An Introduction to the Medicare EHR Incentive Program for Eligible Professionals

Transcript

1 EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) An Introduction to the Medicare EHR Incentive Program for Eligible Professionals cms.gov/EHRIncentivePrograms

2 Table of Contents 1 ... . How to Use this Guide ... 1. Program Basics 4 ... What is the EHR Incentive Program? ... 4 6 ... What requirements do you have to meet? ... Program options 9 ... 17 2. How To Participate . ... 17 Eligibility Registration 21 ... 24 3. Meaningful Use ... 24 What do you have to do for meaningful use? ... 25 ... How will certified EHR help you? Core Objectives 32 ... ... Menu Objectives 49 ... Clinical Quality Measures 63 4. Attestation: How you report to CMS 72 ... 72 ... What is attestation? ... Steps to Follow 73 77 After you attest ... ... 5. Resources Library 78 .. Glossary ... 81 i An Introduction to the Medicare EHR Incentive Program for Eligible Professionals

3 How to Use This Guide This guide is intended to provide eligible professionals with a simple overview of the Medicare EHR Incentive Program. Each step of the program is explained in this guide to help health care professionals understand the basics of the program and determine how to successfully participate. Hyperlinks to the CMS website are included throughout the guide to direct you to more information and resources. Table of Contents The table of contents is interactive. Simply click on a chapter to read that section, and then click on the chapter title to return to the table of contents. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 1

4 How to Use This Guide Items This guide includes special icons to better help you understand the program and find resources. While reading the guide, please note the following: The “i” icon inside of a computer screen is intended to alert the reader that there • are additional resources on the specific topic being discussed. The “checklist” icon alerts the reader to the stage of the program that is • discussed in that section. Please also keep in mind that screen shots of user guides and videos can be clicked so the reader can easily locate those resources and review them. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 2

5 How to Use This Guide Resources The resources section located at the end of the guide contains all of the tools CMS has created to help eligible professionals learn more about the EHR Incentive Programs. Next to each resource there is a description to help the reader determine if it will be useful to their needs. The resources are grouped in the following categories: An EHR Incentive Program Overview • • Other CMS Programs • Certified EHR Technology Eligibility • Please note: This guide was prepared as a service to the health care industry and is not intended to grant rights or impose obligations. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 3 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals

6 CHAPTER 1: PROGRAM BASICS What is the EHR Incentive Program? The EHR Incentive Program provides incentive payments for certain healthcare providers to use EHR technology in ways that can positively impact patient care. What is an EHR? An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows healthcare providers to record patient information electronically instead of using paper records. However, EHRs are often capable of doing much more than just recording information. The EHR Incentive Program asks providers to use the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care. It’s important to know that the EHR Incentive Program is NOT a reimbursement program for purchasing or replacing an EHR. Providers have to meet specific requirements in order to receive incentive payments. 4 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

7 Other CMS Progams CMS has a number of quality improvement and incentive programs, but the EHR Incentive The EHR you Program is a separate incentive program with different requirements. use and the information you submit for other programs may not meet the . requirements of the EHR Incentive Program CMS QUALITY IMPROvEMEnT PROGRAMS • Medicare EHR Incentive Program Physician Quality Reporting System (PQRS) • • Medicare Improvements for Patients and Providers Act (MIPPA) e-Prescribing Incentive Pr ogram An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 5 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

8 What requirements do you have to meet? To receive an EHR incentive CMS has established the payment, providers have to show objectives for that they are “meaningful use” “meaningfully using” that everyone must meet to receive their EHRs by meeting thresholds for an incentive payment. a number of objectives. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 6 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

9 What is Meaningful Use? In other words, it’s not enough just to own a certified EHR. Providers have to show CMS that they are using their EHRs in ways that can positively affect the care of their patients. To do this, providers must meet all of the objectives established by CMS for this of their EHRs MEAnInGFUL USE program. Then they will be able to demonstrate and receive an incentive payment. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 7 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

10 How does the program work? The EHR Incentive Program consists of 3 stages. Each stage will have its own set of requirements to meet in order to demonstrate meaningful use. are focused on providers capturing Stage 1 . The requirements in Stage 1 We are currently in patient data and sharing that data either with the patient or with other healthcare professionals. Improved outcomes Advanced clinical processes Data capturing and sharing STAGE 3 STAGE 2 STAGE 1 8 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 4. Attestation: How You 3. Meaningful Use 5. Resources Library 2. How to Participate 1. Program Basics Navigation Report to CMS Links

11 PROGRAM OPTIOnS What kind of an EHR do you need? In order to capture and share patient data efficiently, providers need an EHR that stores data in a structured format. Get a certified EHR Make sure you are eligible Register Structured data allows patient information to be easily retrieved and Meaningful use transferred, and it allows the provider to use the EHR in ways that can aid Attest patient care. CMS and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must use in order to qualify for this incentive program. To get an incentive payment, you must use an EHR that is certified specifically for the EHR Incentive Programs. EHRs certified or qualified for other Medicare incentive programs may not be certified for this program. Also, if you already own an EHR, it may not be certified for use in the EHR Incentive Programs. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 9 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

