Critical Access Hospital Reimbursement May Be In Trouble if CMS Changes Rules

The Centers for Medicare and Medicaid Services (CMS) has signaled its intent to increase enforcement of the location requirements for critical access hospitals (CAHs).  CMS created the CAH certification program to provide additional reimbursement for hospitals in rural areas that are located more than 35 miles from another hospital, or more than 15 miles from another hospital if the area has mountainous terrain.

Prior to 2006, states could designate certain hospitals as “necessary providers” that did not have to meet the location requirements.  Many of these “necessary provider” CAHs would not meet the current locations standards for the CAH designation.

A recent report from the Department of Health and Human Services (HHS) found that CMS would have saved $449 million in 2011 if it had decertified all CAHs that were 15 or fewer miles from their nearest hospitals.   In order to take advantage of these potential savings, CMS has stated that it will seek legislative authority to remove the “necessary provider” exemption, and require all CAHs to meet the location requirements.

In addition to removing the exemption, CMS has also agreed to pursue other changes to the CAH program, including:  (1) periodically reassess CAHs for compliance with all location-related requirements; and (2) apply a uniform definition of “mountainous terrain” to all CAHs.

It is important to note that these changes would require legislative action by Congress and currently there is no such legislation to take action on these recommendations.  Nevertheless, CAHs should keep a close eye on these potential changes as they could have a huge impact on the reimbursement levels of CAHs that do not currently meet the location requirements.  Please contact Don Black or Casey Moriarty for more information.

CMS Posts Meaningful Use Stage 2 Specification Sheets

Looking for more detail on the Meaningful Use Stage 2 requirements?  CMS has conveniently created specification sheets for each Meaningful Use measure.  These sheets explain in detail each numerator and denominator eligible professionals and hospitals much achieve to be eligible for the EHR Incentive Payments.  The sheets also contain the certification and standards criteria issued from the Office of the National Coordinator.

For Eligible Professionals click here.

For Eligible Hospitals and Critical Access Hospitals click here.

For assistance with the EHR Incentive Programs and meaningful use in general please contact Elana Zana.

Comparison of Stage 1 vs Stage 2 Meaningful Use

Sifting through the hundreds of pages of new rules can be overwhelming.  Luckily, CMS has provided comparison charts to help navigate the meaningful use changes coming our way with Stage 2.  Along with the new rules, CMS clarified that the earliest Stage 2 meaningful use is effective is fiscal year 2014 for hospitals and calendar year 2014 for eligible professionals (more on 2014 to come in future posts).

Click on the links below to see the comparison charts:

Stage 2 Meaningful Use – Eligible Professionals: 17 core objectives, 3 of 6 menu objectives, 9 of 64 clinical quality measures.

Stage 2 Meaningful Use – Hospitals & CAHs: 16 core objectives, 3 of 6 menu objectives, 16 of 29 clinical quality measures.

For more information about meaningful use and the EHR Incentive Programs please contact Elana Zana.

Hospital Deadline for Medicare EHR Incentive Payments Near

For those hospitals interested in applying for the Medicare EHR Incentive Payments for 2011, the last day to begin the 90-day reporting period is July 3rd.  Hospitals and CAHs must demonstrate meaningful use for 90-days during the 2011 fiscal year (which ends September 30, 2011).  Hospitals and CAHs have until November 30, 2011 to register and attest to meaningful use.

$12 Million in New Grant Funding to Assist Physicians with EHRs

As reported in Healthcare IT News “The Health Resources and Service Administration has made available $12 million in grants for rural healthcare network organizations to help them become meaningful users of certified electronic health records.” According to HRSA officials “the grants may support health IT activities, such as development of a strategic plan for electronic health records (EHRs), workforce analysis, purchase of health IT equipment and installation of broadband for connectivity.” For more details see

Attestation for EHR Incentive Programs Available

Earlier this month, CMS launched the attestation portion of the EHR Incentive Payment Program.  Beginning on April 18th, eligible professionals and hospitals are now able to attest to meaningful use (or adopt, implement or upgrade for Medicaid).  Along with the attestation itself, CMS launched its Meaningful Use Attestation Calculator, a wizard which walks eligible professionals and hospitals through the meaningful use objectives and enables the entity to determine if it can successfully meet the meaningful use standards prior to filling out the registration form. 

For those providers that are able to begin the registration and attestation process, access to registration and attestation is available here.  The CMS website also has a user guide that is helpful when registering as well as FAQs.  To be eligible for either the Medicare or Medicaid EHR Incentive Programs an eligible professional or hospital must be using certified EHR technology.  The ONC provides a list of which EHR systems are “certified.”

In addition, CMS is offering teleconferences regarding registration and attestation:

  • Tuesday, May 3, 2:00 – 3:30 p.m. ETRegister to join this call if you are an eligible hospital or CAH who wants to learn more about the attestation process for the Medicare EHR Incentive Program.
  • Thursday, May 5, 1:30 – 3:00 p.m. ETRegister to join this call if you are an EP who wants to learn more about the attestation process for the Medicare EHR Incentive Program.

