Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 71 Date: May 6, 2011

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1 anual ystem Pub emonstrations epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 71 ate: ay 6, 2011 hange equest 7360 UBJT: larification to Payment Processing for the lectronic ealth ecords emonstration. UY O NG: The purpose of this is to clarify the intent of 6603, "Payments to Practices Participating in the lectronic ealth ecords () emonstration", issued November 6, Unless otherwise noted in this, all other provisions of 6603 remain in the effect. T T: October 1, 2011 PLNTTON T: October 3, 2011 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the newrevised information only, and not the entire table of contents.. NG N NUL NTUTON: (N if manual is not updated) =, N=N, =LT-Only One Per ow. N N PT TON UBTON TTL. UNNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s): No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.. TTNT: Business equirement *Unless otherwise specified, the effective date is the date of service.

2 ttachment Business equirements Pub Transmittal: 71 ate: ay 6, 2011 hange equest: 7360 UBJT : larification to Payment Processing for the lectronic ealth ecords emonstration ffective ate: October 1, 2011 mplementation ate: October 3, GNL NOTON: The purpose of this is to clarify the intent of 6603, Payments to Practices Participating in the lectronic ealth ecords () emonstration, issued November 6, Unless otherwise noted in this, all other provisions of 6603 remain in the effect.. Background: The goal of the emonstration is to encourage the adoption and implementation of electronic health record systems by small to medium sized primary care practices. t is a pay for performance program under which participating practices will be eligible to earn periodic incentive payments based on (1) their performance on an Office ystems urvey that reflects their use of s; and (2) the reporting and performance of clinical quality measures. 6603, Payments to Practices Participating in the lectronic health ecords () emonstration issued November 6, 2009, was intended to outline the requirements for processing incentive payments to participating practices. ue to difficulties encountered in processing the first year s payments, the clarifications provided below are being provided to improve the process going forward. B. Policy: ontractors shall process periodic emonstration lump sum incentive payments to eligible participating demonstration practices as requested by the O project officer. ndividual payments shall be processed for participating demonstration practices as identified by their demonstration number. The project officer shall provide to the contractors in the affected jurisdictions a file (see 6603 for the file layout) with the names of each practice to be paid, the amount to be paid, and the entity to which the payment shall be made, as defined by the edicare Provider dentification Number (PN) and NP. lthough it is possible that a practice will receive two different types of incentive payments in a given period, the carrier shall institute checks to insure that duplicate payments of the same type are not processed for a given practice for the same period.. BUN QUNT TBL

3 Number equirement esponsibility (place an in each hared- ystem OT B aintainers or each practice to be paid, the O demonstration implementation contractor shall provide a specific demo payment file (see 6603) containing a Group billing PN and Group billing NP or practices where a Group billing PN and Group billing NP are not available (e.g. some solo practitioners), an individual billing PN and individual billing NP will be provided n error message will be sent if the file received from the O implementation contractor does not contain both a billing PN and a billing NP f the combination of billing PN and billing NP provided on the file is not on the contractor s file, an error message will be returned The contractor shall send a report to O staff project officers notifying them of all error messages returned f the PN NP combination on the demo payment file matches a PN NP combination on the contractor file, the contractor shall process payment against the corresponding Tax number of the entity indicated ach demonstration practice, as identified by its demonstration practice number on the demo payment file, shall have its payment processed and paid separately from any other practice emonstration practices that have the same demonstration practice number shall not have their payments combined into a single payment even if they share the same PN or TN new segment on the GL 810 P interface file will be created to contain a sequence identifier for demonstration payments. The segment, identified with the 'xx' qualifier (TB), is situational and alphanumeric values (4 digits) will be accepted. The segment will be in the existing 'provider' loop that is being renamed to 'payment' to accurately describe the data. This segment is used only for demonstration and be allowed to repeat only one time. Note: The qualifier 'xx' is just a placeholder for the segment until one has been determined. O O cont GL

4 Number equirement esponsibility (place an in each hared- ystem OT B aintainers shall create an 835 edit for GL to reject any payment set that does not contain the sequence identifier as a suffix for the demonstration qualifier. GL GL shall use an 824 error code to reject transaction on the 810 interface file that does not contain the sequence key identifier information on the payment set The ncentive eporting Year field on the demonstration payment file provided by the O implementation contractor indicates the year and type of payment. ndividual practices may receive multiple types of incentive payments in a given year but shall not be paid twice for the same type of incentive for the same year f there are multiple payments in a given year, the second digit of the ncentive eporting Year field on the payment file shall be different for each type of payment The shall create a duplicate error when a record on the emonstration ncentive file matches a record on a prior file. duplicate record is when the following fields match: ncentive Type Year ncentive eporting Year arrier Practice emo # The shall not error a payment transaction entered manually by the contractor. GL O O. PO UTON TBL Number equirement esponsibility (place an in each hared- ystem OT B aintainers

5 None.. UPPOTNG NOTON ection : or any recommendations and ing information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. -ef equireme nt Number ecommendations or other ing information: ection B: or all other recommendations and ing information, use this space:. ONTT Pre-mplementation ontact(s): Jody Blatt, Jody.Blatt@cms.hhs.gov ; (410) ; ebbie anoven, ebbie.anhoven@cms.hhs.gov ; (410) Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable.. UNNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s): No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.