Medicaid Compliant EHR Software

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Achieving and maintaining compliance with various state and federal regulations is something that every behavioral health practice must be able to do. In 2019, there are a variety of entities and regulations that govern compliance on a variety of levels. Your electronic health records (EHR) system must be up to date with all applicable regulations if you want your practice to remain in the good graces of the many regulating bodies that demand compliance.

Becoming familiar with the entities that require and demand compliance is the first step to determining the suitability of your EHR.

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Medicaid Quick Facts:

Official Title: Medicaid
Year Enacted: 1965
Aliases: Medical Assistance (MA), Children's Health Insurance Program (CHIP)
Jurisdiction: State and Regional, A/B and DME Medicare Administrative Contractors (MAC)
Most Recent Update to Medicaid: August 2019, Medicaid receives expansions on a state-by-state basis. Some are still currently deciding on new Medicaid rules and regulations.
Medicaid Compliance & Enforcement: The Centers for Medicare & Medicaid Services (CMS)

What Is Medicaid?

Medicaid extends health coverage to millions of Americans. Low-income adults, children, pregnant women, people with disabilities and the elderly are the primary recipients of Medicaid. The program is run by states according to federal requirements and receives joint funding from both systems.

The amount, type, duration and scope of services available under Medicaid are established by individual states. Federal law includes a few mandatory benefits. Individual states may cover other benefits. Mandatory benefits include:

Inpatient hospital services
Outpatient hospital services
Physician services
Lab and X-ray services
Home health services

Some of the common voluntary benefits set by states include things like physical therapy, prescription drugs and vision coverage.

Patient Rights Under Medicaid

Medicaid does not protect patient rights in and of itself. Instead, it adheres to the protections included in the new rights in the Affordable Care Act (ACA), such as:

Requiring insurance plans to cover people with pre-existing health conditions, including pregnancy, without charging more.
Providing free preventive care.
Giving young adults more coverage options.
Ending lifetime and yearly dollar limits on coverage of essential health benefits.
Helping patients understand the coverage they are getting.
Holding insurance companies accountable for rate increases.
Making it illegal for health insurance companies to cancel health insurance just because a patient gets sick.
Protecting patient choice of doctors.
Protecting patients from employer retaliation.

Healthcare providers participating in Medicaid are also expected to adhere to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which, together with laws like the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, places strict rules on how clinicians can handle patient information. EHR technology needs to be HIPAA-compliant if psychiatrists want to stay compliant with Medicaid.

Most Common Medicaid Violations for Behavioral Health Providers

Other than adherence to HIPAA and HITECH, Medicaid compliance is about avoiding fraud. These are some of the violations mental health providers need to be aware of:

False claims
Improper employee training or lack thereof
Stark Law violations
Anti-Kickback Statute violations
Medicaid fraud
Phantom billing
Patient billing fraud
Upcoding scheme and unbundling
Exclusion Statute

The Office of Inspector General (OIG) within the Department of Health and Human Services (HHS) monitors for these violations and enforces penalties. The range of civil and criminal penalties for Medicaid fraud include fines up to $25,000 to prison terms up to 10 years.

Medicaid and EHR Incentives

Mental and behavioral health providers who want to receive incentives must participate in the Promoting Interoperability (PI) Program. There are several important differences between the EHR Incentive Programs for Medicare and Medicaid.

Program administration: The federal government administers the Medicare EHR Incentive Program, while states administer the Medicaid EHR Incentive program on a voluntary basis.
Common definition: The Medicare EHR Incentive Program operates on a common definition of meaningful use, now known as Promoting Interoperability. Medicaid programs can add additional requirements for meaningful use of EHRs.

Frequently Asked Questions About Medicaid

Despite the number of Medicaid patients behavioral health professionals treat, many providers still have questions about how it works. These are five of the most common.

What does CHIP mean?

Is CHIP the same as Medicaid?

What is the Basic Health Program?

What is the difference between Medicare vs. Medicaid?

How is Medicaid affected by the ACA?

Medicaid Compliance and EHRs

To meet the demands of Medicaid and earn incentives, you need to follow the guidelines of the Medicaid EHR Incentive Program, which has now pivoted to the Promoting Interoperability Program. The central requirement is choosing an EHR technology certified by the Office of the National Coordinator (ONC).

Certified EHR Technology (CEHRT) meets the requirements for protected health information (PHI) security laid out by HIPAA, the most stringent of all compliance regulations. Some features you should expect in CEHRT include:

Access controls
User authentication
Audit trails
Alarm and event reporting
Encryption

Medicaid Compliance with ICANotes

Compliance with major regulations and payment systems is a constant struggle for behavioral health clinicians without an EHR, or with an EHR designed for use by physicians. ICANotes was built specifically to address the unique needs of mental health professionals in documentation for compliance and better quality care. With lightning-fast and accurate notes alongside robust security and interoperability, ICANotes allows clinicians to spend less time on compliance and more time on care.

To see the innovation of ICANotes in action, we invite you to request a live demo or try the solution out for yourself with a free trial of our EHR software.

More Resources on Behavioral Health Compliance

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