and territories awarded funding for HIE planning
   and implementation
 • States need an ONC-approved State Plan before federal
   funding can be used for implementation
 • Exchange must meet national standards
  Workforce Training Programs
• Goal: Help train up to 50,000 new HIT workers to assist
  providers in becoming Meaningful Users of EHRs

• Four distinct programs that aim to support the education
  of new HIT professionals, including:
   – Community college consortia
   – Curriculum development centers
   – University-based training
   – Competency examination program
The Beacon Community Program
• Goal: Share best practices that help communities
  achieve cost savings and health improvement
• 15 demonstration communities* that will:
  – Build and strengthen their HIT infrastructure and
    exchange capabilities and showcase the Meaningful
    Use of EHRs
  – Provide valuable lessons to guide other communities
    to achieve measurable improvement in the quality
    and efficiency of health services or public health
    outcomes
  *Two additional communities to be funded in Summer 2010
         Eligibility Overview
• Medicare Fee-For-Service (FFS)
  • Eligible Professionals (EPs)
  • Eligible hospitals and critical access hospitals
    (CAHs)
• Medicare Advantage (MA)
  • MA EPs
  • MA-affiliated eligible hospitals
• Medicaid
  • EPs
  • Eligible hospitals
                   Who is a Medicare Eligible
                           Provider?
                               Eligible Providers in Medicare FFS
                                    Eligible Professionals (EPs)
    Doctor of Medicine or Osteopathy
    Doctor of Dental Surgery or Dental Medicine
    Doctor of Podiatric Medicine
    Doctor of Optometry
    Chiropractor
                                            Eligible Hospitals
    Acute Care Hospitals*
    Critical Access Hospitals (CAHs)

*Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington, DC (including
                                                    Maryland)
             Who is a Medicaid Eligible
                     Provider?
                       Eligible Providers in Medicaid
                        Eligible Professionals (EPs)
Physicians
Nurse Practitioners (NPs)
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (PAs) working in a Federally Qualified Health Center
(FQHC) or rural health clinic (RHC) that is so led by a PA


                             Eligible Hospitals
Acute Care Hospitals (now including CAHs)
Children’s Hospitals
         Hospital-based EPs
• Hospital-based EPs do not qualify for Medicare
  or Medicaid EHR incentive payments.
• The Continuing Extension Act of 2010 modified
  the definition of a hospital-based EP as
  performing substantially all of their services in
  an inpatient hospital setting or emergency
  room. The rule has been updated to reflect this
  change.
• A hospital-based EP furnishes 90% or more of
  their services in either the inpatient or
  emergency department of a hospital.
Medicaid Only: Adopt/Implement/
        Upgrade (A/I/U)
• First participation year only for Medicaid providers
• Adopted – Acquired and Installed
   • Ex: Evidence of installation prior to incentive
• Implemented – Commenced Utilization of
   • Ex: Staff training, data entry of patient demographic
     information into EHR
• Upgraded – Expanded
   • Upgraded to certified EHR technology or added new
     functionality to meet the definition of certified EHR
     technology
• Must use certified EHR technology
• No EHR reporting period
     Meaningful Use: HITECH Act
            Description
• The Recovery Act specifies the following 3
  components of Meaningful Use:
  1. Use of certified EHR in a meaningful manner
     (e.g., e-prescribing)
  2. Use of certified EHR technology for electronic
     exchange of health information to improve
     quality of health care
  3. Use of certified EHR technology to submit
     clinical quality measures (CQM) and other
     such measures selected by the Secretary
Conceptual Approach to
   Meaningful Use



                           Improved
                           outcomes
               Advanced
               clinical
 Data          processes
 capture
 and sharing
             Meaningful Use Stage 1 –
             Health Outcome Priorities*
• Improve quality, safety, efficiency, and
  reduce health disparities
• Engage patients and families in their health
  care
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security
  protections for personal health information
•   *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s
                                  Healthcare. Washington, DC: National Quality Forum; 2008.
Meaningful Use: Basic Overview
         of Final Rule
• Stage 1 (2011 and 2012)
  • To meet certain objectives/measures, 80%
    of patients must have records in the
    certified EHR technology
  • EPs have to report on 20 of 25 MU
    objectives
  • Eligible hospitals have to report on 19 of 24
    MU objectives
  • Reporting Period – 90 days for first year;
    one year subsequently
               Next Steps
• Summer/Fall 2010 – Outreach and education
  campaign
• CMS to issue State Medicaid Directors Letter
  with policy guidance on the implementation of
  the Medicaid EHR Incentive Program
• Early 2011 – EPs and eligible hospitals can
  register for the Medicare and Medicaid EHR
  Incentive Programs
• More Information:
  http://www.cms.gov/EHRIncentivePrograms
       For More Information
Visit the ONC Web site: healthit.hhs.gov
                                                      Current RECs
United States Regional Extension Centers




