It s where we drive Quality Improvement and Get Money to aid in our ability to provide quality patient care

Transcription

1 Leslie H. Perkins

2 Leslie H. Perkins

3 It s where we drive Quality Improvement and Get Money to aid in our ability to provide quality patient care

4 The American Recovery and Reinvestment Act (Recovery Act) of 2009 provides for incentive payments beginning in 2011 for Medicare EPs, eligible hospitals, including Medicare Advantage affiliated hospitals, and CAHs that are meaningful users of certified EHR technology.

5 PQRS, erx and EHR Incentive Programs Review: Medicare Incentive Program Medicaid Incentive program Stage 1 Meaningful Use Performance Requirements Meaningful Use Enrollment Attestation How to Prepare Medicare Medicaid Meaningful Use Payments Meaningful Use Audits Stage 2 preview

6 As of 4/30/2012 for Medicare, 439 providers in SC have received $7,665,678 in Medicare EHR Incentive $. 17 CITIA providers have received $306,000 in Medicare EHR Incentive $. 6 SC Hospitals have received a combined total $13,519, providers and 44 hospitals have REGISTERED for either the Medicare or Medicaid Incentive Program

7 As of 5/25/2012 for Medicaid, 1138 providers in SC have received $24,033,757 in Medicaid EHR Incentive $. 451 CITIA providers have received $9,583,750 in Medicaid EHR Incentive $. 4 SC Hospitals have received a combined total $2,973, providers with the SCPHCA have received $4,823,750 in incentive payments..

8 Alabama Alaska Indiana Iowa Kentucky Louisiana Michigan Missouri Mississippi North Carolina Ohio Oklahoma Pennsylvania South Carolina Tennessee Texas Washington 17 states have initiated their Medicaid EHR incentive programs since January 2011, issuing about $83 million in incentive payments

9 Physician Quality Reporting System (PQRS) Payments are available until Beginning in 2015, EPs who do not satisfactorily report Physician Quality Reporting System measures will be subject to payment adjustments Electronic Prescribing (erx) Payments are available until 2013 Beginning in 2012, payment adjustments will take effect for EPs who are not successful e-prescribers. Electronic Health record Incentive Program (EHR) Began in calendar year 2011 EPs can earn incentive payments for up to 5 years for Medicare or 6 years for Medicaid No Medicare EHR incentive payments will be made to EPs whose first year of participation in the Medicare EHR Program is 2015 or later 2015, payment adjustments will take effect for Medicare FFS EPs who cannot successfully demonstrate meaningful use of certified EHR technology There are currently no penalties for not demonstrating meaningful use for Medicaid EPs.

10 PQRS erx EHR PQRI Yes Yes erx Yes Only if EHR payments through Medicaid EHR Yes Only if EHR payments through Medicaid

11 PROGRAM PQRS erx Medicare EHR Medicare x x x Total Incentive PAYMENT AMOUNT $ % of the $50,000 in allowed charges submitted to Medicare $0.00 Not eligible for Payment $18,000 The maximum incentive available through Medicare $18, 250 The physician bills $50,000 in allowable charges and participates in PQRS and Medicare EHR Incentive Program

12 DO YOU HAVE A CERTIFIED.EHR.? For the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals, must use certified EHR technology

13 Participation can begin in Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA). To get the maximum incentive payment, Medicare eligible professionals must begin participation by Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment. Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.

14 Incentive payments for eligible professionals are based on individual practitioners. If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology. Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services. Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting. Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor

15 The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories started in Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is Hospital payments are based on a number of factors, beginning with a $2 million base payment. There are no payment adjustments under the Medicaid EHR Incentive Program.

16 Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals * Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria. Eligible professionals under the Medicaid EHR Incentive Program include: Physicians (primarily doctors of medicine and doctors of osteopathy) Nurse practitioner Certified nurse-midwife Dentist Physician Assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

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19 Core set: All 15 Measures Required Menu set: Select 5 of 10 Demographics (50%) Vitals: BP and BMI (50%) Problem list: ICD-9-CM (80%) Active medication list (80%) Medication allergies (80%) Smoking status (50%) Patient clinical visit summary (50% in 3 days) Patient with electronic copy (50% in 3 days) e-prescribing (40%) CPOE medication) (30% at least 1 Drug-drug and drug-allergy interactions (functionality enabled) Exchange critical information (perform test) Clinical decision support (one rule) Security risk analysis Report Clinical Quality Measures-Core + 3(BP, BMI, Smoking, plus 3 others) Drug-formulary checks (one report) Structured lab results (40%) Patients by conditions (one report) Send patient-specific education (10%) Medication reconciliation (50%) Summary care record at transitions (50%) Send reminders to patients for preventative and follow-up care (20% > 65yrs. < 5yrs.) Patient electronic access to labs, problems, meds and allergies (10% in 4 days) Immunization registries (perform at least one test) Syndromic Surveillance reporting (perform at least one test)

20 A National Provider Identifier (NPI) All eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must have a National Provider Identifier (NPI) to participate in the Medicare and Medicaid EHR Incentive Programs. An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) All eligible hospitals and Medicare eligible professionals must have an enrollment record in PECOS to participate in the EHR Incentive Programs. (Note: Eligible professionals who are only participating in the Medicaid EHR Incentive Program are not required to be enrolled in PECOS.) If you do not have an enrollment record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs.

