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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

NC Medicaid Electronic Health Record Incentive Program

Breaking News!

NC-MIPS is now accepting Stage 2 Meaningful Use (MU) attestations! If you have already met Stage 1 MU, you may now attest for Stage 2 MU in NC-MIPS.

Medicare Payment Adjustments

Any provider who attested to Meaningful Use (MU) on or before September 30, 2014 to avoid the 2015 Medicare payment adjustments, please note we have sent your information to CMS. EPs may be asked to withdraw and resubmit their attestation on NC-MIPS to address an attestation discrepancy, but you will not be penalized by CMS for doing so. EPs will only be penalized by CMS if they are not deemed to be a meaningful user.

CMS 2014 Certified Electronic Health Record Technology (CEHRT) Flexibility Final Rule

This information from the Centers for Medicare and Medicaid Services (CMS) explains the new published on August 29, 2014. CMS’ Flexibility Final Rule became effective October 1, 2014. For FAQs regarding the Flexibility Rule, please click here.
The Rule grants flexibility to providers participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2014 who are unable to fully implement a 2014 Edition CEHRT for a 2014 EHR reporting period due to delays in 2014 Edition CEHRT availability. The reason for the delay must relate to software development, certification, implementation, testing, or release of the product by the EHR vendor, which resulted in the inability of a provider to fully implement 2014 Edition CEHRT. Important Note: A provider’s participation in the EHR Incentive Program for 2015 and subsequent years is not altered under this rule.

The Flexibility Rule:

  • Allows providers to meet meaningful use (MU) for Program Year 2014 if the EHR software is certified to meet either the 2011 or 2014 Edition criteria, or a combination of criteria from both Editions
  • Requires providers to report using 2014 Edition CEHRT for an EHR Reporting Period in 2015
  • Extends Stage 2 through 2016, pushing Stage 3 out to 2017
  • Requires providers in their first year of participation who are attesting to Adopt, Implement or Upgrade (AIU) criteria to use 2014 Edition CEHRT
  • Does not allow for objectives and clinical quality measures (CQMs) to be mixed and matched from different years (e.g., 2013 and 2014 definitions)
  • CQMs cannot be separated from MU objectives and measures, but providers can use the updated electronic specifications of the CQMs.

The Rule defines that a provider’s inability to fully implement a 2014 Edition CEHRT must be based on:

  • Delays in software development
  • Delayed or missing software updates
  • Being able to implement 2014 CEHRT for part of the reporting period (not the full reporting period)
  • Inability to train staff, test the updates system, or put new workflows in place due to delay with installation of 2014 CEHRT
  • Inability for a referring provider to meet Stage 2 Summary of Care measures because the receiving provider was impacted by 2014 CEHRT issues. [Referring providers may experience significant difficulty meeting the 10% threshold for electronic transmissions, despite their ability to send the electronic document, if the receiving provider couldn’t fully implement 2014 Edition CEHRT.]

The Rule specifically states that the following are unacceptable reasons for NOT fully implementing CEHRT:

  • Financial issues
  • Inability to meet one or more measures
  • Staff turnover and change
  • Waiting too long to engage a vendor
  • Refusal to purchase the requisite software
  • Ability to fully implement 2014 Edition CEHRT and report in 2014 but choosing not to do so

In early January 2015, the NC Medicaid EHR Incentive Program plans to accept CMS’ 2014 CEHRT Flexibility Rule criteria into the North Carolina Medicaid Incentive Payment System (NC-MIPS) website. An Eligible Professional (EP) Flexibility Final Rule Attestation Guide will be available to help providers navigate through the new reporting options in NC-MIPS.  For specific dates and details, visit the N.C. Division of Medical Assistance (DMA) NC Medicaid EHR Incentive Program Website at www.ncdhhs.gov/dma/provider/ehr.htm.

Per CMS, the Flexibility Final Rule is only applicable for Program Year 2014 attestations. The NC Medicaid EHR Incentive Program will be accepting Program Year 2014 attestations until the end of Program Year 2014’s attestation tail period on April 30, 2015 at 11:59 pm EST.  Providers are advised to submit their attestation before the deadline to allow time to address any attestation discrepancies.

Attestations cannot be altered after the close of the attestation tail period. If EPs are denied for Program Year 2014 and the attestation tail period has ended, they will not be able to re-attest for Program year 2014, but may re-attest for Program Year 2015 with no penalty and still have the opportunity to earn the full incentive payment of $63,750 over six years of participation.

Note: If you are planning to attest using the new CMS Flexibility Rule, please be sure to start and end your Meaningful Use reporting period prior to the end of calendar year 2014.

Medicare Penalties

The deadline to submit an MU attestation to avoid 2015 Medicare payment adjustments has passed. Payment adjustments will be applied beginning on October 1, 2014 for hospitals and on January 1, 2015 for Medicare eligible professionals.

If you know that you will be unable to meet MU in Program Year 2014 or 2015, to avoid 2016 Medicare payment adjustments, you may consider filing for a hardship exemption. For more information, please visit CMS' page on Payment Adjustments & Hardship Exemptions by clicking here. Please note, hardship exemptions are only to be filed with CMS.

Don't have a Medicaid Provider Number (MPN)?

If you are trying to register a provider who was registered with NC Medicaid on or after July 1, 2013, please enter an MPN of XXXXXXX for that provider. You will receive a pop-up warning message indicating the MPN is invalid. Please ignore the pop-up warning and move forward with the attestation.

Introduction (+/-)

 

For the NC Medicaid EHR Incentive Program Overview webinar, please click here! (Windows Media Audio/Video File - 13,107 KB)

The NC Medicaid Electronic Health Record (EHR) Incentive Program was created by the federal government as part of the American Recovery and Reinvestment Act of 2009.  The goal of the program is to encourage eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) to adopt, implement, or upgrade to a certified EHR technology, and then to demonstrate meaningful use (MU) of that technology.