 *Note: applicable regions across the nation may also be supported by the Indian Health Board Regional Extension Center, headquartered in Washington DC.
       Registration Overview
• All providers must:
   • Register via the EHR Incentive Program website
   • Be enrolled in Medicare FFS, MA, or Medicaid
     (FFS or managed care)
   • Have a National Provider Identifier (NPI)
   • Use certified EHR technology to demonstrate
     Meaningful Use
      • Medicaid providers may adopt, implement, or upgrade in
        their first year
• All Medicare providers and Medicaid eligible
  hospitals must be enrolled in PECOS
       Registration: Medicaid
• States will connect to the EHR Incentive
  Program website to verify provider
  eligibility and prevent duplicate payments
• States will ask providers for additional
  information in order to make accurate and
  timely payments
  •   Patient Volume
  •   Licensure
  •   A/I/U or Meaningful Use
  •   Certified EHR Technology
  Registration: Requirements
1. Name of the EP, eligible hospital, or qualifying
   CAH
2. National Provider Identifier (NPI)
3. Business address and business phone
4. Taxpayer Identification Number (TIN) to which the
   provider would like their incentive payment made
5. CMS Certification Number (CCN) for eligible
   hospitals
6. Medicare or Medicaid program selection (may
   only switch once after receiving an incentive
   payment before 2015) for EPs
7. State selection for Medicaid providers
Incentive Payments for Medicare
             EPs
• First Calendar Year (CY) for which the EP Receives an
  Incentive Payment
          CY 2011   CY 2012    CY 2013   CY2014    CY 2015
                                                   and later
CY 2011   $18,000
CY 2012   $12,000   $18,000
CY 2013   $8,000    $12,000    $15,000
CY 2014   $4,000    $8,000     $12,000   $12,000
CY 2015   $2,000    $4,000     $8,000    $8,000    $0
CY 2016             $2,000     $4,000    $4,000    $0
TOTAL     $44,000   $44,000    $39,000   $24,000   $0
Additional Incentive Payments for
Medicare EPs Practicing in HPSAs
 • First Calendar Year (CY) for which the EP Receives an
   Incentive Payment
           CY 2011   CY 2012    CY 2013   CY2014    CY 2015
                                                    and later
 CY 2011   $1,800
 CY 2012   $1,200    $1,800
 CY 2013   $800      $1,200     $1,500
 CY 2014   $400      $800       $1,200    $1,200
 CY 2015   $200      $400       $800      $800      $0
 CY 2016             $200       $400      $400      $0
 TOTAL     $4,400    $4,400     $3,900    $2,400    $0
 Incentive Payments for Medicaid EP
• First Calendar Year (CY) for which the EP Receives an Incentive
  Payment
             CY 2011   CY 2012   CY 2013   CY 2014   CY 2015   CY 2016
CY 2011      $21,250
CY 2012      $8,500    $21,250
CY 2013      $8,500    $8,500    $21,250
CY 2014      $8,500    $8,500    $8,500    $21,250
CY 2015      $8,500    $8,500    $8,500    $8,500    $21,250
CY 2016      $8,500    $8,500    $8,500    $8,500    $8,500    $21,250
CY 2017                $8,500    $8,500    $8,500    $8,500    $8,500
CY 2018                          $8,500    $8,500    $8,500    $8,500
CY 2019                                    $8,500    $8,500    $8,500
CY 2020                                              $8,500    $8,500
CY 2021                                                        $8,500
TOTAL
 20-Jul-10   $63,750   $63,750   $63,750   $63,750   $63,750   $63,750   77
      EHR Incentive Program Timeline
•   January 2011 – Registration for the EHR Incentive Programs begins
•   January 2011 – For Medicaid providers, States may launch their programs if
    they so choose
•   April 2011 – Attestation for the Medicare EHR Incentive Program begins
•   May 2011 – EHR incentive payments begin
•   November 30, 2011 – Last day for eligible hospitals and CAHs to register and
    attest to receive an incentive payment for FFY 2011
•   February 29, 2012 – Last day for EPs to register and attest to receive an
    incentive payment for CY 2011
•   2015 – Medicare payment adjustments begin for EPs and eligible hospitals
    that are not meaningful users of EHR technology
•   2016 – Last year to receive a Medicare EHR incentive payment; Last year to
    initiate participation in Medicaid EHR Incentive Program
•   2021 – Last year to receive Medicaid EHR incentive payment
       EHR Incentive Resources
• OFMQHIT Oklahoma REC – Daniel T. Golder,
  DDS, MBA (405) 302-3318

• Oklahoma Health Care Authority – John
  Calabro, CIO www.okhie.org/default.aspx

• Dallas CMS HITECH Team Lead – Kathy Maris
  (214) 767 -4446 kathy.maris@cms.hhs.gov
               QUESTIONS?
• Thank you for all you do to serve Medicare
  and Medicaid beneficiaries in rural areas!


  Becky Peal-Sconce
  CMS Regional Rural Health Coordinator
  Dallas, Texas
  (214) 767-6444
  becky.peal-sconce@cms.hhs.gov

				
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