Oklahoma Electronic Health Records Incentive Program Provider Manual State of Oklahoma

Transcription

State of Oklahoma
Oklahoma Health Care Authority
Oklahoma Electronic Health Records
Incentive Program
Provider Manual
TABLE OF CONTENTS
Background: ............................................................................................................. 3
Resources: ............................................................................................................... 3
Revisions:................................................................................................................. 3
Definitions Per Final Rule and/or Oklahoma State Medicaid:................................... 5
Useful Acronyms ...................................................................................................... 7
Eligibility: .................................................................................................................. 8
Out-of-State Providers:............................................................................................. 9
Establishing Patient Volume:.................................................................................... 9
Patient Encounters Methodology: .......................................................................... 10
Payment Methodology for EPs............................................................................... 11
Payments for SoonerCare Eligible Professionals ................................................... 12
Payment Methodology for Eligible Hospitals .......................................................... 13
Adopt, Implement or Upgrade (AIU) and Meaningful Use (MU): ............................ 16
Eligible Professionals:…………………………………… ................................... ……17
Eligible Professionals - 10 Stage 1 Menu Set ........................................................ 17
Eligible Hospitals – 14 Stage 1 Core Objectives: ................................................... 18
Eligible Hospitals – 10 Stage 1 Menu Set Objects ................................................. 18
Provider Registration.............................................................................................. 19
Provider Attestation Process and Validation .......................................................... 19
Requesting Payment: ............................................................................................. 21
Program Integrity:................................................................................................... 21
Payment Recoupment:........................................................................................... 21
Administrative Appeals:.......................................................................................... 21
Patient Volume Documentation Form....................... Error! Bookmark not defined.
Provider/Physician Grievance Form ....................................................................... 23
Eligibility at a Glance .............................................................................................. 24
Attestation Chart – EP............................................................................................ 25
Attestation Chart – EH............................................................................................ 27
Meaningful Use Core Sets ..................................................................................... 29
Meaningful Use Menu Set ...................................................................................... 32
Meaningful Use Measure Calculation..................................................................... 35
Screen Shots of EPE used for Attestation…………… ........................................... .40
Checklist for Eligible Professionals……………………………………………………..50
Checklist for Eligible Hospitals…………………………………………………………..52
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Background:
The Centers for Medicare & Medicaid Services (CMS) has implemented, through provisions of the
American Recovery and Reinvestment Act of 2009 (ARRA), incentive payments to eligible professionals (EP)
and eligible hospitals (EH), including critical access hospitals (CAHs), participating in Medicare and
Medicaid programs that are meaningful users of certified Electronic Health Records (EHR) technology.
The incentive payments are not a reimbursement, but are intended to encourage EPs and EHs to adopt,
implement, or upgrade certified EHR technology and use it in a meaningful manner.
Use of certified EHR systems is required to qualify for incentive payments. The Office of the National
Coordinator for Health Information Technology (ONC) has issued rules defining certified EHR systems
and has identified entities that may certify systems. More information about this process is available at
www.healthit.hhs.gov
Goals for the national program include: 1) enhance care coordination and patient safety; 2)
reduce paperwork and improve efficiencies; 3) facilitate electronic information sharing across
providers, payers, and state lines; and 4) enable data sharing using state Health Information Exchange (HIE)
and the National Health Information Network (NHIN). Achieving these goals will improve health outcomes,
facilitate access, simplify care, and reduce costs of health care nationwide.
OHCA will work closely with federal and state partners to ensure the Oklahoma EHR Incentive
Program fits into the overall strategic plan for the Oklahoma Health Information Exchange (OKHIE),
thereby advancing national and Oklahoma goals for HIE.
Resources:
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OAC 317: 30-3-28 – Electronic Health Records Incentive Program
OAC 317: 2-1-2 (b) – Administrative Appeals
42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record
Incentive Program; Final Rule
Oklahoma State Medicaid HIT Plan (SMHP) Version 1.0
www.okhca.org/ehr-incentive
www.cms.gov/EHRIncentivePrograms
www.HealthIT.hhs.gov
Provider Services 877-823-4529, option 2
Revisions:
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Original 11/2010
Revision 1 12/2010
Revision 11/29/2010
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Definitions Per Final Rule and/or Oklahoma State Medicaid:
Acceptable documentation means satisfactorily completed written evidence of an approved phase of
work or contract and acceptance of the evidence thereof by the OHCA. Acceptable documentation will
refer to the certified EHR technology by name and certification number and will include financial and/or
contractual commitment. Document date does not have to be within the preceding fiscal year, if the
reported version of the EHR technology was certified after the document date. See examples below:
 Copy of invoice
 Copy of receipt
 Copy of contract
Acquisition means to acquire health information technology (HIT) equipment and/or services from
commercial sources or from State or local government resources for the purpose of implementation and
administration of EHR.
Acute care hospital means a health care facility—
(1) Where the average length of patient stay is 25 days or fewer; and
(2) With a CMS certification number (previously known as the Medicare provider number) that
has the last four digits in the series 0001–0879 or 1300–1399; or
(3) Critical Access Hospitals
Adopt, implement, or upgrade (AIU) means—
(1) Acquire, purchase, or secure access to certified EHR technology (proof of purchase or signed
contract will be an acceptable indicator);
(2) Install or commence utilization of certified EHR technology capable of meeting meaningful use
requirements; or
(3) Expand the available functionality of certified EHR technology capable of meeting meaningful
use requirements at the practice site, including staffing, maintenance, and training, or upgrade
from existing EHR technology to certified EHR technology per the ONC EHR certification criteria.
Children’s hospital means a separately certified children’s hospital, either freestanding or hospital-within
hospital that—
(1) Has a CMS certification number, (previously known as the Medicare provider number), that
has the last 4 digits in the series 3300–3399; and
(2) Predominantly treats individuals less than 21 years of age.
Hospital-Based means a professional furnishes ninety percent (90%) or more of their SoonerCarecovered professional services during the relevant EHR reporting period in a hospital setting, whether
inpatient or Emergency Room, through the use of the facilities and equipment of the hospital; verified by
MMIS claims analysis.
Medicaid Encounter for an EP means services rendered to an individual on any one day where:
 Medicaid paid for part or all of the service; or
 Medicaid paid all or part of the individual’s premiums, copayments, and cost-sharing.
Medicaid Encounter for an EH means services rendered to an individual per patient discharge or
services rendered to an individual in an emergency room on any one day where:
 Medicaid paid for part or all of the service; or
 Medicaid paid all or part of the individual’s premiums, copayments, and cost-sharing.
Medicaid Management Information System (MMIS) means the electronic Medicaid claims payment
system.
Needy individuals mean individuals that meet one of following:
(1) Were furnished medical assistance paid for by TXIX Medicaid or TXXI Children’s Health
Insurance Program funding including SoonerCare, out-of-state Medicaid programs, or a Medicaid
or CHIP demonstration project approved under section 1115 of the Act;
(2) Were furnished uncompensated care by the provider; or
(3) Were furnished services at either no cost or reduced cost based on a sliding scale determined
by the individuals’ ability to pay.
Physician Assistant (PA) led Federally Qualified Health Clinic (FQHC) or Rural Health Clinic (RHC)
means:
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A PA is the primary provider in a clinic (for example, when there is a part-time physician and fulltime PA, we would consider the PA as the primary provider);
A PA is a clinical or medical director at a clinical site of practice; or
A PA is an owner of an RHC.
Patient volume means the proportion of an EP's or EH's patient encounters that qualify as a Medicaid
encounter. This figure is estimated through a numerator and denominator as defined in the State
Medicaid HIT Plan (SMHP) for Oklahoma.
Pediatrician means a Medical doctor who diagnoses, treats, examines, and prevents diseases and
injuries in children. A pediatrician must (1) hold a four-year undergraduate college degree, (2) hold a fouryear Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree, (3) have at least three years of
residency training, (4) hold a valid, unrestricted medical license, and (4) hold a board certification in
Pediatrics through either the American Board of Pediatrics (ABP) or the American State of Oklahoma
Osteopathic Board of Pediatrics (AOBP).
Practices predominantly means an EP for whom more than 50 percent of his or her total patient
encounters occur at a federally qualified health center or rural health clinic. The calculation is based on a
period of 6 months in the most recent calendar year.
State Medicaid HIT Plan (SMHP) means a document that describes the State’s current and future HIT
activities.
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Useful Acronyms
ARRA American Recovery and Reinvestment Act of 2009
AAC Average Allowable Cost (of certified EHR
technology)
AIU Adopt, Implement, Upgrade (certified EHR
technology)
CAH Critical Access Hospital
CAHPS Consumer Assessment of Healthcare Providers
and Systems
CCN CMS Certification Number
CFR Code of Federal Regulations
CHIP Children’s Health Insurance Program
CHIPRA Children’s Health Insurance Program
Reauthorization Act of 2009
CMS Centers for Medicare & Medicaid Services
CPOE Computerized Physician Order Entry
CY Calendar Year
EHR Electronic Health Record
EH Eligible Hospital
EP Eligible Professional
EPE Electronic Provider Enrollment
EPO Exclusive Provider Organization
FACA Federal Advisory Committee Act
FFP Federal Financial Participation
FFY Federal Fiscal Year
FFS Fee-For-Service
FQHC Federally Qualified Health Center
FTE Full-Time Equivalent
FY Fiscal Year
HEDIS Healthcare Effectiveness Data and Information
Set
HHS Department of Health and Human Services
HIE Health Information Exchange
HIT Health Information Technology
HIPAA Health Insurance Portability and Accountability Act
of 1996
HITECH Health Information Technology for Economic and
Clinical Health Act
HMO Health Maintenance Organization
HOS Health Outcomes Survey
HPSA Health Professional Shortage Area
HRSA Health Resource and Services Administration
IAPD Implementation Advance Planning Document
ICR Information Collection Requirement
IHS Indian Health Service
IPA Independent Practice Association
IT Information Technology
MA Medicare Advantage
MAC Medicare Administrative Contractor
MAO Medicare Advantage Organization
MCO Managed Care Organization
MITA Medicaid Information Technology Architecture
MMIS Medicaid Management Information Systems
MSA Medical Savings Account
NAAC Net Average Allowable Cost (of certified EHR
technology)
NCQA National Committee for Quality Assurance
NCVHS National Committee on Vital and Health Statistics
NPI National Provider Identifier
NPRM Notice of Proposed Rulemaking
OHCA Oklahoma Health Care Authority
ONC Office of the National Coordinator for Health Information
Technology
PAHP Prepaid Ambulatory Health Plan
PAPD Planning Advance Planning Document
PFFS Private Fee-For-Service
PHO Physician Hospital Organization
PHS Public Health Service
PHSA Public Health Service Act
PIHP Prepaid Inpatient Health Plan
POS Place of Service
PPO Preferred Provider Organization
PQRI Physician Quality Reporting Initiative
PSO Provider Sponsored Organization
RHC Rural Health Clinic
RHQDAPU Reporting Hospital Quality Data for Annual
Payment Update
RPPO Regional Preferred Provider Organization
SMHP State Medicaid Health Information Technology Plan
TIN Tax Identification Number
Eligibility:
Per federal rule, EPs must begin the program no later than CY 2016 and EHs must begin by FFY 2016.
The following SoonerCare and out-of-state Medicaid providers are eligible to participate in the Oklahoma
incentives program:
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A physician (MD and DO)
A dentist
A certified nurse-midwife
A nurse practitioner
A physician assistant practicing in a Federally Qualified Health Center (FQHC) led by a physician
assistant or a rural health clinic (RHC), that is so led by a physician assistant (see definition on
page 5).
Acute care hospitals
Children’s hospitals
Additional requirements for the EP - To qualify for an EHR incentive payment for each year the EP seeks
the incentive payment, the EP must not be hospital-based and must meet the following criteria:
1. Meet one of the following patient volume criteria:
a. Have a minimum of 30 percent patient volume attributable to individuals receiving TXIX
Medicaid funded services; or
b. Have a minimum 20 percent patient volume attributable to individuals receiving TXIX
Medicaid funded services, and be a pediatrician; or
c. Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient
volume attributable to needy individuals.
2. Have a valid contract with OHCA*;
3. Have no sanctions and/or exclusions;
* A valid contract means that the provider is currently contracted with OHCA to provide services and
has been contracted for at least 90 days. An individual EP may choose to receive the incentive
him/herself or assign it to a Medicaid contracted clinic or group to which he is associated. The tax
identification number (TIN) of the individual or entity receiving the incentive payment is required when
registering with the National Level Registry (NLR) and must match a TIN linked to the individual
provider in OHCA's system. Also, the banking information for the individual or entity receiving the
payment must be on file with OHCA. Finally, providers may not enter into the Oklahoma EHR Incentive
system while their contract is under review by OHCA for renewal. This means the system will not be
available to a provider for attestation from the time the contract is submitted for renewal until it has
been approved by OHCA.
Additional requirement for the EH - To qualify for an EHR incentive payment for each year the EH seeks
the incentive payment, the EH must be one of the following:
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An acute care hospital (includes CAH) that has at least a 10 percent Medicaid patient volume for
each year the hospital seeks an EHR incentive payment.
A children’s hospital (exempt from meeting a patient volume threshold).
Hospital-based providers are not eligible for the EHR incentive program. Other providers and hospitals
that are currently ineligible for the Oklahoma EHR Incentive Program include behavioral health
(substance abuse and mental health) providers and facilities and long-term care providers and facilities.