12 More about certified EHR For more information Certified EHR For more information about certified EHR technology , visit the CMS website, http://www.cms.gov/EHRIncentivePrograms/25_Certification.asp#TopOfPage . You can Certified Health IT Product find a complete list of certified EHR technology at the List (CHPL) website, http://healthit.hhs.gov/CHPL . 10 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

13 Choosing a Program: Medicare or Medicaid? The EHR Incentive Programs are available for Medicare and Medicaid eligible professionals. Medicare EHR Incentive Program Medicaid EHR Incentive Program Although the two programs are similar in many ways, there are also some differences between them. Providers must select either Medicare or Medicaid. They can only participate in one of the programs. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 11 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

14 Choosing a Program: Medicare or Medicaid? Medicaid EHR Incentive Program Medicare EHR Incentive Program Run by CMS Every state runs its own program Maximum incentive amount is $44,000 Maximum incentive amount is $63,750 (across 6 years of program participation) (across 5 years of program participation) Payment reductions begin in 2015 for No Medicaid payment reductions if you providers who are eligible but choose not choose not to participate to participate In the first year, providers can receive an incentive payment for adopting, In the first year and all remaining years, implementing, or upgrading a certified EHR. providers have objectives they must achieve to get incentive payments. In all remaining years, providers have objectives to achieve, just like Medicare. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 12 Skip 4. Attestation: How You 5. Resources Library 1. Program Basics 2. How to Participate 3. Meaningful Use Navigation Report to CMS Links

15 For more information For more information Medicare EHR Incentive Program This is a guide to the Medicare EHR Incentive Program. To learn more about differences program between the Medicare and Medicaid EHR Incentive Programs, visit the http://www.cms.gov/EHRIncentivePrograms/35_ basics section of our website, basics.asp#TopofPage . An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 13 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

16 How much will you get paid? The amount of your incentive payment depends on when you begin participating in the program. The incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap. The table below shows the maximum incentive amounts broken down by the year you start participating in the program. Calendar Year (CY) for which EP Receives an Incentive Payment CY 2012 CY 2013 CY 2014 CY 2015 and CY 2011 later CY 2011 $18,000 CY 2012 $12,000 $18,000 CY 2013 $8,000 $12,000 $15,000 CY 2014 $12,000 $4,000 $8,000 $12,000 CY 2015 $4,000 $8,000 $8,000 $0 $2,000 CY 2016 $2,000 $4,000 $4,000 $0 TOTAL $44,000 $44,000 $39,000 $24,000 $0 14 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

17 How much will you get paid? The total maximum incentive amount that you can be paid under the Medicare EHR Incentive Program is $44,000 over five consecutive years of program participation. As you can see, you receive the maximum incentive by starting in 2011 or 2012 . If you don’t start by 2014, you are not eligible to receive any incentive payment under the Medicare EHR Incentive Program. 15 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

18 Are there penalties? Medicare eligible professionals who do not meet the requirements for meaningful use by 2015 and in each subsequent year are subject to payment adjustments to their Medicare reimbursements that start at 1% per year, up to a maximum 5% annual adjustment. on to the Medicare EHR Incentive Program for Eligible Professionals 16 An Introducti Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

19 CHAPTER 2: HOW TO PARTICIPATE Eligibility Get a certified EHR. Make sure you are How do you get started? eligible. Register. Meaningful use. Before you do anything, make sure you are eligible for Attest. the program. The following are considered “eligible professionals” who can participate in the Medicare EHR Incentive Program: Doctors of medicine or osteopathy • Doctors of dental surgery or dental medicine • Doctors of podiatry • Doctors of optometry • Chiropractors • 17 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 5. Resources Library 4. Attestation: How You 3. Meaningful Use 2. How to Participate 1. Program Basics Navigation Report to CMS Links

20 Eligibility Are you eligible? CMS has developed a web tool that can help you determine whether or not you are eligible to participate in the EHR Incentive Programs. Click on the image at right to try out the tool on our website, https://www.cms.gov/ EHRIncentivePrograms/15_Eligibility.asp#TopOfPage . An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 18 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

21 Eligibility Can practices participate? nO Incentive payments for the Medicare EHR Incentive Program are made to individual providers, not to practices or medical groups. Although a provider can designate a practice to receive the incentive funds on their behalf, it is up to the provider to make this decision—the practice or medical group cannot claim the money or make the decision for the provider, even if the EHR belongs to the practice. 19 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

22 Eligibility Are you hospital-based? Eligible professionals who are hospital-based cannot participate in the EHR Incentive Programs. A provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23) of a hospital. CMS makes the determination if you are hospital-based . You will find out your status when you register for the program. 20 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

23 Registration How do you register? Get a certified EHR. Make sure you are eligible. If you fall into one of the eligible professional categories and you have Register. Meaningful use. decided to participate in the Medicare EHR Incentive Program, the next Attest. step is to get registered for the program. By registering, you can Registering does not You can register online at: see if you are hospital- mean that you have to https:// based or if there are participate. You can ehrincentives.cms.gov other issues that could cancel your registration at interfere with or delay any time. your participation. 21 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

