2015 Meaningful Use Flexibility Rule Brings Much-Needed Relief

Yes, October is pretty late to be formalizing changes to meaningful use (MU) for the current year, but these changes provide some welcome relief to eligible providers (EPs) who are still finding their stride when it comes to MU. Here are the highlights of the adopted changes:

  • 90-day reporting period for all EPs in 2015. All EPs, regardless of previous MU participation may attest to a reduced period of 90 consecutive days for 2015. Although you can attest to any 90-period in CY 2015, the attestation system will be available only between January 4 and February 29, 2016. If you’ve been keeping up with your meaningful use throughout 2015, you can choose any 90-day reporting period. If you relaxed your meaningful use in 2015, your reporting period will likely be October 1–December 31.
  • 90-day reporting period for new participants in 2016. Any EP beginning participation in 2016 may report a reduced period of 90 consecutive days for 2016. All EPs continuing or resuming participation will be required to report a full year for 2016.
  • Streamlined measure and objective reporting. This streamlined reporting eliminates the need to report several redundant objectives and measures that have been widely adopted in the industry (and thus assumed you are fulfilling). While you might view this streamlined reporting as removing the low-hanging fruit, it removes a lot of the clutter that complicates reporting.
  • Aligning Stage 1 and Stage 2. CMS is overhauling the structure of the objectives by eliminating the Menu Set in favor of a streamlined Core Set. All providers, regardless of stage will attest to the same core set. For those EPs who were scheduled to attest to Stage 1, additional exclusions and alternative measures are available.

Highlights of the Changes

Most EPs will breathe a sigh of relief over these two modifications:

  • The Patient Electronic Access threshold is reduced from 5% of the patient population to at least one patient. This is a huge relief to those EPs who serve patient populations who are uncomfortable accessing their records online.
  • The Use Secure Messaging is changing from a percentage-based objective to a yes-no objective. This means that you can report that you have the functionality fully enabled even if none of your patients sent you a message.

In addition, the following measures have been removed because they were redundant or the industry has already widely adopted them as best practice:

  • Record Demographics
  • Record Vital Signs
  • Record Smoking Status
  • Clinical Summaries
  • Clinical Lab Test Results
  • Patient Lists
  • Preventive Care (Patient Reminders)
  • Summary of Care (measures 1 and 3)
  • Electronic Notes
  • Imaging Results
  • Family Health History

These are just the highlights of the meaningful use changes that go into effect for the 2015–17 reporting years. We’ll post the details and updated documentation within the next few days on eyefinity.com.

PQRS vs. CQMs—What’s the Difference and How Do I Report Them?

There’s a lot of confusion and frustration in the healthcare industry right now about the government quality programs, where they overlap (and where they still don’t), and how to report the correct information.

A (Brief) History

The Physician Quality Reporting System (PQRS) has been around since 2007. Traditionally providers voluntarily reported at least three measures by including level II CPT codes on their Medicare Part B claims, and they received an incentive payment from CMS.

Clinical Quality Measures (CQMs) were introduced in 2011 as part of the EHR Incentive Program, better known as meaningful use. This program required providers to manually enter a calculated percentage for six to nine measures to receive an incentive as part of meaningful use.

A Confluence of Program Changes

Recently, the Centers for Medicare and Medicaid Services (CMS) initiated plans to align the PQRS and the CQM measures to make reporting easier for providers. At the same time, CMS is laying the groundwork to discontinue the claims-based PQRS reporting that providers have become accustomed to. CMS’ goal is for providers to electronically submit a file that contains all of their yearly quality data to satisfy the requirements for both PQRS and CQMs. You may have heard of this file referred to as QRDA. Continue reading

Meaningful Use Hardship Exceptions Extended

Featured imageCMS has reopened the submission period for hardship exception applications, allowing eligible providers (EPs), like you, one last chance to avoid the 1% Medicare payment penalty in 2015. The new deadline is November 30 at 9:59 pm Pacific. You must complete the Hardship Exception Application and email it to ehrhardship@provider-resources.com.

Chasing Deadlines

October 1 was a frenzied rush as thousands of EPs attempted to attest to meaningful use to avoid the 1% Medicare penalty in 2015. The crushing volume strained the attestation system as well as the call centers of EHR vendors. Frustration increased when EPs attempted to attest to the 2011 Edition criteria under the recent delay because CMS’s attestation system had not been retrofitted to accommodate the revised rules.

