DOWNLOAD the Patient Volume Data Tool (.xlsx, 35 KB, updated 03/06/2019)
Background
The definition of Medicaid Encounter is not limited to a patient encounter paid for, in whole or in part, by Medicaid. This Medicaid encounter definition allows inclusion of services rendered on any one day to a Medicaid-enrolled individual, “regardless of payment liability.”
Impact
This definition of Medicaid encounter has an impact on the way the Vermont Medicaid PIP/EHRIP Team conducts its pre-payment validation of patient volume. CMS requirements state that auditable data sources must be used in order to validate provider attestations.
It has been standard VT Medicaid PIP/EHRIP practice to request data to support patient volume calculations if the attested numbers could not be independently verified using state administrative data alone. There are many valid reasons why this may occur, and it is not uncommon to require ancillary documentation for a provider's PIP/EHRIP attestation.
It is strongly recommended that the Patient Volume Tool be uploaded with each provider's attestation.
Compile and Retain Patient Volume Data
To help providers and preparers comply with these requests for supporting documentation for Medicaid encounters, the EHRIP Team has developed a Patient Volume Data Tool:
DOWNLOAD the Patient Volume Data Tool (.xlsx, 35 KB, updated 03/06/2019).
The tool provides guidance for compiling the necessary data in the required formats during the attestation process.
The template on Worksheet #2 of the document specifies the data required to validly calculate and verify Medicaid patient volume for Vermont Eligible Professionals.
Note: The data provided should include each and all of the direct patient encounters which were counted in either the patient-volume numerator or the patient-volume denominator of the attestation (i.e., we need data to support both the numerator and the denominator).
For any questions about the Patient Volume Data Tool term definitions or data formatting, please contact the Vermont EHRIP Team at ahs.dvhaEHRIP@vermont.gov
Important Documentation Changes for Audits
As audit processes evolve, there will be changes to the supporting documentation Eligible Professionals will be required to submit. If selected for audit, providers must supply the patient volume data that supports their attestations. Audits may occur some time after an incentive payment has been received. To avoid having to retrieve or recreate the documentation, please submit your patient volume data at the time of attestation, using the the Patient Volume Data Tool.
For questions, contact the Vermont PIP/EHRIP Team at ahs.dvhaEHRIP@vermont.gov
Back to the Vermont Medicaid PIP/EHRIP Home Page
(Page last updated 03/06/2019)