CMS Incentive Programs

Meaningful Use Generally
MU, Stage 1
MU, Stage 2
Considerations for Specialists
New Requirements for 2014
Audits
PQRS
eRx
Penalties
MU, Stage 3

Meaningful Use Generally

Indictment Issued for False Statements to CMS and Aggravated Identity Theft

meaningfuluseaudits.com February 10, 2014
By Jim Tate

"It was just a matter of time before the CMS EHR Incentive audit process uncovered alleged actions so severe that there was nothing left to do but issue Federal criminal indictments..."

Medicaid EHR Incentive Program Intro Presentation

cms.gov

"This guide is intended to provide eligible professionals with a simple overview of the Medicaid 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."

Medicaid Provider Incentive Program Resources

medicaid.ohio.gov

"The following resources are intended to assist eligible professionals and eligible hospitals complete registration, enrollment and attestation for the Ohio Medicaid Provider Incentive Program (MPIP)."

Medicaid Registration User Guide

cms.gov

"This is a step-by-step guide for the Medicaid Eligible Professionals (EPs) Electronic Health Record (EHR) Incentive Program."

Medicare EHR Incentive Program Intro Presentation

cms.gov

"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."

Medicare Registration User Guide

cms.gov

"This is a step-by-step guide for the Medicare Eligible Professionals (EPs) Electronic Health Record (EHR) Incentive Program."

Ohio Medicaid Incentive Program Presentation

neohc.com

"Topics covered in PDF presentation:

MPIP Overview
MPIP Eligibility
Patient Volume Requirements
Patient Volume Calculation
EP Group Enrollment
MPIP Payment
CMS Registration
MPIP System Demonstration"

MU, Stage 1

Attestation Worksheet

cms.gov

"The EP Attestation Worksheet is for EPs in Stage 1 of meaningful use and allows them to log their meaningful use measures on this page to use as a reference when attesting for the Medicare EHR Incentive Program in the CMS system."

CMS 2013 Changes

cms.gov

"Beginning in 2013, there are several changes to the Stage 1 Electronic Health Record (EHR) Incentive Programs meaningful use objectives, measures, and exclusions for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). These changes took effect on October 1, 2012, for eligible hospitals and CAHs and on January 1, 2013, for EPs. Although some of the changes to meaningful use objectives, measures, and exclusions are optional, others are required. Below is an overview of the Stage 1 changes that apply in 2013."

MU, Stage 2

Additional Guidance: How the Proposed New Timeline for the EHR Incentive Programs Affects You

cms.gov
December 18, 2013

Last week, CMS and ONC announced the intent to change the Stage 3 timeline and extend Stage 2 of meaningful use through 2016.

Important to note about the proposed timeline

It does not delay the start of Stage 2 of meaningful use.
It does not affect the current reporting periods and deadlines for 2014 participation.

What this Means for You If you begin participation withyour first year of Stage 1 for the Medicare EHR Incentive Program in 2014:

You must begin your 90 days of Stage 1 of meaningful use no later than July 1, 2014 and submit attestation by October 1, 2014 in order to avoid the 2015 payment adjustment.

If you have completed 1 year of Stage 1 of meaningful use:

You will demonstrate a second year of Stage 1 of meaningful use in 2014 for a three-month reporting period fixed to the quarter for Medicare or any 90 days for Medicaid.
You will demonstrate Stage 2 of meaningful use for two years (2015 and 2016).
You will begin Stage 3 of meaningful use in 2017.

If you have completed two or more years of Stage 1 of meaningful use:

You will still demonstrate Stage 2 of meaningful use in 2014 for a three-month reporting period fixed to the quarter for Medicare or any 90 days for Medicaid.
You will demonstrate Stage 2 of meaningful use for three years (2014, 2015 and 2016).
You will begin Stage 3 of meaningful use in 2017.

Please be sure to look for additional guidance in the Federal Register for rulemaking on this proposal.

For More Information Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

CMS MU II Guide

cms.gov

"This guide is intended to provide eligible professionals (EPs) with an overview of Stage 2 of meaningful use. The guide discusses changes to meaningful use objectives and to Clinical Quality Measures (CQMs), and the overall goals of Stage 2. Hyperlinks to the CMS website are included throughout the guide to direct you to more information and resources."

