Frequently Asked Questions

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FAQ

For the Medicaid EHR Incentive Program, how do we determine Medicaid patient volume for procedures that are billed globally, such as obstetrician (OB) visits or some surgeries? Such procedures are billed to Medicaid at a global rate where one global rate might cover several visits.

CMS leaves it up to the states how to operationalize the patient volume considerations of global payments with the following guidance: the numerator and denominator must be incorporated consistently. The total encounters can be kept global, or broken down into individual visits. If a global payment is broken down into separate visits in the numerator, then for purposes of the denominator, the state must break down any other global payments received from other payers. We recognize this could be administratively challenging and are open to reviewing strategies for doing this that may involve sampling (e.g., if the Medicaid global payment for OB averages 12 visits, we would expect to see the numerator expanded to 12 visits for Medicaid encounters, and a denominator constructed using sample data from a random file review that similarly breaks down any global payments into separate visits for Medicaid and non-Medicaid payers). Additionally, if the state's approach to global payments excludes providers from the Medicaid EHR Incentive Program who would otherwise be eligible, the state must create a mechanism to re-review their eligibility. FAQ10957
(FAQ5995)

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