NC Medicaid Electronic Health Record Incentive Program FAQ

MU refers to the use of certified EHR technologies by health care providers in ways that measurably improve health care quality and efficiency.

The ARRA defines MU as:

• Use of certified EHR in a meaningful manner (e.g., e-prescribing);
• Use of certified EHR for electronic exchange of health information to improve quality of health care; and,
• Use of certified EHRs to submit Clinical Quality Measures (CQM).

The goal is to bring about health care that is:

• Patient-centered;
• Evidence-based;
• Prevention-oriented;
• Efficient; and,
• Equitable.

Neither the statute nor the CMS final rule dictates how a Medicaid provider must use their EHR incentive payment.

An incentive payment can be found as a separate item on the RA after paid and denied claims in the “Payouts” section, before the Financial Summary page. RAs are available on the NCTracks Provider Portal.

Payment information will be posted under the 'Path to Payment' tab on the Program website. The payment spreadsheet will contain the provider NPI, payee NPI, the amount paid, the EFT date, and a CCN to reconcile the payment on their RA.

No. The Medicaid EHR incentive payments made to providers are not subject to ARRA 1512 reporting because they are not made available from appropriations made under the Act.

CMS notes that nothing in the HITECH Act excludes such payments from taxation or as tax-free income, so it is likely that payments would be treated like any other income. Providers should consult with a tax advisor or the IRS regarding how to properly report this income on their filings.

In general, there are three things providers need to know regarding taxes and the NC Medicaid EHR Incentive Program:

1. If you assign your payment to a third party (such as your group practice), CMS is still obligated to report a payment to the eligible professional her/himself. The eligible professional will then bear a reporting obligation with respect to the assignment to a third party. CMS would not have a reporting obligation with respect to the third-party assignee unless CMS exercised managerial oversight with respect to, or had a significant economic interest in, the assignment.
2. Recipients must include incentive payments as part of their gross income unless they receive payments as a conduit or an agent of another and are thus unable to keep the payments. For example, Dr. Smith works at ABC Healthcare and they use a 3rd party billing agency. Dr. Smith’s Electronic Funds Transfer (EFT) may get sent to the 3rd party billing agency and redirected directly to Dr. Smith. Be that the case, the 3rd party billing agency would not need to include the EHR incentive payment as gross income, but Dr. Smith would need to include the EHR incentive payment as gross income.
3. To see the CMS reporting requirements with regard to eligible providers, see section 6041 of the Internal Revenue Code.

For specific provider questions, please call the Internal Revenue Service (IRS) toll-free at 800-829-3903.

Once a payment has been issued for an NC Medicaid EHR incentive payment, the Program posts to the program website under "Path to Payment" a spreadsheet with the provider NPI, the payee NPI, the payee name, the amount paid, the EFT date, and a CCN, which should make the payment easily identifiable on the remittance advice (RA), available on the NCTracks Provider Portal.

The incentive payment can also be found as a separate item on the RA after paid and denied claims in the "Payouts" section, before the Financial Summary page.

The "EFT effective date" given on the spreadsheet can be used to reconcile the payment against the 835 or RA.

An EP may check the status of their attestation at any time by logging onto NC-MIPS.

If you are listed on the Paid-to-Date spreadsheet on the "Path To Payment" tab, you were approved for an NC Medicaid EHR Incentive Program payment and the Program team authorized issuance of payment to the payee NPI listed on your attestation. If you are unable to locate that payment, please contact CSRA (formerly CSC), the fiscal agent for NCDHHS, which operates the NCTracks system. You can reach them 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 RA with details on payment.

No. Any reassignment of payment must be voluntary as stated in CMS' Final Rule. Per 495.10(f), EPs are permitted to reassign their incentive payments to their employer or to an entity with which they have a contractual arrangement allowing the employer or entity to bill and receive payment for the EP’s covered professional services. Medicaid EPs may also assign their incentive payments to a TIN for an entity promoting the adoption of EHR technology.

NC Medicaid EHR Incentive Program staff conducts audits.

After receiving payment, providers will receive an audit preparedness letter via email, to the contacts provided on their attestation.  This letter provides details on what type of documentation is requested for post payment audits.

An audit may include a review of any of the documentation needed to support the information that was provided in the attestation.