Note that some provider types eligible for the Medicare program, such as chiropractors, are not eligible
for the Oklahoma EHR Incentive Program per federal regulations.
Qualifying Providers by Type and Patient Volume
Out-of-State Providers:
The Oklahoma EHR Incentive Program welcomes any out-of-state provider to participate in this
advantageous program. Out-of-state providers have the same eligibility requirements as in-state
providers. Oklahoma must be the only state they are requesting an incentive payment from during that
participation year. For audit purposes, out-of-state providers must make available any and all records,
claims data, and other data pertinent to an audit by either the Oklahoma Medicaid program or CMS.
Records must be maintained as applicable by law in the state of practice or Oklahoma, whichever is
deemed longer.
Establishing Patient Volume:
A Medicaid provider must annually meet patient volume requirements of Oklahoma’s EHR incentive
program as established through the State’s CMS approved SMHP. Patients’ funding source identifies who
can be counted in the patient volume: Title XIX (TXIX) – Medicaid and Title XXI (TXXI) - CHIP. All EPs
(except EPs predominantly practicing in an FQHC/RHC) will calculate patient volume based on TXIX
SoonerCare and out-of-state Medicaid patients. The EHR statue allow for an EP practicing predominantly
in an FQHC or RHC to consider CHIP patients under the needy individual patient volume requirements.
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Patient Encounters Methodology:
ELIGIBLE PROFESSIONALS
1 (A) EPs (except those practicing predominantly in an FQHC/RHC) –
To calculate TXIX SoonerCare patient volume, an EP must divide:
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The total TXIX SoonerCare or out-of-state Medicaid patient encounters in any representative,
continuous 90-day period in the preceding calendar year; by
The total patient encounters in the same 90-day period.
1 (B) EPs Practicing Predominantly in an FQHC/RHC To calculate needy individual patient volume, an EP must divide:
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The total needy individual patient encounters in any representative, continuous 90-day period in
the preceding calendar year; by
The total patient encounters in the same 90-day period.
Definition of an Eligible Professional SoonerCare Encounter:
For purposes of calculating EP patient volume, a SoonerCare encounter is defined as services
rendered on any one day to an individual where TXIX SoonerCare or another State’s Medicaid
program paid for
(1) Part or all of the service; or
(2) Part or all of their premiums, co-payments, and/or cost-sharing.
Definition of a Needy Individual Encounter
For purposes of calculating patient volume for an EP practicing predominantly in an FQHC/RHC, a
needy individual encounter is defined as services rendered on any one day to an individual where
medical services were:
1) Paid for by TXIX Medicaid or TXXI Children’s Health Insurance Program funding
including SoonerCare, out-of-state Medicaid programs or a Medicaid or CHIP
demonstration project approved under section 1115 of the Act;
2) Furnished by the provider as uncompensated care, or
3) Furnished at either no cost or reduced cost based on a sliding scale determined by
the individuals’ ability to pay.
Group practices - Clinics or group practices will be permitted to calculate patient volume at the
group practice/clinic level, but only in accordance with all of the following limitations:
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The clinic or group practice’s patient volume is appropriate as a patient volume methodology
calculation for the EP;
There is an auditable data source to support the clinic’s or group practice’s patient volume
determination;
All EPs in the group practice or clinic must use the same methodology for the payment year;
The clinic or group practice uses the entire practice or clinic’s patient volume and does not
limit patient volume in any way; and
If an EP works inside and outside of the clinic or practice, then the patient volume calculation
includes only those encounters associated with the clinic or group practice, and not the EP’s
outside encounters.
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ELIGIBLE HOSPITALS
To calculate TXIX SoonerCare patient volume, an EH must divide:
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The total TXIX SoonerCare and out-of-state Medicaid encounters in any representative 90-day
period in the preceding fiscal year; by
The total encounters in the same 90-day period.
o Total number of inpatient bed days for all discharges in a 90-day period (even if some of
those days preceded the 90-day range) plus total number of emergency department visits in
the same 90-day period.
o An emergency department must be part of the hospital.
Eligible Hospital SoonerCare Encounter:
For purposes of calculating eligible hospital patient volume, a SoonerCare encounter is defined
as services rendered to an individual (1) per inpatient discharge, or (2) on any one day in the
emergency room where TXIX SoonerCare or another State’s Medicaid program paid for:
(1) Part or all of the service;
(2) Part or all of their premiums, co-payments, and/or cost-sharing;
Exception - A children’s hospital is not required to meet Medicaid patient volume requirements.
Payment Methodology for EPs
Payment for EPs equals 85 percent of ‘‘net average allowable costs,’’ or NAAC. NAAC are capped by
statute at $25,000 in the first year, and $10,000 for each of 5 subsequent years. NAAC for pediatricians
with SoonerCare patient volume between 20-29 percent are capped at two thirds of those amounts
respectively. Thus, the maximum incentive payment an EP could receive from Oklahoma Medicaid equals
$63,750, over a period of 6 years, or $42,500 for pediatricians with a 20-29 percent SoonerCare patient
volume.
Provider
Patient Volume
Year 1
Year 2
Year 3
Year 4
Year 5
Total Incentive Payment
EP
30%
$21,250
8,500
8,500
8,500
8,500
$63,750
EP-Pediatrician
20-29%
$14,167
5,667
5,667
5,666
5,666
$42,500
The incentive payment amount must be reduced by any cash payments made to an EP over $29,000 for
payment to gain access to certified EHR technology or support services of such technology. The only
exception to this requirement is that payments from State or local governments do not reduce the
average allowable costs. So, if an EP receives cash to obtain access to a certified EHR system from a
source other than a state or local government in the amount of $30,000, the incentive payment must be
reduced by $1,000 ($30,000 received less $29,000 allowed). If an EP (30 percent patient volume)
receives $30,000 cash assistance in reporting Year 1, the EP would receive $20,250 ($21,250 less
$1,000). If the EP in the example received $28,000 (less than the $29,000 allowable) in assistance,
he/she would receive the full incentive amount of $21,250.
Since pediatricians are qualified to participate in the Oklahoma Medicaid EHR incentive program as
physicians, and therefore classified as EPs, they may qualify to receive the full incentive if the pediatrician
can demonstrate that they meet the minimum 30 percent Medicaid patient volume requirements.
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EP AIU or MU Payments
CY 2011
CY 2012
CY 2013
CY 2014
PY 2011 PY 2012
AIU / MU
MU
Stage 1
Effective
PY 2013 PY 2014
MU
MU
Stage 1
AIU / MU
Stage 2
MU
Stage 2
MU
Stage 1
Stage 1
AIU / MU
Stage 2
MU
Stage 1
Stage 1
AIU / MU
Stage 1
PY 2015
TBD
TBD
TBD
TBD
Payments for SoonerCare Eligible Professionals
EP payments will be made in alignment with the calendar year and an EP must begin receiving incentive
payments no later than CY 2016. EPs will assign the incentive payments to a tax ID (TIN) in the CMS
EHR Registration and Attestation national level repository (NLR). The TIN must be associated in the
Oklahoma SoonerCare MMIS system with either the EP him/herself or a group or clinic with whom the EP
is affiliated. EPs who assign payment to themselves (and not a group or clinic) will be required to provide
OHCA with updated EFT information for payments. Each EP must have a current SoonerCare contract
with OHCA, and be contracted for at least 90 days.
The Oklahoma Medicaid EHR Incentive program does not include a future reimbursement rate reduction
for non-participating Medicaid providers. (Medicare requires providers to implement and meaningfully
using certified EHR technology by 2015 to avoid a Medicare reimbursement rate reduction.) For each
year a provider wishes to receive a Medicaid incentive payment, determination must be made that he/she
was a meaningful user of EHR technology during that year. Medicaid EPs are not required to participate
on a consecutive annual basis, however, the last year an EP may begin receiving payments is 2016, and
the last year the EP can receive payments is 2021.
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Maximum Incentive Payments for EPs
OHCA currently requires that all providers submit a valid NPI as a condition of SoonerCare provider
enrollment. Each EP or EH will be enrolled as an OHCA SoonerCare provider and will therefore, without
any change in process or system modification, meet the requirement to receive an NPI. OHCA performs a
manual NPPES search to validate NPIs during the enrollment process.
In the event OHCA determines monies have been paid inappropriately, incentive funds will be recouped
and refunded to CMS. Providers may refund the money to OHCA in a lump sum, or an AR account will be
set up for the provider and the overpayment recouped through future payments. The existing practice
allows OHCA to work out an acceptable repayment period dependent upon the provider circumstances.
Payment Methodology for Eligible Hospitals
Statutory parameters placed on Oklahoma Medicaid incentive payments to hospitals are largely based on
the methodology applied to Medicare incentive payments. The specifications described in this section are
limits to which all States must adhere when developing aggregate EHR hospital incentive amounts for
Medicaid-eligible hospitals. States will calculate hospitals’ aggregate EHR hospital incentive amounts on
the federal fiscal year (FFY) to align with hospitals participating in the Medicare EHR incentive program.
Oklahoma may pay children’s hospitals and acute care hospitals up to 100 percent of an aggregate EHR
hospital incentive amount provided over a 3-year period. Section 1905(t)(5)(D) requires that no payments
can be made to hospitals after 2016 unless the provider has been paid a payment in the previous year;
thus, while Medicaid EPs are afforded flexibility to receive payments on a non-consecutive, annual basis,
hospitals receiving a Medicaid incentive payment must receive payments on a consecutive, annual basis
after the year 2016. Prior to 2016, Medicaid incentive payments to hospitals can be made on a
nonconsecutive, annual basis. The aggregate EHR hospital incentive amount is calculated using an
overall EHR amount multiplied by the Medicaid share.
Oklahoma is responsible for using auditable data sources to calculate Medicaid aggregate EHR hospital
incentive amounts, as well as determining Oklahoma Medicaid incentive payments to those providers.
Auditable data sources include:
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Providers’ Medicare cost reports;
State-specific Medicaid cost reports;
Payment and utilization information from the Oklahoma MMIS (or other automated claims
processing systems or information retrieval systems); and
Hospital financial statements and hospital accounting records.
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For purposes of the Oklahoma Medicaid EHR hospital incentive program, the overall EHR amount is
equal to the sum over 4 years of (I)(a) the base amount (defined by statute as $2,000,000); plus (b) the
discharge related amount defined as $200 for the 1,150th through the 23,000th discharge for the first year
(for subsequent years, CMS assumes discharges increase by the provider’s average annual rate of
growth for the most recent 3 years for which data are available per year): multiplied by (II) the transition
factor for each year equals 1 in year 1, 3⁄4 in year 2, 1⁄2 in year 3, and 1⁄4 in year 4.
The statute specifies that the payment year is determined based on a Federal fiscal year. Section
1886(n)(2)(C) of the Act provides the Secretary with authority to determine the discharge related amount
on the basis of discharge data from a relevant hospital cost reporting period, for use in determining the
incentive payment during a Federal fiscal year.
Federal fiscal years begin on October 1 of each calendar year, and end on September 30 of the
subsequent calendar year. Hospital cost reporting periods can begin with any month of a calendar year,
and end on the last day of the 12th subsequent month in the next calendar year. For purposes of
administrative simplicity and timeliness, Oklahoma will use data on the hospital discharges from the
hospital fiscal year that ends during the Federal fiscal year prior to the fiscal year that serves as the first
payment year.
The discharge-related amount is $200 per discharge for discharges 1,150 through 23,000. To determine
the discharge-related amount for the three subsequent years that are included in determining the overall
EHR amount, Oklahoma will assume discharges for an individual hospital have increased by the average
annual growth rate for an individual hospital over the most recent 3 years of available data from an
auditable data source. Per federal regulations, if a hospital’s average annual rate of growth is negative
over the 3 year period, it will be applied as such.
The overall hospital EHR amount requires that a transition factor be applied to each year. This transition
factor equals 1 for year 1, ¾ for year 2, ½ for year 3, and ¼ for year 4, as provided
for in sections 1886(n)(2)(A) and 1886(n)(2)(E) of the Act, and as incorporated through section
1902(t)(5)(B) of the Act.
The ‘‘Medicaid Share,’’ against which the overall EHR amount is multiplied, is essentially the percentage
of a hospital’s inpatient, non-charity care days that are attributable to Medicaid inpatients. More
specifically, the Medicaid share is a fraction expressed:
Estimated Medicaid inpatient-bed days plus estimated Medicaid managed care inpatient-bed-days;
Divided by;
Estimated total inpatient-bed days multiplied by ((estimated total charges minus charity care charges)
divided by estimated total charges).
As indicated in the above formula, the Medicaid share includes both Medicaid inpatient-bed-days and
Medicaid managed care inpatient-bed-days. This is in keeping with section 1903(t)(5)(C) of the Act, which
provides that in computing inpatient-bed-days, the Secretary shall take into account inpatient-bed-days
that are paid for individuals enrolled in a Medicaid managed care plan under sections 1903(m) or 1932 of
the Act.
In addition, because the formula for calculating the Medicaid share requires a determination of charity
care charges, Oklahoma will use the revised Medicare 2552–10, Worksheet S–10 or another auditable
data source to determine the charity care portion of the formula. In the absence of sufficient charity care
data to complete the calculation, section 1886(n)(2)(D) of the Act, requires the use of uncompensated
care data to derive an appropriate estimate of charity care, including a downward adjustment for bad
debts. CMS interpreted bad debt to be consistent with the Medicare definition of bad debt as promulgated
at § 413.89(b)(1).
Finally, per section 1886(n)(2)(D) of the Act, to the extent there is simply not sufficient data that would
allow us to estimate the inpatient bed-days attributable to Medicaid managed care patients, the statute
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directs that such figure is deemed to equal 0. Likewise, if there is simply not sufficient data for the State to
estimate the percentage of inpatient bed days that are not charity care (that is, [estimated total charges—
charity care charges]/estimated total charges), the statute directs that such figure is deemed to equal 1.
Unlike Medicaid EPs, who must waive rights to duplicative Medicare incentive payments, hospitals may
receive incentive payments from both Medicare and Medicaid, contingent on successful demonstration of
meaningful use and other requirements under both programs.
The last year that a hospital may begin receiving Medicaid incentive payments is FY 2016. States must
make payments over a minimum of 3 years. Additionally, in any given payment year, no annual Medicaid
incentive payment to a hospital may exceed 50 percent of the hospital’s aggregate incentive payment.
Likewise, over a 2- year period, no Medicaid payment to a hospital may exceed 90 percent of the
aggregate incentive.
For a more simple view of the EH payment calculation CMS has broken it down into four steps:

EH Payment Calculation Step 1:
o
o
o
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o
o
o
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o
Overall EHR Amount multiplied by…..
 Medicaid Share:
 Estimated Medicaid inpatient-bed-days divided by…
o The results of:
o Estimated total inpatient-bed-days multiplied by…
o Estimated total charges minus charity care charges divided by estimated total
charges
= Aggregate EHR Hospital Incentive Amount for the reporting year
o

Subtotal from previous calculation multiplied by….
Transition Factor =
 Year 1: 1
 Year 2: ¾
 Year 3: ½
 Year 4: ¼
= Overall EHR Amount
o
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Add: Base Amount (per statue) = $2,000,000, plus
Discharge related amount =
th
th
 Year 1: $200 per discharge for 1,150 – 23,000 discharge
 Year 2-4: multiplied by the hospitals growth rate over the previous three years’ data
= Subtotal
= Aggregate EHR Hospital Incentive Amount for the reporting year multiplied by….
 Year 1: 50%
 Year 2: 40%
 Year 3: 10%
= Total EH Annual Incentive
15
EH AIU or MU Payments
FFY 2011
FFY 2012
FFY 2013
FFY 2014
Effective
PY 2011 PY 2012 PY 2013 PY 2014 PY 2015
AIU / MU
MU
MU
MU
TBD
Stage 1 Stage 1 Stage 2 Stage 2
MU
MU
AIU / MU
TBD
Stage 1 Stage 1 Stage 2
MU
AIU / MU
TBD
Stage 1 Stage 1
AIU / MU
TBD
Stage 1
Adopt, Implement or Upgrade (AIU) and Meaningful Use
(MU):
Adopt, Implement or Upgrade (AIU). The federal regulations allow EPs and EHs in the Medicaid EHR
Incentive Program to receive incentive payments for year one if they adopt (acquire and install),
implement (train staff, deploy tools, exchange data) or upgrade (expand functionality or interoperability) of
their certified EHR systems technology. (This option is not available through the Medicare Incentive
Program in which all providers must meet meaningful use in the first year.) At the time of attestation, the
EP or EH will be required to provide documentation supporting the claim of AIU, such as a contract or
paid invoice.
Meaningful Use (MU) Meaningful use of EHR technology is a major goal of this program. CMS has
determined that MU will be rolled out in three stages. The current rule provides specific information on
Stage 1 which focuses heavily on establishing the functionalities in certified EHR technology that will
allow for continuous quality improvement and ease of information exchange. They include:
 Electronically capturing health information in a structured format;
 Using that information to track key clinical conditions and communicating that information for care
coordination purposes (whether that information is structured or unstructured, but in structured format
whenever feasible);
 Implementing clinical decision support tools to facilitate disease and medication management; using
EHRs to engage patients and families; and
 Reporting clinical quality measures and public health information.
Though some functionalities are optional in Stage 1, as outlined in discussions later in this manual, all of
the functionalities are considered crucial to maximize the value to the health care system provided by
certified EHR technology. CMS encourages all EPs, eligible hospitals and CAHs to be proactive in
implementing all of the functionalities of Stage 1 in order to prepare for later stages of meaningful use,
particularly functionalities that improve patient care, the efficiency of the health care system and public
health. Current federal regulations indicate that providers practicing in multiple locations must provide
meaningful use data only for locations that utilize certified EHR technology.
16
To meet Stage 1 meaningful use criteria, EPs and EHs must meet all core objectives and five from the
menu set of objectives, with at least one being a public health objective (denoted by the asterisk). A
particular objective may be excluded if the following criteria are met:
EPs only:
1. The federal regulations indicate the objective includes the option to attest that the objective is not
applicable;
EPs and EHs:
2. Meets the criteria in the applicable objective that would permit the attestation; and
3. Attests. An exclusion reduces the number of objectives that otherwise apply. For instance, an EP
that qualifies for the exclusion of an objective from the menu set will be required to select only
four from the menu set. The EP must still report at least one of the public health objectives.
Following are the elements for the core and menu sets divided by EP and EH requirements. See the chart
beginning on page 29 for specific measures explaining how to meet the objectives.
Eligible Professionals – 15 Stage 1 Core Objectives (objectives with exclusion
permitted for qualified EPs are indicated with a ^; check federal regulations for explanatory information
regarding specific exclusions):














Computerized Physician Order Entry (CPOE) ^
E-Prescribing (eRx) ^
Report ambulatory clinical quality measures to CMS/State
Implement one clinical decision support rule
Provide patients with an electronic copy of their health information, upon request ^
Provide clinical summaries for patients for each office visit ^
Drug-drug and drug-allergy interaction checks
Record demographics ^
Maintain an up-to-date problem list of current and active diagnoses
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs ^
Record smoking status for patients 13 years or older ^
Capability to exchange key clinical information among providers of care and patient-authorized
entities electronically
Eligible Professionals - 10 Stage 1 Menu Set (Must choose five including at least 1
public health objective*; objectives with exclusion permitted for qualified EPs are indicated with a ^; check
federal regulations for explanatory information regarding specific exclusions)):










Drug-formulary checks
Incorporate clinical lab test results as structured data ^
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for preventive/follow up care ^
Provider patients with timely electronic access to their health information ^
Use certified EHR technology to identify patient-specific education resources and provide to
patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals ^
*Capability to submit electronic data to immunization registries/systems ^
*Capability to provide electronic syndromic surveillance data ^
17
Eligible Hospitals – 14 Stage 1 Core Objectives:














CPOE
Drug-drug and drug-allergy interaction checks
Record demographics
Maintain up-to-date problem list of current and active diagnoses
Maintain active medication allergy list
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Report hospital clinical quality measures to CMS or State
Provide patients with an electronic copy of their health information, upon request
Provide patients with an electronic copy of their discharge instructions at time of discharge, upon
request
Capability to exchange key clinical information among providers of care and patient-authorized
entities electronically
Protect electronic health information
Eligible Hospitals – 10 Stage 1 Menu Set Objects (Must choose five including at
least 1 public health objective* must be selected):