CMS MU II Toolkit

cms.gov

"This Stage 2 Toolkit is an interactive document that provides users with resources and information about Stage 2 of the EHRIncentive Programs and 2014 Clinical Quality Measure requirements. The toolkit includes materials for eligible professionals (EPs), eligible hospitals, and critical accesshospitals(CAHs)."

CQM Reporting

cms.gov

"Meaningful Use Stage 2:
Clinical Quality Measures for Eligible Professionals in 2014 and Beyond"

EHR Incentive Program Meaningful Use Stage 2 Requirements for Eligible Professionals

cms.gov

EHR Incentive Program Meaningful Use Stage 2
Requirements for Eligible Professionals

Industry Stakeholders Weigh In on Adjusted Meaningful Use Timeline

ihealthbeat.org
December 9, 2013

"Industry stakeholders have begun to comment on CMS' decision to adjust the timeline of the meaningful use program..."

Meaningful-use deadline pushed back one year

modernhealthcare.com December 6, 2013
By Joseph Conn

"The CMS is giving providers another year to show they've met the Stage 2 criteria of the federal government's incentive program to encourage the adoption and meaningful use of electronic health records. That means the start of the next phase will be pushed back a year..."

MU I and MU II Comparison

cms.gov

Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals

MU II To-Do List

physicianpractice.com March 06, 2013
By Marisa Torrieri

"Several months before attesting for Stage 1 of CMS' meaningful use EHR incentive program, solo internal medicine physician Bob Fishman brought home armfuls of patient charts to enter data on the people he was seeing for the next two days..."

New CMS and ONC Tool Enables Providers to Meet Transitions of Care Measure

February 10, 2014
CMS

Are you a provider who is demonstrating Stage 2 of meaningful use? If so, a new CMS and ONC tool called the Randomizer will let you exchange data with a Test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement. The transitions of care requirement for eligible professionals (See Stage 2 Core Measure 15 - Transitions of Care) and eligible hospitals includes three measures. Measure #3 is outlined below:

Conduct one or more successful electronic exchanges of a summary of care document with a recipient who has EHR technology that was developed by a different EHR technology developer than yours, or
Conduct one or more successful tests with the CMS designated test EHR during the EHR reporting period.

How to Use the Tool To use the tool to meet this measure, you must register with EHR Randomizer. Once registered, it will pair your EHR technology with a different test EHR from the list of authorized systems. You must then send a Consolidated Clinical Document Architecture (CCDA) summary of care record to the Test EHR. CMS and ONC recommend that you send a test CCDA document that does not contain actual patient information.

Test EHRs will be required to email you within one day of the test, with notification of success or failure. A notification of a successful test can be used as proof of meeting the transitions of care measure.

Refer to the Randomizer Test Instructions and FAQs for more information.

Review Steps for Submitting Stage 2 Meaningful Use Data through the Attestation System

May 16, 2014
cms.gov

Are you preparing to submit Stage 2 meaningful use data for the Medicare EHR Incentive Program? If so, CMS has recently posted the following step-by-step guides to help navigate the CMS Attestation System:

These guides provide instructions and important information that you will need in order to successfully attest, as well as helpful tips and screenshots to walk you through the process.

Note: While all providers begin their registration through the CMS Registration & Attestation System, Medicaid eligible professionals and Medicaid-only eligible hospitals must attest through their State Medicaid Agency’s website. Please visit the Medicaid State Information page to learn more.

Additional Stage 2 Resources CMS has additional resources to help ensure your attestation will be successful:

For More Information Visit the Registration and Attestation and Stage 2 pages for more information on how to successfully demonstrate meaningful use.

Considerations for Specialists

HHS spreads the word about how specialists can meet meaningful use

amednews.com Nov. 15, 2010
By PAMELA LEWIS DOLAN

"For ophthalmologists talking about meaningful use requirements during the recent American Academy of Ophthalmology meeting, their question wasn't what information technology to buy in order to receive incentive payments. Their question was whether they would have to allow time to routinely weigh patients and check their blood pressure..."

Meaningful Use for Specialists Tipsheet

cms.gov

"Recognizing that not every meaningful use measure applies to every provider, this fact sheet gives specialty providers tips about how to successfully meet meaningful use measure requirements and navigate the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs."

New Requirements for 2014

6 Things you need to know about Meaningful Use and EHR Certification in 2014

hitechanswers.net September 25, 2013
By: Steven Posnack

"With the 2014 EHR reporting period for meaningful use right around the corner, here are 6 key pieces of information you need to know..."

