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NC Medicaid Electronic Health Record Incentive Program

Latest News

NC-MIPS is open for Program Year 2018. Please see the Meaningful Use (MU) tab for more details on attesting to MU in Program Year 2018.

Attesting in Program Year 2018

In the IPPS Final Rule, CMS finalized policies that will impact the NC Medicaid EHR Incentive Program in Program Year 2018. Stage 3 is no longer required in Program Year 2018, but will be required in Program Year 2019.

In Program Year 2018, providers may choose to attest to either Modified Stage 2 MU or Stage 3 MU. Additionally, providers may choose to use a 2014 Edition CEHRT (only if attesting to Modified Stage 2 MU), 2015 Edition CEHRT, or a combination of 2014 Edition and 2015 Edition CEHRT (only permitted to use a combination 2014 and 2015 Edition CEHRT for Stage 3 if the CEHRT is capable of capturing Stage 3 MU objectives/measures). Also in Program Year 2018, providers may continue to use a 90-day MU objective reporting period.

In Program Year 2018, providers who have met MU in a previous program year will be required to report a full calendar year of CQM data.

The IPPS Final Rule also changed the way CQMs will be reported in Program Year 2017 and beyond. For more detailed information, please see the Clinical Quality Measure tab below.

This is a reminder to those providers who have successfully attested at least once by April 30, 2017 that participation does not need to be done in consecutive years. If a provider is unable to attest this year due to problems with their EHR, or for any other issues, they will still be able to earn the full incentive payment if they attest for a total of six year by 2021.

Attestation Tail Period (deadline)

North Carolina has adopted an attestation tail period of 120 days to allow for attestation beyond the end of the payment year.

This means providers will have until April 30, 2019, to submit a complete and accurate attestation for Program Year 2018. After that no changes can be made.

We guarantee to review the provider’s attestation, and conduct outreach if needed, if we receive the signed attestation and required documentation via email by Feb. 28, 2019.

Promoting Interoperability Program

Centers for Medicare & Medicaid Services (CMS) is overhauling and streamlining the Electronic Health Record (EHR) Incentive Program. The goal is to move the program beyond requirements for meaningful use (MU) to increase focus on interoperability and improving patient access to health information.

To better reflect this focus, effective April 24, 2018, CMS renamed the Medicaid EHR Incentive Program to the Promoting Interoperability Program (PIP).

Please note, while the EHR Incentive Program is part of the Promoting Interoperability Program, we will still operate under the name NC Medicaid EHR Incentive Program.

For more information, please visit the CMS Promoting Interoperability Program website.

Medicare Penalties

Eligible professionals (EPs) who service the Medicare population and are not deemed to be meaningful users may be subject to Medicare payment adjustments beginning on Jan. 1, 2015. These payment adjustments will be applied to the Medicare physician fee schedule amount for covered professional services furnished by the EP in 2015. EPs who do not demonstrate meaningful use is subsequent years will be subject to increased payment adjustments in 2016 and beyond. Lists of EPs who met MU in previous years are located here:  2014-2016

Payment Adjustments & Hardship Exceptions Table from 2017 through 2019 can be found here.

If there are questions regarding Medicare penalties, EPs are encouraged to work with CMS directly since they are issuing the penalties. Medicaid does not have any provider penalties for not being deemed a meaningful user.

For additional information and guidance regarding these penalties, please see CMS's Payment Adjustment & Hardship Information website.

More About the NC Medicaid EHR Incentive Program

Introduction

Introduction

See the Introduction to the NC Medicaid EHR Incentive Program webinar. (Run time: 5:44)

The NC Medicaid Electronic Health Record (EHR) Incentive Program was created by the federal government as part of the American Recovery and Reinvestment Act of 2009. The goal of the program is to encourage eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) to adopt, implement, or upgrade (AIU) to a certified EHR technology, and then to demonstrate meaningful use (MU) of that technology.

Providers must have attested successfully at least once, to AIU or MU, before April 30, 2017, to be able to participate in the NC Medicaid EHR Incentive Program in program years 2017-2021.

The NC Medicaid EHR Incentive Program began in 2011 and will end in 2021. EPs may receive up to $63,750* in incentive payments over six years of participation in the program. EPs may no longer receive the first year payment of $21,250, but each subsequent payment is $8,500. Participation years do not need to be consecutive.

*Pediatricians attesting with a reduced patient volume (PV) threshold are eligible to receive $42,500 over six years. EPs attesting at a reduced PV may no longer receive the first year payment of $14,167, but each subsequent payment is $5,667.

Timelines

Timelines

The NC Medicaid EHR Incentive Program extends 11 years, 2011 through 2021. EPs need to successfully attest six of 11 program years to receive the full incentive payment.

Providers must have attested successfully at least once, to AIU or MU, in program years 2011-2016 to participate in the NC Medicaid EHR Incentive Program in program years 2017-2021. A denied attestation does not count as a successful attestation.

Attestation Tail Period

North Carolina has adopted an attestation tail period of 120 days to allow for attestation beyond the end of the payment year.

That means EPs will have until April 30, 2019, to attest for Program Year 2018; however, if submitted after February 28, 2019, review by program staff prior to close of NC-MIPS is not guaranteed.

Are You Eligible

Are You Eligible

Each year of attestation, to be eligible to apply for an NC Medicaid EHR incentive payment, a provider must:

  1. Meet the required Medicaid Patient Volume (PV) threshold (this needs to be calculated every year of program participation);
  2. Be a Medicaid physician, nurse practitioner, certified nurse midwife, or dentist (some physician assistants also qualify); and,
  3. Have a certified EHR technology. Please see ONC’s Certified Health IT Product List (CHPL) to see if it meets certification criteria.