Some states are also offering webinars about the Medicaid EHR Incentive Payment Program and how to register.  Registration for the Medicaid EHR Incentive Program requires both registration with CMS and on the state level.  However, eligible professionals and hospitals will not be able to register with CMS for the Medicaid EHR Incentive Program until their state is ready to start its Medicaid EHR Incentive Program.  Washington expects to go-live in June 2010; California plans to go-live this Summer for eligible professionals. 

If you have questions regarding the Medicare or Medicaid EHR Incentive Programs or would like some assistance with understanding meaningful use or calculating patient volume (Medicaid) please contact Elana Zana or Dave Schoolcraft.

Registration for Medicare EHR Incentive Payments Starts January 3rd

Starting on January 3rd, 2011, registration for the HITECH Electronic Health Record Medicare Incentive Payments will open.  This registration is available for both eligible professionals and eligible hospitals, including Critical Access Hospitals.  The registration link will be available starting on January 3rd and can be accessed here.  Registration for the Medicaid EHR Incentive Payments will be available for the following states:  Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.  In February, registration will likely open in California, Missouri, and North Dakota.  It is anticipated that other states, including Washington, will  launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.

For mor information regarding the Medicare Incentive Payments see the CMS press release.  For a general overview of the HITECH incentive payments please read our previous blog posts for physicians and hospitals.  As a disclaimer, these blog posts were written prior to the issuance of the Final Rules but provide a good overview of the statutory requirements.

CMS has also issued tip sheet regarding Stage 1 Meaningful Use for hospitals, and Critical Access Hospitals, click here to access the tip sheet.  The tip sheet for eligible professionals can be accessed here.  Additional information may be obtained by contacting CMS or your State directly (CMS and State Medicaid Contact List & Information).

If you would like further information regarding achieving Meaningful Use, registering for the Medicare Incentive Payments, or assistance calculating the Medicare or Medicaid incentive payments please contact Dave Schoolcraft or Elana Zana.

Critical Access Hospital Incentive Payments

CMS has issued a Critical Access Hospital (CAH) Tip Sheet to assist CAH’s in evaluating eligibility under the Medicare EHR Incentive Payment program.  Though, CAH’s are now eligible for Medicaid EHR Incentive Payments, this eligibility is similar to all other acute care hospitals.  CAH’s are not entitled to a different calculation formula for Medicaid EHR Incentive Payments.   

To view the Medicare CAH Tip Sheet click here.

To view the Medicaid Tip Sheet for Acute Care Hospitals click here.

If you have questions or need assistance in calculating the estimated Medicare or Medicaid Incentive Payments for your hospital or with achieving meaningful use please contact Elana Zana.

CMS Presentation on Meaningful Use & EHR Incentives Final Rules

On July 13, CMS issued the Medicare and Medicaid Programs Electronic Health Record Incentive Program Final Rules.  These final rules were published in the Federal Register on July 28th. 

On July 22nd, CMS hosted a conference call to explain the changes in the Final Rules as compared to the Proposed Rules.  Some key changes include:

  • Inclusion of Critical Access Hospitals in the definition of eligible hospital for Medicaid incentives.
  • A revised definition of hospital based eligible professionals to exclude only those physicians that provide 90% or more of their services in either an inpatient or emergency department.
  • Eligible Professionals and Eligible Hospitals may defer 5 optional “menu set” Meaningful Use reporting objectives.
  • Reduction in measure thresholds for Meaningful Use reporting objectives.

To view the CMS slide presentation click here.  ONC has also published a slide deck entitled “Supporting Meaningful Use” that provides helpful guidance.  CMS has also launched an EHR Incentives website which has fact sheets, press releases, general information, and instructions on how to participate, also on the website will be the transcript of the CMS conference call.

In addition, CMS has published the Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology.  For more information on these Standards click here.

If you have questions regarding how these final rules will affect your practice please contact Elana Zana.

Comments on Meaningful Use and EHR Incentives Proposed Rule Accepted Through March 15th

At the end of the year, CMS finally issued the much anticipated Electronic Health Record Incentive Payments proposed rule, including the definition of “meaningful use.” CMS has also published fact sheets to help distill the information:

Fact Sheet on Medicaid Incentive Payments

Fact Sheet on Medicare Incentive Payments

Fact Sheet on the Definition of Meaningful Use 

Physicians and Hospitals are encouraged to comment on the proposed rule through March 15th.  Some specific hot topics include: the definition of meaningful use, the exclusion of provider-based physicians from incentive payments, calculation for Critical Access Hospital Medicare incentive payments, exclusion of Critical Access Hospitals in Medicaid incentive payments, and the requirements for certified EHR systems. 

To view some of the submitted comments so far go to:

The American Hospital Association also encourages hospitals to send out this comment letter.

If you are interested in drafting your own comment and require some assistance please contact Elana Zana or Dave Schoolcraft.