Patient Volume Pitfalls Massachusetts Medicaid EHR Incentive Program September 19 & 20, 2017 Hello, and welcome. Thanks for joining us today to discuss the PVT Pitfalls. Please feel free to participate in the discussion, and as we go along, please ask questions. We will do our best to address your questions, but we are fortunate to have the manager, Nicole Bennett, here with us, so hopefully we are able to address any questions. Today’s presenters: Margaret Lellman Ebonee Veale

Patient Volume Pitfalls Agenda Patient Volume Pitfalls Defining an Encounter Duplicates Tips on extracting data Group vs. Individual Paid vs. Enrollee Use of patient volume templates There are different ways that providers can meet the 30% Threshold of Medicaid encounters. Your organization will need to decide the best method to use to meet the 30% threshold in the most cleanest and less time consuming way. We have provided templates on our website, and depending on what method you chose to attest to the PVT will determine which template you use.

Encounter - one service, per patient, per day, per provider… Definitions Patient Volume Threshold – percentage that determines if a provider is eligible to participate in the Medicaid EHR Incentive Program Encounter - one service, per patient, per day, per provider… Paid - where Medicaid or 1115 waiver paid for part or all of a service (no zero paid claims) – see Medicaid 1115 Waiver Population Grid Enrollee – where patient was enrolled with Medicaid or 1115 waiver population on the date of service (all paid and zero paid claims can be included; remove only claims denied due to the patient’s ineligibility) Reporting period – any consecutive 90-day period chosen to demonstrate provider’s eligibility to receive Medicaid incentives When deciding which method to use, consider how your system captures the information or how the information is entered in the system. Paid claims, be sure that the EOB $ is applied for the DOS encounters you are using. Your data is going to be as good as what is entered into the billing system. Enrollee method. How are you capturing or entering this information into your system. If you are billing Medicaid or an insurance from the 1115 waiver population grid, be sure to capture the EOB reason for zero payments, such as patient eligible on DOS, but rendering provider not eligible.

PVT Reporting Period – Two Options Eligible Professionals (EPs) may select a 90-day period from either: Calendar year preceding payment year Previous calendar year (Jan 2016 – Dec 2016) 12 months preceding attestation date 12 months prior to date of submission (moving target) For example: If submitting an application on 2/19/2018, reporting period can be any 90-day period from 2/19/2017 – 2/19/2018 When choosing a reporting period, ensure the following: EP was actively working during the 90 days Current selected reporting period is different from the previous program year CHIP factor was applied to instate numerator

Duplicates - Individual Scenario: On 9/12/16 Marjorie fell ill and went to Kennedy CHC. Dr. Ace observed Marjorie's symptoms, hydrated the patient and sent her home. Later that evening, Marjorie felt worse and returned to the CHC. Dr. Ace decided to run additional tests on the patient. When extracting patient volume detail, would the visit for Marjorie count as 1 or 2 encounters? Remember, even if you are using a different code for the service on the same day, you can only count this encounter once. When you do remove the duplicates from your PVT report, please do not hide the lines, this will still show up in our duplicate check. The best way to remove duplicates from the PVT report is to delete the cells from the report, or create a new report once the duplicates are removed. All reports must be in an excel format when uploaded into MAPIR. We cannot manipulate the data if the report is in a pdf format. This service would count as one encounter. Remember the definition of an encounter: one service, per patient, per day.

Duplicates - Group Scenario: On 9/12/16 Marjorie fell ill and went to Kennedy CHC. Dr. Ace observed Marjorie's symptoms, hydrated the patient and sent her home. Later that evening, Marjorie felt worse and returned to the CHC. Dr. Bravo decided to run additional tests on the patient. When extracting patient volume detail, would the visit for Marjorie count as 1 or 2 encounters? You can count this service twice, the service for Dr. Ace once and the service for Dr. Bravo once. One of the encounters can be counted in your numerator, and two encounters in your denominator. In this case, the service would count as two encounters because the patient saw two different providers. 2 visits would count in the denominator 1 Medicaid visit would count in the numerator 1 duplicate service would need to be removed

Extracting Data - Individual Scenario: Dr. Veale renders services at 4 CHCs: Kennedy, Roslindale, Codman, and Mattapan. Is Dr. Veale required to extract patient volume data from all 4 locations? No. If the EP satisfies the 30% patient volume from one location, Dr. Veale has the option of reporting volume from one location only. When extracting your data, try to use the cleanest way possible to meet the 30%. If your providers can meet the 30% at one location, choose this location in MAPIR and enter the numerator and denominator in MAPIR from your data. Use the templates on our website as your guide to what data we will need.

Extracting Data – Group Scenario: Kennedy CHC has 4 EPs who are participating in the Medicaid Program. Kennedy has decided to attest using Group Methodology. The 4 attesting EPs work across 5 locations. Dr. Ace, Dr. Bravo, and Dr. Clean all render services at the following Kennedy CHC locations: Codman, Kennedy, Roslindale, and Mattapan. Dr. Dodge is the only EP who renders services at Roslindale and Westborough. How does the organization gather data to properly report that the 4 EPs satisfied the 30% required patient volume threshold? Extract data from all 5 locations where the EPs rendered services Extract data from the 4 locations where Dr. Ace, Dr. Bravo, and Dr. Clean render services. Extract data solely from the Roslindale location. C if the EP’s meet the 30% threshold data can be pulled for solely one location, in this case Roslindale. Use the templates on our website as a guide to what data elements or fields we require to tie out the numerator & denominator Answer: C – Since all of the EPs rendered services at the Roslindale location, data can be pulled solely from Roslindale to demonstrate the 30% threshold.

Extracting Data – Group Scenario: Kennedy CHC has 4 EPs who are participating in the Medicaid Program. Kennedy has decided to attest using Group Methodology. The 4 attesting EPs work across 5 locations. Dr. Ace, Dr. Bravo, and Dr. Clean render services at the following Kennedy CHC locations: Codman, Kennedy, Roslindale, and Mattapan. Dr. Dodge is the only EP who renders services solely in Westborough. How does the Organization gather data to properly report the 4 EPs satisfied the 30% required threshold? Extract data from all 5 locations where the EPs rendered services Extract data from Roslindale and Westborough Extract data from solely the Roslindale location Answer: B – To demonstrate the 30% threshold data can be extracted from both Roslindale and Westborough locations. Confirm all locations do not have inpatient services Locations all share the same TIN and/or NPI

Recommendations: Avoid sending PVT detail with PHI: Patient’s Full Name CPT Codes Diagnosis Employee ID Certification ID Use the templates provided on the MeHI website: Includes all essential data elements Decreases the chances of missing pertinent data Increases the probability of submitting accurate data the first time Provide a Key which identifies each payer Use the Medicaid 1115 Waiver Population Grid to ensure all payers are captured