In addition to the eligibility requirements above, to be eligible to attest in program years 2017-2021, a provider must have attested successfully at least once, to AIU or MU, in program years 2011-2016. A denied attestation does not count as a successful attestation.

For providers who are part of a practice, please note that each EP in that practice may qualify for an incentive payment if each EP successfully demonstrates meaningful use of that technology.

Each EP is eligible for only one incentive payment per payment year, regardless of how many practices or locations at which s/he provide services.

Incentive payments for EPs are tied to individual practitioners. EPs may voluntarily assign their payment to an employer or and entity of their choosing. It is against federal and program rules for an organization to require that affiliated providers assign incentive payments to an organization or practice.

Hospital-based professionals who can demonstrate they funded the acquisition, implementation and/or maintenance of a certified EHR technology without reimbursement from the hospital and uses the certified EHR technology in an inpatient/hospital setting, may be eligible to receive an incentive payment.

1. What are the eligible types of Medicaid providers under the NC Medicaid EHR Incentive Program?

EPs under the NC Medicaid EHR Incentive Program include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy);
  • Nurse practitioners;
  • Certified nurse midwives;
  • Dentists; and,
  • Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

2. What is the Medicaid Patient Volume threshold?

To qualify for an incentive payment under the NC Medicaid EHR Incentive Program, an EP must meet one of the following criteria:

  • Have a minimum 30 percent Medicaid patient volume
  • Have a minimum 20 percent Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30 percent patient volume attributable to needy individuals.

NOTE: Health Choice patients do not count toward the Medicaid patient volume criteria. As of Oct. 1, 2012, NC Medicaid no longer excludes Medicaid Children's Health Insurance Program (MCHIP) encounters from counting toward the Medicaid patient volume criteria.

*NC Medicaid recognizes an Eligible Professional as being a pediatrician if they are a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) and meet one of the two requirements below:

  • Enrolled in NC Medicaid with a pediatrics specialty; or,
  • Board certified by a national certification board in Pediatrics, Adolescent or Child medical specialty area.

Please note, pediatricians may qualify for a reduced incentive payment ($42,500 over six years) with a reduced patient volume threshold of 20 percent.

Per the given definition, NPs are not eligible to qualify with a Medicaid PV threshold of 20 percent. All NPs need to meet the 30 percent Medicaid PV threshold to be eligible to receive an EHR incentive payment.

3. What is a certified EHR technology?

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must meet in order to qualify for use in the Medicaid EHR Incentive Program.

In Program Year 2018, if attesting to Modified Stage 2 MU a provider may use a 2014, 2014/2015 combination or 2015 edition of certified EHR Technology. If attesting to Stage 3 MU, a provider will need a 2015 Edition CEHRT or may use a 2014/2015 combination, if that CEHRT is capable of capturing Stage 3 MU objectives and measures.

Visit ONC's Certified Health IT Product List to see if it meets the program's certification standards.

There are two webinars which explain updating the CMS EHR Certification ID Numbers, one is an overview and one is more detailed:

An Overview of CMS EHR Certification ID Numbers

A Detailed Look at CMS EHR Certification ID Numbers

Physician Assistant Eligibility

Physician Assistants (PAs) are only eligible for the NC Medicaid EHR Incentive Program if they furnish services at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a PA (and so long as the PA meets all other Program eligibility requirements - 30 percent Medicaid/needy individual PV, not hospital-based, etc.). This applies to all PAs in a practice. In other words, if an FQHC/RHC is considered to be PA-led (per one of the requirements below), all PAs in that practice would be eligible.

The Final Rule states, an FQHC or RHC is considered to be PA-led under any of the following circumstances:

  • When a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, we would consider the PA as the primary provider);
  • When a PA is a clinical or medical director at a clinical site of practice; or,
  • When a PA is an owner of an RHC.

For eligibility, PA-led facilities should submit (with their signed attestation) a memo on group letterhead listing the reason(s) the FQHC or RHC (and thereby the attesting EP) meets the criteria of being PA-led.

Unique Reporting Periods

There are four unique reporting periods. The scenarios below assume the EP is attesting for Program Year 2018 on Oct. 14, 2018.

  • Patient Volume - Consecutive 90-day period in the calendar year prior to the program year (i.e., calendar year 2017 for Program Year 2018), or from the 12 months immediately preceding the date of attestation (Oct. 13, 2017 - Oct. 13, 2018). This will be individual or group encounters/data.
  • Promoting Interoperability (PI)- Consecutive 90 or 365 days in the current calendar year (2018). This will be individual encounters/data. *Providers may use a 90-day PI reporting period in Program Year 2018.
  • Clinical Quality Measure (CQM)- In Program Year 2018, providers who have met MU in a previous program year will be required to use a full year reporting period for CQMs. Providers who have only attested to AIU may use a 90-day or full calendar year CQM reporting period. This will be individual encounters/data.
  • Practicing Predominantly (FQHC/RHCs only) - Consecutive six-month period in the calendar year prior to the program year (i.e., calendar year 2017 for Program Year 2018), or from the 12 months immediately preceding the date of attestation (October 13, 2017 - October 13, 2018). This will be individual encounters/data.
Patient Volume

Patient Volume

Calculate patient volume (PV) using the following formula:

All Medicaid-enrolled encounters in a consecutive 90-day period divided by all encounters in the same consecutive 90-day period

Please note, 'all Medicaid-enrolled encounters' includes Medicaid zero-paid encounters.

