Calculating Patient Volume

For the purposes of the New Jersey Medicaid Promoting Interoperability Program, a hospital patient encounter is defined as services rendered to an individual per inpatient discharge or in an emergency department.

An eligible hospital Medicaid patient encounter is defined as services rendered to an individual per inpatient discharge or in an emergency department where Medicaid or a Medicaid demonstration project under section 1115 paid for part or all of the service (including part of their premiums, co-payments, and/or any cost-sharing).

The Medicaid Promoting Interoperability Program patient volume reporting period is always a continuous 90-day period within the most recently completed hospital fiscal year.

Using this method, the numerator for the patient volume calculation is the total number of Title XIX Medicaid patient encounters (not CHIP or any other state medical assistance program) provided in the selected 90-day period in the most recently completed hospital fiscal year and the denominator is all patient encounters in the same 90-day period.

If a hospital is unable to separate their Title XIX Medicaid patient encounters from their encounters for other state medical assistance programs (such as CHIP or General Assistance prior to April 1, 2011), please contact the Molina Provider Services Help Desk at (800) 776-6334, option 7 or e-mail to receive a proxy percentage to use to establish a Title XIX Medicaid patient volume measure.  This proxy is based on the percentage of Title XIX Medicaid claims within the NJMMIS for the calendar year the facility's 90 day patient volume measurement period falls.

Additional Considerations for Calculating Patient Volume
  • For those hospitals who are enrolled in both Medicaid Fee-for-Service and Medicaid Managed Care plans, patient volume will be aggregated, minus any potential cross over patients during the relevant time period.
  • If a health system has multiple hospitals on different campuses but some or all bill under the same provider number and/or the same NPI, CMS will base patient volume calculations on data associated with the provider number/NPI rather than from each hospital campus.
Last Reviewed: 5/9/2018