Meaningful use deadlines extended to March 13
It is the season for Medicare program deadline extensions. If you are in the process of reporting your 2016 data for the Medicare Electronic Health Record (EHR) Incentive Program, also known as meaningful use, the deadline has just been extended from Feb. 28 to 11:59 pm (PT) on March 13. The Centers for Medicare & Medicaid Services (CMS) said this extension applies to those eligible professionals looking to avoid a negative payment adjustment on Medicare reimbursements in 2018. Those participating in the Medicaid EHR Incentive Program should refer to the attestation deadlines in their particular state.
However, there is still one critical Feb. 28 deadline remaining. If CMS has notified you that your practice failed to successfully demonstrate meaningful use for the 2015 performance year, meaning you are scheduled to receive a negative payment adjustment on all Medicare reimbursements in the associated 2017 payment year, you still must complete and submit a application to request reconsideration by the end of the month. Likewise, if you applied for a hardship exception tied to challenges in the 2015 performance year and your application was denied, you still need to complete a request for reconsideration by Feb. 28 or face negative payment adjustments this year.
The application for reconsideration and instructions related to the application are available on the CMS website for EHR Incentive programs, payment adjustments, and hardships. For questions about the Reconsideration Application, email firstname.lastname@example.org.
For questions about the Registration and Attestation System, contact the EHR Information Center at 1-888-734-6433 (option 1), which is open Monday through Friday from 6:30 am to 5:30 pm ET.
– Theresa Wilkes, Medical Informatics Strategist for AAFP
CMS looks to reduce 2016 meaningful use reporting period to 90 days
The Centers for Medicare & Medicaid Services (CMS) has proposed reducing the amount of time physicians and practices need to report to comply with the meaningful use (MU) program.
Originally, eligible professionals and eligible hospitals needed to report a full year’s worth of data from their electronic health records (EHRs) to meet the 2016 requirement and avoid a financial penalty.
But as part of a group of proposed policy and payment changes released earlier this month and published in the Federal Register this week, CMS says it would require those parties to submit data for any continuous 90 days between Jan. 1 and Dec. 31 of this year.
“We believe it would continue to assist health care providers by increasing flexibility in the program,” CMS said in a release, noting this is the same reporting period as in 2015.
CMS also said that physicians and hospitals who have not successfully attested to MU in a previous year would have to meet modified Stage 2 requirements by Oct. 1, 2017, instead of Stage 3.
Also, certain eligible professionals who have not successfully demonstrated MU in a previous year, plan to attest to MU in 2017, and plan to report data for the advancing care information performance category under the Merit-Based Incentive Payment System (MIPS) in 2017 can apply for a significant hardship exception from payment penalties in 2018.
CMS is accepting comments on the proposed rule though Sept. 6 before releasing a final rule.
If you don’t want to read the full proposed rule, CMS released a more succinct fact sheet.
Deadline for meaningful use hardship exception extended
The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for physicians and other providers to submit hardship exceptions for the meaningful use (MU) program. Providers now have until July 1 to apply for an MU exception. An exception would allow them to avoid the 2017 payment adjustment for failure to meet the reporting requirements in 2015. The previous deadline was March 15. CMS encourages providers to submit their applications electronically as soon as possible to avoid delays.
Applying for and receiving an exception does not prevent a provider from potentially receiving an incentive payment if they successfully attest for 2015 later. The exception simply protects the provider from the payment adjustment should they be unsuccessful in their attestation. Those who are unable to attest at all and fall into any of the exception categories may also submit an application.
The Meaningful Use attestation deadline is March 11. Additionally, providers can satisfy the Clinical Quality Measure (CQM) requirement of MU by reporting on Physician Quality Reporting System (PQRS) measures using the Electronic Health Record (EHR) method. The deadline for this is also March 11.
--Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians
CMS gives physicians more time to attest to 2015 meaningful use
The Centers for Medicare & Medicaid Services (CMS) has extended the attestation deadline for the meaningful use program. Eligible Professionals (EPs) now have until 11:59 PM ET on Friday, March 11, to attest to the 2015 reporting year. The previous deadline was Feb. 29. Failure to attest will result in a 3 percent cut to your 2017 Medicare Part B payments.
