WHAT S NEW ON THE EHRFRONT? Mike Orr, Director Travis Skinner, Senior Managing Consultant TODAYS AGENDA Finalized 2015 EHR Modification Rule (EHs & EPs) New Measures & Objectives EHR Tentative Settlement Letters HITECH Payment Audits Medicaid EHR Audits Meaningful Use Audits / SRA guidance / Flexibility Rule 1
Stage III Regulations Snippets from the Stage III public notice: Stage 3 will focus on improving health care outcomes and further advance interoperability. CMS plans to propose changes to the reporting period, timelines, and structure of the [EHR Incentive Program], including providing a single definition of meaningful use CMS intends to provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements. Finalized 2015 EHR Modification Rule The Finalized rule was published on October 6th and is based on: Elevating patient-centered care Improving health outcomes Supporting the providers who care for patients The delay for the rule was due to the combining of the three proposed rules; the ONC Rule, Stage III Meaningful Use Rule, & the 2015 Modification Rule. 2
Finalized 2015 EHR Modification Rule Major Changes approved: Program year 2015 is now any continuous 90 day reporting period Program year 2015 will be 15 months 10/01/2014 to 12/31/2015 Attestation window for Program year 2015 is 01/04/2016 to 2/29/2016 Program year 2016 and after will now be a calendar year Modified other aspects of the programs Alternative Exclusions & Specifications for Stage 1 & Stage 2 1 st Year Stage of Meaningful Use 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2011 1 1 1 2 2 3 3 TBD TBD TBD TBD 2012 1 1 2 2 3 3 TBD TBD TBD TBD 2013 1 1 2 2 3 3 TBD TBD TBD 2014 1 1 2 2 3 3 TBD TBD 2015 1 1 2 2 3 3 TBD 2016 1 1 2 2 3 3 2017 1 1 2 2 3 3
NPRM FROM 2014 CMS Flexibility & ONC Rule Schedule 8// experience ideas 4
Modifying other aspects of the programs for EPs Major Changes approved For Stage 1: Previous Stage 1 EP Objectives: 13 Core Objectives 5 of 9 Menu Objectives EP Objectives for 2015-2017 (Modified Stage 2) 10 Core Objectives Modifying other aspects of the programs for EPs Major Changes approved For Stage 2: Previous Stage 2 EP Objectives: 17 Core Objectives 3 of 6 Menu Objectives EP Objectives for 2015-2017 (Modified Stage 2) 10 Core Objectives 5
10 Objectives for 2015-2017 (Modified Stage 2) Security Risk Analysis Clinical Decision Support CPOE eprescribing Health Information Exchange (Summary of Care) Patient Specific Education Medication Reconciliation Patient Electronic Access (VDT) Secure Messaging Public Health Reporting Modifying other aspects of the programs for EPs Major Changes approved: Secure Messaging Changed from 5% to having fully enabled the capability for patients to send/receive a secure electronic message with the EP during 2015 EMR reporting period Patient Portal Changed the second measure from 5% to at least one patient Public Health Reporting Immunizations Registries Syndromic Surveillance Specialized Registries From On-going Submission to Active Engagement Completed Registration Testing & Validation Production 6
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15// experience ideas PQRS Penalty: PQRS & value based modifier penalties Didn t meet PQRS in 2013 1.5% Medicare Fee Schedule penalty in 2015 Didn t meet PQRS in 2014 2.0% Medicare Fee Schedule penalty in 2016 Didn t meet PQRS in 2015 2.0% Medicare Fee Schedule penalty in 2017 16// experience ideas 8
EP EHR Penalties STOP in 2018!!! Merit-Based Incentive Payment System! 17// experience ideas Modifying other aspects of the programs for EHs Major Changes approved For Stage 1: Previous Stage 1 EH Objectives: 11 Core Objectives 5 of 10 Menu Objectives EH Objectives for 2015-2017 (Modified Stage 2) 9 Core Objectives 9
Modifying other aspects of the programs for EHs Major Changes approved For Stage 2: Previous Stage 2 EH Objectives: 16 Core Objectives 3 of 6 Menu Objectives EH Objectives for 2015-2017 (Modified Stage 2) 9 Core Objectives 9 Objectives for 2015-2017 (Modified Stage 2) Security Risk Analysis Clinical Decision Support CPOE eprescribing Health Information Exchange (Summary of Care) Patient Specific Education Medication Reconciliation Patient Electronic Access (VDT) Public Health Reporting 10
Modifying other aspects of the programs for EHs Major Changes approved: Patient Portal Changed the second measure from 5% to at least one patient Public Health Reporting Immunizations Registries Syndromic Surveillance Specialized Registries Electronic Reportable Lab Results From On-going Submission to Active Engagement Completed Registration Testing & Validation Production PPS PENALTIES 11
CAH PENALTIES EHR TENTATIVE SETTLEMENTS 12
HITECH PAYMENT AUDITS (MAC) For every Medicare EHR incentive payment, every facility that receives an EHR incentive payment will have one of three audits on their cost report: Desk review In-House Audit On-Site Audit 13
HITECH PAYMENT AUDITS (MAC) Positive Adjustment Opportunities Part C Days Total Days Charity Care Presumptive Charity Care Policy Review Pre/Post Payment Medicaid EHR Audits OIG has these EHR post-payment audits as a high priority through 2018 Positive Adjustment Opportunities Potential missing Medicaid days Incorrect reporting period used for payment calculation Total Days (including hospice days, employee days, Part B days, etc.) Be alerted to potential overpayments for things like unpaid days and bad debts being included with Charity care 14
EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Worked on program years 2011, 2012 and 2013 2014 and /or Stage II audits have yet to begin The audit protocol for Stage II audits has yet to be released Still auditing a minimum of 5% of the nations Meaningful Users ALL or NOTHING penalty Including Medicare & Medicaid incentive payments Flexibility Final rule Allowed facilities to attest to a lower level of criteria than the facility was scheduled to attest for Program Year 2014 No upfront checking of qualifications for appropriate use of the rule Check the radial button, put in an ONC certification number consistent with the lower level of criteria, and click a button saying you will maintain documentation supporting the facility s use of the Flexibility Rule for at least 6 years that s all that s required Documentation, Documentation, Documentation is the key 15
EHR MEANINGFUL USE AUDITS (FIGLIOZZI) Working with Figliozzi is easier than with CMS if facility fails. Can appeal Figliozzi failure with CMS One Bite at the Apple Submit only NEW evidence 16
KEY TAKE AWAYS FROM THIS PRESENTATION Program year 2015 is 15 months long ending 12/31/2015 with an any continuous 90 day reporting period, open window starts on 01/4/2016! Every participant that receives an interim payment will experience a HITECH audit! Medicaid recoupments are REALand can be significant, don t go down without a fight! Use of the Flexibility Final Rule needs to be DOCUMENTED! MU Audit penalty is very REALand the key is your documentation! 33// experience ideas THANK YOU! // visit bkd.com or contact: FOR MORE INFORMATION Mike Orr // Director morr@bkd.com// 254.776.8244 ext. 43928 Travis Skinner // Senior Managing Consultant tskinner@bkd.com // 254.776.8244 ext. 43936 17