To apply for an incentive payment under the NC Medicaid EHR Incentive Program, an EP must meet one of the following criteria:

  • Have a minimum 30 percent Medicaid PV
  • Have a minimum 20 percent Medicaid PV, and is a pediatrician
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30 percent PV attributable to needy individuals

To calculate PV, EPs may select a consecutive 90-day period:

  • In the calendar year prior to the program year for which the EP is attesting (e.g., if attesting for Program Year 2018, it will be a 90-day period from calendar year 2017); or,
  • In the 12 months immediately preceding the date of attestation (e.g. if attesting on Oct. 4, 2018, it will be any consecutive 90 days from Oct. 3, 2017 through Oct. 3, 2018).

Quick Tip: If the EP attested to Program Year 2017 using a PV reporting period from calendar year 2017 and passed the PV requirements, they may use the same PV reporting period when attesting in Program Year 2018!

NOTE: If an EP (or a group) has unique billing practices, please include a memo on practice letterhead explaining the situation and submit it with the signed attestation to help us provide focused outreach if necessary.

Definition of a Group

For the purposes of attesting to PV with group methodology, the NC Medicaid EHR Incentive Program uses the following definition of a group. A group means one or more eligible professionals practicing together at one practice location or at multiple practice locations within a logical geographical region under the same healthcare organization.

This definition was written to be as flexible as possible within the federal regulation, while still lending enough definition for auditing and program integrity purposes.

Group and Individual Methodology for Calculating Patient Volume for EPs

Calculating Medicaid PV is essential for determining if a provider is eligible to participate in the NC Medicaid EHR Incentive Program. We have created several visual aids to ensure EPs have the information needed to calculate their Medicaid PV accurately.

Click on the scenarios below to see visual guidance for calculating PV given the methodology used.

Group methodology may be used by any EP who has a current group affiliation.

MU has no impact on the way patient volume is calculated. MU is based on the attesting EPs individual MU data and is separate from PV.

EPs may use a clinic or group practice’s PV as a proxy for their own under five conditions:

  • The attesting EP had at least one encounter with a Medicaid-enrolled patient during the program year.
  • The clinic or group practice’s PV is appropriate as a PV methodology calculation for the attesting EP (for example, if an EP only sees Medicare, commercial, or self-pay patients, this is not an appropriate calculation); 
  • There is an auditable data source to support the EP’s PV determination;
  • The EP has a current affiliation with the clinic whose PV s/he is using to attest; and,
  • So long as the practice and EPs decide to use one methodology for a 90-day reporting period (in other words, clinics could not have some of the EPs using their individual PV for patients seen at the clinic, while others use the clinic-level data during the same 90-day reporting period). The clinic or group must use the entire group’s PV and not limit it in any way. EPs may attest to PV under the individual calculation or the group/clinic proxy in any participation year. Furthermore, if the EP works in both the clinic and outside the clinic (or with and outside a group practice), then the clinic/group level determination includes only those encounters associated with the clinic/group.

Practicing Predominantly, New Providers, and Group Methodology

An EP who has more than 50 percent of her/his total patient encounters at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) during any continuous six-month period in the calendar year preceding the current program year OR the 12 months immediately preceding the date of attestation qualifies as “practicing predominately” at an FQHC or RHC. An EP who attests to practicing predominately in an FQHC or RHC may count needy individuals toward the 30 percent PV requirement necessary to receive an EHR incentive payment. 

Needy individuals include: 

  • Individuals receiving assistance from Medicare or the Children’s Health Insurance Program (Health Choice);
  • Individuals provided uncompensated care by the EP; and
  • Individuals who received services at no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.

NC Medicaid recognizes that this issue has implications for newer FQHC and RHC staff who cannot attest to practicing predominantly during the previous year and who wish to use group methodology for calculating Medicaid PV. The following examples attempt to clarify these implications for eligibility of such providers to receive EHR incentives.

Example 1: A new provider is hired into an FQHC that attested using group methodology to calculate PV and met the 30 percent Medicaid PV requirement without using needy individual patient encounters. The new provider did not practice at an FQHC or RHC for six continuous months during the previous year or the 12 months immediately preceding the date of attestation, and would answer “No” to the practices predominantly question. This provider expects to see Medicaid patients in keeping with the FQHC’s reported patient volumes from the previous year, and due to her/his current affiliation with the FQHC, s/he may attest using the group’s pre-calculated PV (group methodology) from the previous year.

Example 2: A new provider is hired into an FQHC that attested using group methodology to calculate PV and was able to meet the 30 percent Medicaid PV requirement by using needy individual patient encounters. The new provider did not practice at an FQHC or RHC for six continuous months during the previous year or the 12 months immediately preceding the date of attestation, and would answer “No” to the practices predominantly question. Although this provider expects to see Medicaid patients in keeping with the FQHC’s reported patient volumes from the previous year and has a current affiliation with the FQHC, s/he may not attest using the group’s pre-calculated PV (group methodology) from the previous year, as the practicing predominantly requirement must be satisfied in order to use needy individuals toward the Medicaid patient volume requirement.