Drug-formulary checks
Record advanced directives for patients 65 years or older
Incorporate clinical lab test results as structured data
Use certified EHR technology to identify patient-specific education resources and provide to
patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
*Capability to submit electronic data to immunization registries/systems
*Capability to provide electronic submission of reportable lab results to public health agencies
*Capability to provide electronic syndromic surveillance data to public health agencies
Stage 2: The goals for the Stage 2 meaningful use criteria, consistent with other provisions of Medicare
and Medicaid law, expand upon the Stage 1 criteria to encourage the use of HIT for continuous quality
improvement at the point of care and the exchange of information in the most structured format possible,
such as the electronic transmission of orders entered using CPOE and the electronic transmission of
diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac
imaging, nuclear medicine tests, pulmonary function tests, genetic tests, genomic tests and other such
data needed to diagnose and treat disease).
It is expected that stage two meaningful use requirements will include rigorous expectations for health
information exchange, including more demanding requirements for e-Prescribing and incorporating
structured laboratory results and the expectation that providers will electronically transmit patient care
summaries to support transitions in care across unaffiliated providers, settings and EHR systems.
Increasingly robust expectations for health information exchange in Stage 2 and Stage 3 will support and
make real the goal that information follows the patient.
CMS has indicated that more information about Stage 2 MU will be released at a later date.
Stage 3: The goals for the Stage 3 meaningful use criteria are, consistent with other provisions of
Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency leading
to improved health outcomes, focusing on decision support for national high priority conditions, patient
access to self management tools, access to comprehensive patient data through robust, patient-centered
health information exchange and improving population health. (More information to be released at a later
date.) CMS has indicated that more information about Stage 3 MU will be released at a later date.
18
Provider Registration
Both EPs and EHs are required to begin by registering at the national level with the Medicare and
Medicaid registration and attestation system (also referred to as the federal repository or NLR). Providers
must provide their name, NPI, business address, phone number, tax payer ID number (TIN) of the entity
receiving the payment and hospitals must provide their CCN. EPs may choose to receive the incentive
payment themselves or assign them to a clinic or group to which they belong. In order to receive the
incentive payments from Oklahoma, the EP must have a billing provider contract versus a rendering
provider contract.
EPs must select between Medicare or Medicaid’s incentive program (a provider may switch from one to
the other once during the incentive program prior to 2015). If Medicaid is selected, the provider must
choose only one state (EPs may switch states annually). Providers must revisit the NLR to make any
changes to their information and/or choices, such as changing the program from which they want to
receive their incentive payment. After the initial registration, the provider does not need to return to the
NLR before seeking annual payments unless information needs to be updated. EHs seeking payment
from both Medicare and Medicaid will be required to visit the NLR annually to attest to meaningful use
before returning to OHCA’s website to attest for Oklahoma’s Medicaid EHR Incentive Program. OHCA will
assume meaningful use is met for hospitals deemed so for payment from the Medicare EHR Incentive
Program.
The NLR will assign the provider a CMS Registration Number and electronically notify OHCA of a
provider’s choice to access Oklahoma’s Medicaid Incentive Program for payment. The CMS Registration
Number will be needed to complete the attestation form at OHCA’s enrollment and attestation website.
The information completed by the provider is sent to OHCA electronically overnight so there will be a
delay between the time a provider registers at the federal level and the time that OHCA’s system receives
the information. One to two business days will be required for the transaction to be received by OHCA
and the validation process (described below) to be performed before the provider can obtain access to
the attestation system.
On receipt of NLR Registration transactions from CMS, two basic validations take place at the state level:
1) validate the NPI in the transaction is on file in OHCA’s MMIS Provider database, and 2) validate the
provider is currently contracted with OHCA (specific contracting requirements can be found on the OHCA
public web site at www.okhca.org). If either of these conditions is not met, a ‘provider not eligible’ status
will be automatically sent back to the CMS NLR. Providers may check back at the NLR level to determine
if the registration has been accepted.
Once payment is disbursed to the eligible TIN, OHCA will notify the NLR that a payment has been made.
Provider Attestation Process and Validation
OHCA will utilize the secure provider website to house the attestation system. The attestation site is
currently in development and should be available by January 3, 2011. Due to the short timeframe
between release of the final rule and the start date of the program, not all forms will be immediately
available in an electronic format. The system will be revised to upgrade features in subsequent versions
of the attestation.
Once the registration information for an EP / EH has been validated, the provider should see a banner on
their OHCA secure website and a link to the attestation system. The link will only be visible to providers
whose type in the MMIS system matches an EHR incentive eligible provider category. If an eligible
provider registers at the NLR and does not receive the link to the attestation system within two business
days, assistance is available by contacting the SoonerCare Helpline at 800-522-0114.
19
The attestation is an amendment and becomes part of the to the provider’s contract. Following is a
description by eligible provider type of the information that a provider will have to report or attest to during
the process.
Eligible Professional:
1. The EP will be asked to provide their CMS Registration Number.
2. The EP will be asked to provide:
a. A completed patient volume form (link on the webpage);
b. The certification number for the ONC-ATCB certified EHR system (or numbers if
obtained in modules); and
c. Number of full-time employee jobs created by implementing a certified product.
3. The EP will be asked to attest to:
a. Assigning the incentive payment to a specific TIN (only asked it applicable;
provider and TIN to which the payment was assigned at the NLR will be
displayed;
b. Not working as a hospital based professional (this will be verified by OHCA
through claims analysis);
c. Not applying for an incentive payment from another state or Medicare;
d. Not applying for an incentive payment under another SoonerCare ID; and
e. Adoption, implementation or upgrade of certified EHR technology.
4. EP will be asked to electronically sign the amendment.
a. There is a place for an agent or staff member of the provider to so identify.
b. The person filling out the form should enter his or her name.
Eligible Hospital:
1. The EH will be asked to provide their CMS Registration Number.
2. The EH will be asked to provide:
c. A completed patient volume form (link on the webpage);
d. A completed Hospital EHR Incentive Payment Worksheet;
e. The certification number for the ONC-ATCB certified EHR system (or numbers if
obtained in modules); and
f. Number of full-time employee jobs created by implementing a certified product.
3. The EH will be asked to attest to:
a. Adoption, implementation or upgrade of certified EHR technology or meaningful
use;
b. Not receiving a Medicaid incentive payment from another state;
4. EP will be asked to electronically sign the amendment.
g. There is a place for an agent or staff member of the provider to so identify.
h. The person filling out the form should enter his or her name.
Once the electronic attestation is submitted by a qualifying provider and appropriate documentation
provided, OHCA will conduct a review which will include cross-checking for potential duplication payment
requests, checking provider exclusion lists and verifying supporting documentation.
The attestation itself will be electronic and will require the EP or EH to attest to meeting all requirements
defined in the federal regulations. Some documentation will have to be provided to support specific
elements of attestation. For instance, providers who attest to AIU of certified EHR technology will be
required to submit a copy of a signed contract or paid invoice. All providers will be required to submit an
OHCA form supporting patient volume claimed in the attestation. More information on documentation will
be provided on the attestation website.
During the first year of the program, EPs will only be able to attest to adopting, implementing or upgrading
to certified EHR technology. This will allow OHCA to implement a data warehouse for meaningful use
information. It should be noted that the documentation for AIU of certified EHR technology for EPs or EHs
does not have to be dated in the year of reporting. Documentation dated anytime prior to the attestation is
acceptable if the system and version of EHR technology has been certified by ONC (the Certified Health
20
IT Product List can be located at ONC’s website at www.healthit.hhs.gov). EHs can attest to either AIU or
meaningful use as appropriate.
All providers will be required to attest to meeting meaningful use (see page 25) to receive incentive
payments after the first year.
Requesting Payment:
Upon completion of the attestation process, including submission of the electronic attestation, receipt of
required documentation and review and acceptance by OHCA, an incentive payment will approved.
Incentive payments will be made once per month and electronically deposited based on EFT information
on file for the provider or his assignee.
Program Integrity:
OHCA will be conducting regular reviews of attestations and incentive payments. These reviews will be
selected in as part of our current audit selection process, including risk assessment, receipt of a
complaint or incorporation into reviews selected for other objectives. Be sure to keep supporting
documentation for information you report for the incentive program.
Payment Recoupment:
When an erroneous payment occurs which results in an overpayment, repayment options will be
discussed with the provider. A provider may choose to refund the payment in full in a lump sum, or an
automatic recoupment will be set up to deduct the refund from future claim payments. The provider can
send payment in full to:
OHCA
Attention: Finance Division
PO Box 18299
Oklahoma City, OK 73154
Administrative Appeals:
Administrative appeals of decisions related to the Oklahoma EHR Incentive Payment program will be
handled under the procedures described in OAC 317:2-1-2(b). See below for the provider process
overview:






All provider appeals are initially heard by the OHCA Administrative Law Judge under OAC 317:21-2(c)(2).
The Appellant (Appellant is the provider who files a grievance) files an LD form requesting a
grievance hearing within 20 days of the triggering event. The triggering event occurs at the time
when the Appellant knew or should have known of such condition or circumstance for appeal.
(LD-2 forms are for provider grievances and LD-3 forms are for nursing home wage enhancement
grievances.)
If the LD form is not received within 20 days of the triggering event, OHCA sends the Appellant a
letter stating the appeal will not be heard because it is untimely.
The staff advises the Appellant that if there is a need for assistance in reading or completing the
grievance form that arrangements will be made.
A decision will be rendered by the ALJ ordinarily within 45 days of the close of all evidence in the
case.
The Administrative Law Judge's decision is appealable to OHCA's CEO under OAC 317:2-1-13.
21
22
OKLAHOMA HEALTH CARE AUTHORITY
PROVIDER/PHYSICIAN GRIEVANCE FORM
In order to process your grievance request, all of the requested information must be
supplied. Failure to provide all of the information will result in an automatic denial of
your appeal.
--------------------------------------------------------------------------------------------------------Provider Information:
Company Name (if any): _________________________ Provider ID #: ______
Individual Name (if any): _________________________ Federal Tax ID # ____
Mailing Address: __________________________________________________
NUMBER
STREET
________________________________________________________________
CITY
STATE
ZIP CODE
Phone Number: (___) __________________
Date of Adverse Action:
_______________________
Authorized Representative Information (If any):
Name: __________________________________________________________
Mailing Address: __________________________________________________
NUMBER
STREET
________________________________________________________________
CITY
STATE
ZIP CODE
Phone Number: (___) __________________
Please give a complete narrative explanation of the problem you have encountered.
Include the names of OHCA personnel you have dealt with, and the dates that specific
events occurred. Use additional paper if necessary. Attach copies of any documents
you would like to be considered. If your appeal involves a recipient denial, please
include the pertinent case number.
[If you need more space, use another sheet of paper]
______________________________________________________________________
__________________________________________________________
PLEASE SEND THIS FORM TO:
Oklahoma Health Care Authority
Grievance Docket Clerk
Legal Division
P.O. Drawer 18497
Oklahoma City, Oklahoma 73154-0497
OHCA Fax Number is (405) 530-3455
OHCA Docket Clerk Telephone Number is (405) 522-7217
Eligibility at a Glance
Qualifying Eligible Professionals (EP)
1 Current SoonerCare Provider Contract
2 Hospital-based EPs are
NOT eligible
3 Provider Type
90% or more of services are performed in a hospital
inpatient or emergency room setting.
Physicians (MD, DO)
Pediatricians
Dentists
Certified Nurse Midwives
Nurse Practitioners
Physician Assistants (PA) practicing at a FQHC/RHC
so led by a PA
4 Patient Volume over a 90
day period
30% SoonerCare
20-29% SoonerCare - Pediatricians = 2/3 of
incentive payment
30% Needy Individuals Medical EPs practicing
predominantly in FQHC or RHC
Qualifying Eligible Hospitals (EH)
1 Current SoonerCare Provider Contract
2
Hospital Types
Acute Care Hospital
(includes CAHs &
cancer hospitals)
Avg. length of stay < 25 days
Children’s Hospital
CCN* last 4 of 3300 – 3399
CCN* last 4 of
0001 – 0879; 1300 – 1399
Not applicable to children’s
wings of larger hospitals
3 Patient Volume over a 90
Acute Care Hospital
10% SoonerCare
Children’s Hospitals
No Requirement
day period
Attestation Chart – EP
During EHR Year 1 reporting periods, the
EP attests:
During EHR Years 2 through 6 reporting period,
the EP attests:
The EP is a board certified Pediatrician, if applicable
The Physician Assistant attest that he/she is working in
an FQHC or RHC so led by: a) a PA as the primary
provider in the clinic, b) a PA as the clinical or medical
director at a site of practice or c) a PA as an owner of
an RHC
The EP attests that he/she practices predominantly in
an FQHC or RHC, if applicable
The EP is a board certified Pediatrician, if applicable
The EP is not hospital based professional who furnishes
90% or more of his/her professional services in an
inpatient hospital or emergency room setting, if he/she
does not practice predominately in an FQHC or RHC
The EP is not hospital based professional who furnishes 90%
or more of his/her professional services in an inpatient hospital
or emergency room setting, if he/she does not practice
predominately in an FQHC or RHC
The EP is not concurrently receiving an incentive
payment from another state or under another
SoonerCare ID number or Medicare Program
The EP is not concurrently receiving an incentive payment from
another state or under another SoonerCare ID number or
Medicare Program
The EP has adopted, implemented or upgraded (A/I/U)
a certified EHR
The EHR product used is certified and EP entered a
product certification number
The EP has reported the number of FTE jobs created by
implementing this certified EHR product
The Physician Assistant attest that he/she is working in an
FQHC or RHC so led by: a) a PA as the primary provider in the
clinic, b) a PA as the clinical or medical director at a site of
practice or c) a PA as an owner of an RHC
The EP attests that he/she practices predominantly in an FQHC
or RHC, if applicable
The EP used certified EHR technology
The EHR product used is certified and EP entered a product
certification number
The EP has reported the number of FTE jobs created by
implementing this certified EHR product
The EP has reported the amount of cash payments
made directly attributable to him/her for the certified
EHR (not including payments from state or local
governments, in-kind contributions, etc.)
The EP has reported the amount of cash payments made
directly attributable to him/her for the certified EHR (not
including payments from state or local governments, in-kind
contributions, etc.)
The EP has confirmed that at least $3,750 of the EHR
technology is the responsibility of him/her or his/her
employer, group, clinic, hospital affiliation, or in-kind
contributions or grants
The EP has confirmed that at least $1,500 of the EHR
technology is the responsibility of him/her or his/her employer,
group, clinic, hospital affiliation, or in-kind contributions or
grants
The EP has confirmed assignment of his/her payment to
another TIN and agrees to this assignment, if applicable
The EP has confirmed assignment of his/her payment to
another TIN and agrees to this assignment, if applicable
The EP's percentage of Medicaid encounters or Needy
Individual (for EP's practicing predominantly in an
FQHC/RHC) patient volume is equal to or greater than
the allowed percentage of their specialty (see Appendix
E)
The EP's percentage of Medicaid encounters or Needy
Individual (for EP's practicing predominantly in an FQHC/RHC)
patient volume is equal to or greater than the allowed
percentage of their specialty (see Appendix E)
The EP has specified the patient volume date range of
at least 90 days
The EP has specified the patient volume date range of at least
90 days
The EP has specified the EHR reporting period and provided
the result of each applicable measure for all patients seen
during the EHR reporting period for which a selected measure
is applicable
The EP has satisfied the required objectives and associated
measures under § 495.6(e), except § 495.6 (d)(10) "Report
ambulatory clinical quality measures to the State"
The EP attests to meeting the meaningful use criteria
associated with his/her year of participation and applicable
stage per the rule
If applicable, the EP attests that the clinical quality measures
not reported do not apply to any patients treated by the EP
During EHR Year 1 reporting periods, the
EP attests:
During EHR Years 2 through 6 reporting period,
the EP attests:
The EP attests that all information is true and accurate
per wording in the rule
The EP's electronic signature on the attestation is valid
for the Oklahoma EHR Incentive Program payment
request
The EP attests that all information is true and accurate per
wording in the rule
The EP's electronic signature on the attestation is valid for the
Oklahoma EHR Incentive Program payment request
26
Attestation Chart – EH
Eligible Hospitals or CAHs eligible
only for the Oklahoma SoonerCare
EHR Incentive Payment Program,
attesting to Adopt, Implement, or
Upgrade in their first participation
year attests that:
During 2011 reporting
period, the eligible
hospitals or CAHs
attesting to Meaningful
Use attests that:
During 2010 and subsequent
reporting periods, the eligible
hospitals or CAHs attesting to
Meaningful Use attests that"
The EH or CAH adopted, implemented or
upgraded (A/I/U) a certified her
The EH or CAH used certified
EHR technology
The EH or CAH used certified EHR
technology
The EH or CAH has reported the number of
FTE jobs created by implementing this
certified EHR product
The EHR product used is
certified and EH or CAH
entered product certification
number, vendor, product, and
version
The EH or CAH has reported
the number of FTE jobs
created by implementing this
The EH or CAH satisfied the
required objectives and
associated measures under
§495.6(f) and §495.6(g).
The EHR product used is certified and EH
or CAH entered product certification
number, vendor, product, and version
The EH or CAH has reported the number
of FTE jobs created by implementing this
The EH or CAH satisfied the required
objectives and associated measures
under §495.6(f) and §495.6(g), except §
495.6(f)(9) "Report hospital clinical quality
measures to the State"
The EH or CAH attests that the
information submitted with respect to
clinical quality measures was generated
as output from an identified certified EHR
technology
information was submitted to the
knowledge and belief of the official
submitting on behalf of the eligible
hospital or CAH
information submitted includes
information on all patients to whom the
measure applies
For EHs or CAHs that do not report one
or more measures, the EH or CAH attests
that the clinical quality measures not
reported do not apply to any patients
treated by the EH or CAH during the
reporting period
The EH or CAH attest numerators,
denominators, and exclusions for each
clinical quality measure result reported,
providing separate information for each
clinical quality measure including the
numerators, denominators, and
exclusions for all patients irrespective of
third party payer or lack thereof; for
Medicaid patients
27
Attestation Chart – EH continued
Eligible Hospitals or CAHs eligible
only for the Oklahoma SoonerCare
EHR Incentive Payment Program,
attesting to Adopt, Implement, or
Upgrade in their first participation
year attests that:
During 2011 reporting
period, the eligible
hospitals or CAHs
attesting to Meaningful
Use attests that:
During 2010 and subsequent
reporting periods, the eligible
hospitals or CAHs attesting to
Meaningful Use attests that"
The EH or CAH attests the beginning and
end dates for which the numerators,
denominators, and exclusions apply
The EH or CAH attests that all information is
true and accurate per wording in the rule
The EH or CAH electronic signature on the
attestation is valid for the Oklahoma EHR
incentive Program payment request
The EH or CAH specified the
EHR reporting period and
provided the result of each
applicable measure for all
patients admitted to the
inpatient or emergency
department (POS 21 or 23) of
the hospital during the EHR
reporting period for which a
selected measure is
applicable
The EH or CAH attests that all
information is true and