24 Registration How do you register? Click the image on the right to download a Registration User Guide that will give you step- by-step directions on how to register online, https://www.cms.gov/EHRIncentivePrograms/ Downloads/EHRMedicareEP_RegistrationUserGuide. pdf . The Registration User Guide also contains instructions for how a provider can let a 3rd party, such as an office manager, register on his or her behalf. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 22 Skip 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library 1. Program Basics Navigation Report to CMS Links

25 Registration How do you register? Click on the image on the right to watch a video tutorial that will walk you through CMS’s registration system, http://youtu.be/sKngNjd8Iuc. 23 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

26 CHAPTER 3: MEAnInGFUL USE What do you have to do for Meaningful Use? To show CMS that they have meaningfully used their certified EHR, providers Get a certified EHR. Make sure you are eligible. must meet all of the Stage 1 requirements that CMS has established. Register. Meaningful use. Attest. For the first year they participate, eligible professionals have to meet the requirements for and report data on a continuous 90-day period during the calendar year (any 90 days from January 1st to December 31st). For the remaining years they participate, eligible professionals have to meet the requirements for the entire calendar year. reporting periods. Both of these are called the An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 24 Skip 5. Resources Library 4. Attestation: How You 1. Program Basics 2. How to Participate 3. Meaningful Use Navigation Report to CMS Links

27 How will certified EHR help you? You probably think there is a lot of information you’re going to have to keep track of in order to get an incentive payment, but that’s where your certified EHR will help you meet the requirements for meaningful use. • All certified EHR technology adheres to the standards and criteria of the EHR Incentive Program—which means it is certified to include functionality that will help you accomplish the core and menu objectives you must meet. • Certified EHR technology includes the ability to calculate the numerators and denominators for all of the objectives based on the patient information you enter as part of your everyday workflow. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 25 Skip 1. Program Basics 2. How to Participate 4. Attestation: How You 5. Resources Library 3. Meaningful Use Navigation Report to CMS Links

28 What are the requirements? CMS has established objectives that all providers must meet in order to show that they are using their EHRs in ways that can positively affect the care of their patients—in other words, meaningful use . so that providers can demonstrate have a minimum percentage that providers have to meet. Other Some of the objectives objectives specify an action that must be taken or a functionality of the EHR that must be enabled for the duration of the reporting period. 26 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

29 What are the requirements? Objectives and Measures Measures Objectives The minimum requirement to achieve What every eligible professional is objective . Every objective has an each required to achieve in order to be able associated measure , which the eligible meaningfully to show that they are professional must meet or surpass. using their EHR. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 27 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

30 What are the requirements? There are EXCLUSIOnS that exempt you from having to meet specific objectives. If you meet the qualifications for an exclusion, then you will not have to report on that objective and can still receive a full EHR incentive payment. These exclusions may be applicable to certain specialists who do not perform the actions specified in the objective as a normal scope of practice. Check the exclusion for each objective to see if you can qualify for it. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 28 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

31 What are the requirements? As you will see, there is a lot of flexibility about what providers have to report. • • But you have to meet the thresholds for ALL of the objectives (or qualify for an exclusion to objectives) in order to be able to show meaningful use. If you fail to meet even one of the measures, you will not receive a payment. • There are no partial incentive payments. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 29 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

32 What are the requirements? Eligible Professionals have to meet the measures for the following in order to receive a payment: —These are objectives that everyone who participates in the 15 CORE OBJECTIvES program must meet. Some of the core objectives have exclusions that could exempt you from having to meet them, but many of them do not. You have to report on all 15 core objectives and meet the thresholds established by those objectives. —You only have to report on 5 out of the 10 available menu 10 MEnU OBJECTIvES objectives. You can choose objectives that make sense for your workflow or practice. Again, some of these objectives have exclusions that could exempt you from having to meet them. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 30 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

33 What are the requirements? In addition to meeting the thresholds for the 15 core and 5 menu objectives, all eligible Clinical Quality Measures . professionals have to report on later, but for now you should know that Clinical Quality Measures We’ll review the Clinical Quality Measures are different from core and menu objectives. —you simply report the data Clinical Quality Measures here are no thresholds to meet for T exactly as it is calculated by your certified EHR. Meaningful Use 15 + 5 + 6 = MU Meaningful Core Menu CQMs Use Measures Measures An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 31 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

34 Meaningful Use: 15 Core Objectives Below are the 15 core objectives that every eligible professional must meet in order to receive an EHR Incentive Payment. 1. Computerized provider order entry (CPOE) 2. Drug-drug and drug-allergy checks Maintain an up-to-date problem list of current and active diagnoses 3. E-Prescribing (eRx) 4. 5. Maintain active medication list 6. Maintain active medication allergy list 7. Record demographics 8. Record and chart changes in vital signs 9. Record smoking status for patients 13 years or older 10. Report ambulatory clinical quality measures to CMS/States 11. Implement clinical decision support 12. Provide patients with an electronic copy of their health information, upon request 13. Provide clinical summaries for patients for each office visit 14. Capability to exchange key clinical information 15. Protect electronic health information 32 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

