NY Medicaid EHR Incentive Program
Common Pre–Payment Review Scenarios
- Remediation Letter Quick Reference Guide (PDF)
During pre–payment review, the NY Medicaid EHR Incentive Program may identify additional information or actions that are needed, and outreach will be sent to inform the provider or organization of this. The scenarios listed below are the most frequently occurring but do not encompass all possible scenarios. This page is meant to serve as a guidance only. Please contact NY Medicaid EHR Incentive Program Support for additional assistance.
Provider Response Needed (Individual) | |||
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EP#–L | Scenario | Why might this happen? | How can we remediate this? |
EP7 | No Affiliation with Payee NPI The NPI that the incentive would be paid to is not affiliated with the Payee NPI in the eMedNY system. The provider would need to update the NPI affiliation to receive the incentive payment. |
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EP13 | Individual Replacement % is below 30% and Pediatrician is below 20% The program noticed the encounter data in Medicaid Data Warehouse (MDW) is far less (< 30% MPV Threshold) than what the provider attested to in MEIPASS. |
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EP18 | Individual Replacement % is over 100% The program noticed the encounter data in MDW is far greater (> 30% MPV Threshold) than what the provider attested to in MEIPASS. |
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EP20 | "Home Health Agency – Personal Care" The program noticed the encounter data in MDW has encounters in the Home Health category.The provider needs to confirm if Home Health encounters were included in their Medicaid Patient Volume.Depending on the response, additional outreach may be sent (EP13 or EP18) |
Home Health Encounters are tracked separately from normal encounters, as providers can decide whether to include them in their attestations.If a number of these Home Health Encounters are identified, the program must confirm if the provider included them in their Patient Volume Data.Even if a provider does not provide Home Health services themselves, they can still appear if the provider:
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EP23 | Alternate Patient Volume Method The program provides an alternative approach for providers with significant managed care populations.It is recommended that a provider first try to use the standard patient volume method, which is total Medicaid encounters divided by total encounters.If a provider cannot meet at least 30% Medicaid threshold (20% for pediatricians), then the provider should try the alternative patient panel calculation, which is the sum of Medicaid patient panel and Medicaid encounters divided by the sum of total patient panel and total encounters. |
If a provider decides to use the Alternate Patient Volume Method, they are required to confirm that they intended to attest using this method.This is because many providers do not fully understand what the patient panel volume is or how to use it, and this outreach lets them know that it is optional, not required, and should only be used if necessary. | The provider must indicate whether they intended to use the Patient Panel Method or not.To determine if this method is necessary, please review the Patient Panel Decision Tool.
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EP29 | Inactive Enrollment Status The provider did not keep their enrollment status with NY Medicaid active.To be eligible to participate in the program, providers must have an active fee–for–service enrollment on file with eMedNY. |
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EP31 | License Expiration The provider has an inactive license.In order to process the attestation for the incentive, the provider must re–activate their license through the New York State Education Department website. |
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EP46 | Hospital Based Provider Hospital–based practitioners are defined by CMS as those practitioners who furnish 90% or more of their covered professional (i.e., Medicaid) services in the hospital inpatient and emergency department (defined as services that would be identified using place of service (POS) codes 21 and 23 on HIPAA– standard transactions).To be eligible to receive the NY Medicaid EHR Incentive, the healthcare practitioner must not be "hospital– based." |
The state Medicaid database distinguishes between POS (Place of Service) codes when categorizing Medicaid encounters.When each provider attests, we perform a query to determine what MPV information is on file for that provider.If 90% or more of the returned encounters are from a POS code 21 (Inpatient Hospital) or 23 (Emergency Room – Hospital) location, the provider is considered "Hospital Based" and may not be eligible to attest in the program. |
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EP60 | Payee TIN Mismatch The NY Medicaid EHR Incentive Program has noticed a mismatch between the Payee TIN/SSN in MEIPASS and eMedNY. |
Individuals: eMedNY began to require that all individual providers use their SSNs instead of separate TINs midway through the program.If a provider does not update their Payee Information in the CMS Registration and Attestation System, there can be a mismatch which will affect their ability to be paid.Organizations: This is likely a data entry error.Ensure that the correct TIN is input in both eMedNY and the CMS Registrations for all providers attesting with this Organization NPI as their Payee. | Update whichever system does not have the correct SSN/TIN listed.