Example 3: A new provider is hired into an FQHC that attested using group methodology, either with or without the use of needy individual patient encounters. The new provider came to the new practice from another FQHC or RHC and can answer “Yes” to the practices predominantly question. In this scenario, the provider expects to see Medicaid patients in keeping with the new FQHC’s reported patient volumes from the previous year or the 12 months immediately preceding the date of attestation, and due to her/his current affiliation with the FQHC and her/his ability to satisfy the practicing predominantly requirement, s/he may attest using the group’s pre-calculated PV (group methodology) from the previous year.

Note: In all of the above examples, a provider who practiced elsewhere during the previous year and saw the requisite 30 percent Medicaid patients may be eligible to attest using individual methodology for calculating PV. In this case, the provider would calculate her/his individual patient encounters from the previous practice site(s), as long as the previous practice group did not attest using group methodology for the same 90-day period.

*Please note that PV methodology and assignment of payment are not related. A provider may attest having used group methodology to calculate PV, and assign the incentive payment to her/himself or to another practice with whom s/he is affiliated that promotes the meaningful use of certified EHR technology.

Additional PV Resources

If an EP billed any of their Medicaid claims through an Local Management Entity (LME) for encounters reported on their attestation, please complete the behavioral health template to report PV and then submit the completed template with the EP's signed attestation. Please note, the behavioral health (BH) template has been updated. There are two separate templates, one for individuals and one for groups. If completing an attestation for the group, using group methodology for patient volume, it is permissible to complete one group behavioral health template and submit that same group BH template with each attesting group member’s attestation packet.

The PV section on our FAQ page addresses the most common PV questions we receive.

Please also see the EP MU Attestation Guides (right-hand side of NC-MIPS) for step-by-step instructions and guidance for each field on the PV page in NC-MIPS.

Additional PV information can be found in the revised Patient Volume Memorandum issued by the NC Medicaid EHR Incentive Program on Jan. 15, 2016.

Patient Volume: Outreach Explained Webinars

Medicaid-verified PV number is lower than the attested PV number (Run time: 12:43)

Medicaid verified PV number is higher than the attested PV number for individual providers (Run time: 6:11)

Medicaid-verified PV number is higher than the attested PV number for group providers (Run time: 6:54)

Path to Payment

Path to Payment

See a list of providers and hospitals who were paid Jan. 1, 2015 to the most recent incentive payment checkwrite (January 15, 2019).

See a cumulative list of all providers paid from 2011 through January 2015.

Note: Per CMS's Stage 1 Final Rule and 495.10(f), NC Medicaid EHR Incentive Payments are linked to professionals and may be assigned on a voluntary basis to an affiliated organization promoting the adoption and meaningful use of certified EHR technology. It is against federal and program rules for an organization to require that affiliated EPs assign an incentive payment to a practice or organization.

Need help locating a payment?

If the provider is listed on the Paid To Date spreadsheet on the Path To Payment tab, s/he was approved for an NC Medicaid EHR Incentive Program payment and the Program team authorized issuance of payment to the payee NPI listed on their attestation. If a provider is unable to locate that payment, please contact CSRA (formerly CSC), the fiscal agent for NC DHHS, which operates the NCTracks system. They can be reached at 800-688-6696 or NCTracksprovider@nctracks.com. Request that the representative open a PEGA ticket to forward your concern to their Finance department. The Finance team can track electronic payments and provide information on when electronic funds transfer occurred and to what bank account the funds were sent. They can also provide the relevant page of the remittance advice (RA) with details on payment.

For assistance reading an RA, NCTracks has several trainings that can be used a point of reference. NCTracks has also recorded a Computer-Based Training, accessible through their provider training. Learn more about NCTracks.

Providers who want a copy of an RA generated after July 1, 2013, should be able to retrieve it from the Message Center Inbox on the secure NCTracks Provider Portal. The RAs are retained in the Message Center Inbox for up to seven years. There is no cost associated with retrieving an NCTracks RA from a previous checkwrite using the Message Center Inbox. See the User Guide “How to Retrieve an NCTracks RA from a Previous Checkwrite” on the Provider User Guides and Training page of the public Provider Portal.

Tips for returning providers

Providers do not need to re-register with CMS. However, if information has been altered (site address, CEHRT number, payee NPI, etc.) this needs to be done on CMS's Registration & Attestation System prior to attesting on NC-MIPS.

Providers will login to NC-MIPS using the NCID username/password they used when they created a first-time account setup in NC-MIPS. If the NCID username has been updating since creating the first-time account setup, please update it using the NCID Username Update tool in NC-MIPS.

Providers may apply for a total of six incentive payments based upon the meaningful use of their certified EHR technology (as defined by CMS).

Provider Registration and Attestation

Provider Registration and Attestation

Do not complete another First-time Account Setup if the EP already has an account with NC‐MIPS.

Each attesting provider needs a working NCID username and password to complete an attestation. If the provider’s NCID username has been updated since completing a First-time Account Setup on NC-MIPS, please use NC-MIPS' NCID Username Update tool in the sign-in box on the welcome page to sync the provider's NCID username in NC-MIPS. To update an NCID or if there are any questions about a provider's NCID, please contact NCID.

NC Medicaid is a completely separate entity from NCTracks and NCID. Please contact NCID or NCTracks directly for any issue on their site.

Please update any new registration information, such as CEHRT number, site address, payee NPI/payee TIN type, etc., on CMS’s R&A System.  Note that it takes two business days for changes made with CMS to be reflected in NC-MIPS. For additional assistance making updates on CMS's R&A system, please refer to CMS's Medicaid Eligible Professionals Registration User Guide.

Please submit all required documentation via email to NCMedicaid.HIT@dhhs.nc.gov. The NC Medicaid EHR Incentive Program does not accept documentation via fax.