EPs must attest to a continuous 90-day period between Jan. 1, 2015, and Dec. 31, 2015. Those scheduled to attest to Stage 2 will report on 10 objectives, while EPs scheduled to attest to Stage 1 will have alternate measures and exclusions available to them for 2015. Attestation is completed through the online Registration and Attestation System. You must have a National Plan and Provider Enumeration System (NPPES) web user account to log on. If someone is attesting on your behalf (such as a practice administrator) that individual must have an Identity and Access Management web user account and must be granted the appropriate authorizations to complete the attestation.
This announcement is the latest of many regarding meaningful use in recent months. In October, CMS released a final rule that, among other things, condensed Stages 1 and 2 into Modified Stage 2 and announced the Stage 3 objectives. Last month, CMS was granted the authority to streamline its exception process. Providers have until March 15 to submit a hardship application to avoid the 2017 payment adjustment. Also in January, acting administrator Andy Slavitt announced that the meaningful use program will be ending as a standalone program as the Medicare Access and CHIP Reauthorization Act (MACRA) is implemented in 2019.
– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians
Survey: EHR adoption continues to increase, information sharing limited
The percentage of office-based physicians using federally certified electronic health record (EHR) systems continued to climb in 2014 although the number sharing patient information with third parties was limited, according to new federal data.
The Centers for Disease Control and Prevention, referencing the National Electronic Health Records Survey, says 74.1 percent of physicians in 2014 reported having a certified EHR, up from 67.5 percent in 2013. Primary care physicians, including family physicians, were more likely to have a certified EHR (78.6 percent) compared with non-primary care specialists (70.3 percent).
Researchers theorized that incentives provided through the Centers for Medicare & Medicaid Services’ meaningful use program helped encourage physicians to adopt certified EHRs.
One of the goals of persuading physicians to adopt EHRs is so they can share medical history, lab results, medication, and other patient information with other physicians and hospitals as the patient moves between health care providers.
The survey showed that 32.5 percent of physicians with certified EHRs were electronically sharing patient information with third-party ambulatory physicians or nonaffiliated hospitals. By comparison, only 16.8 percent of physicians without a certified EHR were sharing information with those third-parties.
The numbers were even smaller for electronically sharing patient information with other types of health care providers. The survey found that 15.2 percent of those with certified EHRs said they shared information with home health providers, 13.6 percent shared with long-term care providers, and 14 percent shared with behavioral health providers.
New rules available for requesting MU hardship exceptions
Congress has provided additional details for physicians wanting to claim a hardship exception from the Medicare Electronic Health Record (EHR) Incentive Program, also known as “meaningful use” (MU). In December, President Obama signed into law the Patient Access and Medicare Protection Act (PAMPA), which gave Congress the authority to streamline the exception process.
The updated process reduces the amount of information required to apply for an exception. For example, multiple providers can now use the same exception application. Also, the Centers for Medicare & Medicaid Services (CMS) can review applications based on “categories” rather than on a case-by-case basis. These categories include: insufficient Internet connectivity, extreme and uncontrollable circumstances, lack of control over Certified EHR Technology (CEHRT) availability, and lack of face-to-face patient interaction.
Physicians who did not successfully meet the MU requirements for the 2015 reporting year may apply for a hardship exception. If granted, the exception would protect the physician from the negative payment adjustment that would have been applied in 2017. An exception is effective for one year – physicians must reapply each year they wish to be exempted. A new eligible professional (EP) who began submitting Medicare claims in 2015 does not need to apply for an exception.
If you want to use the streamlined exception process, you need to submit your application by March 15. CMS will notify applicants of its determinations by email. All decisions are final and cannot be appealed. CMS encourages the use of the electronic application to avoid potential processing delays.