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EP65 | Inactive Enrollment Status – Payee NPI The enrollment status of the Assigned Payee NPI is not active with NY Medicaid.To be eligible to participate in the program, providers and their payee´s must have an active fee–for–service enrollment on file with eMedNY.Payment cannot be made to an inactive Payee NPI. |
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Provider Response Needed (Organization) | |||
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EP#–L | Scenario | Why might this happen? | How can we remediate this? |
EP23 | Alternate Patient Volume Method The program provides an alternative approach for providers with significant managed care populations.It is recommended that a provider first try to use the standard patient volume method, which is total Medicaid encounters divided by total encounters.If a provider cannot meet at least 30% Medicaid threshold (20% for pediatricians), then the provider should try the alternative patient panel calculation, which is the sum of Medicaid patient panel and Medicaid encounters divided by the sum of total patient panel and total encounters. |
If an organization decides to use the Alternate Patient Volume Method, they are required to confirm that they intended to attest using this method.This is because many organizations do not fully understand what the patient panel volume is or how to use it, and this letter lets them know that it is optional, not required, and should only be used if necessary. | The organization must indicate whether they intended to use the Patient Panel Method or not.To determine if this method is necessary, please review the Patient Panel Decision Tool
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EP24 | Organization NPI Replacement % is below 30% The program noticed the encounter data through MDW was far less (< 30% MPV Threshold) than what the group attested to in MEIPASS. |
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Informational Outreach | |||
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EP#–L | Scenario | Why might this happen? | How can we remediate this? |
EP61 | Syndromic Surveillance Registry Urgent Care Encounters The NY Medicaid EHR Incentive Program has noticed the provider attested to being actively engaged with the Syndromic Surveillance registry.However, NY Medicaid does not show the provider as having any Urgent Care Center encounters during the Payment Year. |
The state Medicaid database distinguishes between Place of Service (POS) codes when categorizing Medicaid encounters.When each provider attests, a query is performed to determine what types of encounters are on file for that provider.Only providers practicing in Licensed Urgent Care Centers are able to engage with the Syndromic Surveillance registries, we send informational outreach to any providers attesting with that registry type if they have no urgent care encounters. |
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EP62 | Registering Intent with Public Health The NY Medicaid EHR Incentive Program has noticed that the provider attested to reporting to at least one registry but is not registered on the Meaningful Use Registration for Public Health (MURPH) System to report data to the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) sponsored registries.Providers must register their intent to submit data for a given Public Health Reporting measure, before or within 60 days of the start of their EHR Reporting Period. |
This issue can occur in two situations:
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EP63 | Dentist Public Health Reporting (Immunization) The NY Medicaid EHR Incentive Program has noticed the provider is attesting as a Dentist and claiming active engagement for the Immunization Registry Reporting Measure, under the Public Health Registry Reporting Objective.Dentists may be eligible to claim the Measure 1 Exclusion if they do not administer any immunizations to any of the populations for which data is collected by their jurisdiction´s immunization registry or immunization information system during the EHR Reporting Period. |
As dentists do not usually have the capability to administer vaccinations, if a dentist attests to active engagement with an immunization registry our system identifies it and informs the provider to avoid any mistakes. |
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EP64 | Registering Intent with Public Health (60 Days EHR Reporting Period) The NY Medicaid EHR Incentive Program has noticed that the provider attested to reporting to at least one registry, but did not register before or within 60 days of the start of their EHR Reporting Period on the Meaningful Use Registration for Public Health (MURPH) System to report data to the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) sponsored registries.Providers must register their intent to submit data for a given Public Health Reporting measure, before or within 60 days of the start of the EHR Reporting Period. |
If a provider does not register in the MURPH system within 60 days of the start of their chosen reporting period, they will receive this message.This could be for new registrations or existing registrations where registry selections were updated for individual providers. | The provider should review the registries in their attestation and confirm what their initial declaration of intent date was.This can be done using the Audit Report Card function in the MURPH system, or by communicating directly with the registry for their jurisdiction (NYS or NYC).
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EP68 | FQHC/RHC Validation The NY Medicaid EHR Incentive Program has noticed that the provider attested to working at a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC).However, NY Medicaid does not recognize the name of the FQHC or RHC submitted with the MEIPASS attestation. |
If a provider enters the name of an FQHC or RHC that is not recognized by NY Medicaid within the MEIPASS attestation. |
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Date: 1/13/2020 | Version 1.0
New York Medicaid EHR Incentive Program Support Team
(877) 646–5410, Option 2
hit@health.ny.gov
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