35 Meaningful Use: 15 Core Objectives pages, we’ll take a quick look at each of these core objectives so that you Over the next 15 can see at a glance: • What the objective requires • What you have to do to meet the required threshold What exclusions exist for the objective • Keep in mind that this is only a quick guide. There are many details about meeting these objectives that cannot be addressed here. Once you have a grasp of the program basics, Meaningful Use Specification Sheets (https://www. we encourage you to explore our , which give cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf) in-depth information on each of the objectives, including how to calculate numerators and denominators, definitions of important terms, and additional information about achieving the objectives. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 33 Skip 5. Resources Library 4. Attestation: How You 1. Program Basics 2. How to Participate 3. Meaningful Use Navigation Report to CMS Links

36 CORE OBJECTIvES Computerized provider order entry (CPOE) Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from More than 30% of all For at least 30% of meeting this objective if unique patients with at your patients that have you write fewer than 100 least one medication in a medication listed prescriptions during the their medication list seen in the EHR, you or a reporting period. by the EP have at least licensed staff person will one medication order have to use the EHR’s entered using CPOE. CPOE module to enter medication orders. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 34 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

37 CORE OBJECTIvES Drug-drug and drug-allergy checks Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for EP has enabled this Certified EHR comes with this objective. Everyone functionality for the entire the ability to automatically has to meet it. EHR reporting period. check for potentially adverse drug-drug or drug-allergy interactions. You have to turn this functionality on and keep it on. 35 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

38 CORE OBJECTIvES Maintain an up-to-date problem list of current and active diagnoses Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for More than 80% of all More than 80% of your this objective. Everyone unique patients seen by patients have to have an has to meet it. the EP have at least one entry in the EHR about entry or an indication that current diagnoses—either no problems are known actual problems or just an for the patient recorded as indication that there are no structured data. problems right now. 36 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

39 CORE OBJECTIvES E-Prescribing (eRx) Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from More than 40% of all More than 40% of meeting this objective if permissible prescriptions the prescriptions you you write fewer than 100 written by the EP are write have to be sent prescriptions during the transmitted electronically electronically—not by reporting period. using certified EHR phone and not by fax— technology. using your certified EHR. 37 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

40 CORE OBJECTIvES Maintain active medication list Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for More than 80% of all More than 80% of your this objective. Everyone unique patients seen by patients have to have an has to meet it. the EP have at least one entry in the EHR about entry (or an indication that medications—either the patient is not currently medications they are prescribed any medication) currently taking or just an recorded as structured indication that they aren’t data. taking any medications right now. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 38 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

41 CORE OBJECTIvES Maintain active medication allergy list Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for More than 80% of all More than 80% of your this objective. Everyone unique patients seen by patients have to have an has to meet it. the EP have at least one entry in the EHR about entry (or an indication that medication allergies— the patient has no known either medication allergies medication allergies) they have or just a note recorded as structured that they don’t have any data. medication allergies. 39 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

42 CORE OBJECTIvES Record demographics Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for More than 50% of all For more than half of this objective. Everyone unique patients seen by your patients you have to has to meet it. the EP have demographics record the following in the recorded as structured EHR: data. • Preferred language • Gender • Race • Ethnicity • Date of Birth An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 40 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

43 CORE OBJECTIvES Record and chart changes in vital signs Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from For more than 50% of For more than half of this objective for either of all unique patients age 2 your patients, you have to these reasons: and over seen by the EP, record the following in height, weight and blood the EHR: • You don’t see any pressure are recorded as patients 2 years or older • Height structured data. • You don’t believe any • Weight of these vital signs are • Blood pressure relevant to your scope A certified EHR will chart of practice. changes in those vital signs for you. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 41 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

44 CORE OBJECTIvES Record smoking status for patients 13 years or older Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from More than 50% of all Smoking status is meeting this objective if unique patients 13 years recorded in the EHR for you don’t see any patients old or older seen by the over half of your patients who are 13 years or older. EP have smoking status that are over the age of 13. recorded as structured data. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 42 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

45 CORE OBJECTIvES Report ambulatory clinical quality measures to CMS Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for Successfully report to You have to report data on this objective. Everyone CMS ambulatory clinical clinical quality measures— has to report clinical quality measures selected which we’ll discuss in quality measures. by CMS in the manner another section of this specified by CMS. guide. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 43 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

46 CORE OBJECTIvES Implement clinical decision support Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for Implement one clinical Certified EHRs have the this objective. Everyone decision support rule. ability to program clinical has to meet it. decision support that can trigger alerts or clinical information for providers when they encounter patients with certain diagnoses or treatments. You should implement one of these rules that makes sense for your medical practice. 44 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

47 CORE OBJECTIvES Provide patients with an electronic copy of their health information Are You Excluded from What the Measure What That Means Having to Do This? Requires for You If none of your patients More than 50% of all You must provide an requests an electronic patients who request an electronic copy of a copy of their health electronic copy of their patient’s records in a information, you can be health information are timely fashion for over half excluded from meeting provided it within of all patients who ask for this objective. 3 business days. an electronic copy. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 45 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

