Electronic Health Record Initiative FAQ

 
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Medicaid & Long-Term Care
 
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What you need to know

​Frequently Asked Questions

Am I eligible for the EHR incentive program?

Providers must be an enrolled Nebraska Medicaid provider who has received their first payment from Nebraska or another state's EHR Incentive Program prior to or in 2016.

When will my attestation be processed?

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

When will I get paid?

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.

How will payments be made?

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. 

What are the eligibility requirements for qualifying provider types?

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 demonstrated meaningful use of certified EHR technology
  • Certified EHR technology must meet current CMS program requirements and ONC certification
  • Current Meaningful Use requirements can be found at the CMS website: CMS Promoting Interoperability
  • For hospitals - data on Medicaid discharges, total discharges, Medicaid inpatient days, total inpatient days, hospital's total charges and charity care charges
  • Physician Assistants (PA) must practice in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is so led by a PA. 

When do providers complete attestations?

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

Who are eligible professionals?

Participation in the Medicaid EHR Incentive Payment Program requires an Eligible Professional (EP) 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 90day Medicaid Patient Volume Threshold
Physicians (M.D. and D.O.)30 percent
Pediatricians (if Medicaid patient volume is not at 30%, but is 20% or more, can receive 2/3 of the payment)20 percent
Dentists30 percent
Certified Nurse Midwives30 percent
*Physician Assistants (PAs) practicing at an FQHC/RHC led by a PA30 percent
Nurse Practitioner30 percent

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.​

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.

What is an encounter?

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

  • The patient must have been enrolled in an allowable Medicaid program (this will include Medicaid expansion) 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 percent 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.

EHR Audit Information and Tips

Nebraska conducts pre-payment audits on all attestations and conducts post payment audits on a number of attestations. This is to ensure accuracy of eligibility both before payments are made and in some cases, after payments have been made.

This is a guide of Audit Tips and is not an all-inclusive list of audit requirements.

Program Integrity within Nebraska Medicaid conducts the post-payment audits. Information regarding Program Integrity audits can be found at their website: Program Integrity


 

Why is the state conducting audits of the Nebraska Medicaid EHR Incentive Program payments?

The Final Rule issued by the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) requires that the states have a process in place to provide oversight of the expenditures for the Medicaid EHR Incentive Program. Because the Nebraska Department of Health and Human Services is accountable to CMS for the incentive payments made, the state conducts audits of some incentive payments. It is possible that providers might be selected for an audit for any incentive payment.

What can I expect if I am selected for a document review or a review at my place of business?

You will receive a notification via email that will indicate if the audit will be completed as a document review or a review at your place of business. This notification is sent to the contact individual identified as the representative of the provider at the CMS EHR Incentive Program Registration website. The email will list the initial documentation needed to complete the review. Depending on the information provided, the state reviewer may request additional information. Failure to document eligibility or failure to cooperate with the State Reviewer may result in recoupment of an incentive program payment. DHHS will notify you of the results of the audit. If you do not agree with the results, Medicaid-eligible professionals may appeal the decision in accordance with the Nebraska appeal process. All appeals of Medicaid-eligible hospital audits should be filed with CMS.

What documents should I be able to provide?

All information under attestation is subject to audit. Documentation to support all attestations must be retained and readily available for six years from the date of submitting your attestation.

Eligible hospitals must maintain, at a minimum, all work papers to substantiate the Medicare cost report as well as any documentation if the provider data for hospital payment calculations differ from the Medicaid cost report (such as amended cost report data or intent to amend the cost report data.)

Will Nebraska DHHS state reviewers be conducting audits of meaningful use measures and clinical quality measures?

Yes. It is important for you to maintain detailed documentation for your meaningful use reporting period supporting your meaningful use attestations. A few examples of this documentation include dashboard screenshots of meaningful use and clinical quality measures. You must also maintain documentation supporting exclusions and “yes/no" attestation questions. Additionally, you must maintain documentation of the security risk analysis that was performed within the proper time window.

What agencies are conducting post-payment reviews of the incentive payments?

In addition to the Nebraska DHHS state reviewers, the federal government and its contractor are also conducting post-payment reviews. You may be contacted by the Office of Inspector General (OIG) or CMS.