Comparison of Stage 1 vs Stage 2 Meaningful Use

September 7, 2012 By

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.

Filed Under: Critical Access Hospital, HITECH, Incentive Payments, Meaningful Use, Medicaid, Medicare Tagged With: , ,

CMS Issues 3 FAQs on Stage 2 Rules and the Medicaid EHR Incentive Program

September 5, 2012 By

CMS has responded to several questions following the issuance of its Stage 2 Meaningful Use Final Rule.  Along with publishing new meaningful use guidelines, the Final Rule adds new provisions regarding the calculation of patient volume for Medicaid providers.  CMS has recently published these new FAQs, some of which take effect immediately, while others will start in 2013, giving the states some time to update their guidance.  These new rules will affect all eligible professionals, regardless of their stage in participation in meaningful use.  To see additional FAQs click here.

Medicaid changes to patient volume calculations 

Q: The EHR Incentive Programs Stage 1 Rule stated that, in order for a Medicaid encounter to count towards the patient volume of an eligible provider, Medicaid had to either pay for all or part of the service, or pay all or part of the premium, deductible or coinsurance for that encounter.  The Stage 2 Rule now states that the Medicaid encounter can be counted towards patient volume if the patient is enrolled in the state’s Medicaid program (either through the state’s fee-for-service programs or the state’s Medicaid managed care programs) at the time of service without the requirement of Medicaid payment liability. How will this change affect patient volume calculations for Medicaid eligible providers?  

A: Importantly, this change affecting the Medicaid patient volume calculation is applicable to all eligible providers, regardless of the stage of the Medicaid EHR Incentive Program they are participating in. Billable services provided by an eligible provider to a patient enrolled in Medicaid would count toward meeting the minimum Medicaid patient volume thresholds.  Examples of Medicaid encounters under this expanded definition that could be newly eligible might include: behavioral health services, HIV/AIDS treatment, or other services that might not be billed to Medicaid/managed care for privacy reasons, but where the provider has a mechanism to verify eligibility.  Also, services to a Medicaid-enrolled patient that might not have been reimbursed by Medicaid (or a Medicaid managed care organization) may now be included in the Medicaid patient volume calculation (e.g., oral health services, immunization, vaccination and women’s health services, telemedicine/telehealth, etc.).

Providers who are not currently enrolled with their state Medicaid agency who might be newly eligible for the incentive payments due to these changes should note that they are not necessarily required to fully enroll with Medicaid in order to receive the payment.

In some instances, it may now be appropriate to include services denied by Medicaid in calculating patient volume.  It will be appropriate to review denial reasons.  If Medicaid denied the service for timely filing or because another payer’s payment exceeded the potential Medicaid payment, it would be appropriate to include that encounter in the calculation.  If Medicaid denied payment for the service because the beneficiary has exceeded service limits established by the Medicaid program, it would be appropriate to include that encounter in the calculation.  If Medicaid denied the service because the patient was ineligible for Medicaid at the time of service, it would not be appropriate to include that encounter in the calculation.

Further guidance regarding this change will be distributed to the states as appropriate.

CHIP patients eligible to be included in Medicaid patient volume totals
Q: The Stage 2 Rule describes changes to how a state considers CHIP patients in the Medicaid patient volume total when determining provider eligibility. Patients in which kinds of CHIP programs are now appropriate to be considered in the Medicaid patient volume total?  

A: States that have offered CHIP as part of a Medicaid expansion under Title 19 or Title 21 can include those patients in their provider’s Medicaid patient volume calculation as there is cost liability to the Medicaid program in either case (under the Stage 1 Rule, only CHIP programs created under a Medicaid expansion via Title 19 were eligible). Patients in standalone CHIP programs established under Title 21 are not to be considered part of the patient volume total (in Stage 1 or Stage 2). This change to the patient volume calculation is applicable to all eligible providers, regardless of the stage of the Medicaid EHR Incentive Program they are participating in.

Changes to the base year of the Medicaid EHR Incentive Program for hospital incentive payment calculation 
Q: Are there any changes to the base year for the Medicaid EHR Incentive Program hospital incentive payment calculation?