Breathing a Collective Sigh of Relief

To alleviate the situation, CMS has decided to reopen the submission period for hardship exception applications after a three-month hiatus. EPs who were stuck in the snarl of October 1 will surely appreciate this extension.

Reading the Fine Print

This extension is not an outright postponement of Medicare penalties in 2015. To be eligible for a hardship exception, you must meet the following criteria:

  • You were unable to fully implement a 2014 Edition certified EHR because your certified software was not available soon enough for you to install, train, and use prior to July 1
  • You were unable to attest by October 1, 2014, using the flexibility options provided in the 2014 Flexibility Rule

Visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments.

Closing Out 2012 Meaningful Use

MSMU VerticalAs 2012 comes to a close, many of you, who are participating in the Medicare and Medicaid EHR Incentive Programs, are going to be attesting to meaningful use for the first time. While attesting or reporting your meaningful use might seem like a daunting and nerve-wracking process, it only seems that way because it’s a new experience.

Here are some things to keep in mind and links to additional resources where you can find complete information about meaningful use, attestation, and the EHR Incentive Programs.

Attesting on Time

You must attest to meaningful use after your reporting period, and not during your reporting period. If your attestation period continues through December 31, you may then complete your attestation beginning January 1. For the Medicare EHR Incentive Program you must complete your attestation by February 28, 2013. If you are participating in the Medicaid EHR Incentive Program, check with your state’s Medicaid for applicable deadlines.

Even if you can’t officially attest until January 1, you will want to perform steps 1 and 2 below to head off any potential shortcomings.

Navigating the Attestation System

Each doctor must attest individually, you cannot attest as a practice. Follow these steps to ensure your attestation goes smoothly:

  1. In ExamWRITER, click the Reports menu and run the CMS Meaningful Use Reporting and CMS Quality Reporting. For complete instructions, press F1 for help.
    – The meaningful use report lists only those measures that require percentages. The unlisted measures require a simple yes or no answer.
    – If your percentages are low in some of the menu measures, don’t fret. You only need to report on 5 out of the 10 menu set measures, provided one of them is menu 9 or 10.
    – Many of the measures may be satisfied by claiming an allowable exclusion.
    – The clinical quality measures may show low percentages. That’s okay. They don’t have minimum thresholds.
  2. Practice your attestation using CMS’ Meaningful Use Attestation Calculator.
    – If your numbers are low review the “Achieving Meaningful Use with OfficeMate/ExamWRITER” or “Tracking CMS Quality Measures in ExamWRITER” documents, which can be found on our Meaningful Use Starter Kit page. If your attestation period has not ended, there may still be time to correct some shortcomings.
    – If didn’t realize that you were short in a measure until after 2012 was over, look for allowable exclusions. If no exclusion applies to you, it is too late to correct any shortcomings.
  3. Attest to your meaningful use through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.
    – Use the Attestation User Guide for Eligible Professionals for visual, step-by-step instructions.
    – Attestation is self-reported. You do not need to furnish documentation when you attest. Documentation may be required later (see “Surviving an Audit,” below).
    – If you are asked for your EHR Certification Number, refer to this knowledge base article.

Surviving an Audit

Since the EHR incentive programs are government-funded initiatives, audits are an important part of abating fraud and waste in the program. CMS will not release specific information about the nature of the audits, but they have posted some general guidelines on their Frequently Asked Questions page. While OfficeMate/ExamWRITER users have nothing to fear from these audits, we encourage you to save a printed or electronic copy of your meaningful use calculations and any communications that you have had regarding meaningful use. For example, you’ll want to save copies of the following:

  • Meaningful use report calculations
  • Clinical quality report calculations
  • Email showing that you transmitted a CCR to a colleague (core 14)
  • Checklist or documentation from your security audit (core 15)
  • A full screenshot of OfficeMate or ExamWRITER with the About window open (showing the date and the practice license information)
  • Any other documents or communications you have regarding meaningful use

Getting Paid

In theory, you can expect to see your check between six to eight weeks after attesting to meaningful use.

