Process of Attestation The CMS EHR Incentive program continues to require a manual attestation process through the Registration and Attestation system: https://ehrincentives.cms.gov/hitech/login.action. RevolutionEHR users will need to potentially access two documents for attestation: Meaningful Use - Stage 2 scorecard (in RevolutionEHR: Reports > Administration > Providers > Meaningful Use - Stage 2) Clinical Quality Measures scorecard (in RevolutionEHR: Reports > Administration > Providers > Clinical Quality Measures) An important change to the attestation process in 2014 is the idea that you need to generate your scorecard and capture it on the day you attest. So if you plan to attest on September 14th, you need to run your scorecard and capture it (via print or screenshot) on September 14th. Expect the attestation process to take about one hour. Login As in the Stage 1 attestation process, the login credentials for each provider will be the NPPES web user account login ID and password. These credentials should be known by the practice billing staff and are identical to those used for registration (if completed prior to attestation). 1
Navigation After login, navigation within the website is possible through us of the tabs along the top of the screen or the similarly named buttons under Instructions : Click the Attestation tab or button to proceed. 2
Attestation The attestation landing page will show a grid containing historical attestations as well as a link to start a new one for 2014. Click Attest to begin your 2014 attestation: 3
Attestation Progress Page The attestation progress page lists a grouping of topics that must be completed. The topics can be completed sequentially by starting with topic 1: Attestation Information and ending with topic 4: Clinical Quality Measures. This page can be returned to anytime prior to submission of the attestation. 4
Attestation Information The attestation information page allows the user to enter their EHR certification number if it wasn t entered during registration. For RevolutionEHR customers that are also RxNT customers, the certification number will be A014E01OS90NEAR as shown below. If a RevolutionEHR user is not a customer of RxNT, the procedure outlined in the file on the Quest for Excellence page should be followed with this modification: Instead of locating and adding RxNT to the cart at Step 5, the e-prescribing system used by the provider should be added. Once both proper versions of RevolutionEHR and the e-prescribing system in use are in the cart, the proper EHR certification number can be obtained and then entered on the attestation page shown below. The EHR Reporting Period dropdown list should be used to indicate your 2014 reporting period. 5
Meaningful Use Core Measures Clicking Save & Continue on the attestation information page will take the user to attestation for the Stage 2 Core measures. Core 1 - CPOE for Medication Orders Selecting No for the exclusion question will show fields for numerator and denominator entry: 6
Core 1 - CPOE for Laboratory Orders Selecting No for the exclusion question will show fields for numerator and denominator entry: 7
Core 1 - CPOE for Radiology Orders Selecting No for the exclusion question will show fields for numerator and denominator entry: 8
Core 2 - E-prescribing Core 3 - Record Demographics 9
Core 4 - Vital Signs Based on the multiple ways of reporting compliance with the vital signs objective, there are multiple questions about exclusions. The attestation system presents these questions in a logical sequence and your answers should be specific to your individual plans for attestation. 10
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Core 5 - Record Smoking Status Core 6 - Clinical Decision Support 12
Core 7 - Incorporate Clinical Lab-Test Results Core 8 - Patient Lists 13
Core 9 - Preventative Care 14
Core 10 - Patient Electronic Access and Use (V/D/T) 15
Core 11 - Clinical Summaries Core 12 - Patient-Specific Education Resources 16
Core 13 - Medication Reconciliation Core 14 - Summary of Care The summary of care objective has 3 measures. Providers who have initiated less than 100 referrals out of the practice during the reporting period are offered an exclusion from all 3 measures. Answering No will require numerical data for the first two measures and a Yes/No attestation for the cross-vendor test exchange. 17
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Core 15 - Immunization Registries RevolutionEHR users must select Yes to the exclusion for this objective. Core 16 - Protect Electronic Information 19
Core 17 - Secure Electronic Messaging 20
Meaningful Use Menu Measures Upon completion of the core measure entry, you will be presented with a list of the six menu objectives. RevolutionEHR users must select the first objective (Imaging Results), the second (Family Health History) and the sixth (Electronic Notes) prior to clicking Save & Continue. 21
Menu Objective - Imaging Results Although two exclusions are shown as available, exclusions are not acceptable to achieve Menu items. RevolutionEHR users should select No for both exclusions and report their scorecard data. 22
Menu Objective - Family Health History Although an exclusion is shown as available, exclusions are not acceptable to achieve Menu items. RevolutionEHR users should select No and report their scorecard data. 23
Menu Objective - Electronic Notes Although an exclusion is shown as available, exclusions are not acceptable to achieve Menu items. RevolutionEHR users should select No and report their scorecard data. 24
Clinical Quality Measures As the final component to meaningful use attestation in 2014, Clinical Quality Measures must be submitted electronically (Option 1) or manually entered during the attestation process (Option 2). Electronic reporting allows the submitted data to be utilized not only for the EHR Incentive Program, but also other quality measurement programs such as PQRS. If, and only if, the provider selects to manually enter their data, they will be presented with a list of the 64 clinical quality measures broken down by the 6 HHS National Quality Strategy domains. The provider must select 9 of these measures that span at least 3 of the 6 domains. The following screenshots show the clinical quality measures as listed in the attestation system. The available measures tracked for RevolutionEHR users are highlighted in red. 25
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CMS156v1/CMS156v2 - Use of High-Risk Medications in the Elderly CMS68v2/CMS68v3 - Documentation of Current Medications in the Medical Record 29
CMS132v1/CMS132v2 - Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures CMS550v1/CMS550v2 - Closing the referral loop: receipt of specialist report 30
CMS166v2/CMS166v3 - Use of Imaging Studies for Low Back Pain CMS126v1/CMS126v2 - Use of Appropriate Medications for Asthma 31
CMS131v1/CMS131v2 - Diabetes: Eye Exam CMS143v1/CMS143v2 - Primary Open Angle Glaucoma: Optic Nerve Evaluation 32
CMS167v1/CMS167v2 - Diabetic Retinopathy: Documentation of the Presence of Absence of Macular Edema and Level of Severity of Retinopathy CMS142v1/CMS142v2 - Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 33
CMS133v1/CMS133v2 - Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery CMS75v1/CMS75v2 - Children Who Have Dental Decay of Cavities 34
Completion of Attestation Steps Upon completion of the 4 steps of the attestation process, you will land on the following progress page: Click Continue with Attestation to proceed to the following summary screen. Each section can be opened, if desired, to review the entered data. 35
When ready to proceed, click Continue with Attestation. You will then be asked to attest to the fact that the data you entered matches the EHR scorecard and, if you selected to electronically submit your CQM data, that you will submit your CQM data within 2 months of the end of the EHR reporting period: In the event that you chose to manually enter your CQM data, the second attestation in the above screen will ask you to attest to the fact that the CQM information you entered was generated by the certified EHR technology. 36