accurate per wording in the
rule
The EH or CAH electronic
signature on the attestation is
valid for the Oklahoma EHR
Incentive Program payment
request
The EH or CAH specified the EHR
reporting period and provided the result of
each applicable measure for all patients
admitted to the inpatient or emergency
department (POS 21 or 23) of the hospital
during the EHR reporting period for which
a selected measure is applicable
The EH or CAH attests that all information
is true and accurate per wording in the
rule
The EH or CAH electronic signature on
the attestation is valid for the Oklahoma
EHR Incentive Program payment request
28
Meaningful Use Core Sets
Health Outcomes Policy
Priority
Improving quality, safety,
efficiency, and reducing health
disparities
Eligible Professionals
Eligible Hospitals and CAHs
Stage 1 Measures
Use CPOE for medication orders
directly entered by any licensed
healthcare professional who can
enter orders into the medical
record per state, local and
professional guidelines.
Use CPOE for medical orders
directly entered by any licensed
healthcare professional who can
enter orders into the medical record
per state, local and professional
guidelines
More than 30% of unique patients with at least
one medication in their medication list seen by
the EP or admitted to the eligible hospital's or
CAH's inpatient or emergency department
(POS 21 or 23) have at least one medication
order entered using CPOE
Implement drug-drug and drugallergy interaction checks
Implement drug-drug and drugallergy interaction checks
The EP/eligible hospital/CAH has enabled this
functionality for the entire EHR reporting period
Generate and transmit permissible
prescriptions electronically (eRx)
More than 40% of all permissible prescriptions
by the EP are transmitted electronically using
certified EHR technology.
Record demographics:
*preferred language
*gender
*race
*ethnicity
*date of birth
*preferred language
*gender
*race
*ethnicity
*date of birth
*date and preliminary cause of
death in the event of mortality in the
eligible hospital or CAH
More than 50% of all unique patients seen by
(POS21 or 23) have demographics recorded as
structured data
Maintain an up-to-date problem
list of current and active
diagnoses
Maintain an up-to-date problem list
of current and active diagnoses
(POS 21 or 23) have at least one entry or an
indication that no problems are known for the
patient recorded as structured data
(POS 21 or 23) have at least one entry (or an
indication that the patient is not currently
prescribed any medication) recorded as
structured data
Priority
Stage 1 Measures
Maintain active medication allergy
list
Maintain active medication allergy
list
(POS 21 or 23) have at least one entry (or an
indication that the patient has no known
medication allergies) recorded as structured
data
Record and chart changes in vital
signs:
*Height
*Weight
*Blood Pressure
*Calculate and display BMI
*Plot and display growth charts for
children 2-20 years, including BMI
Record and chart changes in vital
signs:
*Height
*Weight
*Blood Pressure
*Plot and display growth charts for
children 2-20 years, including BMI
For more than 50% of all unique patients age 2
and over seen by the EP or admitted to eligible
hospital's or CAH's inpatient or emergency
department (POS 21 or 23), height, weight, and
blood pressure are recorded as structured data
Record smoking status for
patients 13 years old or older
Record smoking status for patients
13 years old or older
More than 50% of all unique patients 13 years
old or older seen by the EP or admitted to the
eligible hospital's or CAH's inpatient or
emergency department (POS 21 or 23) have
smoking status recorded as structured data
Implement on clinical decision
support rule relevant to specialty
or high clinical priority along with
the ability to track compliance with
that rule
Implement one clinical decision
support rule related to a high
priority hospital condition along with
the ability to track compliance with
that rule
Report ambulatory clinical quality
measures to CMS or the State
Report hospital clinical quality
measures to CMS or the State
For 2011, provide aggregate numerator,
denominator, and exclusions through
attestation as discussed in section II(A)(3) of
the final rule
For 2012, electronically submit clinical quality
measures as discussed in section II(A)(3) of the
final rule
30
Priority
Engage patients and families in
their health care
Stage 1 Measures
Provide patients with an electronic
copy of their health information
(including diagnostic test results,
problem list, medication lists,
medication allergies), upon
request
copy of their health information
(including diagnostic test results,
medication allergies, discharge
summary, procedures), upon
request
More than 50% of all patients of the EP or the
inpatient or emergency departments of the
eligible hospital or CAH (POS 21 or 23) who
request an electronic copy of their health
information are provided it within 3 business
days
copy of their discharge instructions
at time of discharge, upon request
More than 50% of all patients of the EP or the
inpatient or emergency departments of the
eligible hospital or CAH (POS 21 or 23) who
request an electronic copy of their discharge
instructions are provided it within 3 business
days
Clinical summaries provided to patients for
more than 50% of all office visits within 3
business days
Capability to exchange key clinical
information (for example, discharge
summary, procedures, problem list,
medication list, medication
allergies, diagnostic test results),
among providers of care and
patient authorized entities
electronically
Protect electronic health
information created or maintained
by the certified EHR technology
through the implementation of
appropriate technical capabilities
Performed at least one test of certified EHR
technology's capacity to electronically
exchange key clinical information
Provide clinical summaries for
patients for each office visit
Improve care coordination
information (for example, problem
list, medication list, medication
allergies, diagnostic test results),
among providers of care and
patient authorized entities
electronically
Ensure adequate privacy and
security protections for personal
health information
Protect electronic health
information created or maintained
by the certified EHR technology
through the implementation of
Conduct or review a security risk analysis per
45 CFR 164.308 (a)(1) and implement security
updates as necessary and correct indentified
security deficiencies as part of its risk
management process
31
Meaningful Use Menu Set
Priority
Improving quality, safety,
efficiency, and reducing health
disparities
Stage 1 Measures
Implement drug-formulary checks
The EP/eligible hospital/CAH has enabled this
functionality and has access to at lease one
internal or external drug formulary for the entire
EHR reporting period
Record advance directives for
patients 65 years old or older
More than 50% of all unique patients 65 years old
or older admitted to the eligible hospital's or
CAH's inpatient department (POS 21) have an
indication of an advance directive status recorded
Incorporate clinical lab test results
into certified EHR technology as
structured data
Incorporate clinical lab test results
into certified EHR technology as
structured data
More than 40% of all clinical lab tests results
ordered by the EP or by an authorized provided of
the eligible hospital or CAH for patients admitted
to its inpatient or emergency department (POS 21
or 23) during the EHR reporting period whose
results are either in a positive/negative or
numerical format are incorporated in certified EHR
technology as structured data
Generate lists of patients by
specific conditions to use for
quality improvement, reduction of
disparities, research or outreach
Generate lists of patients by specific
conditions to use for quality
improvement, reduction of disparities,
research or outreach
Generate at least one report listing patients of the
EP, eligible hospital or CAH with a specific
condition
Send reminders to patients per
patient preference for
preventive/follow up care
Engage patients and families in
their health care
More than 20% of all unique patients 65 years or
older or 5 years old or younger were sent an
appropriate reminder during the EHR reporting
period
More than 10% of all unique patients seen by the
EP are provided timely (available to the patient
within four business days of being updated in the
certified EHR technology) electronic access to
their health information subject to the EP's
discretion to withhold certain information
Provide patients with timely
electronic access to their health
information (including lab results,
medication allergies) within four
business days of the information
being available to the EP
Use certified EHR technology to
identify patient-specific education
resources and provide those
resources to the patient if
appropriate
resources to the patient if appropriate
EP or admitted to the eligible hospital's or CAH's
inpatient or emergency department (POS 21 or
23) are provided patient-specific education
resources
Priority
Improve care coordination
Improve population and public
health
Stage 1 Measures
The EP, eligible hospital or CAH
who receives a patient from
another setting of care or provider
of care or believes an encounter is
relevant should perform medication
reconciliation
The EP, eligible hospital or CAH who
receives a patient from another
setting of care or provider of care or
believes an encounter is relevant
should perform medication
reconciliation
the EP, eligible hospital or CAH performs
medication reconciliation for more than 50% of
transitions of care in which the patient is
transitioned into the care of the EP or admitted to
the eligible hospital's or CAH's inpatient or
emergency department (POS 21 or 23)
The EP, eligible hospital or CAH
who receives a patient from
another setting of care or provider
of care or refers their patient to
another provider of care should
provide summary of care record for
each transition of care or referral
receives a patient from another
setting of care or provider of care or
refers their patient to another provider
of care should provide summary of
care record for each transition of care
or referral
The EP, eligible hospital or CAH who transitions
or refers their patient to another setting of care or
provider of care provides a summary of care
record for more than 50% of transitions of care
and referrals
Capability to submit electronic data
to immunization registries or
Immunization Information Systems
and actual submission in
accordance with applicable law
and practice
Capability to submit electronic data to
immunization registries or
Immunization Information Systems
and actual submission in accordance
with applicable law and practice
technology's capacity to submit electronic data to
immunization registries and follow up submission
if the test is successful (unless none of the
immunization registries to which the EP, eligible
hospital or CAH submits such information have
the capacity to receive the information
electronically)
technology's capacity to provide electronic
submission of reportable lab results to public
health agencies and follow-up submission if the
test is successful (unless none of the public health
agencies to which eligible hospital or CAH
submits such information have the capacity to
receive the information electronically)
Capability to submit electronic data on
reportable (as required by state or
local law) lab results to public health
agencies and actual submission in
accordance with applicable law and
practice
Capability to submit electronic
syndromic surveillance data to
public health agencies and actual
submission in accordance with
applicable law and practice
Capability to submit electronic
syndromic surveillance data to public
health agencies and actual
submission in accordance with
technology's capacity to provide electronic
syndromic surveillance data to public health