If the attestation meets all eligibility requirements, the attestation will be made eligible for payment and processed by CSRA. Payments will be posted under the Path to Payment tab on this website. The attesting provider's NPI, payee name, payee NPI, amount paid, EFT effective date, and a CCN to reconcile with the RA will be included on the payment spreadsheet.

For attestation assistance, please review the NC-MIPS attestation user guides which are located on the right-hand side of NC-MIPS.

If after reviewing those documents the EP needs further assistance, please email the NC-MIPS Help Desk at NCMedicaid.HIT@dhhs.nc.gov and provide the attesting provider's NPI, NCID, CMS Registration ID, the program year they are attesting for, a screenshot of the information being entered with the error message being received, and a brief description of the issue.

If you need assistance making updates to NCTracks, please refer to the following NCTracks user guides:

For additional NCTracks assistance, please contact their help desk. Their contact information can be found at the bottom of every page in NCTracks.

Attestation Statements in Program Year 2018

For EPs, the summary PDF will include this section covering the attestation statements below. The attesting provider must review each attestation statement. The attesting provider’s signature is acknowledgement that the statements are true, accurate, and complete.

With my signature below, I attest that I

  1. Acknowledge the requirement to cooperate in good faith with ONC direct review of my health information technology certified under the ONC Health IT Certification Program if a request to assist in ONC direct review is received; and
  2. If requested, cooperated in good faith with ONC direct review of my health information technology certified under the ONC Health IT Certification Program as authorized by 45 CFR part 170, subpart E, to the extent that such technology meets (or can be used to meet) the definition of CEHRT, including by permitting timely access to such technology and demonstrating its capabilities as implemented and used by the EP in the field.
  3. Did not knowingly and willfully take action (such as to disable functionality) to limit or restrict the compatibility or interoperability of certified EHR technology.
  4. Implemented technologies, standards, policies, practices, and agreements reasonably calculated to ensure, to the greatest extent practicable and permitted by law, that the certified EHR technology was, at all relevant times—
    • Connected in accordance with applicable law;
    • Compliant with all standards applicable to the exchange of information, including the standards, implementation specifications, and certification criteria adopted at 45 CFR part 170;
    • Implemented in a manner that allowed for timely access by patients to their electronic health information; and
    • Implemented in a manner that allowed for the timely, secure, and trusted bi-directional exchange of structured electronic health information with other health care providers (as defined by 42 U.S.C. 300jj(3)), including unaffiliated providers, and with disparate certified EHR technology and vendors.
  5. Responded in good faith and in a timely manner to requests to retrieve or exchange electronic health information, including from patients, health care providers (as defined by 42 U.S.C. 300jj(3)), and other persons, regardless of the requestor's affiliation or technology vendor.

More information for EPs.  

Meaningful Use

Meaningful Use

The American Recovery and Reinvestment Act of 2009 specifies three main components of meaningful use:

  • The use of a certified EHR in a meaningful manner, such as e-prescribing.
  • The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and,
  • The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

Please note, Meaningful Use is based on individual numbers, so when entering your MU information into NC-MIPS, base it off the individual encounters, not that of the group (even if the EP used group methodology to calculate patient volume).

Meaningful Use in Program Year 2018

In Program Year 2018, all providers may use a 90-day MU objective reporting period. This means, at a minimum all providers will report MU objective data from a consecutive 90-day period in calendar year 2018. In Program Year 2018, providers who have met MU in a previous program year will be required to report a full calendar year CQM reporting period.

Modified Stage 2 Meaningful Use

EPs will attest to 10 MU objectives (including one consolidated public health reporting objective) and six of 53 CQMs.

Program Year 2018 Modified Stage 2 MU Specification Sheets

Program Year 2018 CQMs

All providers must have the 2014 Edition, a combination of 2014 and 2015 Edition, or a 2015 Edition of certified EHR technology to meet Modified Stage 2 MU. Please update your certified EHR technology number on CMS's Registration & Attestation System prior to attesting on NC-MIPS.

Stage 3 Meaningful Use in Program Year 2018:

Stage 3 is optional in Program Year 2018.

EPs will attest to eight MU objectives and six of 53 CQMs.

Program Year 2018 Stage 3 MU Specification Sheets

Program Year 2018 CQMs

Stage 3 will be required in Program Year 2019. CMS has published the Stage 3 Specification Sheets for Program Year 2019. Please use the following link to access the Program Year 2019 Stage 3 MU Specification Sheets.

All providers must have a 2015 Edition certified EHR technology (CEHRT), or a combination of 2014 Edition and 2015 Edition CEHRT (only permitted to use a combination 2014 and 2015 Edition CEHRT if the CEHRT is capable of capturing Stage 3 MU objectives and measures) to meet Stage 3 MU. Please update your certified EHR technology number on CMS's Registration & Attestation System prior to attesting on NC-MIPS.

