Meaningful Use: Registration, Attestation, Workflow Tips and Tricks

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1 Meaningful Use: Registration, Attestation, Workflow Tips and Tricks Allison L. Weathers, MD Medical Director, Information Services Rush University Medical Center Gregory J. Esper, MD, MBA Vice Chair, Neurology Associate Medical Director, Information Services Emory University and Emory Healthcare

2 Pathway to Getting Incentive Dollars Registration Attestation Preregistration

3 Determining Eligibility Medicare Based on 75% of Medicare Part B allowed charges for the calendar year Should have at least $24K in allowed charges to maximize incentive payment in year one Medicare will hold incentive payment until you meet threshold or until final attestation deadline (~Feb 28, 2013 Medicare) Medicaid 30% Medicaid volume for 90-consecutive day period during past calendar year 20% threshold for Pediatricians (reduced incentive) Additional rules may apply based on state regulations

4 Pre-Registration: NPPES National Plan and Provider Enumeration System NPPES Username and Password required Obtained during NPI application process NPI Enumerator:(800) minutes per provider EP must be physically present

5 Pre-Registration: PECOS Provider Enrollment, Chain and Ownership System EPs must have an enrollment record Billing and receiving payments from Medicare does not equal enrollment record PECOS Help Desk number: (866)

6 Creating a Proxy Can elect to have someone complete process on your behalf Will need to login to the Identify and Access Management System (I&A) Locate the request for a proxy, approve the subsequent change. EP will appear in the proxy s account one day later. https://nppes.cms.hhs.gov/nppes/iapecoslogin.do?forward=static.login Physician signs in and clicks here to approve a proxy access request

7 Registration Tips/Tricks User name and password are case sensitive Can register before you have a certified EHR Register even if you do not have an enrollment record in PECOS Though required for all Medicare EPs Can t register for Medicaid EHR Incentive Program until: State's program has launched State's site has opened

8 Registration

9 You can change program registration as many times as needed prior to attestation. Once you ve attested, you may only change programs once. You will need to know your certified EHR technology certification number for attestation, so we recommend looking it up and entering it here.

10 SSN Payee TIN Type = provider receives payment **have not reassigned Medicare benefits to another entity in PECOS EIN Payee TIN Type = group receives payment

11 This information will be posted on the EHR Incentive Program website once you have received payment. Data on this page is pulled from the provider s practice location stored in NPPES. You can update your information, however, it will not be sent back to NPPES.

12

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14 Rejected Registration/Attestation Reasons 1) Death Master File (DMF) validation failed: Provider s legal name and SSN are on the DMF 2) NPI status in NPPES is in Deactivated status 3) Enrollment status in PECOS not approved 4) OIG Exclusions in PECOS 5) Hospital-based Professional: > 90% allowed services in inpatient or ED setting

15 Meaningful Use = MU Core Menu CQMs Meaningful Measures Measures Use

16 Eligible Professional Meaningful Use Table of Contents Core Set of Objectives 1. Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines 2. Implement drug/drug and drug/allergy interaction checks Attestation 3. Maintain an up-to-date problem list of current and active diagnoses 80% 4. Generate and transmit permissible prescriptions electronically (erx) 40% 5. Maintain active medication list 80% 6. Maintain active medication allergy list 80% 7. Record all following demographics: Preferred language, Gender, Race, Ethnicity, Date of birth 50% 8. Record and chart changes in the following vital signs: Height Weight Blood Pressure Calculate and display body mass index (BMI) 9. Record smoking status for patients 13 years old and older 50% 10. Report ambulatory clinical quality measures to CMS or in the case of Medicaid EPs, the states Attestation 11. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule 12. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request 13. Provide clinical summaries for patients for each office visit 50% 14. Capability to exchange key clinical information (e.g. problem list, med list, allergies, dx test results), among providers of care and patient authorized entities electronically 15. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities 30% 50% Attestation 50% within 3 business days Attestation Attestation

17 Eligible Professional Meaningful Use Table of Contents Menu Set of Objectives 1. Implement drug formulary checks Attestation 2. Incorporate clinical lab-test results into EHR as structured clinical data 40% 3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach Attestation 4. Send patient reminders per patient preference for preventive/follow-up care 10% 5. Provide patients with timely electronic access to their health information (including lab results, problems lists, med lists, allergies) within 4 business days of the information being available to the EP 10% 6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate 7. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation 8. The EP who receives a patient from another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral 9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice 10% 50% 50% Attestation (must have at least this measure or #10) 10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice Attestation (must satisfy at least this measure or #9)

18 Workflow Tips/Tricks Work from your electronic note Notes will generally have many MU features embedded Will need voice recognition software to facilitate flow Leverage other resources to do work for you Patients: document height, weight, BP via waiting room check in Staff: population of problem list, med reconciliation Get on a Portal Gives you core 12, 13, 14 and menu 4, 5, 6,

19 What CQMs should I use?

20 3 Core Measures Core Measures - ALL PROVIDERS REPORT ON THESE (IF NO PATIENTS< OK TO ENTER "0") Adult Weight Screening and Follow-Up Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented. Hypertension: BP Measurement Preventive Care /Screening Measure Pair: a. Tobacco Use Assessment b. Tobacco Cessation Intervention Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded. Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months. Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who received cessation intervention.

21 0004 NCQA Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement The percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit NCQA Low Back Pain: Use of Imaging Studies The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis NCQA Diabetes: Foot Exam The percentage of patients aged years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam).

22 0068 NCQA Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1 November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of use of aspirin or another antithrombotic during the measurement year NCQA Ischemic Vascular Disease (IVD): Blood Pressure Management The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1 November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and whose most recent blood pressure is in control (<140/90 mmhg) NCQA Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1 November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had a complete lipid profile performed during the measurement year and whose LDL-C was <100 mg/dl.

23 Clinical decision support rules: unify with CQMs A fib on problem list? Anticoagulation Prescribed? Smoker? Smoking cessation counseled? Low back pain < 28 days? Imaging cancelled? BMI out of range? Dietetics Consult?

24 Attestation Tips/Tricks Retain all attestation documents (paper or electronic) for 6 yrs in case of audit Objective data: numerator/denominator Clinical Quality Measure data: denominator/numerator Average time to attest min / EP Payment received within 4-8 wks of attestation *Pending allowed charges threshold for Medicare EPs has been met, otherwise, CMS will hold funds

25 Attestation 1) Exclusions 2) Pt Records 3) Enter Data 4) Accuracy 5) Save/Continue 6) Repeat

26 Menu Objectives select 5 4 of 8 1 of 2 You must submit at least one measure from the public health list even if an Exclusion applies to both.

27 Key Issue/Tips with CMS Webpages 1) Invisible or Missing Buttons 2) Only Press button once or it will redirect you back and hold up the process *Look at your browser to see if it is thinking

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