Meaningful Use Resource Center

On October 6, 2015, CMS published a final rule that specifies criteria that EPs must meet in order to participate in the Medicare and Medicaid Electronic Health Record Incentive Programs. The final rule’s provisions encompass 2015 through 2017 (Modified Stage 2) as well as Stage 3 in 2018 and beyond.

New participants – 90 continuous days for reporting period in each year:

• In CY 2015, new participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustments in CYs 2016 and 2017 if the EP successfully attests by February 29, 2016.
• In CY 2016, new participants who attest prior to October 1, 2016 will avoid the payment adjustments for CY 2017 and CY 2018. If new participants attest between October 1, 2016 and February 28, 2017, they will avoid the CY2018 payment adjustment.
• In CY 2017, new participants who attest prior to October 1, 2017 will avoid the payment adjustment for CY 2018.

Returning Participants – 90 continuous days in 2015, 365 days in 2016:

• In CY 2015, returning participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustment in CY 2017 if the EP successfully attests by February 29, 2016.
• In CY 2016, returning participants will avoid the CY 2018 payment adjustment if successfully attested by February 28, 2017.

Your EHR should provide the ability to generate reports that show the data needed to report on quality measures for MU to CMS. Once you have the data, the EP registers on the CMS site and manually types in the 'answers' for the objectives. The 'answers' MUST be as reported by the certified EHR technology but there is not an electronic connection between your EHR and the CMS attestation program.

The incentive is paid to one tax ID per physician, so the employed physician and the MSO would need to review their contracts to see if the employed physician must (or has already agreed to) assign payments, including EHR incentives to the MSO tax ID. If not, in the attestation process, the employed physician may determine the tax ID to which the incentive should be paid.

The term “structured data” typically implies that a piece of information has been entered into a specific field within the electronic health record.

For instance, if there is a field for blood pressure and you enter 120/80, the ‘120’ and the ’80’ are structured data. If a field in the EHR is structured data, then there are 'rules' about what you could type into that field. For example a "date" could be an 8 numeric character field meaning you could only type 04242013, NOT April 24, 2013. If a field is un-structured, you could type anything—letters, numbers symbols, spaces, etc. Structured data is easier to find, to sort, and to count and move between systems.

You should get started as soon as possible. New practice EPs get a two year grace period without the penalty kicking in. For more details, look at www.cms.gov because eventually the penalty does take effect if the new EP is not participating as a Medicare meaningful user.

None of these can qualify for Medicare incentives. The one exception to this is the case of a PA or NP who is the primary provider and/or owner of a rural health clinic. Mid-level providers (NPs) can qualify for Medicaid incentives. However, to do so requires that the provider have a minimum of 30% of their visits billed to Medicaid. EPs in a pediatric practice must only meet a 20% Medicaid visit threshold to receive 2/3 of the Medicaid incentive that an EP who has 30% or more Medicaid visits earns.

No, you will not be penalized for changing to a new EHR. What matters is that the new EHR is 2014 certified.

The previous measure structure of core and menu objectives has been replaced with 10 objectives, including one consolidated public health reporting objective. The objectives are the same regardless of what year of attestation you are in.

The Modified Stage 2 objectives require all providers to use an EHR that is certified to the 2014 Edition. Kareo was certified in March 2014 and this certification will be valid through 2017.

Beginning in 2016, the reporting period for all providers will be based on the calendar year. Any provider who is attesting for the first time will report on any 90 consecutive days. All returning providers will attest for the full calendar year—365 days.

To assist providers who may have already started working on meaningful use in 2015, there are alternate exclusions and specifications within individual objectives for providers who were previously scheduled to be in Stage 1 of meaningful use. These include:

• Allowing providers who were previously scheduled to be in a Stage 1 EHR reporting period for 2015 to use a lower threshold for certain measures.
• Retaining different specifications between Stage 1 and Stage 2
• Allowing providers to exclude for Stage 2 measures in 2015 for which there is no Stage 1 equivalent.