In reality, there are a number of factors that could delay your payment:

  • If you have not yet reached $24,000 in Medicare Part B billings, your payment will be held until you do. Your incentive payment for 2012 is based on 75% of your Part B billings up to a ceiling of $24,000, making the maximum payment $18,000.
  • If you do not bill $24,000 in Medicare Part B billings in 2012, your payment will be sent six to eight weeks after the final day to bill for 2012, which is February 28. So, you won’t see your check until April.
  • If you participated in a state Medicaid incentive program, the payment timeframe varies drastically.

Payments are made on a per-provider basis, and not per practice. Payments are based on a percentage of your allowable Medicare Part B billings. Even if your practice bills under one NPI, the incentive is determined by the rendering provider’s NPI on the CMS 1500.

Continuing Meaningful Use

For 2013, you will once again attest to stage 1, but for the entire calendar year.

For 2014, you will attest to 90 days of stage 2 meaningful use (we’ll be communicating with you about that throughout 2013 and 2014).

There’s Still Time to Reach Your Full Potential

James Kirchner, OD

2012 is a very important year from an EHR meaningful use incentive perspective. A year that should not be ignored if you have plans to move into a certified EHR system and get the most incentive money possible from Uncle Sam. Under the HITECH act, 2012 is that last chance to get the full $44,000 under the Medicare meaningful use program. Here’s how it works.

The HITECH incentive plan began January 1, 2011. On that date, CMS began the meaningful use program under the first of three stages. In Stage 1, which is the easiest of the three stages, an eligible provider (both optometrists and ophthalmologists are EPs in the Medicare program) can fulfill meaningful use for 90 days in their first year. If that is accomplished in either 2011 or 2012, an eyecare professional is qualified to receive a potential $44,000 (depending on your annual Medicare Part B allowable billings) over the length of the incentive program, with the first year check of $18,000.

If for whatever reason, you fail to get your first year accomplished in 2012, you will automatically lose $5,000 in potential incentive money. Realize this means that you must start your 90 days of meaningful use no later than October 1, 2012. If you miss that date, you have missed fulfillment in 2012 and must wait for 2013.

Another HITECH bonus for getting it done in 2012 is that CMS has just announced that Stage II meaningful use will not begin until 2014 rather than 2013. That means you will have two years to fulfill meaningful use under the easier Stage I. For those of you who were successful in 2011, you have three years of fulfillment under Stage I.

There is no reason to wait. At Eyefinity, we have our certified suite of OfficeMate/ExamWRITER v10 ready for you. In fact we already have thousands of offices using the certified version and we are proud to say that in 2011 nearly 1,000 of our customers fulfilled meaningful use, almost twice as many as our competitors. We have a full training program and a powerful meaningful use knowledge base on our website at eyefinity.com.

So don’t wait any longer. Do yourself and your practice a favor by moving into the modern world of EHR. You will never regret the move and your pocketbook will be the proof. Don’t run the risk of someday looking back and saying, “if only I had…”

– James K. Kirchner, OD
Chief Professional Officer, Eyefinity

Attesting to Meaningful Use: Getting Paid to Improve Patient Care

Today’s entry comes from Robert Bass, OD, FAAO

CMS, the HITECH Act, meaningful use? Oh, no!! Improved patient care and stimulus money? Oh, yes!! How to get it done painlessly? OfficeMate and ExamWRITER!!

Dr. Robert Bass

Dr. Bass recently implemented OfficeMate/ExamWRITER v10 as his certified EHR and has already qualified for stimulus money.

For me, the HITECH Act was initially difficult to understand, especially all of the requirements for meeting meaningful use (MU). OfficeMate/ExamWRITER v10 made it easy for me to comply with the requirements and document the necessary information. CMS warns that it may take a doctor 10–20 hours to complete the attestation, but I was able to complete it in less than 45 minutes and was successful in my attesting to meaningful use within the first quarter of the reporting year. The OfficeMate/ExamWRITER software was integral in my successful and prompt attestation.

