NC Department of Health and Human Services

NC Division of
Medical Assistance

DMA Services> Medicaid, Health Choice

For County Staff> Manuals, Forms, Training

For Providers> Policies, Forms, Billing

Statistics and Reports> Performance Data

DMA HOME

Medicaid Providers

Quick Links

Basic Medicaid Billing Guide

Clinical Coverage Policies and Provider Manuals

EHR Newsletters

Medicaid Bulletin

Proposed Medicaid Clinical Coverage Policies

Related Sites

Certified Health IT Product List (CHPL)

CMS EHR Incentive Programs Website

CMS Registration and Attestation Information Web Page

CMS State Medicaid Information - Launch Times and HIT Websites

Medscape EHR Self Assessment

NC DHHS Health Information Technology Website

NC Tracks NC-MIPS Website

US HHS Health Information Technology Website

DHHS > DMA > Medicaid Providers > Electronic Health Records Incentives

NC Medicaid Electronic Health Record Incentive Program

Important Information

NOTE: The Medicaid Incentive Payment System (NC-MIPS) is currently undergoing upgrades to allow for 2012 attestations for both EPs and EHs. The deadline for EPs to attest for a 2011 payment was February 29, 2012. To attest for a Year 1 Adopt/Implement/Upgrade payment in 2012, please register with CMS and the NC-MIPS Operations Team will work with you offline until the new system is ready. For more information on the NC-MIPS upgrade, click here.

Payment Assignments
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 Eligible Professionals (EPs) assign an incentive payment to a practice or organization.

Update on Physician Assistant Eligibility
Physician Assistants (PAs) are currently able to apply for enrollment in Medicaid. PAs that are eligible for the EHR Incentive Program will be able to attest on or after April 1, 2012, the effective date of enrollment in Medicaid for all PAs that have successfully applied to date.

Attestation Tail Period
North Carolina will mirror CMS’ Medicare EHR Incentive Program with the adoption of a 60-day “attestation tail period,” or an extension beyond the year-end deadline to attest for a NC Medicaid EHR Incentive Payment. Now and in future payment years, this will allow eligible professionals and hospitals additional time to attest for a payment beyond the year during which requirements are met. Deadlines for Payment Year 2011 are below:

November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an incentive payment for Federal Fiscal Year (FFY) 2011.
December 31, 2011 – Reporting year ends for eligible professionals.
February 29, 2012 – Last day for eligible professionals to register and attest to receive an incentive payment for calendar year (CY) 2011.

Recent Memoranda

NC-MIPS Upgrade Memo (PDF, 92KB)
Local Health Department Methodology Memo (PDF, 41KB)

Introduction

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 of that technology.

Eligible professionals may receive up to $63,750 in incentive payments over the six years that they choose to participate in the program. The first incentive payment is $21,250, additional payments of $8500 are available for up to five years.

Eligible hospital 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.

Are You Eligible?

Eligibility Requirements for Professionals

Incentive payments for EPs are based on 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.
Each eligible professional 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 are not eligible for incentive payments. A professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service Code 21) or emergency room (Place of Service Code 23) setting.

Who is an Eligible Professional under the NCMedicaid EHR Incentive Program?
Eligible professionals under the NC Medicaid EHR Incentive Program include:

Physicians (primarily doctors of medicine and doctors of osteopathy)
Nurse practitioners
Certified nurse-midwives
Dentists
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 eligible professional 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

* Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

NOTE: Eligible professionals must choose to participate in either the Medicare or the Medicaid EHR Incentive Program. EPs may not receive incentive payments from both programs.

Eligibility Requirements for Hospitals
What is an Eligible Hospital under the Medicaid EHR Incentive Program?

Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume
Children's hospitals (no Medicaid patient volume requirements)

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 and this may cause significant delays in receiving a Medicare EHR incentive payment.

Additional guidance on this issue is available from CMS.

Program and Payment Years

The NC Medicaid EHR Incentive Program extends 10 years, from 2011-2021.
EPs may participate in any 6 of 10 program years.
Participation years do not have to be consecutive.
Payment Year One – an EP will Adopt, Implement or Upgrade a certified EHR technology.
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.

NOTE: We are currently in Stage 1 of meaningful use. Stage 2 meaningful use requirements are under development and will be rolled out in 2013-2014.

Path to Payment

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

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.
EP Attestation. EPs attest to information about their practice, patient encounters and certified EHR system. EP Attestation Guide is available at the NC MIPS portal to assist in the process. Additional assistance is available from the NC-MIPS call center at 1-866-844-1113. 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:

Mail: NC-MIPS CSC EVC Center
PO Box 300020
Raleigh, NC 27622-8020
Fax: 866-844-1382
Email: ncmips@csc.com

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 call center at 1-866-844-1113. 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:

Mail: NC-MIPS CSC EVC Center
PO Box 300020
Raleigh, NC 27622-8020
Fax: 866-844-1382
Email: ncmips@csc.com

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 4-10 weeks. 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.

For technical issues or to inquire about the status of your attestation, please contact ncmips@csc.com. For questions on the program or process, please contact NCMedicaid.HIT@dhhs.nc.gov.

Provider Registration and Attestation

Providers must register with the Centers for Medicare and Medicaid Services (CMS) to begin the process to receive an EHR incentive payment.

Registration and attestation with the state of NC is done through the NC Medicaid Incentive Payment System (NC-MIPS).

Meaningful Use

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

The use of a certified EHR in a meaningful manner, such as e-prescribing.
The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
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.

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 (expected to be implemented in 2013-2014) 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 or EHs and CAHs.

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 15 required core objectives.
The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

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 5 objectives may be chosen from the list of 10 menu set objectives.

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

What are Clinical Quality Measures (CQMs)?
To demonstrate meaningful use successfully, EPs, EHs and CAHs are also required to report clinical quality measures specific to EPs or EHs and CAHs.

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.

Please see the additional resources section below, for slides providing an overview on Clinical Quality Measures.