Audits

EHR Incentive Programs Supporting Documentation For Audits

cms.gov

"Providers who receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program potentially may be subject to an audit. Eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) should retain ALL relevant supporting documentation (in either paper or electronic format) used in the completion of the Attestation Module responses..."

How does a failed meaningful use audit affect providers?

ehrintelligence.com September 18, 2013
By: Kyle Murphy, PhD

"Odds are that at least one eligible hospital or professional has failed a meaningful use audit. If there’s a story about a failed meaningful use audit out there, no one is willing to share it. But what happens when an eligible provider participating in the EHR Incentive Program does indeed fail a meaningful use audit? What becomes of the incentives disbursed? What impact does the failed audit have on the provider’s involvement in future stages of meaningful use?..."

How to Prepare For, Survive an EHR Meaningful Use Audit

aafp.org May 15, 2013
By: Sheri Porter

"Use of the words "audit" and "Medicare" in the same sentence tend to make even the most seasoned physician uncomfortable. So when the news broke in March that CMS had added prepayment meaningful use (MU) audits to its ongoing postpayment audit process, some family physicians expressed concern..."

PQRS

2013 Quality Reporting Programs Comparison

cms.gov

"Summary of Value Modifier, Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program"

2014 is the Last Year Eligible Professionals Can Earn a PQRS Incentive Payment

CMS
January 27, 2014

This is the last year eligible professionals can earn an incentive payment for satisfactorily reporting PQRS quality data to CMS, and this year’s participation in PQRS will also determine the 2016 PQRS payment adjustment.

If you satisfactorily submit PQRS quality measures to CMS using one of the approved reporting options for services provided during the 2014 reporting period, you will qualify to earn an incentive payment.

If you qualify, you will receive an incentive payment equal to 0.5% of your total estimated Medicare Part B Physician Fee Service (PFS) allowed charges for covered professional services supplied during that same reporting period, and ensure that you will also avoid the 2016 payment adjustment.

Steps to Participate and Earn an Incentive

STEP 1: Determine if you are eligible to participate. See PQRS List of Eligible Professionals.

STEP 2: Determine which PQRS reporting method best fits your practice.

An individual eligible professional may choose from the following methods to submit data to CMS:

Medicare Part B claims
Qualified PQRS registry (See PQRS Registry Made Simple)
Qualified electronic health record (EHR) product
Qualified PQRS data submission vendor
Qualified Clinical Data Registry (QCDR) (See PQRS Qualified Clinical Data Registry Made Simple)

A group practice may choose from the following methods to submit data to CMS:

Qualified PQRS Registry
GPRO Web Interface (for groups of 25+ only)
Qualified electronic health record (EHR) product
Qualified PQRS data submission vendor
CG CAHPS CMS-certified survey vendor (for groups of 25+ only)

STEP 3: Determine which measures to report, and review the specific criteria for the chosen reporting option in order to satisfactorily report. Download the PQRS Implementation Guide zip file for helpful resources. (See PQRS Measures List Implementation Guide.)

STEP 4: Report your quality measures. The number of measures you will have to report varies by reporting method. Be sure to pay attention to requirements for National Quality Strategy domains.

For More Information For more information or support on the 2014 PQRS program, please visit the PQRS Incentive Program website or the Help Desk.

2015 PQRS Payment Adjustment

cms.gov

"Section 1848(a)(8) of the Social Security Act, requires the Centers for Medicare & Medicaid Services (CMS) to subject eligible professionals and group practices who do not report data on Physician Quality Reporting System (PQRS) quality measures for covered professional services during the 2013 program year for a payment adjustment beginning in 2015. Eligible professionals and group practices receiving a PQRS payment adjustment in 2015 will be paid 1.5% less than the PFS amount for services rendered January 1-December 31, 2015."

Learn How to Avoid the 2015 PQRS Payment Adjustment

cms.gov
November 22, 2013

Providers considered eligible and able to participate in the Physician Quality Reporting System (PQRS) may be subject to payment adjustments beginning in 2015. Eligible professionals (EPs) and group practices that fail to satisfactorily report data on quality measures during the 2013 program year will be subject to a 1.5% payment adjustment of their Physician Fee Schedule (PFS) charges beginning in 2015.

Individuals and group practices participating in PQRS must meet one of the following criteria to avoid payment adjustments in 2015.

