In This Issue                                                                


Total EP MU Payments

Program Highlights

Provider FAQs

Pre-Payment Guidance

Audit Tips

Program Reminders

Did You Know?







As of Monday, November 14th, the Medical Assistance Health IT initiative has issued 12,900 Eligible Professional (EP) and 512 Eligible Hospital (EH) payments.  To date, we have made payments of $190,315,251. for Eligible Professionals and $198,036,048 for Eligible Hospitals totaling $388,351,299.


As of November 14th, we have made 6,565 payments to EPs for meeting requirements that they are Meaningfully Using their EHR.  Of the 6,565 MU payments, 3,372 were made to unique providers.









Provider Survey Update

Analysis of provider survey results continues.  A few weeks ago, we estimated Pennsylvania’s certified EHR system adoption rate at approximately 60%.  This week we looked more closely at PA’s pool of Eligible Professionals (EPs) that responded to the survey.  69% of surveys were from EP “type” practices, representing 73% of individual providers.  Of those surveyed EP type practices, 96.5% represent providers using a certified EHR system.  Stay tuned for the full report.



Receive Quality Payment Program Email Alerts

Subscribers of the EHR listserv are encouraged to sign up for the new CMS Quality Payment Program listserv.  The Quality Payment Program is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and includes two tracks—Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS).

MIPS will replace three Medicare reporting programs:

The Quality Payment Program listserv will provide news and updates on:

The Quality Payment Program’s first performance period opens on January 1, 2017 and closes December 31, 2017. Participation in MIPS can start as early as January 1, 2017 or as late as October 2, 2017. The first payment adjustments based on performance go into effect on January 1, 2019. Subscribe to the Quality Payment Program listserv to receive reminders for all of these important deadlines.


To subscribe, visit the Quality Payment Program portal and select “Subscribe to Email Updates” in the footer. The Education & Tools page includes program resources to help you learn more about eligibility and how to participate.





Program Year 2016 Applications


Just a reminder that providers attesting to Adopt, Implement or Upgrade (AIU) or 90 days of Meaningful Use are able to complete program year 2016 applications in MAPIR now.  As program year 2016 is the last year a provider can ‘start’ to participate in the MA EHR Incentive program, we encourage you to submit your applications as soon as possible.



CORRECTION - OPPS Final Rule: 90 Days of MU for 2016 and 2017


In last week’s message, we had an incorrect date in this section.  We have corrected it (see highlighted date) and here is the update:  Due to the release of the OPPS Final Rule, MAPIR will allow returning participants to attest to 90 Days of Meaningful Use (MU) for Program Year 2016 beginning January 1, 2017.  Providers will be able to attest to 90 days of MU for Program Year 2017 in April 2017.  If you have questions about application requirements, please contact us at: [log in to unmask]








Q. If a provider switched EHR incentive programs from Medicare to Medical Assistance (MA), are they still eligible for the maximum incentive amount of $63,750 or does it pick up depending on where they were in the attestation year process?


A. If a provider received a payment at Medicare then that would have been payment 1.  If they come into the MA EHR Incentive Program the following year, they would have started at payment year 2 and be considered for the $8,500 payment (not the standard first payment of $21,250).  They could still get 6 payments but their total would depend on the amount they received at Medicare for their first payment.  NOTE: Keep in mind that Medicare does not allow provider’s to skip years.  So, if a provider attested at Medicare in 2012 then did not attest anywhere in 2013 but switched to MA and attested in 2014, that would actually be payment year 3 even though they did not attest in 2013.  That would not be the situation for providers who switched from MA to Medicare


As always, contact [log in to unmask] if you have questions about program requirements.









All applications are required to submit specific pre-payment documentation.  Below are the items that we often find are missed when applications are submitted and do not represent all of our pre-payment documentation requirements.


·      Objective 9 Secure Messaging:  During payment year 2015 it was required that EHR Secure Messaging be “Fully Enabled” to indicate the use of secure messaging to communicate with patients on relevant health information. The requirement has changed for 2016 applications as indicated by CMS; in order to pass this measure at least one (1) patient-initiated message with provider response is now required for all 2016 Eligible Professionals. The action for the numerator must occur within the calendar year but may occur before, during or after the EHR reporting period if that period is less than one full calendar year.

·      In the event your Patient Volume Report is requested, we request that you submit your report in EXCEL format. The link below will provide you with an example of a Patient Volume Report:  


The report must have the following:

Ø Medicaid Patient ID or Patient Full Name and Date of Birth or SSN

Ø Date of Service

Ø Eligible Professional Name, Two-Digit Place of Service Code, Primary/Secondary Insurance Carrier Name, MA Encounter (Y/N)

Ø If using a Group Patient Volume please include the NPI’s for all providers on this report.


*Please Note: Patient Volume Reports are not part of our regularly required Pre-Payment Documentation; however, in the event your Patient Encounter Volume in PROMISe does not meet our requirements we will request your Patient Volume Report prior to payment.

We prefer you to directly upload pre-payment documentation in the MAPIR system under the applicable application, however, you may also email the documentation to [log in to unmask]


To view the complete list of all pre-payment documentation requirements please go to our website:











Q – Do I need to save supporting documentation that is already submitted to the program?


A – Saving supporting documentation with the EHR Incentive Program is crucial.  Supporting documentation is needed with the pre-payment process and audit(s).  Please organize your documentation according to the program year that you are applying for.  In addition, please remember to save documents in approved formats such as PDF, MS Excel, and MS Word. 


Examples of Approved Supporting Documentation:      


·      Meaningful Use Core Measures Acceptable Auditing Supporting Documentation


·      Meaningful Use Menu Measures Acceptable Auditing Supporting Documentation


If you have any questions, please email us at: [log in to unmask].









Program Email Alert


Please make sure to check your junk mail or spam folder for program messages.  A few providers have indicated that they have not received timely program requests for documentationUpon closer inspection, program emails were found in junk mail or spam folders.  As always, if you have program specific questions, email us at [log in to unmask]For audit related questions, email us at [log in to unmask].



Program Year 2015 Applications Status


As you are aware, the grace period for program year 2015 applications ended July 31, 2016.  We received the majority of the program year 2015 applications in June and July.  We are processing these applications based on the date we received them.  Currently, we are reviewing applications submitted the first week in July 2016.   If we have any questions when we are reviewing your application, we will contact you with the details.


Submitting Inquiries, Checking Application Status


Please include the provider name and NPI# when submitting an inquiry or checking the status of an application.

Help us to identify your supporting documentation quicker by including your Inquiry Number in the subject line of your email.






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Did you know that November is National Diabetes Month?  One of the many things that a provider can do to help patients is Screen and Refer them to a CDC recognized diabetes prevention lifestyle change program.


One-third of patients over age 18, and half over age 65, likely have prediabetes. Nearly 90% of people with prediabetes don’t know they have it. Progression from prediabetes to type 2 diabetes can take as little as 5 years, but it doesn’t have to be a sure thing.

Visit the CDC to learn what you can do to:

·      Help patients prevent diabetes and delay diabetes type 2 onset

·      The benefits of prevention lifestyle change programs for patients and providers

·      Find resources for screening and referral

·      Learn which billing codes apply to prediabetes and diabetes screening and referral activities


Helpful Diabetes Links


CDC National Diabetes Program home page:  

National Diabetes Education Program:

Diabetes at Work:









Monica R. Fisher, OMAP HIT Health Analyst

Department of Human Services | Office of Medical Assistance Programs

DGS Annex Complex | Willow Oak Bldg. #41|1006 Hemlock Drive |Harrisburg, PA  17110


NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.