There are two separate EHR Incentive Programs, Medicare and Medicaid. EPs may only participate in one of these programs and may switch between them one time. EHs in North Carolina are considered dually eligible and may participate in both programs.

Medicare vs Medicaid

For Medicaid, EPs may receive up to $63,750 in incentive payments over the six years that they choose to participate in the program.  The first year's incentive payment is $21,250, and additional payments of $8,500 each are available for up to five years.

EH incentive payments are based on a number of factors, including annual growth rates and projected discharges.  The EH incentive payment is calculated by starting with a base payment, then using a precise formula to adjust up or down depending on specific hospital activity.  The payment is then divided into three annual installments.  The first installment is 50 percent, the second is 40 percent, and the third is 10 percent.

New to the program? Click here for a simple program overview!

 

Timelines (+/-)

 

The NC Medicaid EHR Incentive Program extends 11 years, from 2011-2022. EPs may participate in any 6 of 10 program years. Years of participation do not have to be consecutive. Please note, to receive the full incentive payment amount, providers will need to begin their attestation by Program Year 2016.

  • Payment Year One – an EP will typically Adopt, Implement or Upgrade a certified EHR technology. Please note, a provider may choose to attest to Meaningful Use in their first participation year.
  • Payment Year Two – Meaningful Use.  Providers attest to a 90-day period in the current calendar year.
  • Payment Year Three and beyond – EPs will attest to Meaningful Use for the entire year.
    *For program year 2014 CMS is allowing a 90-day MU reporting period for ALL participating EPs.

EP’s may switch one time between the Medicare and Medicaid EHR Incentive Programs. If in their first year the EP receives a payment from Medicare and then switch to the Medicaid program for their second year of participation they would attest for a year 2 payment and will not be able to attest to AIU.

Visual Path to Payment

  • If the EP plans to attest/attested to AIU in their first year of participation, click here.
  • If the EP plans to attest/attested to MU in their first year of participation, click here.

Attestation Tail Period

North Carolina has extended the attestation tail period to 120 days to allow for attestation beyond the end of the payment year.

That means:

  • EHs will have until January 28, 2015 to attest for Program Year 2014.
  • EPs will have until April 30, 2015 to attest for Program Year 2014. 

Medicare Penalties

Medicare eligible professionals (EPs) who do not demonstrate meaningful use for the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. Because payment adjustments are mandated to begin on the first day of the 2015 calendar year, CMS will determine the payment adjustments based on meaningful use data submitted prior to the 2015 calendar year.

These payment adjustments will be applied to the Medicare physician fee schedule amount for covered professional services furnished by the EP in 2015. EPs who do not demonstrate meaningful use is subsequent years will be subject to increased payment adjustments in 2016 and beyond.

For additional information and guidance regarding these penalties, please see CMS' Payment Adjustment & Hardship Exemption webpage, which can be found by clicking here.

Please note, Medicaid does not have any provider penalties for not being deemed a meaningful user.

CMS' New Interactive Resource to Determine Timeline for Participation in the EHR Incentive Programs
CMS recently posted a new web resource for eligible professionals (EPs), My EHR Participation Timeline, to the EHR Incentive Programs website. This interactive tool allows EPs to determine what year you will meet Stage 1, Stage 2, and Stage 3 of meaningful use in the Medicare and Medicaid EHR Incentive Programs. It also provides information on:

  • The length of time EPs are required to demonstrate meaningful use at each stage;
  • The maximum incentive payment you can receive each year;
  • The total incentive payment amount you will receive based on your initial year of participation; and,
  • Links to helpful resources from the CMS website.

*Note - Pediatricians may qualify for the NC Medicaid EHR Incentive Program at a reduced 20% Medicaid Patient Volume threshold.

After choosing between the Medicare and Medicaid EHR Incentive Programs, select your first year of participation and the tool will create a personalized timeline with your results. This timeline can be printed and used as a reference for successful EHR Incentive Programs participation. 

For more CMS resources, visit the Educational Resources section of their website.

 

Are You Eligible? (+/-)

 

Eligibility Requirements for Professionals

  • Incentive payments for EPs are tied to individual practitioners.
  • If you are part of a practice, each EP may qualify for an incentive payment if each EP successfully adopts, implements, or upgrades to a certified EHR technology in Payment Year 1 and later demonstrates meaningful use of that technology.
  • Each EP is eligible for only one incentive payment per payment year, regardless of how many practices or locations at which he or she provide services.
  • Hospital-based professionals who can demonstrate they funded the acquisition, implementation and/or maintenance of a certified EHR technology without reimbursement from the hospital and uses the certified EHR technology in an inpatient/hospital setting, may be eligible to receive an incentive payment.

Who is an EP under the NC Medicaid EHR Incentive Program?
EPs under the NC Medicaid EHR Incentive Program include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy);
  • Nurse practitioners;
  • Certified nurse midwives;
  • Dentists; and,
  • Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

To qualify for an incentive payment under the NC Medicaid EHR Incentive Program, an EP must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician**
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals
    • NOTE: Health Choice patients do not count toward the Medicaid patient volume criteria. As of October 1, 2012 NC Medicaid no longer excludes Medicaid Children's Health Insurance Program (MCHIP) encounters from counting toward the Medicaid patient volume criteria.

*North Carolina Medicaid recognizes an Eligible Professional as being a pediatrician if they are a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) and meet one of the two requirements below:

  • Enrolled in NC Medicaid with a pediatrics specialty; or,
  • Board certified by a national certification board in Pediatrics, Adolescent or Child medical specialty area.

Please note, pediatricians may qualify for a reduced incentive payment with a reduced patient volume threshold of 20%.