My practice began using OfficeMate/ExamWRITER a little over a year ago and upgraded to the certified v10 on January 3, 2011. Implementing a certified electronic health record (EHR) for meaningful use has raised the level of attention to detail of my staff and myself because we now have to document specific criteria for every patient. This enforces a consistently high level of care from one patient to the next. We have noticed better recordkeeping in such areas as patient demographics, correspondence, and referring doctors. All of these improvements took shape without our having to drastically change how we use OfficeMate and ExamWRITER.

I am looking forward to receiving my incentive check for my compliance, but even more so, I am looking forward to continuing to provide the utmost care for my patients.

I urge all optometrists to implement an EHR, and I recommend that you start now. Each year of the HITECH Act builds on the next, and the incentive payments are reduced each year. In 2011, you can be eligible to receive incentive payments after 90 days of using a certified EHR in a meaningful manner. In the coming years, the attestation period will be longer, and the payments will be smaller. Act today while the rewards are at their highest.

Dr. Bass is a proud alumnus from the College of William and Mary, where he earned a Bachelor of Science in Biology. He graduated with honors from the Southern College of Optometry in Memphis, Tennessee. In 1986, Dr. Bass became a Fellow in the American Academy of Optometry. Dr. Bass practices optometry in Manassas, Virginia, where ha has practiced for thirty years. An accomplished professional, Dr. Bass is also an avid fisherman and a dedicated family man.

Attesting to Meaningful Use: Another Success Story

Today’s entry comes from Ryan Wineinger, OD.

Dr. Ryan Wineinger

Dr. Wineinger has leveraged OfficeMate/ExamWRITER to fulfill meaningful use.

Many optometrists don’t want to look at or think about meaningful use (MU) because they doubt that they will be included in the HITECH Act or eligible for stimulus money. Well, I can now say that, as an optometrist, I have successfully attested to using a certified electronic health record in a meaningful manner. I am now eligible for the funds allotted in Year 1, Stage 1 of the HITECH Act.

My practice started using OfficeMate/ExamWRITER v10 the day after returning from the New Year’s holiday. In fact, I registered for the EHR incentive program on the first day that we were allowed to apply.

Our practice has used OfficeMate/ExamWRITER for the last seven years. Since we’ve been using the programs for so long, I thought that I’d be able to breeze through meaningful use. I can now honestly say it takes some time to study and understand the requirements for meeting all of the necessary measures. Once I spent a few hours studying all of the incentive program information on the CMS Web site and Eyefinity’s Meaningful Use Starter Kit, I was confident that I would know how to meet each measure.

ExamWRITER is designed in such a way that I didn’t need to document my eye examinations much differently than I did before the incentive program. There are areas of the software where I had to document items in a different place, because fields were added or moved, but I didn’t necessarily need to change what I was doing.

A critical feature in OfficeMate/ExamWRITER v10 is the MU Report Card, which helps you gauge your meaningful use. Initially, I looked at the report several times a day to ensure that I was getting credit for each measure. After the second week, I looked at the report card report only weekly to ensure that I was on pace to meet MU requirements at the end of my 90-day reporting period.

Finally, on April 18th, CMS allowed us to attest to the fact that we had indeed met the meaningful use requirements. I plugged in my numbers from my report card into the Meaningful Use Attestation Calculator to ensure I was eligible to qualify. After verifying our numbers, I logged into the attestation site, entered my information, and after roughly 30 minutes, I successfully completed the attestation process!

Now I have reached the hardest part of the process—waiting for my incentive money! Based on the calculations used for the HITECH Act, we will meet the maximum billable amount sometime this summer, and once we do that, we will receive our incentive money.

I encourage every optometrist out there to start using an EMR. I feel that it gives me more information at my fingertips and allows me to provide more thorough care for my patients. The government believes this, too, and that is why they allowed optometrists to participate in the HITECH Act. I’m happy to say that OfficeMate/ExamWRITER gave me the appropriate tools to participate in the meaningful use incentive program.

Dr. Ryan Wineinger received his undergraduate degree from Kansas University. He then graduated from The Southern College of Optometry in Memphis, Tennessee. After graduation, he went into practice with his father at Wineinger Eyecare. Dr. Wineinger thoroughly enjoys the technological side of optometry and has made concentrated efforts to bring in the latest equipment to ensure that his patients are receiving the highest level of comprehensive care possible in regards to their eyesight. He is a member of the American Optometric Association and the Greater Kansas City Optometric Society.