The primary documentation that will be requested for all North Carolina audits includes supporting documentation that the provider used when completing the attestation. This documentation must come from an auditable data source.

Documentation should include, at minimum:

• Proof of patient volume numerator and denominator for the PV reporting period (report should include Medicaid ID numbers for Medicaid encounters and dates of service for all encounters);
• The numerators and denominators for the CQMs (this documentation must come from the EHR, proof should be patient-level system generated documentation with dates of service);
• Documentation to support the MU objectives/measures (this documentation must come from the EHR, the CQM report should be a list of all the patients in the numerator and denominator with dates of service);
• The time the report covers;
• Evidence to support that it was generated for the attesting provider; and,
• AIU documentation proof can include copy of EHR contract, purchase order, cost associated with EHR installation, staff EHR training, software license agreements or data use agreements.

Please note, all PHI should be submitted via secured email. If the EP does not already have a secured email service, please email our Program Investigators at NCMedicaid.HITInvestigator@dhhs.nc.gov.

EPs must maintain all documentation for at least six years post-payment in case of an audit. The documentation should reflect the information provided in the attestation. If an EP fails an audit, the incentive payment will be recouped from the NPI that received the payment.

Where can I find additional information regarding the security risk assessment (SRA)?

Watch the SRA webinar (Run time: 5:19) that provides insight into what will be required when submitting the SRA if selected for post-payment audit.

In addition to the SRA webinar, find below a list of several resources that are available to assist providers with conducting a security risk assessment:

Healthit.gov's Security Risk Assessment Tool

HHS' "The Security Rule" Website

HHS' Security Standards: Technical Safeguards

HHS' Security Standards: Administrative Safeguards

HHS' Security Standards: Physical Safeguards

CMS' Security Risk Analysis Tip Sheet: Protect Patient Health Information

No. If the state has made a payment to an EP, and the EP later fails an audit, they must return the payment, and will be unable to re-attest to receive the first-year payment of $21,250. 

In other words, if the first-year payment is recouped, an EP will be unable to get another first-year payment. Similarly, if an EP has their second-year payment recouped, they are ineligible to receive another second-year payment.

Therefore, an EP that participates successfully for all six program years may receive up to $63,750; however, if the EP fails an audit and their first payment of $21,250 is recouped, the most the EP would qualify for during the life of the program is $42,500 ($63,750 – $21,250 = $42,500).

An auditable data source is defined as an electronic or manual system that an external entity can use to replicate the data from the original data source to support their attested information.

In the event of an audit, at a minimum, providers should have available documentation that supports a provider's attestation, including documentation that supports the provider's reported patient volume and each MU objective and measure (including CQMs).

Per the Final Rule, providers must keep documentation for at least six years following the date of attestation.

My practice does not have a system to submit documentation securely. Can I submit my audit documentation via U.S. mail?

No, providers must submit all documentation electronically. We use ZixMail to securely send messages and we are able to share our certificate with you, which will allow you to submit your documentation securely.

What documentation is needed to demonstrate compliance with Objective 8, Measure 1 (NCIR)?

When registration is complete, NCIR sends a confirmation email to participants. If a bulk registration is completed, the participants will receive an email confirmation and an excel spreadsheet with all participants listed. This documentation from NCIR is what should be submitted if selected for post-payment audit to demonstrate your compliance with Objective 8, Measure 1.

I received a notice on September 10, 2018 from Greenway Health regarding the time frame used to calculate View, Download, Transmit (VDT) and Patient-Specific within Prime Suite that may have led to reporting a higher result than achieved. What do I need to do?

You need to:

• Keep a copy of this email from Greenway and any other related communication from Greenway, for six years.
• Take screenshots of the applicable measures for your reported performance period prior to Oct. 5, 2018, for your records and keep for six years.

If selected for audit for Program Year 2017, in addition to the standard documentation requested on the records request letter you may need to submit communication from Greenway to the provider who attested (or to her/his practice), screenshots taken prior to Oct. 5, 2018 of the applicable measures for your Program Year 2017 reporting period, and revised performance measures retrieved from your EHR after Greenway’s fix.

For questions regarding audit, please email NCMedicaid.HITInvestigator@dhhs.nc.gov.