Important Announcement on Post-Payment Audits

The Department of Health Care Policy and Financing has hired the firm Myers and Stauffer, LLC to perform all post-payment audits for the Colorado Medicaid EHR Incentive Program. This includes all Eligible Professionals and Medicaid-only Eligible Hospitals.

Myers and Stauffer, LLC will contact you directly if you have been chosen for a post-payment audit and will be the only entity working with you to complete the audit process.

Reminder: You should keep all related documents to your attestation for a minimum of six years.

FOR MORE INFORMATION Contact Tracy McDonald, Medicaid EHR Incentive Program Coordinator, by email at MedicaidEHR@corhio.org or by phone at 720.285.3232.

CMS Clarifies Sequestration Reduction for Medicare EHR Incentive Payments

Office of Management and Budget on Sequestration:

CMS has clarified that incentive payments for reporting periods prior to April 1 2013 will not be subject to the sequestration reduction! This is welcome news to our many hospitals who attested for a reporting period in 2012 an have yet to be paid due to the delays with Novitas assuming the Medicare contractor role.

Click here for exact language. If you have any questions, please email our Senior Adviser David Ginsberg at dg@coruralheatlh.org.

Free Boot Camp in Durango: EHR & Meaningful Use

Interested in learning how you can optimize the use of your EHR?
Want to avoid incurring Medicare penalties?

Attend the free EHR & Meaningful Use Boot Camp and learn how to incorporate Meaningful Use objectives into your practice to increase efficiency, improve patient outcomes and make the most of the expense and time you put into your EHR adoption. Click HERE for more information.

EHR Incentive Programs

The EHR Incentive Programs Stage 1 Rule stated that, in order for a Medicaid encounter to count towards the patient volume of an eligible provider, Medicaid had to either pay for all or part of the service, or pay all or part of the premium, deductible or coinsurance for that encounter. 

The Stage 2 Rule now states that the Medicaid encounter can be counted towards patient volume if the patient is enrolled in the state’s Medicaid program (either through the state’s fee-for-service programs or the state’s Medicaid managed care programs) at the time of service without the requirement of Medicaid payment liability.

 

How will this change affect patient volume calculations for Medicaid eligible providers?
Importantly, this change affecting the Medicaid patient volume calculation is applicable to all eligible providers, regardless of the stage of the Medicaid EHR Incentive Program they are participating in. Billable services provided by an eligible provider to a patient enrolled in Medicaid would count toward meeting the minimum Medicaid patient volume thresholds. Examples of Medicaid encounters under this expanded definition that could be newly eligible might include: behavioral health services, HIV/AIDS treatment, or other services that might not be billed to Medicaid/managed care for privacy reasons, but where the provider has a mechanism to verify eligibility. Also, services to a Medicaid-enrolled patient that might not have been reimbursed by Medicaid (or a Medicaid managed care organization) may now be included in the Medicaid patient volume calculation (e.g., oral health services, immunization, vaccination and women’s health services, telemedicine/telehealth, etc.).

Providers who are not currently enrolled with their state Medicaid agency who might be newly eligible for the incentive payments due to these changes should note that they are not necessarily required to fully enroll with Medicaid in order to receive the payment.
In some instances, it may now be appropriate to include services denied by Medicaid in calculating patient volume. It will be appropriate to review denial reasons. If Medicaid denied the service for timely filing or because another payer’s payment exceeded the potential Medicaid payment, it would be appropriate to include that encounter in the calculation. If Medicaid denied payment for the service because the beneficiary has exceeded service limits established by the Medicaid program, it would be appropriate to include that encounter in the calculation. If Medicaid denied the service because the patient was ineligible for Medicaid at the time of service, it would not be appropriate to include that encounter in the calculation.

Further guidance regarding this change will be distributed to the states as appropriate.