– Erin Solis, Regulatory Compliance Strategist for the
American Academy of Family Physicians
Congress passes legislation to provide meaningful use relief
Physicians who face potential Medicare payment cuts in 2017 because they can't meet new requirements for the meaningful use program in 2015 may soon get a reprieve.
Congress has passed legislation that requires the Centers for Medicare & Medicaid Services (CMS) to grant a hardship exemption from those penalties to any physician who requests one by March 15. The bill now goes to President Obama for his signature.
CMS released modifications to the meaningful use program in October, including new rules for Stage 2. For 2015, physicians may attest to the program by reporting any consecutive 90 days during the year.
Previously, CMS could provide hardship exemptions on a "case by case" basis. But the legislation's supporters, as well as several medical associations, said the late release of the Stage 2 changes means many physicians do not have enough time to meet the regulations and should be granted an automatic exemption. Failing to achieve meaningful use in 2015 can lead to a reduction in Medicare payments in 2017.
UPDATE: President Obama signed the bill into law on Dec. 28.
CMS offers help for new Meaningful Use program rules
The Centers for Medicare and Medicaid (CMS) has released new resources for physicians and other providers making sense of the recent changes to the Electronic Health Record Incentive Programs, also known as Meaningful Use (MU).
A variety of information sheets are available to eligible professionals (EPs) to help them successfully attest to MU in 2015. The resources include an overview that outlines key changes to the program, a tip sheet highlighting specific criteria for 2015, and specification sheets and tables covering the program’s measures and objectives. CMS has also included an attestation worksheet that providers can use to record their numerators and denominators as a reference during the attestation process. These resources are all available on the CMS website. Additional resources will be added to the website as they are available.
In October, CMS released its final rule for the EHR Incentive Program, effectively condensing it down to two stages – a modified Stage 2 and a new Stage 3. Stage 1 has been eliminated from the program. For reporting year 2015, CMS is allowing providers who were scheduled to attest to Stage 1 to use alternate measures and exclusions. Additionally, CMS removed measures that were considered redundant or “topped out,” leaving a total of nine objectives for Stage 2. Starting in 2017, providers will have the option to attest to the Stage 2 or Stage 3 requirements. Stage 3 will be mandatory for all providers beginning in 2018.
– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians
CMS updates meaningful use guidance for providers changing EHR vendors
Physicians and other health care providers who are unable to demonstrate meaningful use because they have recently changed vendors for their electronic heath record (EHR) – or worse yet, have seen their EHR system decertified by the Centers for Medicare & Medicaid Services (CMS) – have to work fast to avoid penalties to their Medicare payments.
CMS has updated its guidance for practices wanting to continue participating in the EHR incentive program or apply for a hardship exception:
• If a practice changes certified EHR technology vendors and is unable to demonstrate meaningful use, the practice may apply for an extreme or uncontrollable circumstances hardship exemption before the deadline for a particular program year. If approved, the practice would not incur a Medicare penalty.
• If the practice’s EHR has been decertified, the practice can still use it to attest to meaningful use as long as the EHR reporting period ended before the system became decertified. However, if the reporting period ended after the decertification, the practice must apply for a hardship exemption.
If the EHR was decertified after the hardship exception period for the payment adjustment year had already passed, the practice will need to contact the CMS Hardship Coordinator at EHRinquiries@cms.hhs.gov to apply for an exception under CMS's discretion.
You can get more information from the EHR incentive programs website.
July 1 deadline approaching to avoid 2016 Medicare cut
Physicians who did not successfully participate in the Centers for Medicare & Medicaid Services’ (CMS) Electronic Health Record Incentive Program (also known as "meaningful use") in 2014 are scheduled to see their Medicare payments cut in January 2016.
However, those physicians can avoid a cut if they apply for a hardship exception by July 1.
To qualify for a hardship exception, you must show CMS proof that a specific circumstance beyond your control significantly prevented you from complying with the requirements of the program.
You can download instructions and applications (both for individuals and groups) for the hardship exception on CMS’s Electronic Health Record Incentive Programs website.
CMS will review each hardship application and supporting documentation to determine if an exception is warranted.
