Medicaid EHR Incentive Attestation with Multiple Practices – Meaningful Use Monday


Jessica Shenfeld, Esq. is the founding partner at The Law Office of Jessica Shenfeld, a boutique law firm that caters to physicians’ legal needs. She is also CEO of EHR Incentive Help, Inc., which helps physicians satisfy the Meaningful Use criteria and apply for the Medicare/Medicaid EHR Incentive benefits. For more information, visit www.jessicashenfeld.com.

A reader of this blog, a physician who worked throughout 2011 in one practice, dissolved her practice in November 2011, and immediately opened a new practice with a new Group NPI (National Provider Identifier) number the same month, November 2011. She now wants to qualify for the Medicaid EHR Incentive in 2012, but was told that she cannot do so using data from 2011 because the new practice only has two qualifying months in 2011 (November and December) and the first practice’s data is mute because it was dissolved. The issues boil down to two questions:
1) Can a closed practice’s data be used during Attestation or is the date mute?
2) Can an individual physician use patients from two different practices to satisfy the Medicaid Patient Volume requirement?

The technical answer to the first question is not straightforward – it depends on what your state says. While Medicaid is a federal program, each state is responsible for administering it and each state makes its own rules for eligibility that vary slightly. The threshold issue here is whether the applicant qualifies an Eligible Professional (“EP). Once the applicant is accepted as an EP, the state has vetted his/her eligibility and that EP’s patient data from the last calendar year can be used during Attestation. In New York, the provider described above would qualify as an Eligible Professional since continues to accept Medicaid patients. However, the final decision as to whether an individual qualifies as an EP is up to each state to decide. EP Eligibility is determined when Registration for the EHR Incentive is submitted. I recommend e-mailing your individual state representative for that answer, or just submitting the Registration and seeing whether it is accepted. Upon Registration, the physician is notified whether he or she was deemed an EP.

The answer to the second question – whether an individual physician can use patients from two different practices to satisfy the Medicaid Patient Volume requirement – is no. A provider cannot attest using two group NPI numbers. The Medicaid Patient Volume requirement imposes a threshold of 30%, calculated using a ratio where the numerator is the total number of Medicaid patient encounters over a continuous 90-day period in the most recent calendar year and the denominator is all the patient encounters over that same 90-day period. Luckily, all is not lost. Although in this case the provider cannot attest using the group’s aggregate patient volume, she has the option of attesting using her individual provider’s patient volume. When reporting on her individual data, the 90-day period can consist of 90 days from the first practice, or 90 days that span across both practices if there was no break in time between the two practices.

One final point – even if a provider applying for the Medicaid EHR Incentive is not deemed an EP in 2012, that provider can delay Registration to as late as 2016 without incurring any reduction in the incentive payment. Conversely, applicants for the Medicare EHR Incentive payment must attest by 2013 using data from a 90-day period in 2012 in order to receive the full benefit.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • What about a Medicare EP who successfully attested for year one with her former employer, now works with us. Neither employer has enough information to report a full 12 months of info for her. Do we still attest for year two and fail it all or can we skip a year? And is it ok for the first employer to receive the first payment and we claim the rest? So complicated! Thanks for any input/help!!!

  • Thanks John! I do want to say I have found this blog very helpful and enjoy the posts! Thanks! I do have a more specific question related to our situation I do not believe was answered in Lynn’s post. Our provider in this situation is a Medicare EP and cannot switch to Medicaid. We know she will not be able to successfully attest for year 2 because of her changing jobs and neither employer has enough to report on 12 months. Specifically, can we just skip her attestation altogether for year 2 and skip the payment, or do we still need to attest even though we know it will fail? I guess I am just wondering if there are any consequences to just not attest for year 2 and then continuing onto year 3 next year. We realize either way we will forfeit her year 2 incentive, but do we need to still put the attestation through? Thanks for your help!

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