48 CORE OBJECTIvES Provide clinical summaries for patients for each office visit Are You Excluded from What the Measure What That Means Having to Do This? Requires for You If you do not conduct any Clinical summaries For more than half of office visits, you can be provided to patients for your office visits, patients excluded from meeting more than 50% of all office receive a clinical summary this objective. visits within 3 business within 3 days of the visit. days. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 46 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

49 CORE OBJECTIvES Capability to exchange key clinical information Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for Performed at least one You have to test this objective. Everyone test of certified EHR your EHR’s ability to has to meet it. technology’s capacity to electronically transfer electronically exchange information to another key clinical information. provider. You don’t have to send actual patient information at this point, and a test is the only requirement to meet this objective. Even if the test fails, you have successfully met this objective! An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 47 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

50 CORE OBJECTIvES Protect electronic health information Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion for Conduct or review a You have to meet the this objective. Everyone security risk analysis same HIPAA requirements has to meet it. in accordance with the for protecting patient requirements under information in your EHR as 45 CFR 164.308(a)(1) you do for paper records. and implement security To do this, you must updates as necessary and conduct a security review correct identified security of your system and correct deficiencies as part of its any problems that could risk management process. make patient information vulnerable. 48 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

51 Meaningful Use: 10 Menu Objectives Now that we’ve seen all of the core objectives that you have to meet, let’s look at the 10 menu objectives. • You have to report on 5 of these 10 menu objectives • At least one of the 5 you report must be a Public Health objective Over the next 12 pages, we’ll take a quick look at all of the menu objectives. Again, once Meaningful Use you understand the program basics, we encourage you to explore our Specification Sheets (https://www.cms.gov/EHRIncentivePrograms/Downloads/EP- MU-TOC.pdf) , which give in-depth information on each of the objectives, including how to calculate numerators and denominators, definitions of important terms, and additional information about achieving the objectives. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 49 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

52 Public Health Objectives When selecting your 5 menu objectives, at least one must come from the Public Health list, which consists of the following: 1. Submit electronic data to immunization registries OR Submit electronic syndromic surveillance data to public health agencies 2. Let’s look at each of these objectives in turn. 50 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

53 MEnU OBJECTIvES Submit electronic data to immunization registries Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You could be excluded Performed at least one Your EHR comes from meeting this objective test of certified EHR equipped with the ability for either of these reasons: technology’s capacity to to electronically send submit electronic data to immunization data. You You don’t administer • immunization registries have to test your EHR’s immunizations and follow up submission ability to electronically There’s no immunization • if the test is successful. transmit that information registry to which you can to a public health registry. send information Even if the test fails, you have successfully met this objective! 51 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

54 MEnU OBJECTIvES Submit electronic syndromic surveillance data to public health agencies Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You could be excluded Performed at least one Your EHR comes from meeting this objective test of certified EHR equipped with the ability for either of these reasons: technology’s capacity to electronically send to provide electronic syndromic surveillance You don’t collect any • syndromic surveillance data (e.g., influenza reportable syndromic data to public health population data). You data agencies and follow-up have to test your EHR’s There’s no immunization • submission if the test is ability to electronically registry to which you can successful. transmit that information send information to a public health agency. Even if the test fails, you have successfully met this objective! An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 52 Skip 1. Program Basics 2. How to Participate 4. Attestation: How You 5. Resources Library 3. Meaningful Use Navigation Report to CMS Links

55 Other Menu Objectives After you have selected a public health objective, you still have to choose 4 more menu objectives to report. You can select any 4 from the list below—or you could report on both public health objectives and choose 3 from the list below: 3. Drug formulary checks Incorporate clinical lab-test results 4. Generate lists of patients by specific conditions 5. 6. Send reminders to patients for preventive/follow-up care 7. Patient-specific education resources Electronic access to health information for patients 8. 9. Medication reconciliation Summary of care record for transitions of care 10. Let’s look at each of these. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 53 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

56 MEnU OBJECTIvES Drug formulary checks Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion EP has enabled this Your certified EHR has the for this objective if you functionality and has ability to check potential select it. access to at least one medication orders against internal or external a drug formulary. If you formulary for the entire choose this objective, then EHR reporting period. you need to enable the formulary check for the entire reporting period. 54 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 5. Resources Library 4. Attestation: How You 1. Program Basics 2. How to Participate 3. Meaningful Use Navigation Report to CMS Links

57 MEnU OBJECTIvES Incorporate clinical lab-test results Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from More than 40% of all Results from over 40% of meeting this objective if clinical lab tests results lab tests ordered during you did not order any lab ordered by the EP during the reporting period are tests during the reporting the EHR reporting period recorded in the EHR—as period or if none of the whose results are either long as the tests yield results from the tests you in a positive/negative a number or a positive/ ordered came back as a or numerical format are negative response. Other number or as a positive/ incorporated in certified test results do not count negative response. EHR technology as toward this objective. structured data. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 55 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