Newly practicing physicians, hospital-based physicians, and physicians with certain Medicare Provider Enrollment, Chain, and Ownership System (PECOS) specialties (i.e., anesthesiology, pathology, diagnostic radiology, nuclear medicine, and interventional radiology) do not have to apply for a hardship exception. CMS will use Medicare information to determine if these physicians are eligible for an automatic exception.
A hardship exception applies only to the 2016 payment adjustment. You’ll have to submit another, separate application for subsequent years.
Top 5 things to know about Meaningful Use Stage 2 changes
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that included numerous changes to its Electronic Health Record (EHR) Incentive Program, also known as “Meaningful Use.”
The proposed guidelines are hundreds of pages long. So what is there to know without reading the voluminous rule? Here are five key takeaways from the new rule, which won’t be final until this fall but will affect Meaningful Use for 2015:
• Practices will no longer have to provide information on 10 measures that have been judged redundant, duplicative, or widely adopted. They include imaging results, family health history, electronic notes, patient list, patient reminders, clinical summaries, structured lab results, vital signs, smoking status, and patient demographics.
• The threshold for showing that a practice is successfully providing patients with electronic access to records will change from 5 percent of all patients to at least one patient.
• Showing that a practice is successfully providing patients with secure messaging options will change from meeting or exceeding a threshold of 5 percent of patients to a simple “yes or no” question.
• In 2015, all practices, regardless of when they started meaningful use, can show they are compliant using 90 days of data, as opposed to a full calendar year of data.
• In 2017, all practices, regardless of when they started meaningful use, must report a full calendar year of data to show compliance.
– Steven Waldren, MD, director of the Alliance for eHealth Innovation at the American Academy of Family Physicians
HHS makes EHR Meaningful Use deadline changes final
The Department of Health and Human Services on Friday published the final version of rules that give physicians, hospitals, and other health care providers additional flexibility in how they comply with the Meaningful Use program in 2014.
The final rule largely mirrors the proposal released in May. Specifically, physicians this year can use certified electronic health record technology (CEHRT) that meets the 2011 criteria or a combination of the 2011 and 2014 criteria to attest to the Medicare and Medicaid EHR Incentive Programs. All physicians will be required to use the 2014 CEHRT criteria to attest in 2015.
The change was made after it was determined that technology meeting the updated criteria was not going to be widely available to users this year.
The final rule also gave providers who began Meaningful Use in 2011 or 2012 until 2017 to begin Stage 3 instead of the beginning of 2016.
Of course, although these delays are welcome, practices shouldn't become complacent or slow down their efforts to achieve compliance.
For more information on Meaningful Use and EHRs in general, see FPM's Electronic Health Records topic collection.
CMS providing Meaningful Use exemption for slow Internet
Physicians working to comply with stage 2 of the Centers for Medicare & Medicaid Services' (CMS) Meaningful Use program know that not all of the requirements are under their control.
Specifically, more than 5 percent of patients must send a secure message to their physician that is received using the electronic messaging function of the electronic health record (EHR), and more than 5 percent must view, download, or transmit their health information to a third party.
But both of those require the patient having access to broadband Internet service.
Enough physicians in Internet-poor locales have asked CMS how they can be required to meet those guidelines that the agency has finalized an exemption.
Under the rule, an eligible professional will not have to meet either of the above Meaningful Use measures if at least 50 percent of his or her patient encounters are in a county where more than 50 percent of the housing units lack access to broadband download speeds of at least 3 megabits per second (Mbps), as measured by the Federal Communications Commission (FCC) on the first day of the EHR reporting period.
Physicians can check the broadband download speed in their county through the FCC's National Broadband Map. Click "Analyze the data" and then "Rank your geography." Under step one, pick "Rank within a State," click "County," and then select your state. Under step two, click "Speed" (which defaults to a download speed of > 3Mbps). On the next screen select "Manage metrics" and then click "% housing units." As an example, here's the breakdown for FPM's home state of Kansas.
It must be noted, however, that the FCC map is based on advertised broadband speeds not typical ones, so the vast majority of counties in the United States are considered to have access to broadband speeds of 3 Mbps or more.