Per the given definition, NPs are not eligible to qualify with a Medicaid PV threshold of 20%. All NPs need to meet the 30% Medicaid PV threshold to be eligible to receive an EHR incentive payment.

Update on Physician Assistant Eligibility
Physician Assistants (PAs) are only eligible for the NC Medicaid EHR Incentive Program if they furnish services at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a PA, so long as the PA meets all other Program eligibility requirements (30% Medicaid/needy individual PV, not hospital-based, etc.).

 

The Final Rule states, a PA would be leading an FQHC or RHC under any of the following circumstances:
(1) The PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, we would consider the PA as the primary provider);
(2) The PA is a clinical or medical director at a clinical site of practice; or
(3) The PA is an owner of an RHC.

 

For eligibility, PA-led facilities should submit (with their signed attestation) documentation on group letterhead speaking to one of the three requirements mentioned above.

 

Patient Volume (+/-)

 

Calculate patient volume using the formula below:

PVFormula

Please note, 'all Medicaid-enrolled encounters' include zero-paid encounters.

To qualify for an incentive payment under the NC Medicaid EHR Incentive Program, an EP must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

To calculate patient volume, you may select a consecutive 90-day period:

  1. In the previous calendar year for which you're attesting (e.g., if attesting for program year 2014, you'll use a 90-day period from calendar year 2013); or,
  2. In the 12 months immediately preceding the date of attestation.

Quick Tip! If, when attesting to Calendar Year 2013, you used a PV reporting period from calendar year 2013, when attesting for Program Year 2014 - you may use the same reporting period!

Click here for additional information on calculating patient volume for Program Year 2014.

If you are having difficulty calculating exactly 90 days for your patient volume reporting period, click here for a helpful tool! Please note, enter 89 days (as seen below) to get the 90th day. This will give you your PV reporting period dates.

Calendar Tool

Additional patient volume information can be found by clicking here for a revised Patient Volume Memorandum issued by the NC Medicaid EHR Incentive Program on September 3, 2013.

Also, see our FAQ page under the Patient Volume section. Please also see the EP AIU or MU Attestation Guides (right hand side of NC-MIPS) for step by step instructions and guidance for each field on the PV page in NC-MIPS.

Changes to Stage 1 Patient Volume per CMS' Stage 2 Final Rule

Per the CMS Stage 2 Final Rule released to the Federal Register on September 4th, the NC Medicaid EHR Incentive Program has released important documentation regarding Stage 1 patient volume requirement changes for eligible professionals and hospitals.

To view the EP Stage1 Changes per CMS' Stage 2 Final Rule, please click here.

Definition of a Group
For the purposes of attesting to PV with group methodology the NC Medicaid EHR Incentive Program has adjusted its definition of a group. A group means one or more eligible professionals practicing together at one practice location or at multiple practice locations within a logical geographical region under the same healthcare organization.

This definition was written to be as flexible as possible within the federal regulation, while still lending enough definition for auditing and program integrity purposes.

Group and Individual Methodology for Calculating Patient Volume for EPs

Calculating Medicaid patient volume is essential for determining if a provider is eligible to participate in the NC Medicaid EHR Incentive Program. We have recently created several visual aids to ensure EPs have the information needed to calculate their Medicaid patient volume correctly and accurately.

Click on one of the scenarios below to see visual guidance for calculating patient volume given the methodology used.

NOTE: CMS' Stage 2 Final Rule will impact the way EPs calculate patient volume. EPs, for more guidance on these changes, please click here.

Helpful Information for Calculating Patient Volume
Practicing Predominantly, New Providers, and Group Methodology
An EP who has more than 50 percent of his/her total patient encounters at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) during any continuous six-month period in the previous calendar year OR the 12 months immediately preceeding the attestation qualifies as “practicing predominately” at an FQHC or RHC. An EP who attests to practicing predominately in a FQHC or RHC may count needy individuals toward the 30% patient volume requirement necessary to receive an EHR incentive payment. 

Needy individuals include:  1) Individuals receiving assistance from Medicaid or the Children’s Health Insurance Program (Health Choice); 2) Individuals provided uncompensated care by the EP; and 3) Individuals who received services at no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.

NC Medicaid recognizes that this issue has implications for newer FQHC and RHC staff who cannot attest to practicing predominantly during the previous year and who wish to use group methodology for calculating Medicaid patient volume. The following examples attempt to clarify these implications for eligibility of such providers to receive EHR incentives.

Example 1 –
A new provider is hired into an FQHC that attested using group methodology to calculate patient volume and met the 30% Medicaid patient volume requirement without using needy individual patient encounters. The new provider did not practice at an FQHC or RHC for six continuous months during the previous year or the 12 months immediately preceding the date of attestation, and would answer “No” to the practices predominantly question. This provider expects to see Medicaid patients in keeping with the FQHC’s reported patient volumes from the previous year, and due to his/her current affiliation with the FQHC, s/he may attest using the group’s pre-calculated patient volume (group methodology) from the previous year.

Example 2—
A new provider is hired into an FQHC that attested using group methodology to calculate patient volume and was able to meet the 30% Medicaid patient volume requirement by using needy individual patient encounters. The new provider did not practice at an FQHC or RHC for six continuous months during the previous year or the 12 months immediately preceding the date of attestation, and would answer “No” to the practices predominantly question. Although this provider expects to see Medicaid patients in keeping with the FQHC’s reported patient volumes from the previous year and has a current affiliation with the FQHC, s/he may not attest using the group’s pre-calculated patient volume (group methodology) from the previous year, as the practicing predominantly requirement must be satisfied in order to use needy individuals toward the Medicaid patient volume requirement.