CMS has published the following resources for providers attesting to MU in Program Year 2018:

Here's a visual of the CEHRT a provider may use if they are attesting to Modified Stage 2 MU vs Stage 3 MU:

 

 

 

 

 

 

Program Year 2018 MU Reporting Periods

Program Year 2018 includes updates to MU objectives that affects Promoting Interoperability (PI) reporting periods (formerly EHR reporting periods) for some measures. For example, see the list below for Program Year Stage 3 below:

  • For Objective 1, it is acceptable for the security risk analysis to be conducted outside the PI reporting period; however, the analysis must be conducted for the certified EHR technology used during the PI reporting period and the analysis or review must be conducted on an annual basis prior to the date of attestation. In other words, the provider must conduct a unique analysis or review applicable for the PI reporting period and the scope of the analysis or review must include the full PI reporting period.
  • For Objective 5, actions included in the numerator for measure 2 must occur within the calendar year in which the PI reporting period occurs (between Jan. 1st through Dec. 31st).
  • For Objective 6, for the numerator for measures 1 and 2, beginning in 2017, the action must occur within the PI reporting period if that period is a full calendar year, or if it is less than a full calendar year, within the calendar year in which the PI reporting period occurs (between Jan. 1st and Dec. 31st).
  • For Objective 7 Measure 1, beginning in 2017 in order to count in the numerator, the exchange must occur within the PI reporting period if that period is a full calendar year, or if it is less than a full calendar year, within the calendar year in which the PI reporting period occurs.

More information is available from CMS on Program Year 2018 Modified Stage 2 MU and Stage 3 MU.

Helpful CMS Documents

See a comparison and evolution of MU objectives from Stage 2 to Modified Stage 2 to Stage 3.

Beginning in 2017, the definition of meaningful EHR user includes that s/he supports information exchange and the prevention of health information blocking.

This means that for a PI reporting period in 2018, the attesting EP:

  1. Did not knowingly and willfully take action (such as to disable functionality) to limit or restrict the compatibility or interoperability of certified EHR technology.
  2. Implemented technologies, standards, policies, practices, and agreements reasonably calculated to ensure, to the greatest extent practicable and permitted by law, that the certified EHR technology was, at all relevant times:
    • (i) Connected in accordance with applicable law;
    • (ii) Compliant with all standards applicable to the exchange of information, including the standards, implementation specifications, and certification criteria adopted at 45 CFR part 170;
    • (iii) Implemented in a manner that allowed for timely access by patients to their electronic health information; and
    • (iv) Implemented in a manner that allowed for the timely, secure, and trusted bi-directional exchange of structured electronic health information with other health care providers (as defined by 42 U.S.C. 300jj(3)), including unaffiliated providers, and with disparate certified EHR technology and vendors.

NC Division of Public Health & Meaningful Use

NC DPH is now accepting the electronic submission of data for the NCIR and Central Cancer Registry.

Here are the MU capabilities of NC DPH:

  • NC DPH is capable of accepting Electronic Laboratory Reports (ELR) from eligible hospitals. NCDPH is not requesting and will not receive ELR from eligible professionals.
  • NC DPH is capable of accepting electronic Syndromic Surveillance from eligible hospitals. NC DPH is not requesting and will not receive electronic syndromic surveillance from eligible professionals.
  • NC DPH is capable of accepting electronic Immunization Registry Data from eligible hospitals and eligible professionals. To register your intent to submit immunization registry data to NC DPH, please register via the NC DPH Meaningful Use Site for Registration of Intent.
  • NC DPH is capable of accepting electronic cancer reports from eligible professionals (EPs).To register your intent to submit cancer data to NC DPH, please register via the NC DPH Meaningful Use Site for Registration of Intent.

The only specialized registry currently offered by NC DPH is the NC Central Cancer Registry, which accepts cancer reports from eligible professionals who diagnose or treat cancer.

NC DPH's web page on specialized registries

Specialized Registry Reporting

In Program Year 2018, providers attesting to Modified Stage 2 MU are required to attest to the Specialized Registry Reporting measure (Measure #3) of the Public Health Objective (Objective #10 for EPs). The measure for EPs is: The EP is in active engagement to submit data to a specialized registry.

More information on specialized registries is available on US DHHS' Agency for Healthcare Resarch and Quality (AHRQ) registry of patient registries.

Please note, North Carolina does not endorse any specialized registry. We leave it to each program participant to determine what registry is available and makes the most sense for their practice and patient population. It is up to the EP to do the necessary due diligence to ensure the registry meets all of CMS’s requirements for meeting meaningful use (MU) and to obtain any and all supporting documentation proving compliance.

Per CMS, for the purposes of MU, “public health registries” are those administered by, or on behalf of, a local, state, territorial, or national public health agency and which collect data for public health purposes. A variety of registries may be considered specialized registries, which allows providers the flexibility to report using a registry that is most helpful to their patients.

As stated in the Final Rule, active engagement may be one of the following:
Active Engagement Option 1—Completed Registration to Submit Data: The EP registered to submit data with the Public Health Agency (PHA) or, where applicable, the Clinical Data Registry (CDR) to which the information is being submitted; registration was completed within 60 days after the start of the PI reporting period; and the EP is awaiting an invitation from the PHA or CDR to begin testing and validation. This option allows providers to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each PI reporting period.

Active Engagement Option 2—Testing and Validation: The EP is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within a PI reporting period would result in that provider not meeting the measure.

Active Engagement Option 3—Production: The EP has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

This gives EPsa lot of flexibility in selecting a specialized registry to submit data. So long as the EP submits to us documentation demonstrating they are ‘actively engaged’ with a registry that collects public health data, they will meet Measure #3: Specialized Registry Reporting of and Objective #10 for EPs: Public Health Reporting.