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22 Register for EHR Incentive Program

23 Eligible professional-have your user ID and Password used to register. If the EP uses a third party users working on behalf of an EP must have: an Identity and Access Management System (I&A) web user account (User ID/Password), and be associated to the EP's NPI. Go to the ONC CHPL website: for EHR Certification ID Select your practice type by selecting the Ambulatory or Inpatient buttons. Search for EHR Products by browsing all products, searching by product name or searching by criteria met. Add product(s) to your cart to determine if your product(s) meet 100% of the CMS required criteria. Request a CMS EHR Certification ID for CMS attestation. NOTE: The "Get CMS EHR Certification ID" button will not be activated until the products in your cart meet 100% of the CMS required criteria. If the EHR product(s) do not meet 100% of the CMS required criteria to demonstrate Meaningful Use, a CMS EHR Certification ID will not be issued. The CMS EHR Certification ID contains 15 alphanumeric characters.

24 Use The Meaningful Use Attestation Calculator

25 Medicare eligible professionals, eligible hospitals and critical access hospitals will have to demonstrate meaningful use through CMS' web-based Registration and Attestation System. In the Medicare & Medicaid EHR Incentive Program Registration and Attestation System, providers will: Fill in numerators and denominators for the meaningful use objectives and clinical quality measures, Indicate if they qualify for exclusions to specific objectives, and Legally attes that they have successfully demonstrated meaningful use Immediately after you submit your results you will see a summary of your attestation, and whether or not it was successful

26 Providers will follow a similar process using their state's Attestation System. Under the Medicaid EHR Incentive Program, providers can attest that they have adopted, implemented or upgraded certified EHR technology in their first year of participation to receive an incentive payment.

27 Incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an eligible meets the program requirements and successfully attests. Medicaid incentives will be paid by the states and are expected also to begin in States are required to issue incentive payments within 45 days of providers successfully attesting to having adopted, implemented or upgraded certified EHR technology during their first year of participation in the Medicaid EHR Incentive Program. Payments to Medicare providers will be made to the taxpayer identification number (TIN) you selected at the time you registered for the Medicare EHR Incentive Program. CMS will deposit payment in the first bank account on file. It will appear on your bank statement as "EHR Incentive Payment If you receive payments for Medicare services via electronic funds transfer, you will receive Medicare EHR Incentive Program payment the same way. If you currently receive Medicare payments by paper check, you will also receive your first Medicare EHR Incentive Program payment by paper check. IMPORTANT: Medicare Administrative Contractors (MACs), carriers and fiscal intermediaries will not be making these payments. CMS has contracted with a Payment File Development Contractor to make these payments.

28 The Medicare & Medicaid EHR Incentive Program Registration and Attestation System contains a Status tab at the top which will contain the amount of the incentive payment, the amount of tax or nontax offsets applied, and the remittance advice reason code containing the reason for any reduction. For those receiving paper checks, there will be a tear-off pay stub which identifies offsets made to the incentive payment.

29 Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit. All providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic format used in the completion of the Attestation Module responses). Documentation to support the attestation should be retained for six years post-attestation. Documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes. CMS, and its contractors, will perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers. States, and their contractors, will perform audits on Medicaid providers. CMS and states will also manage appeals processes.

30 To ensure you are prepared for a potential audit, save the supporting electronic or paper documentation that support your attestation. Also save the documentation to support your Clinical Quality Measures (CQMs). Upon audit, the documentation will be used to validate that the provider accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate.

31 There are numerous pre-payment edit checks built into the EHR Incentive Programs' systems to detect inaccuracies in eligibility, reporting and payment. Post-payment audits will also be completed during the course of the EHR Incentive Programs. If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped. CMS will be implementing an appeals process for eligible professionals that participate in the Medicare EHR Incentive Program. States will implement appeals processes for the Medicaid EHR Incentive Program. For more information about these appeals, please contact your State Medicaid Agency.

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33 Stage 1 Stage 2 CPOE-30% Drug-Drug, Drug- Allergy Checking enabled CPOE-60% Rx and Lab orders Drug-Drug, Drug- Allergy Checking enabled erx >40% erx >50% Demographics >50% Report CQMs Demographics >80% Report CQMs Problem List 80% Problem List 80% Medication List 80% Medication List 80% Allergy List 80% Allergy List 80% Vital Signs 50% age 2 and up Smoking Status 50% Vital Signs 80% age 3 and up Smoking Status 80% Stage 1 Stage 2 Decision Support Rule 1 Drug Formulary Checks elective Advanced Directives Lab Results 40%- elective Generate 1 report by specific patient condition NEW Decision Support Drug Formulary Checks required 10% of patients seen during reporting period Lab Results 40%- required Generate patient lists for multiple patient specific parameters 30% of EP visits have at least 1 electronic note-

34 Stage 1 Stage 2 Provide Patients with an electronic copy of health information Send Appropriate Reminders for Preventive Care Timely Access >10% of unique patients have timely access to health information Medication reconciliation- Elective DROPPED Becomes required- (appointment reminders do not count0 10% of patients/families view and download their health information within 24 hours of an encounter Medication reconciliation- Required Stage 1 Stage 2 Clinical Summaries to patients to for >50% of all office visits within 3 business days >10% patients receive specific educational material-elective NEW NEW Patients receive clinical summary for 50% of all visits with 24 hours. 10% patients receive specific educational material-required Patients offered secure on-line messaging, >25 patients have sent secure messaging Record patient preferences for communication

35 Stage 1 Stage 2 Exchange of Clinical Information Summary of Care Record >50% transitions of care NEW NEW Immunization Registry Submission- Elective Eliminated in favor of use case objectives Summary of Care Record at least 25 sent electronically 10% of patients have a list of care team members via electronic exchange Develop Summary and Care Plan Immunization Registry Submission-Core Stage 1 Stage 2 Syndromic Surveillance- Elective Conduct a security analysis and provide corrections for deficiencies NEW Reconsider if applicable to EP Conduct a security analysis and provide corrections for deficiencies Address encryption for data at rest Reportable Cancer Conditions

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