For the most part, the new objectives are identical to the previous Stage 1 and Stage 2 measures. The only exceptions are as follows:

• Patient Electronic Access (VDT): The threshold for the Stage 2 objective for Patient Electronic Access measure #2 has been changed from 5% of the patient population to “equal to or greater than 1 patient seen by the provider”. This means that only 1 patient will need to view, download, or transmit their medical information via the Patient Portal.
• Secure Electronic Messaging: The threshold for the Stage 2 objective Secure Electronic Messaging has been changed to “functionality fully enabled (yes/no).” This means that a provider will only need to indicate by a yes or no whether their patients have the capability to send him/her secure messages.
• Public Health Reporting: The public health reporting objectives have been consolidated into one objective with three measure options for EPs.

No, unlike the previous rules, all providers will be on Modified Stage 2 regardless of their previous scheduled stage and year. The previous rules stated that a provider shall participate in each stage for a minimum of two years. In order to ease the transition, Modified Stage 2 does allow for some alternate exclusions for providers who intended to participate in Stage 1 in 2015.

• Provide a flexible, clear framework to simply the meaningful use program and reduce provider burden
• Ensure future sustainability of Medicare and Medicaid EHR Incentive Programs
• Advance the use of health IT to promote health information exchange and improved outcomes for patients

Yes, Kareo EHR is 2014 Edition certified by the Drummond Group. This certification is valid through 2017. Kareo's CMS EHR Certification ID is: A014E01NDGFDEAD.

Sign up for Kareo’s EHR and start working with a Kareo Customer Success Coach. Start the Boot Camp plan which includes an individual workflow plan to help you start activating features such as Patient Portal and immunization registries, training your staff to collect the data, and engaging patients now.

If an eligible professional (EP) needs advice on MU, who should they contact? Providers should contact Kareo Support. There are dedicated members trained in Meaningful Use to answer your questions.

If you are currently working in a reporting period and have not yet attested, we recommend you stick with your existing EHR until the attestation is complete. If you plan to switch in for 2016, it may be necessary to work with both systems for a time, particularly since in 2016, the reporting period will be for the full calendar year. You will want to transition to be ready for January 1, 2016.

Kareo is certified for 19 CQMs with the 2014 Edition. Providers regardless of attestation year will use the same group of CQMs for attesting.

Adult a Set

1. CMS 2: Screening for Clinical Depression and Follow-up Plan
2. CMS 50: Closing the Referral Loop: Receipt of Specialist Report
3. CMS 68: Documentation of Current Medications in the Medical Record
4. CMS 69: Body Mass Index (BMI) Screening and Follow-up
5. CMS 90: Functional Status Assessment for Complex Chronic Conditions
6. CMS 138: Tobacco Use: Screening and Cessation Intervention
7. CMS 156: Use of High-Risk Medication in the Elderly
8. CMS 165: Controlling High Blood Pressure
9. CMS 166: Use of Imaging Studies for Low Back Pain

Pediatric Recommended Set:

1. CMS 2: Screening for Clinical Depression and Follow-up Plan (also in Adult Set)
2. CMS 75: Children who have Dental Decay or Cavities
3. CMS 117: Childhood Immunization Status
4. CMS 126: Use of Appropriate Medications for Asthma
5. CMS 136: ADHD: Follow-up Care for Children Prescribed ADHD Medication
6. CMS 146: Appropriate Testing for Children with Pharyngitis
7. CMS 153: Chlamydia Screening for Women
8. CMS 154: Appropriate Treatment for Children with Upper Respiratory Infection (URI)
9. CMS 155: Weight Assessment and Counseling for Nutrition and Physician Activity for Children and Adolescents

CQMs carried from 2011 Edition:

1. CMS 127: Pneumonia Vaccination Status for Older Adults
2. CMS 147: Influenza Immunization