Q. The Medicaid electronic health record (EHR) incentive program requires a minimum 30-percent patient volume. How does Texas Medicaid determine if a physician has met this threshold?
A. First determine your reporting period. Texas Medicaid allows physicians to select any three consecutive months in the calendar year prior to applying for the incentive. Next, decide how you will calculate volume. Patients with multiple visits for the same day and service count only once. There are two options for calculating volume:
Encounter Option
Use this formula: Medicaid encounters during a continuous 90-day period divided by overall patient encounters during the same 90-day period multiplied by 100
Medicaid Patient Encounters X 100
Total Patient Encounters
Patient Panel Option
Use the method but include in the numerator all additional patients in your panel who were not included in the Medicaid encounter number (who have visited in the past 12 months).Include in the denominator total additional patients in your panel who were not already included in the encounters (who have visited in the past 12 months).
All Medicaid Encounters + Medicaid MCO* Clients Assigned to Physician** X 100
All Patient Encounters + All MCO Clients Assign to Physician**
* managed care organization
* *Patient with at least one encounter in the calendar year prior to the 90-day period and not included in Medicaid encounters
Group/Clinic vs. Individual Volume
Finally, you have the option to calculate the entire group/clinic volume or an individual physician volume. To use the group/clinic volume method:
- All physicians and other health care professionals in the group/clinic volume must have some Medicaid client base.
- All Medicaid encounters are considered for every practitioner, whether or not the practitioner is eligible for the incentive program.
- The denominator of the above formula must include all patient encounters made from all practitioners, regardless of whether or not all participate in the Medicaid or Medicare EHR incentive programs.
- All physicians or providers in a group/clinic volume must use the same method of calculation in a reporting year.
Resources:
- Here are some examples from the Centers for Medicare & Medicaid Services of using the group/clinic volume method.
- More information about participating (PDF) in the Texas Medicare EHR incentive program, including a Group vs. Individual Decision Tool, is available from the Texas Medicaid and Healthcare Partnership.
- If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to primary care physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. At a cost of $300 per eligible physician, you can get a consultant on site at any location in Texas. Visit TMA’s Texas REC Resource Center for more information.
Published Nov. 17, 2011
TMA Practice E-Tips main page
Last Updated On
May 13, 2016
Originally Published On
November 17, 2011