agencies and follow-up submissions if the test is
successful (unless none of the public health
agencies to which an EP, eligible hospital or CAH
submits such information have the capacity to
receive the information electronically)
33
Priority
Stage 1 Measures
resources to the patient if
appropriate
resources to the patient if appropriate
EP or admitted to the eligible hospital's or CAH's
inpatient or emergency department (POS 21 or
23) are provided patient-specific education
resources
34
Meaningful Use Measure Calculation
Measures with a Denominator of Unique Patients Regardless of Whether the Patient's Records Are Maintained Using Certified EHR Technology
Stage 1 Measures
Maintain an up-to-date problem list of current
and active diagnoses
Maintain an up-to-date problem list of current
and active diagnoses
More than 80% of all unique patients seen by the EP or admitted
to the eligible hospital's or CAH's inpatient or emergency
department (POS 21 or 23) have at least one entry or an
indication that no problems are known for the patient recorded as
structured data
department (POS 21 or 23) have at least one entry (or an
indication that the patient is not currently prescribed any
medication) recorded as structured data
*preferred language
*gender
*race
*ethnicity
*date of birth
*preferred language
*gender
*race
*ethnicity
*date of birth
*date and preliminary cause of death in the
event of mortality in the eligible hospital or
CAH
department (POS 21 or 23) have demographics recorded as
structured data
Provide patients with timely electronic access
tot heir health information (including lab
results, problem list, medication lists,
medication allergies) within four business
days of the information being available to the
EP
Use certified EHR technology to identify
patient-specific education resources and
provide those resources to the patient if
appropriate
More than 10% of all unique patients seen by the EP are provided
timely (available to the patient within four business days of being
updated in the certified EHR technology) electronic access to
their health information subject to the EP's discretion to withhold
certain information
Use certified EHR technology to identify
patient-specific education resources and
provide those resources to the patient if
appropriate
department (POS 21 or 23) are provided patient-specific
education resources
Measures with a Denominator of Based on Counting Actions for Patients who Records are Maintained using Certified EHR Technology
Stage 1 Measures
Use CPOE for medication orders directly
entered by any licensed healthcare
professional who can enter orders into the
medical record per state, local and
professional guidelines
Use CPOE for medication orders directly
entered by any licensed healthcare professional
who can enter orders into the medical record
per state, local and professional guidelines
More than 30% of unique patients with at least one
medication in their medication list seen by the EP or
admitted to the eligible hospital's or CAH's inpatient or
emergency department (POS 21 or 23) have at least one
medication order entered using CPOE
Generate and transmit permissible
prescriptions electronically (eRx)
More than 40% of all permissible prescriptions written by
the EP are transmitted electronically using certified EHR
technology
Record and chart changes in vital signs:
*Height
*Weight
*Blood Pressure
*Plot and display growth charts for children
2-20 years, including BMI
Record and chart changes in vital signs:
*Height
*Weight
*Blood Pressure
*Plot and display growth charts for children 220 years, including BMI
For more than 50% of all unique patients age 2 and over
seen by the EP or admitted to eligible hospital's or CAH's
inpatient or emergency department (POS 21 or 23), height,
weight, and blood pressure are recorded as structured
data
Record smoking status for patients 13 years
old or older
Record smoking status for patients 13 years old
or older
More than 50% of all unique patients 13 years old or older
seen by the EP or admitted to the eligible hospital's or
CAH's inpatient or emergency department (POS 21 or 23)
have smoking status recorded as structured data
Record advance directives for patients 65 years
old or older
More than 50% of all unique patients 65 years old or older
emergency department (POS 21 or 23) have smoking
status recorded as structured data
Incorporate clinical lab-test results into
certified EHR technology as structured data
Incorporate clinical lab-test results into certified
EHR technology as structured data
More than 40% of all clinical lab tests results ordered by
the EP or by an authorized provider of the eligible hospital
or CAH for patients admitted to its inpatient or emergency
department (POS 21 or 23) during the EHR reporting
period whose results are either in a positive/negative or
numerical format are incorporated in certified EHR
technology as structured data
Provide patients with an electronic copy of
their health information (including diagnostic
test results, problem list, medication lists,
medication allergies), upon request
Provide patients with an electronic copy of their
health information (including diagnostic test
results, problem list, medication lists,
medication allergies, discharge summary,
procedures) upon request
More than 50% of all patients of the EP or the inpatient or
emergency departments of the eligible hospital or CAH
(POS 21 or 23) who request an electronic copy of their
health information are provided it within 3 business days
36
Measures with a Denominator of Based on Counting Actions for Patients who Records are Maintained using Certified EHR Technology
Stage 1 Measures
Provide patients with an electronic copy of their
discharge instructions at time of discharge,
upon request
More than 50% of all patients who are discharged from an
eligible hospital or CAH's inpatient department or
emergency department (POS 21 or 23) and who request
an electronic copy of their discharge instructions are
provided it
Clinical summaries provided to patients for more than 50%
of all office visits within 3 business days
Provide clinical summaries for patients for
each office visit
Send reminders to patients per patient
preference for preventive/follow up care
More than 20% of all unique patients 65 years or older or 5
years old or younger were sent an appropriate reminder
during the EHR reporting period
receives a patient from another setting of
care or provider of care or believes an
encounter is relevant should perform
medication reconciliation
The EP, eligible hospital or CAH who receives
a patient from another setting of care or
provider of care or believes an encounter is
relevant should perform medication
reconciliation
The EP, eligible hospital or CAH performs medication
reconciliation for more than 50% of transitions of care in
which the patient is transitioned into the care of the EP or
emergency department (POS 21 or 23)
transitions their patient to another setting of
care or provider of care or refers their
patient to another provider of care should
provide summary of care record for each
transition of care or referral
transitions their patient to another setting of
care or provider of care or refers their patient to
another provider of care should provide
summary of care record for each transition of
care or referral
The EP, eligible hospital or CAH who transitions or refers
their patient to another setting of care or provider of care
provides a summary of care record for more than 50% of
transitions of care and referrals.
37
Measures Requiring Only a Yes/No Attestation
Stage 1 Measures
Implement drug-drug and drug-allergy
interaction checks
Implement drug-drug and drug-allergy
interaction checks
The EP/eligible hospital/CAH has enabled this functionality
for the entire EHR reporting period
The EP/eligible hospital/CAH has enabled this functionality
and has access to at least one internal or external
formulary for the entire EHR reporting period
Generate lists of patients by specific
conditions to use for quality improvement,
reduction of disparities, research or
outreach
relevant to specialty or high clinical priority
along with the ability to track compliance
with that rule
to use for quality improvement, reduction of
disparities, research or outreach
Generate at least one report listing patients of the EP,
eligible hospital, or CAH with a specific condition
relevant to specialty or high clinical priority
along with the ability to track compliance with
that rule
information (for example, problem list,
medication list, medication allergies,
diagnostic test results), among providers of
care and patient authorized entities
electronically
Capability to exchange key clinical information
(for example, discharge summary, procedures,
problem list, medication list, medication
allergies, diagnostic test results), among
providers of care and patient authorized entities
electronically
Performed at least one test of certified EHR technology's
capacity to electronically exchange key clinical information
immunization registries or Immunization
Information Systems and actual submission
in accordance with applicable law and
practice
immunization registries or Immunization
Information Systems and actual submission in
accordance with applicable law and practice
capacity to submit electronic data to immunization
registries and follow up submission if the test is successful
(unless none of the immunization registries to which the
EP, eligible hospital or CAH submits such information have
the capacity to receive the information electronically)
38
Measures Requiring Only a Yes/No Attestation
Stage 1 Measures
Capability to submit electronic data on
reportable (as required by state or local law) lab
results to public health agencies and actual
submission in accordance with applicable law
and practice
capacity to provide electronic submission of reportable lab
results to public health agencies and follow up submission
if the test is successful (unless none of the public health
agencies to which eligible hospital or CAH submits such
information have the capacity to receive the information
electronically)
Capability to submit electronic syndromic
surveillance data to public health agencies
and actual submission in accordance with
Capability to submit electronic syndromic
surveillance data to public health agencies and
actual submission in accordance with
capacity to provide electronic syndromic surveillance data
to public health agencies and follow up submission if the
test is successful (unless non of the public health agencies
to which an EP, eligible hospital or CAH submits such
information have the capacity to receive the information
electronically)
Protect electronic health information created
or maintained by the certified EHR
technology through the implementation of
Protect electronic health information created or
maintained by the certified EHR technology
through the implementation of appropriate
technical capabilities
Conduct or review a security risk analysis per 45 CRF
164.308(a)(1) and implement security updates a necessary
and correct identified security deficiencies as part of its risk
management process
39
Screen Shots of EP EHR Attestation
40
41
42
43
44
Screen Shots of EH EHR Attestation
45
Enter your CMS Registration Number.
The system will verify that OHCA has your CMS
Registration on file.
46
Enter the EHR Certification Number, vendor, product
name, and version number of your certified EHR
technology.
47
Enter the number of jobs created this year due
to the certified EHR technology.
48
Select A/I/U (first participation year only)
or Meaningful Use
49
A document showing all of the other terms and conditions for participation
in the Oklahoma EHR Incentive Program, will display. An authorized
representative, staff member, or agent of the hospital may
electronically sign the amendment.
50
Oklahoma EHR Incentive Program
Checklist for Eligible Professionals – Year 1


