The Centers for Medicare & Medicaid Services (CMS) recently released eight new answers to frequently asked questions (FAQs) to keep providers informed about the Medicare and Medicaid electronic health record incentive programs. Below is a summary of CMS’s responses. CMS also has a document answering other questions about the electronic health record (EHR) incentive program, which is over 100 pages.
Does a provider have to record all clinical data in their certified EHR technology in order to accurately report complete CQM data for the Medicare and Medicaid EHR Incentive Programs?
CMS does not require providers to record all clinical data in their certified EHR technology at this time. CMS recognizes that this may yield numerator, denominator, and exclusion values for clinical quality measures in the certified EHR technology that are not identical to the values generated from other methods (such as record extraction). However, at this time CMS requires providers to report the clinical quality measure data exactly as it is generated as output from the certified EHR technology in order to successfully demonstrate meaningful use.
Do providers have to contribute a minimum dollar amount toward their certified EHR technology for the Medicare and Medicaid EHR Incentive Programs?
There is no general requirement under the Medicare and Medicaid EHR Incentive Programs for providers to contribute a minimum dollar amount toward the certified EHR technology that they use.
The Medicare and Medicaid EHR Incentive Programs provide incentives to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) for the meaningful use of certified EHR technology. Under the Medicaid program, EPs and eligible hospitals may receive an incentive for the adoption, implementation, or upgrade of certified EHR technology in their first year of participation. The incentives are not a reimbursement of costs, and providers are not required to contribute a minimum amount toward the purchase or maintenance of their certified EHR technology in order to participate in the EHR Incentive Programs.
In addition, physicians must comply with the Physician Self-Referral Law, commonly referred to as the “Stark Law.” Under the EHR exception to the Stark Law, physicians who receive a donation of EHR items and services from a DHS entity must satisfy each element of the exception at 42 CFR 411.357(w), which includes paying 15 percent of the donor’s cost for the items and services.
Where can I find a list of public health agencies and immunization registries to submit my data as required by the public health objectives for the EHR Incentive Programs?
For information and/or instructions on where to submit your public health-related data, CMS told providers to contact local or state public health agencies and immunization registries. The EHR Incentive Programs include public health objectives for submitting electronic data to immunization registries or immunization information systems, submitting electronic syndromic surveillance data to public health agencies, and (for eligible hospitals and CAHs only) submitting electronic data on reportable lab results to public health agencies.
Can two separate practices with two different TINs purchase a single certified EHR system and share it in order to participate in the Medicare and Medicaid EHR Incentive Programs?
Yes. Incentive payments are made based on the demonstration of meaningful use by individual eligible professionals (EPs). Certified EHR technology will track each EP’s performance on the individual meaningful use objectives. Multiple practices that do not share a business affiliation could use the same certified EHR technology for their respective EPs.
For the Medicare and Medicaid EHR Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures?
EPs, eligible hospitals, and CAHs should look at the measure of each meaningful use objective to determine the appropriate calculation method for numerators and denominators. The calculation of the numerator and denominator for each measure is explained in the July 28, 2010 final rule (75 FR 44314).
For objectives that require a simple count of actions (e.g., number of permissible prescriptions written, for the objective of “Generate and transmit permissible prescriptions electronically (eRx)”; number of patient requests for an electronic copy of their health information, for the objective of “Provide patients with an electronic copy of their health information”; etc.), EPs, eligible hospitals, and CAHs can usually add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure.
For objectives that require an action to be taken on behalf of a percentage of “unique patients” (e.g., the objectives of “Record demographics”, “Record vital signs”, etc.), EPs, eligible hospitals, and CAHs may not be able to simply add the numerators and denominators calculated by each certified EHR system. The EP, eligible hospital, or CAH must include only unique patients in the numerators and denominators of each objective, and it is the responsibility of the EP, eligible hospital, or CAH to reconcile information from multiple certified EHR systems in order to ensure that each unique patient is counted only once for each objective. Please keep in mind that patients whose records are not maintained in certified EHR technology will need to be added to denominators where applicable in order to provide accurate numbers.
For more information about which objectives require a simple count of actions and which require an action taken on behalf of a percentage of unique patients, consult the Meaningful Use Specification Sheets for EPs and eligible hospitals and CAHs.
To report clinical quality measures, EPs who practice in multiple locations that are equipped with certified EHR technology should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters at those locations.
For the EHR Incentive Programs, how should an eligible hospital or CAH with multiple certified EHR systems report their CQMs?
To report clinical quality measures, eligible hospitals and CAHs that have multiple systems should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters in the relevant departments of the eligible hospital or CAH (e.g., inpatient or emergency department (POS 21 or 23)).
Does the person who completes the registration for the EHR Incentive Programs need to be the same person who completes the attestation?
No. For Medicare providers, CMS has determined that if there are multiple users approved to work on behalf of an eligible professional (EP), any of those authorized users can update the EP’s registration or attestation. In addition, the EP could login and update the information him or herself. For Medicaid, each State determines if they are allowing authorized third parties to attest on behalf of EPs.
For the meaningful use objective “Capability to submit electronic syndromic surveillance data to public health agencies,” what is the definition of “syndromic surveillance”?
Syndromic surveillance uses individual and population health indicators that are available before confirmed diagnoses or laboratory confirmation to identify outbreaks or health events and monitor the health status of a community. For additional information about syndromic surveillance data, please visit: http://www.cdc.gov/EHRmeaningfuluse/Syndromic.html.