Example 3—
A new provider is hired into an FQHC that attested using group methodology, either with or without the use of needy individual patient encounters. The new provider came to the new practice from another FQHC or RHC and can answer “Yes” to the practices predominantly question. In this scenario, the provider expects to see Medicaid patients in keeping with the new FQHC’s reported patient volumes from the previous year or the 12 months immediately preceding the date of attestation, and due to his/her current affiliation with the FQHC and his/her ability to satisfy the practicing predominantly requirement, s/he may attest using the group’s pre-calculated patient volume (group methodology) from the previous year.

Note: In all of the above examples, a provider who practiced elsewhere during the previous year and saw the requisite 30% Medicaid patients may be eligible to attest using individual methodology for calculating patient volume. In this case, the provider would calculate his/her individual patient encounters from the previous practice site(s), as long as the previous practice group did not attest using group methodology for the same 90-day period.
*Please note that patient volume methodology and assignment of payment are not related. A provider may attest having used group methodology to calculate patient volume, and assign the incentive payment to him/herself or to another practice with whom s/he is affiliated that promotes the meaningful use of certified EHR technology.

“Incident to” Billing and the EHR Incentive Program
“Incident to” billing is a long-standing billing practice in North Carolina Medicaid. While there are implications for the NC Medicaid EHR Incentive Program around validating Medicaid patient volume, there is no requirement to have a billed claim tied to your personal MPN/NPI to be eligible for the Program. To be clear, providers who bill “Incident to” a physician, and thus have no or few claims billed under their names, are still eligible to receive incentive payments if they meet all other Program requirements.

Providers who have billed “Incident to” in the year prior to attestation should work with EHR Incentive Program staff to identify all MPNs under which their encounters were billed with NC Medicaid, and provide documentation to this effect. This will ultimately avoid delays in validation and payment.

Click here for more incident to guidance!

 

Path to Payment (+/-)

 

3 Unique Reporting Periods:

There are 3 unique reporting periods that EPs need to be aware of. The scenarios below assume the EP is attesting for Program Year (PY) 2014.

Patient Volume - Consecutive 90-day period in prior calendar year (e.g.: 2013), or from the 12 months immediately preceding the date of attestation (January 1, 2013 - day prior to attesting). This will be individual or group encounters/data.

Meaningful Use- Consecutive 90 or 365 days in the current calendar year (2014). This will be individual encounters/data.

Practicing Predominantly (FQHC/RHCs only) - Consecutive 6-month period in prior calendar year (e.g.: 2013), or from the 12 months immediately preceding the date of attestation (essentially any time between January 1, 2013 through the day prior to attesting). This will be individual encounters/data.

Note: NC Medicaid EHR Incentive Payments are linked to professionals and may be assigned on a voluntary basis to an affiliated organization promoting the adoption and meaningful use of certified EHR technology.  It is against federal and program rules for an organization to require that affiliated EPs assign an incentive payment to a practice or organization.

Click here for a print-friendly version of the reporting periods.

The process to receive a first-time incentive payment (Payment Year 1) includes the following steps below.

  • Eligibility. Determine eligibility for the program using the eligibility wizard.
  • CMS Registration. Register with the Centers for Medicare and Medicaid Services (CMS)
  • A/I/U. Adopt, implement, or upgrade to a certified EHR system. The Office of the National Coordinator for Health Information Technology (ONC) maintains a comprehensive listing of all certified technologies. New vendors and products are certified and added to the list as they become available. 
    • If attesting in Program Year 2014 (for AIU or for the definition of 2014 MU, you will need a 2014 certified EHR. Please check ONC's Certified Health IT Product List to see if your EHR is certified.
  • Confirmation. NC Medicaid will verify information provided from CMS and send a welcome email to providers with an invitation to begin the attestation.
  • Attestation. Once a provider receives a welcome email inviting them to begin the attestation process with the NC Medicaid Incentive Payment System (NC-MIPS), the provider can log onto the NC-MIPS portal, and complete the attestation process.
  • EP Attestation. EPs attest to information about their practice, patient encounters and certified EHR system. The EP Attestation Guide is available at the NC MIPS portal to assist in the process.  Additional assistance is available from the NC-MIPS Help Desk at 919-814-0180.  Do not forget to print and sign a copy; then mail, fax or email it to the NC-MIPS Center at one of the following:

    Email:  NCMedicaid.HIT@dhhs.nc.gov (preferred method of submission)

    Mail:  NC Medicaid EHR Incentive Program, 2501 Mail Service Center, Raleigh, NC  27699-2501

*Effective June 1, 2013, the NC Medicaid EHR Incentive Program will not accept documentation via fax.

NOTE: North Carolina has extended the attestation tail period to 120 days to allow for attestation beyond the end of the payment year. This means EPs will have until April 30, 2015 to attest for Program Year 2014. 

Note that EPs wishing to attest to Meaningful Use must select a continuous 90-day reporting period within the Calendar Year of the attested payment year, even if they plan to attest during the attestation tail period.  Click here for Reporting Periods Defined.

  • Verification. Once attestations are completed, they are verified by NC Medicaid. If any problems are found, providers are notified with instructions on how to address any issue. The verification process consists of multiple internal checks at NC Medicaid and can take as long as four to 10 weeks for an error-free attestation.  This estimate is based on a fully implemented and operational system.  There may be delays as NC Medicaid continues to operationalize the system.  Do not make financial commitments based upon this timeline.  It may take longer than expected to receive incentive payments.
  • Notification. Providers will be notified once the verification process has been completed along with when to expect an incentive payment.  Payments are made according to the established Medicaid payment schedule.
  • Future Payments. EPs are eligible for five additional incentive payments based upon the meaningful use of their certified EHR technology (as defined by CMS). Meaningful use attestation begins in payment year two and will be based upon a 90-day reporting period.  Additional years of meaningful use will have a reporting period of 365 days.  The incentive program runs through 2021 and payment years do not have to be consecutive.  Additional information about Meaningful Use and the measures associated with it can be found on the CMS website.  