Diabetes Specialized Public Health Registry

Effective June 1, 2018, the NC Diabetes Specialized Public Health Registry will be available for population health purposes.  Full participants of NC HealthConnex are eligible to participate in the registry by signing the NC HealthConnex Diabetes Registry Form.  Data submitted to NC HealthConnex will be included in the Diabetes Registry, as appropriate.  No additional data submission from participants is required.  The NC HealthConnex Diabetes Registry supports attestation for Meaningful Use Stage 3 and Modified Stage 2 for eligible professionals and Medicare Quality Payment Program Advancing Care Information for eligible clinicians.  More information about becoming a full participant of NC HealthConnex and about the diabetes specialized registry is available at the website or email.

Clinical Quality Measures

Clinical Quality Measures

CMS defines CQMs as tools that help measure and track the quality of health care services provided by EPs within our healthcare system.

In Program Year 2018, providers who have met MU in a previous program year will be required to report a full calendar year CQM reporting period.

EPs are required to report six CQMs. To see the list of available CQMs for Program Year 2018, please use the links below:

Program Year 2018 CQMs for eligible professionals and clinicians (scroll below the table to see the list of CQMs.)

CMS eCQM library and Electronic Specifications

Resources and Webinars

Resources and Webinars

Helpful Websites

NC-MIPS Attestation Portal

Centers for Medicare and Medicaid's (CMS) Promoting Interoperability Program Website

CMS's Registration & Attestation (R&A) System

CMS's Registration & Attestation System User Guide for Eligible Professionals 

Office of the National Coordinator for Health Information Technology

Stage 1 and Stage 2 Final Rule

Stage 3 Final Rule and Modifications to Meaningful Use in 2015 Through 2017

FY 2018 IPPS Final Rule

FY 2019 IPPS Final Rule

Medicaid Bulletin

 

Webinars

Quick Tip Webinar Series

These webinars serve as a point of reference and give the most important need-to-know information. They offer a high-level overview of pertinent information.

Introduction to the NC Medicaid EHR Incentive Program (Run time: 5:44)

CMS's Registration & Attestation System (Run time: 6:56)

NCID and the NC Medicaid EHR Incentive Program (Run time: 2:45)

NCID Username Update Tool in NC-MIPS (Run time: 2:32)

NC-MIPS First Time Account Setup (Run time: 2:39)

Attesting in NC-MIPS (Run time: 11:40)

Patient Volume Basics for the NC Medicaid EHR Incentive Program (Run time: 5:58)

Meaningful Use in Program Year 2018 (Run time: 5:52)

Submitting an NC Medicaid EHR Incentive Program Attestation (Run time: 4:31)

Processing an NC Medicaid EHR Incentive Program Attestation (Run time: 4:25)

NC Medicaid EHR Incentive Program Outreach (Run time: 6:48)

NC Medicaid EHR Incentive Program Resources (Run time: 5:41)

NC Medicaid EHR Incentive Program Payments (Run time: 5:02)

NC Medicaid EHR Incentive Program Audits (Run time: 5:18)

Tips for Returning Providers in Program Year 2018 (Run time: 4:02)

NC-MIPS, NCID, NCTracks and CMS's R&A System Explained (Run time: 3:15)

 

Patient Volume: Outreach Explained Webinars

Medicaid-verified PV number is lower than the attested PV number (Run time: 12:43)

Medicaid verified PV number is higher than the attested PV number for individual providers (Run time: 6:12)

Medicaid-verified PV number is higher than the attested PV number for group providers (Run time: 6:54)

 

Updating CMS EHR Certification ID Numbers Webinars:

An Overview of CMS EHR Certification ID Numbers

A Detailed Look at CMS EHR Certification ID Numbers

 

Current Program Documents

SMHP (PDF, 8,402 KB)

IAPD (PDF, 1,023 KB)

 

NC-MIPS Attestation Guides

For EPs attesting to MU for the first time:

First-Time EP Modified Stage 2 MU Attestation Guide

First-Time EP Stage 3 MU Attestation Guide

For EPs who have previously attested to MU:

EP Modified Stage 2 MU: Part 1 Attestation Guide for Program Year 2018

EP Stage 3 MU: Part 1 Attestation Guide for Program Year 2018

 

Meaningful Use

EP Modified Stage 2 MU Specification Sheets

EP Stage 3 MU Specification Sheets

 

Reporting Periods Defined

Get guidance for Patient Volume, Meaningful Use & Practicing Predominantly reporting periods.

 

Behavioral Health Template

If a provider billed any of their Medicaid claims through an LME for their encounters reported in their attestation, please complete the behavioral health template to report PV and then submit the completed template with the provider's signed attestation.

 

A Doctor and Her EHR: An Interview with Dr. Karen Smith

Read an article on Dr. Karen Smith, solo practitioner and recipient of the 2017 National Family Physician of the Year, about the use of EHR in her practice and her experience in the NC Medicaid EHR Incentive Program. Her enthusiasm was contagious and it brought the importance of using an EHR into focus.

FAQs

FAQs

The NC Medicaid EHR Incentive Program has a Frequently Asked Questions page with a library of FAQs available to help answer common provider questions. Providers are also encouraged to submit questions to NCMedicaid.HIT@dhhs.nc.gov. Responses will be used to update this FAQ section.

More FAQs are also available on CMS's Promoting Interoperability Program (formerly EHR Incentive Program) website.

Contact Us

Contact Us

Contact the NC Medicaid EHR Incentive Program at NCMedicaid.HIT@dhhs.nc.gov. We do not accept documentation via fax.

Technical Assistance

Technical Assistance

The NC Area Health Education Centers Program (NC AHEC) provides free, individualized, on-site EHR consulting tailored to meet a practice’s specific needs. The NC AHEC staff can also assist providers in meeting Meaningful Use.