A: Yes. Previously Medicaid eligible hospitals calculated the base year using a 12 month period ending in the Federal fiscal year before the hospital’s fiscal year that serves as the first payment year.  In an effort to encourage timely participation in the program, §495.310(g)(1)(i)(B) of the Stage 2 Rule was amended to allow hospitals to use the most recent continuous 12 month period for which data are available prior to the payment year. This change went into effect upon publication of the Stage 2 Rule.  Only hospitals that begin participation in the program after the publication date of the Stage 2 Rule (i.e., program years 2013 and later) will be affected by this change.  Hospitals that began participation in the program prior to the Stage 2 Rule will not have to adjust previous calculations.

 

Filed Under: HIPAA, HITECH, Incentive Payments, Meaningful Use, Medicaid, Washington Tagged With: , , ,

Stage 2 Meaningful Use Final Rules Announced

August 27, 2012 By

After much delay and anticipation, the Stage 2 Meaningful Use Final Rules were announced late last week.  Though the primary focus of the new rules were to update (and increase) the meaningful use objectives and measures for the Medicare and Medicaid EHR Incentive Program, significant additional components regarding the EHR Incentive Program were also included.  To read the 672 pages of the Final Rule click here.  CMS has also posted a fact sheet which provides a good high level summary of some of the main topics of the Final Rule.  In addition to the Meaningful Use final rules, the Office of the National Coordinator has released its new standards governing certified EHR technology and a fact sheet.  The National eHealth Collaborative hosted a helpful webinar with an overview of these new rules, which can be accessed here.

Stay tuned for further information and analysis of these new rules, including an update regarding 2014, batch reporting for groups, commencement of payment adjustments, Medicaid patient volume calculations, new meaningful use measures, and more.

For immediate assistance regarding these new rules or for information regarding Stage 1 Meaningful Use and the EHR Incentive Program generally please contact Elana Zana.

Filed Under: Health Information Technology, HITECH, Incentive Payments, Meaningful Use, Medicare Tagged With: , ,

ONC Issues Guide on HIPAA Privacy and Security and Meaningful Use

May 8, 2012 By

ONC has recently released a new “Guide to Privacy and Security of Health Information” which incorporates tips on complying with HIPAA Privacy and Security as well as meeting related meaningful use measures.  The guide is designed for clinical providers and focuses on the following:

  • Privacy & Security and Meaningful Use
  • Security Risk Analysis and Management Tips
  • Working with EHR and Health IT Vendors
  • A Privacy & Security 10-Step Plan
  • Health IT Privacy and Security Resources

Specifically, with regard to Meaningful Use, the guide describes Meaningful Use measures 12 and 15:

#12. Provide patients with an electronic copy of their health information (including diag­nostics test results, problem
list, medication lists, medica­tion allergies) upon request.  To learn more about this measure click here.

#15. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.  To learn more about this measure click here.

If you have questions regarding HIPAA Privacy and Security or Meaningful Use please contact Elana Zana.

 

Filed Under: HIPAA, HITECH, Meaningful Use Tagged With: , ,

CMS Releases Proposed Rule On Meaningful Use Stage 2

February 23, 2012 By

CMS announced today its proposed rule (NPRM) on Stage 2 of the EHR Incentive Program Meaningful Use requirements.  These requirements apply to both eligible professionals and hospitals participating in the Medicare and Medicaid EHR Incentive Program.  As previously announced, and proposed within this NPRM, the onset of the Stage 2 meaningful use requirements will not begin until 2014.

The Stage 2 requirements include greater applicability to specialists, changes to the clinical quality measures, and modifications to the core and menu measures.  CMS has issued a fact sheet that briefly summarizes the Stage 2 requirements.

The NPRM will be published in the Federal Register on March 7, 2012.

For questions regarding the Stage 2 proposed requirements or for assistance related to the Medicare or Medicaid EHR Incentive Program please contact Elana Zana.

