Medicaid Promoting Interoperability Program

1. Contract between entities

2. Invoice showing payment (actual number blacked out)

3. Purchase Order (A vendor letter is not acceptable)

A. For Eligible Providers

• Date range must be from any continuous 90-day period from the prior calendar year.
• Medicaid Patient Encounter volume equals:

1. Total Medicaid encounters divided by total encounters during same time period.
2. Providers may include hospital encounters that are billed through clinic
3. Encounters may be broken out from bundled charges.
4. Method used to determine Medicaid patient volume must be same the method used to determine total patient volume.

B. Needy Individual Patient Volume (applied to RHC’s/FQHC’s only)

• Date range must be from any, continuous, 90-day period from the prior calendar year.
• Medicaid Patient Encounter volume equals
  • Total needy individual patient encounters divided by total patient encounters during same time period. (Proof of sliding fee scale with methodology required.)

C. Group Practice Volume can be used to calculate patient volume IF:

• Clinic or Group patient volume is appropriate as a patient volume methodology calculation for the EP.
• An auditable data source can support the clinic/group practice patient volume determination.
• ALL EPs in the group practice or clinic use the same methodology for payment year.
• The clinic or group practice uses the ENTIRE practice or clinic’s patient volume and does not limit patient volume in any way.

D. For Eligible Hospitals

• Date range must be from any continuous 90-day period from the FISCAL year preceding the hospitals’ payment year.
• Includes Medicaid patients who are in-patients discharged from acute care AND Medicaid Emergency Department encounters.
• Medicaid Patient Encounter volume equals the total Medicaid encounters divided by total encounters during same time period

• Medicaid EHR Incentive Program – Eligible Professionals and Eligible Hospitals may qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation. They must successfully demonstrate meaningful use for subsequent participation years.
• Adopted: Acquired and installed certified EHR technology. (For example, can show evidence of installation.)
• Implemented: Began using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.)
• Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)

1. Received medical assistance from Medicaid or the Children’s Health Insurance Program. (or a Medicaid or CHIP demonstration project approved under section 1115 of the Act).
2. Were furnished uncompensated care by the provider.
3. Were furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.

According to the Final Rule: In determining the ‘‘needy individual’’ patient volume threshold that applies to EPs practicing predominantly in FQHCs or RHCs, section 1902(t)(2) of the Act authorizes the Secretary to require the downward adjustment to the uncompensated care figure to eliminate bad debt data. We interpret bad debt to be consistent with the Medicare definition, as specified at § 413.89(b)(1). In order to remain as consistent as possible between the Medicare and Medicaid EHR incentive programs, States will be required to downward adjust the uncompensated care figure. Under Medicare, bad debts are amounts considered to be uncollected from accounts and notes receivable that were created or acquired in providing services. ‘‘Accounts receivable’’ and ‘‘notes receivable’’ are designations for claims arising from the furnishing of services, and are collectible in money in the relatively near future.”