Access National Level Repository

Input Name

Input Individual NPI

Business Address & Phone

Input “Incentive Payment To” Tax Identification Number (TIN)
Note: If you wish the payment to go to yourself, and your claims payments are paid to
your group, please call the OHCA Provider Contracting Unit to verify we have your
banking information on file. (800) 522-0114, option #5.

Select Medicaid EHR incentive

Select Oklahoma as the State for Medicaid EHR incentive participation

Record CMS Registration Number
Wait 2 business days then access your OHCA Provider Enrollment Secure Site to fill out your
on-line attestation

Login to the SoonerCare Secure Site under your individual provider ID and location
code. Providers without a SoonerCare ID who work in certain types of clinics will need
to first enroll via the SoonerCare Secure Site to receive an ID and location code.
Select link “Amend my Provider Agreement to receive EHR Incentives”

Input CMS Registration Number

Record Information about your ONC-ATCB Certified EHR System from
http://onc-chpl.force.com/ehrcert :
□
□
□
□


Certification Number:
Vendor Name:
Product Name:
Version:

Input Number of full-time equivalent jobs created by implementing electronic health
records.

Electronically Signe and Submit Attestation to receive an EHR incentive payment.
Upon your submission of attestation you will then view an Acknowledgement page

Print Fax Cover Sheet

Print and Complete the Patient Volume Worksheet
Using the Fax Cover Sheet, fax in the following documents to the number indicated on the fax
cover sheet :

Proof of adopting/implementing/upgrading a certified EHR system (Receipt, Invoice,
Lease, License, etc.)

Patient Volume Worksheet

If Applicable: Proof of certification for board certified pediatricians attesting to
between 20%-29% patient volume
52
Oklahoma EHR Incentive Program
Checklist for Eligible Hospitals – Year 1
 Access National Level Repository


Input Hospital CCN

Input “Incentive Payment To” Tax Identification Number (TIN)

Select Medicaid or Both Medicare & Medicaid EHR incentive

Select Oklahoma as the State for Medicaid EHR incentive participation

Record CMS Registration Number
Wait 2 business days then access your OHCA Provider Enrollment Secure Site to fill out
your on-line attestation

Select link “Amend my Provider Agreement to receive EHR Incentives”

Input CMS Registration Number

Record Information about your ONC-ATCB Certified EHR System from
http://onc-chpl.force.com/ehrcert :
□
□
□
□


Certification Number:
Vendor Name:
Product Name:
Version:

Input Number of full-time equivalent jobs created by implementing electronic health
records.

Electronically Sign and Submit Attestation to receive an EHR incentive payment.
Upon your submission of attestation you will then view an Acknowledgement page

Print Fax Cover Sheet

Click on the link to the Hospital EHR Payment Worksheet, Complete and Print the
worksheet

Print and Complete the Patient Volume Worksheet
Using the Fax Cover Sheet, fax in the following documents to (800) XXX-XXXX :

Proof of adopting/implementing/upgrading a certified EHR system (Receipt, Invoice,
Lease, License, etc.)

Patient Volume Worksheet

Hospital Payment Worksheet
53

If Applicable: Proof of certification for board certified pediatricians attesting to
between 20%-29% patient volume
54

Oklahoma Electronic Health Records Incentive Program Provider Manual State of Oklahoma

Transcription

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