58 MEnU OBJECTIvES Generate lists of patients by specific conditions Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion Generate at least one You can decide what for this objective if you report listing patients of condition is clinically select it. the EP with a specific relevant or useful to your condition. practice, then generate a report from your certified EHR of patients with that condition. 56 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

59 MEnU OBJECTIvES Send reminders to patients for preventive/follow-up care Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from More than 20% of all Over 20% of patients in meeting this objective if patients 65 years or older these age ranges must be you have no patients 65 or 5 years old or younger sent preventive or follow- years or older or 5 years were sent an appropriate up care reminders. The old or younger whose reminder during the EHR information in the reminder information is in your reporting period. and how the reminder certified EHR. is sent (e.g., mail, email, telephone) is up to you. 57 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

60 MEnU OBJECTIvES Patient-specific education resources Are You Excluded from What the Measure What That Means Having to Do This? Requires for You There is no exclusion More than 10% of all For over 10% of your for this objective if you unique patients seen patients, you use your select it. by the EP are provided certified EHR’s ability to patient-specific education recommend educational resources. resources to your patients. Your EHR is certified with the ability to make these recommendations based on patient-specific variables, such as chronic condition (e.g., diabetes). An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 58 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

61 MEnU OBJECTIvES Electronic access to health information for patients Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from At least 10% of all unique You provide electronic meeting this objective patients seen by the access for at least 10% if you do not order or EP are provided timely of your patients to their create any of the following (available to the patient health information. An information: within four business days online portal or access of being updated in the to a personal health Lab results • certified EHR technology) record are two examples Problem list • electronic access to their of doing this. Note that Medication list • health information subject you only have to provide to the EP’s discretion access—not make sure Medication allergy list • to withhold certain the patient actually uses information. the information. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 59 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

62 MEnU OBJECTIvES Medication reconciliation Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from EP performs medication For over half the patients meeting this objective reconciliation for more who see you after if you did not see any than 50% of transitions of receiving care from patients after they received care in which the patient is another provider, you care from another provider. transitioned into the care should update medication of the EP. information by comparing the patient’s medical record to an external list of medications obtained from a patient, hospital, or other provider. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 60 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

63 MEnU OBJECTIvES Summary of care record for transitions of care Are You Excluded from What the Measure What That Means Having to Do This? Requires for You You can be excluded from EP who transitions or You send either an meeting this objective refers their patient to electronic or paper if you don’t refer any another setting of care or summary of care patients or transfer provider of care provides document that is any patients to another a summary of care record generated by your certified setting for care during the for more than 50% of EHR for over half of reporting period. transitions of care and the patients you refer referrals. to another provider or transfer to another setting for care (e.g., nursing home). An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 61 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

64 What if none of the menu objectives are relevant? It’s rare, but it’s possible that none of the menu objectives are applicable to your scope of practice. If that is the case for you and you qualify for all of the exclusions for each of the menu objectives, then you can select 5 menu objectives and claim the exclusion for each. However, if you do not qualify for all of the exclusions to the menu objectives, you should go back and select menu objectives on which you can report. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 62 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

65 Clinical Quality Measures Clinical quality measures do not have thresholds that you have to meet—you simply have to report data Every eligible on them. professional is required to report You don’t have to do any calculations for the clinical quality measures! Your certified EHR will produce a report on clinical quality with clinical quality measure data, and you measures. must enter that data exactly as your certified EHR produced it. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 63 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

66 Clinical Quality Measures You will have to report on: 3 core clinical quality measures AND • clinical quality measures that you select from an additional list 3 • You select the 3 additional clinical quality measures based on their relevance to your scope of practice. If you don’t collect information on one or more of the 3 core clinical quality measures, you can choose one or more replacements from an alternate core list. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 64 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

67 Core Clinical Quality Measures Here are the 3 core clinical quality measures that everyone must report on: Clinical Quality Measure Title NQF Measure Number & PQRI Implementation Number Hypertension: Blood Pressure NQF 0013 Measurement Preventive Care and Screening Measure NQF 0028 Pair: a) Tobacco Use Assessment b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up NQF 0421 PQRI 128 You can find more information on these and other clinical quality measures on our www.cms.gov/EHRIncentivePrograms . 65 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

68 Alternate Core Clinical Quality Measures If the data produced by your EHR indicates a zero for the denominator of one or more of the core clinical quality measures, then you must choose one or more alternate core clinical quality measures from this list. NQF Measure Number & PQRI Clinical Quality Measure Title Implementation Number Weight Assessment and Counseling for NQF 0024 Children and Adolescents Preventive Care and Screening: Influenza NQF 0041 Immunization for Patients 50 Years Old or PQRI 110 Older Childhood Immunization Status NQF 0038 You can find more information on these and other clinical quality measures on our www.cms.gov/EHRIncentivePrograms . 66 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

