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How Should Locum Tenens Attest to Meaningful Use for the Medicaid EHR Incentive Program? – Meaningful Use Monday

Posted on August 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


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 Program benefits. For more information, visit http://jessicashenfeld.com/healthcare-legal-services/ehr-incentive/.

A reader asked about the best way for a locum tenens to attest to Meaningful Use for the Medicaid EHR Incentive Program. As you may know, the phrase “locum tenens” is Latin for “place holder” or “substitute.” Locum tenentes physicians – like substitute teachers – may receive assignments that vary in length from a couple weeks to many months. As such, a locum tenens physician can work in multiple clinic/office locations over any given ninety-day period. This issue addressed below applies not only to locum tenens, but also to any doctor that works in multiple practice locations and wants to apply for the EHR Incentive Program as an individual eligible professional (EP). The reader’s question breaks down into two separate questions:
1. What location should the doctor use to demonstrate Meaningful Use?
2. What patient data should the doctor use to calculate the patient volume threshold – that at least 30% of the patients the EP treated were Medicaid patients?

The important point to remember is that doctors that work at more than one clinical practice site are NOT required to use data from all sites to support their demonstration of meaningful use and the patient volume threshold.

1. Meaningful Use: Under the Medicaid EHR Incentive Program, an EP must have at least 50% of their of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology capable of meeting all of the meaningful use objectives. In lay terms, that means that in order to receive the Medicaid EHR incentive, a doctor must have had a certified EHR system installed (either adopted, implemented, or upgraded) in at least half locations where they practiced over any 90-day period in the prior calendar year.

2. Patient Volume: In order to be eligible for the Medicaid EHR Incentive Program, at least 30% of an EP’s patients over that same 90-day reporting period must have been Medicaid patients. This calculation is called the “patient volume” calculation, and it may be calculated differently in each state. The answer that applies in New York is that EPs may choose one (or more) clinical practice sites in order to calculate their patient volume. While the calculation does not need to include all practice sites, at least one of the sites from which patient data is drawn must have certified EHR technology. In other words, if an EP practices in two locations, one with certified EHR technology and one without, the EP must include the patient volume from the site that includes the certified EHR technology. In this example, the EP has the choice as to whether he wants to include the patient volume from the site without certified EHR technology to calculate patient volume calculation.

Although the reader asked about the Medicaid EHR Incentive Program, a locum tenens can apply for the Medicare EHR Incentive Program using the framework outlined above with one exception: to establish Meaningful Use, at least half the practice sites where the locum tenens worked over a 90-day period in that same calendar year must have had a certified EHR system capable of meeting the Meaningful Use requirements. The patient volume analysis above applies to both Medicaid and Medicare.

Medicaid EHR Incentive Attestation with Multiple Practices – Meaningful Use Monday

Posted on June 18, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


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.