Filed Under: HITECH, Incentive Payments, Meaningful Use, Medicare

EHR Contracting Tip: Attestation for AIU

January 28, 2012 By

Now that most states have their Medicaid EHR Incentive Program in full swing we have gotten a glimpse of what they are requiring for attesting to “adopt, implement and upgrade” aka “AIU”.  As described in the CMS rules themselves, practices need to show that they have some skin in the game and have actually invested in an EHR product.  Many states are asking that an EP (or group practice) upload the actual EHR software contract (or a redacted version).  Some states (such as California) are requesting a signed vendor statement in lieu of the full contract.  

If you are a practice in the process of negotiating an EHR contract, you may want to consider including a provision in the contract specific to the AIU attestation requirements of the state your practice is in.  For example, requiring in the contract itself that the software vendor execute any documents required by the state to attest to AIU or that the vendor provide a letter acknowledging the practice’s EHR license (if such a letter is acceptable in your state). Similar provisions are recommended in situations where the practice is involved with a Stark donation arrangement or other type of third party contract. 

Setting expectations up front and creating a contractual obligation will help ensure that the software vendor or other third party contractor does not stand in the way of your practice receiving EHR incentive dollars.

For assistance in drafting and negotiating EHR software contracts or the Medicaid EHR Incentive Program in general please contact Elana Zana or Dave Schoolcraft.            

Filed Under: Anti-Kickback/Stark, HITECH, Incentive Payments, Meaningful Use

ACO Final Rule – Drastically Reduces Quality Measure Requirements

December 8, 2011 By

The Accountable Care Organization (“ACO”) final rules show that comments to CMS really do make a difference.  The public outcry against the 65 quality measures proposed in the spring led to CMS’ 50% cut of the number quality measures.  Along with the large cut, CMS explained its plan for allowing ACOs to meet the measure requirements by reporting on the measures in the first year and receiving “pay for performance” in the following years based on the weighted scores received in each quality measure.

Quality Measures

The revised list of quality measures are broken out into 33 different measures (predominately with NQF measure numbers) with four umbrella categories and five subcategories as follows:

  1. Patient/Caregiver Experience (7 measures)
  2. Care Coordination/Patient Safety (6 measures, includes the EHR Incentive Program)
  3. Preventative Health (8 measures)
  4. At Risk Population (12 measures)
    1. Diabetes (6 measures)
    2. Hypertension (1 measure)
    3. Ischemic vascular disease (2 measures)
    4. Heart failure (1 measure)
    5. Coronary Artery Disease (2 measures)

The tables provided in the final rule at pages 67889-90 are particularly helpful in visually identifying the measures, the method of data submission and whether the particular measure is pay for reporting or pay for performance.  The measures will be submitted to CMS through either surveys (for patient/caregiver experience measures), claims, the EHR Incentive Program, or the Group Practice Reporting Option (“GPRO”) Web Interface.  The surveys will be conducted using the Consumer Assessment of Healthcare Providers and System (“CAHPS”) surveys for 2012 and 2013, in future years, ACOs will have to select a CMS approved vendor to administer the surveys.

EHR Incentive Program

One of the significant changes to the quality measures was the expansion of the EHR incentive program related measure.  The quality measure no longer requires that 50% of the primary care providers to achieve meaningful use in order for the ACO to participate.  The EHR quality measure now recognizes those participating in the Medicaid EHR Incentive Program do not have to meet meaningful use requirements in their first year of participation.  As such, the new measure now includes primary care providers that successfully qualify for the EHR Incentive Program under either Medicare or Medicaid.  In addition, CMS cut previously proposed measures that were redundant with the EHR Incentive Program such as the measure concerning clinical decision support and electronic prescribing.

CMS still emphasizes the importance of the usage of the EHR technology by giving the EHR quality measure a higher weight.  Eligible professionals participating in ACOs are still eligible to separately participate in the EHR Incentive Programs or the e-prescribing incentive program.

Pay for Reporting vs. Pay for Performance

In the first year of participation, all of the quality measures may be satisfied by merely reporting on the quality measures.  For pay for reporting, ACOs will earn the maximum sharing rate for complete and accurate reporting of 100% of the required data, and no quality threshold must be met.  In the second year, 25 of the quality measures will be pay for performance, and eight will continue to be pay for reporting.  In the third year, all but one quality measure will be on a pay for performance basis.