Visual Path to Payment

  • If the EP plans to attest/attested to AIU in their first year of participation, click here.
  • If the EP plans to attest/attested to MU in their first year of participation, click here.

All program questions should be directed to NCMedicaid.HIT@dhhs.nc.gov.

Provider Registration and Attestation (+/-)

 

Providers must first register with the Centers for Medicare and Medicaid Services (CMS) to begin the process to receive an EHR incentive payment. Once you register with CMS, you will receive a welcome letter to come and attest with NC on the North Carolina Medicaid Incentive Payment System (NC-MIPS).

The first year of participation, program participants will create a First Time Account Setup on NC-MIPS. For each subsequent year of participation, please sign in to NC-MIPS using the NCID username and password used during the NC-MIPS First Time Account Setup.

If the NCID has been updated since the First Time Account Setup and you are unable to retrieve it using the "Forgot Username/Password" links, please email NCMedicaid.HIT@dhhs.nc.gov so we can manually update the NCID associated with the providers' NC-MIPS account.

We are a completely separate entity from NCTracks or NCID. If you are having issues with NCID or NCTracks, please contact them directly.

If you have any questions about your attestation or are experiencing problems in NC-MIPS please review the NC-MIPS Attestation User Guides and the Quick Reference Guide documents below.

If after reviewing those documents you are still experiencing an issue, please email the NC-MIPS Help Desk and provide the providers' NPI, NCID, CMS Registration ID, the program year they are attesting for, a screenshot of the information being entered with the error message being received and a brief description of the issue.

By Email: NCMedicaid.HIT@dhhs.nc.gov

Email is the preferred method of contact.

 

Meaningful Use: Stage 1 (+/-)

 

For an overview of Meaningful Use Stages 1 & 2, click here! (Microsoft Media/audio video file - 19,874 KB)

Providers will spend two years at each stage of MU. EPs must meet Stage 1 MU before they are able to attest to Stage 2 MU. Per CMS' Stage 2 Final Rule, anyone attesting to 2014 MU must have 2014 certified EHR technology.

NC Immunization Registry Exclusion

Until further notice, eligible professionals (EP) and eligible hospitals (EH) participating in the NC Medicaid EHR Incentive Program may continue to claim an exclusion for the Meaningful Use immunization registry measure for the purpose of meeting Stage 1 and Stage 2 Meaningful Use.

The North Carolina Immunization Registry is working toward accepting data electronically and deployment will begin once technical readiness has been proven and administrative operability is available.  

Please continue to check the NC Medicaid EHR Incentive Program website for more updates as they become available. Thank you for your continued patience as we work toward advancing healthcare in North Carolina.

2014 Meaningful Use

Anyone attesting to the 2014 definition of Meaningful Use (MU) must have 2014 certified EHR technology to meet the 2014 definition of MU. Please ensure you update your certified EHR technology number on CMS' Registration & Attestation System prior to attesting on NC-MIPS.

As a reminder, if the EP’s NCID username has been updated since creating a First Time Account Setup with NC-MIPS, please send an email to NCMedicaid.HIT@dhhs.nc.gov with the provider(s) name, NPI & updated NCID username so we may update NC-MIPS with the EPs working/valid NCID username. Please check the https://ncid.nc.gov website to ensure the EP’s NCID username and password are working/valid.

If the EP has never attested with the NC Medicaid EHR Incentive Program, they will need to register on CMS’ R&A & will then be invited to create a First Time Account Setup with NC-MIPS. A First Time Account Setup must be done with NC-MIPS for the EP to attest on NC-MIPS.

For further attestation assistance, particularly as the CQMs will be reported differently in 2014, please refer to the 2014 EP MU Attestation Guide available on the right side of NC-MIPS. The attestation guide provides step by step guidance on successfully registering and attesting for the NC Medicaid EHR Incentive Program.

90-day Meaningful Use Reporting Period in 2014

For Program Year 2014, CMS has issued a one-time 90-day (for EPs) Meaningful Use (MU) reporting period regardless of the provider's participation and/or payment year to allow participants time to upgrade to 2014 EHR certification requirements. This means, all EPs partcipating in the NC Medicaid EHR Incentive Program may demonstrate/report a 90-day MU reporting period for a Program Year 2014 attestation. Please note EHs will report a fiscal quarter MU reporting period.

The American Recovery and Reinvestment Act of 2009 specifies three main components of meaningful use:

  1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
  2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
  3. The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

Please note, Meaningful Use is based on individual numbers, so when entering your MU information into NC-MIPS, base it off of the individual encounters, not that of the group (even if the EP used group methodology to calculate patient volume).

CMS EHR Meaningful Use Criteria Summary
The criteria for meaningful use will be staged in three steps over the course of the next five years.

  • Stage 1 (beginning in 2012) sets the baseline for electronic data capture and information sharing;
  • Stage 2 (going into effect on October 1, 2013 for EHs, and January 1, 2014 for EPs), will advance clinical processes and focus on the electronic exchange of health information. (For the complete Stage 2 Toolkit, please click here); and,
  • Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and will be developed through future rule making.

What are the Requirements for Stage 1 of Meaningful Use (Beginning in 2012)?
Meaningful use includes both a core set and a menu set of objectives that are specific to EPs.

  • For EPs, there are a total of 25 meaningful use objectives.  To qualify for an incentive payment, 20 of these 25 objectives must be met.
    • There are 13 required core objectives. (Two core measures have been removed as a result of the Stage 2 Final Rule.)
    • The remaining five objectives may be chosen from the list of 10 menu set objectives.

These Stage 1 EHR Meaningful Use Specification Sheets for EPs were designed to help EPs understand the specific requirements of each objective.

Please click here for an overview of 2014 Meaningful Use Changes.

Meaningful Use 1-Page Overview

To see a summary of the meaningful use measures (core, menu & CQMs), please click here.

For a more detailed overview of the Stage 1 Requirements, please click here.