Criteria for Individual EPs EPs can avoid the 2015 payment adjustment if one of the following criteria is met during the 2013 PQRS program year:

Meet the requirements outlined in the 2013 PQRS measure specifications* (this will enable the EP to earn a 2013 PQRS incentive payment of 0.5% of their covered Medicare Part B charges)
Report at least:

One valid measure via claims, participating registry, or through a qualified Electronic Health Record (EHR) OR
One valid measures group via claims or participating registry

Elected to participate in the administrative claims-based reporting mechanism October 18, 2013

Criteria for Registered Groups (ACO/PQRS GPRO) Group practices participating in the Group Practice Reporting Option (GPRO) can avoid 2015 payment adjustments if one of the following criteria is met during the 2013 PQRS program year:

Group meets the following requirements, outlined in the 2013 PQRS GPRO Fact Sheet

Report specific ACO/GPRO measures through the Web Interface OR
Report at least 3 registry measures (for 80% of the group’s eligible patients for each measure) for the GPRO outlined in the 2013 PQRS Measure Specification for Claims/Registry Reporting of Individual Measures

Report at least one valid measure through the Web Interface OR participating registry
Elected to participate as a GPRO in the administrative claims-based reporting mechanism by October 18, 2013

Note: Administrative claims-based reporting is not available to ACO GPROs

Learn What’s New in 2014 for PQRS Participation

CMS
February 4, 2014

Are you an eligible professional or group practice participating in PQRS for the 2014 reporting year? CMS has released a new fact sheet to highlight program changes for the 2014 reporting year. See Whats New in PQRS 2014.

Here are some highlights to help you get started with 2014 participation:

2014 Program Changes

An eligible professional or group practice participating in the group practice reporting option (GPRO) must satisfactorily report 2014 PQRS quality measures to avoid a 2% payment adjustment in 2016.
CMS has added 37 new individual quality measures for the 2014 program year and retired 45 measures from 2013. Participants should use the most current version of the 2014 PQRS measure specifications.
Professionals who reassign benefits to a Critical Access Hospital (CAH) that bills professional services at a facility level, such as CAH Method II billing, can now participate (See PQRS List of Eligible Professionals) in PQRS (in all reporting methods except for claims-based).

To do so, the CAH must include the individual provider NPI on their Institutional (FI) claims.

2014 Reporting Changes

Eligible professionals must report on 9 measures across 3 National Quality Strategy (NQS) domains via claims, qualified registry, and EHR-based reporting methods.
EHR-based reporting is now available for groups participating in GPRO. (See PQRS GPRO Requirements.)

The Medicare EHR Incentive Program requires that an eligible professional or group practice submit clinical quality measures using a 2014 certified EHR.

Measure groups can only be reported through the qualified registry.
Eligible professionals can now participate in the qualified clinical data registry (QCDR).

A list of CMS-designated QCDRs will be available on the CMS PQRS website in May 2014.

Group practices of 25 or more eligible professionals now have the option to report PQRS data through the certified survey vendor reporting method (CAHPS).
Eligible professionals and group practices can no longer use the administrative claims-based reporting method to avoid a 2016 payment adjustment.
The Measure-Applicability Validation (MAV) process has expanded from claims-based reporting to also include qualified registry reporting.

For More Information Review the What's New in 2014 (Whats New in PQRS 2014) fact sheet for an overview of 2014 changes to the PQRS program. For more information or support for PQRS, please visit the PQRS website or the Help Desk.

Participation for the PQRS Incentive Payment Made Simple

cms.gov

"This Fact Sheet provides guidance for group practices wishing to participate in the 2013 PQRS for incentive purposes under the GPRO..."

Payment Adjustment Tool For eHealth Programs

cms.gov

"Use this tool to determine whether you will incur a future payment adjustment for not successfully participating in the following eHealth programs..."

The Year of the Penalty (PQRS 2013)

acumenmd.com Monday, February 18th, 2013
Terry Ketchersid, MD, MBA, VP, Clinical Health Information Management

"I know it is difficult to believe but February is rapidly drawing to a close. Those of you keeping track of the Chinese zodiac are keenly aware that we are now one week into the year of the snake. From a CMS incentive program perspective, however, one could consider 2013 the year of the penalty..."

Use New PQRS Interactive Timeline to Prepare for Upcoming Milestones

February 12, 2014
CMS

If you are an eligible professional or group practice participating in PQRS, CMS wants to make sure you are prepared for the many important program milestones that are approaching. To help you navigate these program deadlines, CMS has released a new PQRS interactive timeline that will help you identify key program dates for PQRS between 2014 and 2016, and direct you to related resources.