69 Additional Clinical Quality Measures Finally, you select 3 from this list of 38 additional clinical quality measures and report on those: Additional Clinical Quality Measures 1. Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control 3. Diabetes: Blood Pressure Management 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6. Pneumonia Vaccination Status for Older Adults 7. Breast Cancer Screening 8. Colorectal Cancer Screening 9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 67 Skip 4. Attestation: How You 5. Resources Library 1. Program Basics 2. How to Participate 3. Meaningful Use Navigation Report to CMS Links

70 Additional Clinical Quality Measures Additional Clinical Quality Measures continued 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment,(b)Effective Continuation Phase Treatment 12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 15. Asthma Pharmacologic Therapy 16. Asthma Assessment 17. Appropriate Testing for Children with Pharyngitis 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 68 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

71 Additional Clinical Quality Measures Additional Clinical Quality Measures continued 21. Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 22. Diabetes: Eye Exam 23. Diabetes: Urine Screening 24. Diabetes: Foot Exam 25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 27. Ischemic Vascular Disease (IVD): Blood Pressure Management 28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 69 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

72 Additional Clinical Quality Measures Additional Clinical Quality Measures continued 31. Prenatal Care: Anti-D Immune Globulin 32. Controlling High Blood Pressure 33. Cervical Cancer Screening 34. Chlamydia Screening for Women 35. Use of Appropriate Medications for Asthma 36. Low Back Pain: Use of Imaging Studies 37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38. Diabetes: Hemoglobin A1c Control (<8.0%) 70 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library 1. Program Basics Navigation Report to CMS Links

73 Things to remember about Clinical Quality Measures If your EHR reports zeros on one of the Your certified EHR does all the work—it calculates the measures and gives you core clinical quality measures, replace it the numbers you report to CMS. with one from the alternate core list. There are no minimum values that you Choose 3 measures from the additional must achieve for clinical quality measures. list that are relevant to your scope of You only have to report on them, not practice. achieve a benchmark. 71 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 4. Attestation: How You 5. Resources Library 1. Program Basics 2. How to Participate 3. Meaningful Use Navigation Report to CMS Links

74 CHAPTER 4: ATTESTATIOn: HOW YOU REPORT TO CMS What is attestation? Attestation is a legal statement that you have met the thresholds and all Get a certified EHR. of the requirements of the Medicare EHR Incentive Program. The process Make sure you are eligible. Register. of attestation happens through an internet-based CMS system that Meaningful use. allows you to enter information on all of the following: Attest. • 15 core objectives • 5 out of 10 menu objectives • 3 core (or 3 alternate core) clinical quality measures • 3 out of 38 additional clinical quality measures 72 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

75 Steps to Follow Where do you go to attest? You will attest through the same system where you initially registered. Click , to here, https://ehrincentives.cms.gov go to the CMS EHR Registration and Attestation system now. During the attestation process, you will enter data and answer yes/no questions on the core objectives, menu objectives, and clinical quality measures. Above is an example of how the core objective for Drug-Drug and Drug-Allergy Checks appears in the attestation system. 73 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

76 Steps to Follow How do you attest? Just as with registration, there is also an attestation guide to help you through the process. Click the image on the right, or go to https://www.cms.gov/ EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide . pdf , to download an Attestation User Guide that will give you step-by-step directions on how to enter information and attest online. The Attestation User Guide also contains instructions for how a provider can let a 3rd party register on his or her behalf. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 74 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 5. Resources Library 4. Attestation: How You Navigation Report to CMS Links

77 Steps to Follow How do you attest? There is also a video tutorial to help you successfully attest. Click the image on the right to view this video, . http://youtu.be/sKngNjd8Iuc 75 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

78 Steps to Follow Want to practice? Our Meaningful Use Attestation Calculator allows you to see the language used during attestation and to enter your core and menu objective information to see if you have met all of the requirements for the Medicare EHR Incentive Program. Click the image on the right to try it now, or go to http://www.cms.gov/apps/ehr . An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 76 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

79 After You Attest As soon as you submit your attestation, you will find out immediately whether or not you have successfully achieved the core and menu objectives of the program. If you are not successful, you can edit any information that was entered incorrectly and resubmit your attestation. Or you can resubmit for a different 90-day reporting period with new information. If you are successful, CMS will perform a number of internal checks to be sure you are eligible for payment. You should then receive your EHR incentive payment in approximately 4-8 weeks following attestation. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 77 Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

80 CHAPTER 5: RESOURCES Resources Library DESCRIPTION TOPIC TITLE Key dates of the Medicare and Medicaid EHR Incentive Programs EHR Incentive Program Timeline EHR Incentive Program Notable differences between the Medicare and Medicaid EHR Incentive Overview Programs Comparison Chart Medicare EHR Incentive Provides eligible professionals with an overview of the Medicare EHR Incentive Programs, including information about payments Payments for EPs Tip Sheet CMS webpage that provides information on the PQRS and how to partici- Physician Quality Reporting System pate in it (PQRS) Homepage CMS webpage that provides information on the MIPPA e-prescribing Medicare Improvements for Patients and incentive program and how to participate in it Providers Act (MIPPA) e-Prescribing Other CMS Incentive Program Homepage Programs A PDF document that identifies opportunities for certain Medicare provid- Medicare EHR Incentive Program, ers to receive incentive payments for participating in important Medicare PQRS, and E-Prescribing Comparison initiatives Tip Sheet Certified EHR Webpage maintained by ONC that provides a comprehensive listing of CHPL Certified EHR List Technology complete EHRs and EHR modules Eligibility Widget Helps eligible professionals determine their eligibility for the Medicare and Medicaid EHR Incentive Programs Eligibility Eligibility Flowchart Demonstrates the functionality of the online module for eligible professionals registering for the Medicare program 78 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Navigation Report to CMS Links

