HITECH Alert This HITECH alert calls your attention to a number of critically important items appearing on the CMS Web site for the EHR Medicare and Medicaid Incentive Program as well as Technical Corrections to the Final Rule: (1) Official Opening Day to Register for the Incentive Program; (2) Availability of Eligible Hospital and Eligible Provider guides for each meaningful use measure and calculation; (3) Guidance on EHR Meaningful Use Requirements; and (4) Technical Corrections to Final Meaningful Use Rule.
(1) Medicare and Medicaid EHR Incentive Program Registration. The CMS Web site is now open for registration. Providers are urged by CMS to register even if they do not have a certified EHR. Step-by-step guides are provided for (1) Eligible Professionals— Medicare EHR Incentive Program; (2) Eligible Professionals—Medicaid EHR Incentive Program (3) Eligible Hospitals—Medicare and Medicaid EHR Incentive Programs.
Word of Caution. Although the Medicaid EHR Incentive Program began (Jan. 3, 2011), not all states will be ready to participate on this date. Information on when registration will be available for Medicaid EHR Incentive Programs is state-specific and is posted at Medicaid State Information.
When registering, you must choose Medicare, Medicaid, or both. Hospitals, of course, can choose both. CMS warns that you must choose Medicare, Medicaid, or both very carefully as you can not go back and correct it online. You must be “eligible” for Medicaid to choose “both” and that eligibility is based on having a 10 percent volume for acute care hospitals. The problem is that not everyone will know their volume as states have some latitude in the volume calculation. There is also an issue that your registration will be pended if you register for “both” and your State does not have an approved Medicaid program as yet.
This is a Catch-22 for those organizations in states with no Medicaid program in that the provider will be “pended” if they register for both but will have difficulty changing if they register for Medicare only at this point. The only states with approved programs as of January 3 are Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. In February, registration will open in California, Missouri, and North Dakota. Other states are expected to launch later in 2011.
(2) Stage 1 EHR Meaningful Use Specification Sheets for EPs and EHs. These guides are concise 1 or 2 page summaries for each meaningful use measure. Some of these documents contain important new clarifications and insights. These are “must have” resources for every eligible provider and hospital who seeks to achieve Meaningful Use. Of particular interest is the CPOE measure specification sheet which includes information on the ED options and clarifies when a pharmacist or other licensed professional’s CPOE entered order would count. Here is an excerpt from the CPOE specification sheet: Any licensed healthcare professionals can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local, and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that the CPOE occur when the order first becomes part of the patient’s medical record and before any action can be taken on the order.
(3) Guidance on EHR Meaningful Use Requirements. Just before Christmas (12/23), ONC issued an important new clarification that indicates hospitals must "possess" electronic health record technology certified against all 24 meaningful use objectives, and "demonstrate" meaningful use of 19 objectives in order to qualify for Medicare and Medicaid incentive payments and avoid future payment penalties. A hospital, according to ONC, must have either the physical technology or a contract that provides "a legally enforceable right…to access and use" the technology at its discretion. The degree to which a hospital implements the technology is not a factor in determining "possession." See the FAQs for more information and scroll to #s 17 and 21.
(4) Meaningful Use Final Rule Corrections. A December 29 Federal Register notice made certain technical and typographical changes of a minor nature to the Final Rule published in July. For example, in the section on the clinical summary objective, CMS changed "unique patients" to "office visits" as the measurement to determine whether patients received clinical summaries within three business days. CMS changed the wording on "permissible" prescriptions for electronic prescribing to align with the Drug Enforcement Agency's final rule on e-prescribing of controlled substances.