Some important dates to remember for this year include:

February 28, 2014

Last day to submit 2013 PQRS data through the EHR reporting methods
Last day to submit 2013 clinical quality measures (CQMs) for the PQRS-Medicare EHR Incentive Pilot Reporting Program
Last day that 2013 claims will be processed to be counted for 2013 PQRS reporting
Last day that eligible professionals who participated in the 2012 PQRS program can request an informal review of their 2012 PQRS results

March 21, 2014

Last day for groups to submit 2013 data through the GPRO Web Interface

March 31, 2014

Last day to submit 2013 PQRS data through the registry reporting method
Last day for Maintenance of Certification (MOC) Program entities to submit 2013 quality data
Last day for Qualified Clinical Data Registries (QCDRs) to submit measure information for 2014 participation

September 30, 2014

Last day for groups to register to participate in the Group Practice Reporting Option (GPRO) for the 2014 PQRS program year via Web Interface, registry, EHR reporting, or CAHPS reporting methods

November 1, 2014

Eligible professionals who participated in the 2013 PQRS program can begin requesting an informal review of their 2013 PQRS results

December 31, 2014

Reporting for the 2014 PQRS program year ends for both group practices and individuals

Want to learn more about PQRS? You can find the interactive timeline, along with other helpful information, on the Resources page of the CMS PQRS website.

eRx

2013 Final Program Year for the Medicare Electronic Prescribing (eRx) Incentive Program

February 20, 2014
CMS

Did you know that 2013 was the final program year for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program?

The 6-month 2014 eRx payment adjustment reporting period, which began on January 1, 2013 and ended on June 30, 2013, was the final reporting period to avoid the 2014 eRx payment adjustment. You do not need to report G-codes (G8553) for 2014 eRx events.

Content will remain available on the eRx Incentive Program website so participants have an opportunity to access reference materials associated with the eRx incentive payment, payment adjustment, and feedback reports.

Electronic Prescribing Continues with EHR Incentive Programs It is important to note that electronic prescribing via certified EHR technology is still a requirement for eligible professionals in order to achieve meaningful use under the Medicare and Medicaid EHR Incentive Programs:

Want to find out more about eHealth? Visit the CMS eHealth website for the latest news and updates on CMS eHealth initiatives. Sign up for CMS eHealth Listserv and follow us on Twitter.

2013 Quality Reporting Programs Comparison

cms.gov

"Summary of Value Modifier, Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program"

Overview of the Medicare 2013 E-Prescribing Incentive Program

acponline.org

"The Centers for Medicare and Medicaid Services (CMS) offers an incentive program for eligible professionals to facilitate the use of electronic prescribing (eRx). The incentive program was authorized under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and was implemented in 2009. The following bullets summarize major elements of and changes made for the 2013 program..."

Participation for the eRx Incentive Payment Made Simple

cms.gov

"This Fact Sheet provides step-by-step advice for participating in the 2013 eRx Incentive Program. This document applies to the eRx Incentive Program for incentive payment eligibility only and does not provide guidance for avoiding future payment adjustment(s)..."

Payment Adjustment Tool For eHealth Programs

cms.gov

"Use this tool to determine whether you will incur a future payment adjustment for not successfully participating in the following eHealth programs..."

Penalties

2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment

cms.gov

"Section 1848(a)(8) of the Social Security Act, requires the Centers for Medicare & Medicaid Services (CMS) to subject eligible professionals and group practices who do not report data on Physician Quality Reporting System (PQRS) quality measures for covered professional services during the 2013 program year for a payment adjustment beginning in 2015. Eligible professionals and group practices receiving a PQRS payment adjustment in 2015 will be paid 1.5% less than the PFS amount for services rendered January 1-December 31, 2015..."

Payment Adjustment Tool For eHealth Programs

cms.gov

"Use this tool to determine whether you will incur a future payment adjustment for not successfully participating in the following eHealth programs..."

The Year of the Penalty (PQRS 2013)

acumenmd.com Monday, February 18th, 2013
Terry Ketchersid, MD, MBA, VP, Clinical Health Information Management

"I know it is difficult to believe but February is rapidly drawing to a close. Those of you keeping track of the Chinese zodiac are keenly aware that we are now one week into the year of the snake. From a CMS incentive program perspective, however, one could consider 2013 the year of the penalty..."

MU, Stage 3

None at this time.

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