Nebraska Medicaid Program

Nebraska Medicaid EHR
Incentive Program

EHR FAQs

When will my attestation be processed?

When will I get paid?

How will payments be made?

What are the eligibility requirements for qualifying provider types?

When do providers complete attestations?

Who are eligible professionals?

What is “an encounter”?

We process attestations in the order in which they are received.

 

 

You will receive an email notification of approval for a Nebraska Medicaid EHR Incentive payment.  Payment usually comes between 10 and 14 days after approval notification is received.

 

 

The incentive payment will be issued from and distributed by the state accounting and payment system through electronic fund transfer (EFT).  Nebraska Medicaid EHR staff will contact you if an EFT needs to be set up on your behalf.

 

 

Eligible Medicaid provider types must meet the following criteria in order to participate in the

Medicaid EHR Incentive Program:

Must see patients covered by Nebraska Medicaid;

Must meet appropriate patient volume thresholds;

For eligible providers-must not be hospital-based. A hospital-based EP is defined as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency department of a hospital;

Must meet practitioner licensing requirements for the EP type in the state in which they are located;

Must not have any current sanctions that have temporarily or permanently barred them from participation in the Medicare or State Medicaid programs;

Must demonstrate that during the program year, the provider either adopted, implemented, upgraded or demonstrated meaningful use of certified EHR technology;

For hospitals-data on Medicaid discharges, total discharges, Medicaid inpatient days, total inpatient days, hospital’s total charges and charity care charges;

PA’s must practice in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is so led by a physician assistant.

 

 

The attestation process must be done each year for which payment is being requested.

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Participation in the Medicaid EHR Incentive Payment Program requires an Eligible Professional (EP) to meet specific patient volume requirements.  Medicaid patient volume is determined from any consecutive 90 day period within the 12-months preceding the date of attestation.  The list of eligible professionals and percentage of Medicaid patient volume necessary to qualify is outlined below:

 

​Each year of participation a Medicaid provider must meet patient volume requirements as follows: Minimum 90‐day Medicaid Patient Volume Threshold
​Physicians (M.D. and D.O.) ​30%
​Pediatricians (if Medicaid patient volume is not at 30%, but is 20% or more, can receive 2/3 of the payment) ​20%
​Dentists 30%​​
​Certified Nurse Midwives ​30%
​*Physician Assistants (PAs) practicing at an FQHC/RHC led by a PA ​30%
​Nurse Practitioner ​30%

 

Note:  EPs who practice 50% or more in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) can use needy patient volume in addition to Medicaid patient volume.  See the section under FQHC for further information.

*PAs are only eligible if they are practicing in an FQHC or RHC that is “so led” by a PA.

    • When a PA is the primary provider in an FQHC/RHC.
    • When a PA is a clinical or medical director at a clinical site of practice in an FQHC/RHC.
    • When a PA is an owner of an FQHC/RHC.

DHHS will confirm this by using the Health Resources and Services Administration (HRSA) report to determine if the PA is the primary provider.  If the PA is the owner or medical director, this will be confirmed with the CMS-29.  If the documentation in the HRSA or the CMS-29 is not current,
providers will need to furnish documentation to support the PA eligibility.

For more information click on the EP EHR decision tool at this CMS website and answer a few questions to determine whether or not you are eligible for the Medicaid EHR program.

The setting in which the provider practices is generally irrelevant to determining eligibility for the Medicaid EHR Incentive Program as long as the provider is not hospital-based (having 90% or more of their services performed in an inpatient or emergency room setting).  EPs in Mental Health facilities, Long Term Care facilities, etc. can also qualify if all eligibility requirements are met.

 

The Medicaid encounter definition was expanded on January 1, 2013 as follows:

  • The patient must have been enrolled in an allowable Medicaid program at the time the service was rendered, regardless of whether or not Medicaid paid anything on the bill.  This would include Medicaid patients where:
    • claims were denied due to service limitation
    • claims were denied due to non-covered services
    • claims were denied due to timely filing
    • services were rendered on Medicaid patients that were not billed due to the provider’s understanding of Medicaid billing rules

This can be for any type of service (lab work, immunization, office visit, nursing home visit, ER visit, etc.).

  • Only one service rendered per day per patient per provider can be counted.  For example if a patient came in for an office visit and was also given an allergy shot on that same day by the same physician, this is considered one encounter.  If the patient came in on Monday for an office visit and then back on Tuesday for an allergy shot, this is two encounters.
  • Only Medicaid encounters for patients eligible through funding under Title XIX or the Children’s Health Insurance Program (CHIP) under Title XXI of the Social Security Act can be included in the encounters.  Medicaid encounters for patients eligible for other programs such as state-only funded programs and Federal grant-funded programs cannot be included.  Nebraska pays all of these under the Medicaid program and there is no distinction of the funding source on the Medicaid card or claim. We will validate the Medicaid encounter data and if there is an issue with the Medicaid patient volume being more than 10% different from what the provider indicated, we will work with the provider directly to determine the allowable Medicaid encounters.
  • Both Medicaid as primary and secondary insurer can be counted toward the encounters. If Medicaid is secondary and the primary insurance paid more than the Medicaid allowable share (so Medicaid paid zero), then it would still be counted as an encounter.

 

 
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