Top 10 List for Eligible Providers
Eligible Providers Registering and Attesting for the Medi-Cal Meaningful Use Incentive Program
- Prequalification for physicians: what does it mean and how do I find out if I am prequalified?
California Department of Health Care Services (DHCS) used claims and encounter data to determine that approximately 6000 Medi-Cal providers met the threshold of 30% Medi-Cal visits and are eligible for the A/I/U incentive payments for 2011. A list of the National Provider Identifiers for these providers is posted on the DHCS website at www.dhcs.ca.gov.
Prequalified providers will not need to enter patient volume information when they enroll for the program in the State Level Registry (SLR.) Physicians who are not prequalified will need to enter data in the SLR to demonstrate meeting the Medi-Cal visit eligibility.
- Calculating Medi-Cal Visit Eligibility
Eligible providers that are not on the prequalification list will enter data in the SLR to document their denominator (total number of visits) and numerator (total number of Medi-Cal visits.)
Information on which visits qualify as Medi-Cal, and how to include managed care visits use the guide provided by DHCS is located on their website at www.dhcs.ca.gov.
- Providers should register with CMS first, then register with the state
There is no order required in the registration process, however, the process will be expedited if the provider registers with CMS first. If the provider tries to register at the State Level Registry (SLR) the provider may get an error message that the provider cannot be found in the state level provider master file (PMF). This occurs because the provider has never directly billed Medi-Cal using his/her NPI. If the provider registers with CMS first this problem will not occur.
- Time Period for Medi-Cal Eligibility
Providers’ eligibility is based on a 90 day period of the provider’s choosing in the calendar year 2010.
- Deadline for Registering for A/I/U for 2011
Providers will have until March 31, 2012 to register with the State Level Registry and earn an incentive payment for 2011.
- Documentation needed to prove Adoption/Implementation/Upgrade (A/I/U)
Providers will attach documentation of a binding financial or legal commitment of adoption, implementation or upgrade for a certified EHR that is signed by December 31, 2011for the 2011 payment. If the EHR was originally contracted for in an earlier year, the provider will need to attach both the original contract and a document that proves that the system has been upgraded to the certified version.
- A/I/U versus Attesting to Meaningful Use
Each provider that registers for the Medi-Cal EHR incentive payment will attest to A/I/U in the first participation year. In the second participation year the provider will attest to Meaningful Use and have to demonstrate that he/she is able to meet the Meaningful Use requirements for 90 days. Each subsequent year the provider will have to meet the Meaningful Use requirements for the full 12 month calendar year.
- Pediatricians Can Qualify at 20% Medi-Cal patient volume
Pediatricians are eligible for the incentive f they have a 20% or greater Medi-Cal patient volume. However, if the pediatrician’s Medi-Cal patient volume is 20% or more, but less than 30%, the payment will be only 66.6% of the total possible payment.
- Non-hospital based eligible professionals can include their in-patient encounters for purposes of calculating Medicaid patient volume even if the patient is included in the eligible hospital’s patient volume for the same 90-day period
An EP who sees patients in an in-patient setting, and is not hospital based, can include the in-patient encounter in their Medi-Cal patient volume calculation. Both an eligible hospital and an EP can include an encounter from the same patient in their Medi-Cal patient volume calculations, respectively. This is because the services performed by the EP are distinct from those performed by the eligible hospital.
- Reassignment and Eligibility are not linked
Reassignment happens when the provider or his/her proxy registers at the federal level. The provider or proxy will be asked for PAYEE information and if the provider is reassigning then he/she will enter the group/clinic/health center name and TIN. Eligibility happens at the state level. Groups will create accounts and register and list all providers in their groups. Providers will then register and elect to use those group volumes or not. There is no connection with reassignment. There is also no place in the state registration/attestation process in the State Level Registry (SLR) for the group or provider side to indicate reassignment.