In addition to helping a practice meet Meaningful Use, the NC AHEC staff can also help select, implement and optimize EHRs, help the practice use EHRs to improve the quality of patient care, and assist the practice in attesting for an NC Medicaid EHR Incentive payment.

The AHEC can help practices select, implement and optimize EHRs by:

  • Preparing the practice for an EHR by assessing and redesigning the office systems
  • Facilitating certified EHR vendor selection that is consistent with goals, needs and the budget of the practice
  • Assessing a practice’s goals, needs and return on investment
  • Aiding with EHR contracting and financing

The AHEC can also help practices use EHRs to improve quality of patient care by:

  • Identifying and enhancing practice workflows and systems
  • Assisting with health information exchange (HIE)/Interfaces/Data Dashboards
  • Pinpointing internal and external data reporting needs to track outcomes and set benchmarks
  • Customizing the EHR to meet the practice’s needs

NCAHEC
919-966-2461

Providers are encouraged to find the NC AHEC in their region:

Area L AHEC: Serving Edgecombe, Halifax, Nash, Northampton and Wilson counties. Contact:  Shannon Cambra, shannon.cambra@arealahec.org, 252-813-8613.

Charlotte AHEC: Serving Anson, Cabarrus, Cleveland, Gaston, Lincoln, Mecklenburg, Stanly, and Union counties. Contact:  Erin Cloutier, Erin.Cloutier@carolinashealthcare.org, 704-512-6052.

Eastern AHEC: Serving Beaufort, Bertie, Camden, Carteret, Chowan, Craven, Currituck, Dare, Gates, Greene, Hertford, Hyde, Jones, Lenoir, Martin, Onslow, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington, and Wayne counties. Contact:  Angel Moore, moorean@ecu.edu, 252-744-5221 (office) or 252-327-0207 (cell).

Greensboro AHEC: Serving Alamance, Caswell, Chatham, Guilford, Montgomery, Orange, Randolph, and Rockingham counties. Contact:  Suzanne Lineberry, suzanne.lineberry@conehealth.com, 336-832-4393 (office) or 336-662-5810 (cell).

Mountain AHEC: Serving Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, and Yancey counties. Contact:  Karen Blackman, Karen.Blackman@mahec.net, 828-257-4459.

Northwest AHEC: Serving Alexander, Alleghany, Ashe, Avery, Burke, Caldwell, Catawba, Davidson, Davie, Forsyth, Iredell, Rowan, Stokes, Surry, Watauga, Wilkes, and Yadkin counties. Contact:  Chris Jones, cjones@wakehealth.edu, 336 939-6737.

SEAHEC: Serving Brunswick, Columbus, Duplin, New Hanover, and Pender counties. Contact:  Jessica Williams, Jessica.ReedWilliams@seahec.net, 910-667-9350.

Southern Regional AHEC: Serving Bladen, Cumberland, Harnett, Hoke, Moore, Richmond, Robeson, Sampson, and Scotland counties. Contact:  Lisa Blandin, lisa.blandin@sr-ahec.org, 910-678-0119.

Wake AHEC: Serving Durham, Franklin, Granville, Johnston, Lee, Person, Vance, Wake, and Warren counties. Contact:  Lora Wright, Lowright@wakeahec.org, 919-350-0472.

NC HealthConnex

NC HealthConnex

NC HealthConnex is a secure electronic network that facilitates conversations between health care providers, allowing them to access and share health-related information across North Carolina to improve coordination of care for patients. NC HealthConnex allows participating providers to access their patients’ comprehensive records across multiple providers, as well as review labs, diagnostics, history, allergies, medications, and more to help decrease redundancy and allow for more efficient and accurate diagnoses, recommendations and treatment.

Created by the North Carolina General Assembly (NCGS 90-414.7), NC HealthConnex is the state-operated health information exchange and is managed by the North Carolina Health Information Exchange Authority (NC HIEA) housed within the N.C. Department of Information Technology.

As of July 2017, Duke Health, Novant Health, and Carolinas HealthCare System have signed agreements to connect to NC HealthConnex, North Carolina’s state-designated Health Information Exchange (HIE).

Additionally, Coastal Connect, a regional HIE in southeastern North Carolina, has formally agreed to connect to NC HealthConnex. This connection will add five hospitals and more than 100 data contributors, acute and ambulatory, to the growing statewide HIE.

They join foundational participant UNC Health Care and 26 hospitals that are connected or in the queue for connection to NC HealthConnex. In addition to hospital and health system integrations, NC HealthConnex is in the process of connecting with hundreds of physician practices, health departments, federally qualified health centers, rural health clinics, and other ambulatory facilities that use cloud-based and on-premise electronic health/medical record (EHR/EMR) solutions.

In the past year, the total number of unique patients in NC HealthConnex grew by almost 30 percent, totaling close to 3.7 million.

For more information, see NC HealthConnex’s July 19, 2017 news release.

Diabetes Specialized Public Health Registry

Effective June 1, 2018, the NC Diabetes Specialized Public Health Registry will be available for population health purposes. Full participants of NC HealthConnex are eligible to participate in the registry by signing the NC HealthConnex Diabetes Registry form. Data submitted to NC HealthConnex will be included in the Diabetes Registry, as appropriate. No additional data submission from participants is required. The NC HealthConnex Diabetes Registry supports attestation for Meaningful Use Stage Three and Modified Stage Two for eligible hospitals, eligible critical access hospitals, and eligible professionals and Medicare Quality Payment Program Advancing Care Information for eligible clinicians.