Calculating Medicaid Patient Volume for EHR Incentive Program.

Join us each week for our FAQ Friday. This week we have CMS questions and answers relating to Medicaid. You can find more questions and answers on their FAQ site.
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Question:  When calculating Medicaid patient volume or needy patient volume for the Medicaid EHR Incentive Program, are eligible professionals (EPs) required to use visits, or unique patients?

Answer:  There are multiple definitions of encounter in terms of how it applies to the various requirements for patient volume. Generally stated, a patient encounter is any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums for the service. The requirements differ for EPs and hospitals. In general, the same concept applies to needy individuals. Please contact your State Medicaid agency for more information on which types of encounters qualify as Medicaid/needy individual patient volume.

Question:  If a State proposes a new definition for meaningful use under its Medicaid EHR Incentive Program, will it need to include the new definition of meaningful use in its State Medicaid Health Information Technology Plan (SMHP)? When are the SMHPs due?

Answer:  Yes, if a State wishes to request flexibility with the definition of meaningful use, to the extent permissible under the Medicare and Medicaid EHR Incentive Programs final rule, it would do so via its SMHP.

There is no due date for SMHPs. States are implementing their Medicaid EHR Incentive Programs on a rolling basis. The SMHPs are therefore expected to be iterative, as States implement their programs incrementally, especially in the early years.

Question:  How will eligible professionals (EPs) be required to show that they are meeting the Medicaid or needy individual patient volume thresholds of 30% for the Medicaid EHR Incentive Program?

Answer:  To show that EPs are meeting the Medicaid or needy individual patient volume thresholds of 30% for the Medicaid EHR Incentive Program, States will need to propose one or more methods of calculating patient volume to CMS in their State Medicaid Health Information Technology Plans and would need to identify verifiable data sources available to the provider and/or the State. Please contact your State Medicaid Agency for more information on how your state is calculating patient volume.