Attestation Worksheet for EPs in Stage 1

EPs can use the worksheet to log their meaningful use measures to use as a reference when attesting for the Medicare EHR Incentive Program with CMS. EPs can find the worksheet here.

Note: This was created by CMS specifically for attesting with the Medicare EHR Incentive Program, but this document is also helpful when attesting with the Medicaid EHR Incentive Program.

What are Clinical Quality Measures (CQMs)?
To demonstrate meaningful use successfully in Program Year 2013, EPs are required to report clinical quality measures.

  • A list of 38 CQMs are posted on CMS’ website.
  • EPs must report on 6 total clinical quality measures
    • 3 required core measures (substituting alternate core measures where necessary) and any 3 additional measures from the list.
  • EHs and CAHs must report on 15 core clinical quality measures.

See Clinical Quality Measures to learn more about clinical quality measures for eligible professionals, eligible hospitals and CAHs.

*Note: Requirements for reporting CQMs in 2012 and 2013 are unchanged from past years.  The Stage 2 final rule changes for CQMs do not begin until 2014.

Meaningful Use Specialists Tipsheet

CMS recognizes that not every meaningful use measure applies to every provider participating in the Electronic Health Record (EHR) Incentive Programs. To help specialty providers successfully meet meaningful use measure requirements and navigate the EHR Incentive Programs, CMS created the Meaningful Use for Specialists Tipsheet.  

Tipsheet topics include:

  • Reporting measure exclusions;
  • Using other providers' data;
  • Determining office visits for applicable measures; and
  • Applying for a hardship exemption.

The tipsheet also includes links to resources that can help specialists successfully participate in the EHR Incentive Programs. For helpful materials you can also visit the Educational Resources page on the EHR Incentive Programs website.

For those looking to ask additional questions on the Standards and Certification Criteria for the Stage 2 Final Rule, Steve Posnack, Director of the Federal Policy Division at ONC, will be holding S&CC Office Hours throughout the month of September. You can view the dates and register for these programs at www.nationalehealth.org/OfficeHours.

 

Meaningful Use: Stage 2 (+/-)

 

NC-MIPS is now accepting Stage 2 Meaningful Use (MU)attestations! If you have already met Stage 1 MU, you may now attest for Stage 2 MU in NC-MIPS.

For an overview of Meaningful Use Stages 1 & 2, click here! (Microsoft Media/audio video file - 19,874 KB)

Stage 2 MU became effective on October 1, 2013 for EHs, and January 1, 2014 for EPs.

Providers will spend two years at each stage of MU. EPs must meet Stage 1 MU before they are able to attest to Stage 2 MU. Per CMS' Stage 2 Final Rule, anyone attesting to 2014 MU must have 2014 certified EHR technology.

90 day Meaningful Use Reporting Period in 2014

In Program Year 2014, CMS has issued a one-time or 90-day (for EPs) Meaningful Use (MU) reporting period regardless of the EPs participation/payment year. This means, all EPs partcipating in the NC Medicaid EHR Incentive Program may demonstrate/report a 90-day MU reporting period for a 2014 attestation. Please note EHs will report a fiscal quarter MU reporting period.

NC Immunization Registry Exclusion

Until further notice, eligible professionals (EP) and eligible hospitals (EH) participating in the NC Medicaid EHR Incentive Program may continue to claim an exclusion for the Meaningful Use immunization registry measure for the purpose of meeting Stage 1 and Stage 2 Meaningful Use.

The North Carolina Immunization Registry is working toward accepting data electronically and deployment will begin once technical readiness has been proven and administrative operability is available.  

Please continue to check the NC Medicaid EHR Incentive Program website for more updates as they become available. Thank you for your continued patience as we work toward advancing healthcare in North Carolina.

CMS Releases Meaningful Use Stage 2 Final Rule

Rule Provisions
Through the Stage 2 requirements of the EHR Incentive Programs, CMS will expand meaningful use of certified EHR technology. The rule made consolidated several existing Stage 1 objectives and added new objectives for Stage 2. There will be 20 measures for EPs (17 core and 3 of 6 menu) and 19 measures for eligible hospitals (16 core and 3 of 6 menu) in Stage 2.

Helpful Stage 2 Final Rule Tools from CMS

On August 23, 2012, the Centers for Medicare & Medicaid Services (CMS) published the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The rule provides new criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR Incentive Programs.

CMS recently updated the EHR Incentive Programs website with a new Stage 2 section, which provides helpful information on the Stage 2 final rule and how it affects the EHR Incentive Programs. The Stage 2 page includes an overview of the final rule and links to Stage 2 resources:

Recorded webinars & presentations are available for additional Stage 2 Final Rule information online at www.nationalehealth.org/FinalRules.

CMS will continue to provide resources for providers on Stage 2 rule and the EHR Incentive Programs. Visit the Stage 2 page to view upcoming webinars and sessions discussing Stage 2 and the different changes occurring, or check back with the NC Medicaid EHR Incentive Program website for more information.

 

Clinical Quality Measures (Program Year 2014 and beyond) (+/-)

 

CMS Posts 2014 Clinical Quality Measures, Electronic Specifications and Resources on Website

Beginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers. Electronic Health Record (EHR) technology that has been certified to the 2014 standards and capabilities will contain new CQM criteria, and eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid EHR Incentive Programs.

For Program Year 2014 MU (Stage 1 & 2), EPs will be able to submit their clinical quality measures directly to the State via NC-MIPS. Due to technical difficulties, all EPs attesting for MU in program year 2014 will be unable to do so until further notice.  Updates will be made available on the NC-MIPS homepage and our program website as they become available.

Resources for 2014 CQMs
To help providers navigate the new CQMs, CMS has developed and posted new resources, including:

e-Specifications
The value sets of the electronic specifications code the CQMs in your EHR, allowing you to export the measure results and report them in attestation. EPs and eligible hospitals can view the value sets on the National Library of Medicine Value Set Authority Center (VSAC) webpage.