81 Resources Library TITLE DESCRIPTION TOPIC Medicare EHR Incentive Program EP Video guidance to help eligible professionals through the registration Registration Users Guide process Registration Medicare EP PECOS Notification Helps eligible professionals participating in the Medicare program obtain a PECOS account, which is necessary to register and receive an EHR Incentive Program payment Stage 1 EHR Meaningful Use Specifica- Each sheet provides details about a specific meaningful use measure that tion Sheet for EPs needs to be met by eligible professionals Meaningful Use Stage 1 Summary Helps eligible professionals and hospitals better understand the purpose and importance of meeting meaningful use Meaningful Use Stage 1 Overview Similar to the Meaningful Use Stage 1 Requirements Summary, but pro- vides an overview of the goals of meaningful use for U.S. health care Clinical Quality Measures 101 Provides an overview of the purpose and importance of CQMs, as well as Meaningful Use gives an example to help providers better understand how to complete the measures Provides guidance for understanding and using the CQMs for eligible Guide for Reading the EHR Incentive Program EP CQM Measures professionals EP CQM Measure Specifications A zip file of each CQM measure specification and detail EP CQM Supplemental Measure A zip file of each supplemental CQM measure specification and detail Specifications 79 An Introduction to the Medicare EHR Incentive Program for Eligible Professionals Skip 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library 1. Program Basics Navigation Report to CMS Links

82 Resources Library TITLE DESCRIPTION TOPIC Medicare EHR Incentive Program EP Demonstrates the functionality of the online attestation module for eligible Attestation User Guide professionals Meaningful Use Attestation Calculator Allows eligible professionals and hospitals to test whether or not they will Attestation (version 1) successfully demonstrate meaningful use for the EHR Incentive Programs prior to attestation Attestation Worksheet for Eligible Allows eligible professionals to enter their meaningful use measure values, so they have a quick reference tool to use while attesting Professionals EHR Incentive Program FAQs This interactive document provides all of the FAQs, sorted by topic, to FAQs help you more easily review information about various aspects of the EHR Incentive Programs An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 80 1. Program Basics 2. How to Participate 3. Meaningful Use 4. Attestation: How You 5. Resources Library Skip Report to CMS Navigation Links

83 Glossary of Terms TERM EXPLANATION Attestation In order for EPs to receive an EHR incentive payment, they must attest (legally state) through the secure Medicare website or their state’s secure Medicaid website, depending on the program they are participating in, that they’ve demonstrated “meaningful use” with certified EHR technology. Certified Electronic The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. Standards, Health Record (EHR) implementation specifications, and certification criteria for EHR technology have been adopted by the Secre - tary of the Department of Health and Human Services. EHR technology must be tested and certified by an Of - fice of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) in order for a provider to qualify for EHR incentive payments. Eligible Professional (EP) Eligible professionals under the Medicaid EHR Incentive Program include the health care providers below when they also meet the Incentive Program eligibility criteria. • 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. Exclusion CMS allows providers to report that specific meaningful use measures do not apply to them because they have no patients, or no or insufficient number of actions that would allow calculation of the meaningful use measure. For example, a physician who has no patients age 65 or older or age 5 or younger would not have to meet the requirement to send an appropriate reminder to 20 percent or more of all patients in those age groups during the EHR reporting period. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 81

84 Glossary of Terms TERM EXPLANATION Meaningful Use The requirements for EHR use and reporting to qualify for the incentive payment within the Medicare EHR Incentive Program. Meaningful use will be the standard by which providers will use EHR technology and build enhancements for future reporting and quality measures to improve patient outcomes. Provider Enrollment, PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier Chain, and Ownership information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data System (PECOS) collected in both paper form and electronically via the Internet. All EPs must be enrolled in PECOS in order to register to receive incentive payments in the Medicare EHR Incentive Program. Place of Service (POS) POS codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. CMS maintain POS codes used throughout the health care industry. Reporting Period The reporting period is the period in which an EP must demonstrate meaningful use guidelines for the EHR Incentive Programs. In the first year of the Medicare EHR Incentive Program, EPs have a reporting period of any continuous 90-day period within the calendar year. Third-Party Reporting For the EHR Incentive Programs, CMS implemented functionality that allows an EP to designate a third party to register and attest on his or her behalf. To do so, 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. Those working on behalf of an EP(s) that do not have an I&A web user account can visit I&A Security Check to create one. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 82

85 cms.gov/EHRIncentivePrograms

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