That means unless you practice in some truly remote areas of the country, slow broadband may not be an adequate defense against Meaningful Use stage 2.
More physicians using EHR, but little information flowing between them
A new survey shows that physicians, particularly those in primary care, are continuing to adopt electronic health record systems at a rapid pace.
In fact, almost 80 percent of office-based physicians reported using some form of an electronic health record (EHR) in 2013, according to the study performed by the Centers for Disease Control and Prevention's National Center for Health Statistics and released this week in Health Affairs. Forty-eight percent of all physicians said their EHR systems could perform a series of "basic" EHR functions, such as recording medication and allergy lists, saving clinical notes, prescribing medication electronically, or viewing lab and imaging reports. That was double the adoption rate in 2009 and up 22 percent from 2012.
Primary care physicians' rate of adoption was highest with 53 percent saying they had a basic system, compared with 43 percent of physicians in other specialties.
But the survey also found that relatively few physicians are using or are capable of using their EHR systems to exchange patient care information with their fellow physicians, hospitals, or health systems, or even the patients themselves. Only 39 percent of office-based physicians said they had performed health information exchange with other providers or hospitals last year. Providers in larger practices or those owned by a hospital or academic medical center were far more likely to exchange information than small and solo practices.
Patient engagement with the EHR was also lagging as only 41 percent of physicians said they had the ability to let patients view, download, or transmit their health information online. Of those, about half said they actually used it. And while close to half of all physicians said they could exchange secure messages with patients through their EHR, two-thirds said they didn't in 2013.
Those results will continue to create concerns ahead of the deadline for complying with Stage 2 Meaningful Use requirements, which particularly stress interconnectivity and patient outreach.
A separate study that focused on EHR adoption and use by hospitals found that almost 60 percent of hospitals had adopted at least a basic EHR, but less than 6 percent were considered ready for Stage 2 Meaningful Use.
For information on how your practice can meet Stage 2 Meaningful Use requirements, see "Making Sense of Meaningful Use Stage 2: Second Wave or Tsunami?" in the January/February 2014 issue of FPM.
Proposed delay but no reprieve for Meaningful Use
Health and Human Services (HHS) this month published a new proposed rule to its Meaningful Use program that would change what version of certified electronic health record technology (CEHRT) physicians must use and when they must attest for Stage 2. There are two groups of physicians that this new rule could affect:
• All physicians attesting to Meaningful Use in 2014 – HHS proposes that if a physician has difficulty fully implementing a 2014 edition CEHRT because of a delay in availability in the market, they may use a 2011 edition CEHRT to attest to Meaningful Use in 2014. The rule does not clarify what does and does not constitute a “delay in availability.” This may be clarified in the final version of the rule.
• Physicians currently required to attest to Stage 2 – If you attested to Meaningful Use starting in 2011 or 2012, you were originally required to attest to Stage 2 of Meaningful Use this year. The proposed rule states that if you have difficulty fully implementing a 2014 edition CEHRT, you can (a) use a 2011 edition CEHRT to attest to Stage 1; (b) use a combination of 2011 edition and 2014 edition CEHRT to attest to either Stage 1 or Stage 2; or (3) still use a 2014 edition CEHRT and attest to Stage 2.
Be warned, however, that you will be required to complete your second year of Stage 2 attestation using a 2014 edition CEHRT starting Jan. 1, 2015. This means that although Stage 2 is delayed you do not have a reprieve to slow your implementation of a 2014 edition CEHRT. You will still need to perform the required Stage 2 activities at the first of the year.
The final tricky part is the federal rule-making bureaucracy. HHS must submit a notice of proposed rule making, which is what we are discussing now, before then requesting public comment, and then publishing a final rule. While it is extremely likely that this flexibility in using CEHRT and attesting to Stage 2 will be in the final rule, it may be changed by then. However, the marketplace asked for this flexibility, so it is hard to believe that the final rule would change dramatically.
– Steven E. Waldren, director of the Alliance for E-Health Innovation
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