 

Eligible Hospitals (+/-)

 

For the Eligible Hospital NC Medicaid EHR Incentive Program Overview webinar, please click here! (Microsoft Media/audio video file - 14,036 KB)

Please note, EHs must first complete their MU attestation with Medicare before attesting with Medicaid. The Medicare payment must be received prior to being able to attest with Medicaid.

EHs will participate in the EHR Incentive Program(s) for no more than three years.

Fiscal Quarter Meaningful Use Reporting Period in 2014

In Program Year 2014, CMS has issued a one-time fiscal quarter (for EHs) Meaningful Use (MU) reporting period regardless of the EHs participation/payment year. This means, all EPs partcipating in the NC Medicaid EHR Incentive Program may demonstrate/report a 90-day MU reporting period.

Those hospitals who are attesting for a year 2 or 3 payment do not need to provide cost-report data or patient-level documentation with their attestation.

To see the EH attestation reporting schedule, please click here.

NOTE: North Carolina has extended the attestation tail period to 120 days to allow for attestation beyond the end of the payment year. This means EHs will have until January 28, 2015 to attest for Program Year 2014.

Attention Hospitals:

If your hospital has achieved successful ongoing submission of production syndromic surveillance data to NC Division of Public Health via NCHESS from 2011 certified EHR technology before October 1, 2013, and your hospital owns a 2014 certified EHR technology for Transmission to Public Health Agencies - Syndromic Surveillance, you will be permitted to continue to transmit your syndromic surveillance data using 2011 certified EHR technology for Stage 2.

If you are unsure if your hospital has achieved successful ongoing submission of production syndromic surveillance data, please contact Emilie Lamb at emilie.lamb@dhhs.nc.gov or Jonathan Kea at jkea@ncha.org.

Eligibility Requirements for Hospitals

What is an EH under the Medicaid EHR Incentive Program?

Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume.

PV is calculated by dividing the sum of the Medicaid Acute Care Inpatient Discharges and Medicaid ED Visits by the sum of Total Acute Care Inpatient Discharges and Total ED Visits in a continuous 90-day period during the preceding federal fiscal year or in the most recent continuous 12-month period for which data are available prior to the payment year.

Children's hospitals (no Medicaid patient volume requirements).

For more information on how to calculate an EH payment, please click here.

For guidance from CMS on how to calculate an EH payment, please click here.

Eligible for Both Medicaid and Medicare EHR Incentive Programs?
Some hospitals may receive incentive payments from both Medicare and Medicaid if they meet all eligibility criteria.  Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select "Both Medicare and Medicaid" during the initial CMS registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually eligible hospital to select "Both Medicare and Medicaid" from the start of program registration in order to maintain this option.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to "Both Medicare and Medicaid" or from one program to the other) after a payment is initiated; this may cause significant delays in receiving a Medicare EHR incentive payment.

 

Additional guidance on this issue is available from CMS.

 

Stage 1 of Meaningful Use (Beginning in 2012)

If attesting for MU, please complete the MU attestation with Medicare first. You must receive the Medicare payment prior to being able to attest with Medicaid.

For EHs and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.

    There are 14 required core objectives.

    The remaining five objectives may be chosen from the list of 10 menu set objectives.

These Stage 1 EHR Meaningful Use Specification Sheets for Hospitals/Critical Access Hospitals were designed to help EHs/CAHs understand the specific requirements of each objective.

For a CMS issued Stage 1 EH Attestation worksheet, please click here.

Stage 2 Meaningful Use for Eligible Hospitals

Stage 2 MU went into effect on October 1, 2013 for EHs. As a reminder, to allow providers time to upgrade their EHRs to the 2014 EHR certification standards, CMS has granted a one-time, fiscal quarter MU reporting period for ALL participants in the EHR Incentive Programs in program year 2014, regardless of the hospital's participation year.

To meet Stage 2 Electronic Lab Reporting requirements, hospitals must declare their intent to submit this information electronically to the State Public Health Agency within the first 60 days of their chosen MU reporting period. The NC Division of Public Health (DPH) is developing a mechanism where hospitals participating in the EHR Incentive Programs can state their intent to submit their health information to the state’s public health systems. For more information, please contact the NC DPH Meaningful Use Help Desk by email (ncdphmu@dhhs.nc.gov), or for questions related specifically to immunization reporting contact ncirdataexchange@dhhs.nc.gov.

Click here for more information about the ELR and Meaningful Use.

Stage 2 Resources for EHs
To help providers navigate the new CQMs, CMS has developed and posted new resources, including:

Clinical Quality Measures in Program Year 2014 and Beyond

The updated 2014 clinical quality measures (CQMs) for eligible hospitals are now available, as well as corresponding specifications for electronic reporting and access to the related data elements and value sets.

For more CMS guidance, please click one of the links below:

EH Path to Payment

  • Eligibility. Determine eligibility for the program using the eligibility wizard.
  • CMS Registration. Register with the Centers for Medicare and Medicaid Services (CMS)
  • A/I/U. Adopt, implement, or upgrade to a certified EHR system. The Office of the National Coordinator for Health Information Technology (ONC) maintains a comprehensive listing of all certified technologies. New vendors and products are certified and added to the list as they become available. 
  • Confirmation. NC Medicaid will verify information provided from CMS and send a welcome email to providers with an invitation to begin the attestation.
  • Attestation. Once a provider receives a welcome email inviting them to begin the attestation process with the NC Medicaid Incentive Payment System (NC-MIPS), the provider can log onto the NC-MIPS portal, and complete the attestation process.
  • EH Attestation. EHs attest to information about their patient volume, cost report data and certified EHR system.  EH Attestation Guide is available at the NC MIPS portal to assist in the process.  Additional assistance is available from the NC-MIPS Help Deskat 919-814-0180. Do not forget to print and sign a copy; then mail, fax or email it to the NC-MIPS Help Desk at one of the following:

    Email:  NCMedicaid.HIT@dhhs.nc.gov (preferred method of submission)

    Mail:  NC Medicaid EHR Incentive Program, 2501 Mail Service Center, Raleigh, NC  27699-2501

*Effective June 1, 2013, the NC Medicaid EHR Incentive Program will not accept documentation via fax.