In the pay for performance years, each domain will be given equal weight of 25% in the calculation of the ACOs overall quality performance score.  Each of the individual measures will be equally weighted within the domains, except for the EHR Incentive Program quality measure which is double weighted.  ACOs must minimally attain 30% (or be in the national 30th percentile) for that quality measure.  Subregulatory guidance will indicate the quality performance rates an ACO needs to achieve in order to earn the maximum quality points in a domain.

Recognizing that meeting all 33 measures in a given year may be difficult, CMS is requiring that ACOs achieve the quality performance standards on 70% of the measures in each domain.  Failure to achieve the 70% standard will result in a corrective action plan and re-evaluation in the final year.  However, if an ACO scores a zero for an entire measure, it will not be able to share in the savings generated.  Due to the double weight of the EHR measure, failure to meet the EHR measure in the Care Coordination domain would cause the ACO to miss the 70% cut-off.

Reporting Calendar & PQRS

ACOs are expected to report on the quality measures on a calendar year basis, beginning with the reporting period starting January 1, 2012 through December 31, 2012.  Even though a “performance year” in the regulations may begin in April or July of 2012 and end in December 2013, the quality performance for the first performance year will be based on reporting of the measures from January 1, 2013 through December 31, 2013.  Eligible professionals participating in an ACO that start the agreement in April or July of 2012 will also qualify for the 2012 PQRS incentive under the Shared Savings program by reporting the ACO GPRO measures for the full 2012 Physician Quality Reporting System (“PQRS”) calendar year reporting period.

Note that ACO participant entities that want to qualify for PQRS must participate as group practices and not separately participate or earn a PQRS incentive outside of the Shared Savings Program.  Individual ACO providers may not seek to qualify for the individual PQRS incentive under the traditional PQRS plans.  CMS also relaxed its requirements regarding the PQRS incentives.  If an ACO fails to meet the Shared Savings Program quality performance measures and therefore is not eligible for shared savings, the participating entities may still be eligible to receive the PQRS incentive under the Shared Savings Program.   

More Updates Coming

ACO participants should keep an eye out for subregulatory guidance which will detail the annual measure specifications.  CMS plans on releasing specifications in December and in the first quarter of 2012.

For more information regarding the ACO quality measures or ACOs in general, please contact Elana Zana.

Filed Under: Accountable Care Organizations, Health Reform, Incentive Payments, Meaningful Use, Medicare

Stage 2 Meaningful Use – Delayed to 2014

November 30, 2011 By

HHS announced today that eligible professionals (“EPs”) and hospitals who begin participating in the EHR Incentive Program in 2011 will not have to meet the Stage 2 Meaningful Use standards until 2014.  Therefore, those EPs and hospitals  participating in the Medicare EHR Incentive Program in 2011 will be able to show Stage 1 meaningful use in 2011, 2012, and 2013.  Those participating in the Medicaid EHR Incentive Program in 2011 will show Adopt, Implement or Upgrade in 2011, and Stage 1 meaningful use 2012 and 2013.

If you have questions on achieving meaningful use or the Medicare and Medicaid EHR Incentive Programs please contact Elana Zana.

Filed Under: HITECH, Incentive Payments, Meaningful Use

CMS Issues Stage 1 Info Sheets on Meaningful Use (updated July 2013)

August 12, 2011 By

CMS has issued information sheets on the meaningful use requirements.  Releasing one sheet for eligible professionals and another for eligible hospitals, these sheets are designed to explain each meaningful use objective and its respective measure.  The sheets provide links to each meaningful use objective and then explains the numerator and denominator requirements, attestation requirements and relevant additional information.  To access the information sheets click on the links below:

Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals or view the table of contents.

Stage 1 EHR Meaningful Use Specification Sheets for Eligible Hospitals

CMS is also offering a National Provider call regarding meaningful use on August 18th.  To register for the call click here.

Understanding the meaningful use measures and objectives is sometimes complicated.  For assistance with meaningful use or the EHR Incentive Programs in general contact Elana Zana.

Filed Under: HITECH, Incentive Payments, Meaningful Use, Medicare
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