NOTE: North Carolina has extended the attestation tail period to 120 days to allow for attestation beyond the end of the payment year. This means EHs will have until January 28, 2014 to attest for Program Year 2013. 

  • Verification. Once attestations are completed, they are verified by NC Medicaid. If any problems are found, providers are notified with instructions on how to address any issue. The verification process consists of multiple internal checks at NC Medicaid and can take as long as four to 10 weeks for an error-free attestation.  This estimate is based on a fully implemented and operational system.  There may be delays as NC Medicaid continues to operationalize the system.  Do not make financial commitments based upon this timeline.  It may take longer than expected to receive incentive payments.
  • Notification. Providers will be notified once the verification process has been completed along with when to expect an incentive payment.  Payments are made according to the established Medicaid payment schedule.
  • Future Payments. EPs are eligible for 5 additional incentive payments based upon the meaningful use of their certified EHR technology (as defined by CMS). Meaningful use attestation begins in payment year two and will be based upon a 90-day reporting period.  Additional years of meaningful use will have a reporting period of 365 days.  The incentive program runs through 2021 and payment years do not have to be consecutive.  Additional information about Meaningful Use and the measures associated with it can be found on the CMS website.  

Hospitals and the NC Medicaid EHR Incentive Program Webinar

Hospitals play a unique role in NC’s HIT landscape. In this webinar we will be reviewing hospital-specific information such as how to accurately report HMO bed days and out-of-state days, calculating patient volume, Medicaid/Medicare attestation schedules, and much more.  To all hospitals out there - this is your chance to have a hospital-specific guide through the NC Medicaid EHR Incentive Program!

Click here for the recorded podcast!

Click here for the Powerpoint slide deck. (PDF, 1,299 KB)

 

Links & Resources (+/-)

 

 

Current Program Documents

  • SMHP (PDF, 12,171 KB)
  • IAPD (PDF, 629 KB)

Attestation Documents

Meaningful Use

Reporting Periods Defined

Guidance for Patient Volume, Meaningful Use & Practicing Predominantly reporting periods can be found here.

Visual Path to Payment

  • If the EP plans to attest/attested to AIU in their first year of participation, click here.
  • If the EP plans to attest/attested to MU in their first year of participation, click here.

Behavioral Health Template

Click here for the Behavioral Health Template

Meaningful Use Guidance for Oral Health Professionals

HRSA has recently released some helpful guidance for those oral health professionals who are participating in the NC Medicaid EHR Incentive Program. Click here to learn the best practices when attesting for meaningful use as an oral health professional!

Additional Links to Great Resources for Providers

FAQs (+/-)

 

See the NC Medicaid EHR Incentive Program Frequently Asked Questions Page. Providers are also encouraged to submit questions to NCMedicaid.Hit@dhhs.nc.gov. Responses will be used to update this FAQ section.

More FAQs are also available on the CMS website.

Updated CMS FAQ System

The updated FAQ system allows users to share direct links to specific questions and answers in the frequently asked questions (FAQs) section.

Locating FAQs
There are a few different ways to find the FAQ you need. To browse by topic, click “ Electronic Health Records Incentive Programs on the FAQ page’s blue navigation panel. If you would prefer to search by keyword, enter terms into the Search box in the upper left hand corner.

The Search box also allows users to perform searches by FAQ number. FAQs are still searchable by using its old FAQ number, which is listed after the word “Keywords” below the answer of the FAQ, or by using its new FAQ number, which can be found at the very bottom of the FAQ in parentheses.

When searching by new FAQ number, be sure to select the “FAQ #” option by clicking the circle and highlighting it in blue. Please note that you cannot search by old FAQ number in the “FAQ # Search” box. Instead, search by old FAQ numbers in the “Text Search” box.

Sharing FAQs
Once you have located your desired FAQ, a unique link to the web page will be displayed in the address bar. Using this link, you can go directly to the FAQ. For example, if you want to share the FAQ on How and when will incentive payments for the Medicare Electronic Health Record (EHR) Incentive Programs be made?, you can use the hyperlink to share and direct yourself to the FAQ again in the future.

 

Contact Us (+/-)

 

Providers should use the email, phone number, and mailing addresses listed below for all correspondence with the N.C. Medicaid EHR Incentive Program, including program and attestation inquiries, sending in signed attestations and supporting documentation.

Email: NCMedicaid.HIT@dhhs.nc.gov
Phone Number: 919-814-0180
Mailing Address: NC Medicaid EHR Incentive Program, 2501 Mail Service Center, Raleigh NC 27699

*Email is the preferred method of contact and submission.
Note: Effective June 1, 2013, the N.C. Medicaid EHR Incentive Program no longer accepts documentation via fax.

For technical assistance in the NC Medicaid EHR Incentive Program contact one of the following:

The Carolinas Center for Medical Excellence
www.CCMEConsulting.org
919-461-5699
CCMEconsulting@thecarolinascenter.org

NC Area Health Education Centers (AHECs)/Regional Extension Centers (REC)
http://www.ncahec.net
919-966-2461
ncahec@med.unc.edu

NC Medical Society
http://www.ncmedsoc.org
919-833-3836

For a list of paid providers through 6/9/14, please click here. Please note, this payment spreadsheet does not contain exact dates of payment.

State of North Carolina Home Page