Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11, 2012

1. Meaningful Use OverviewforHIM ProfessionalsPat Gowan & JoAnne HawkinsLast Updated: June 11, 2012

2. Today’s Objectives • Understand the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program • Understand and differentiate the Meaningful Use Performance Measures and Meaningful Use Clinical Quality Measures • Review the current Meaningful Use performance Measures as they pertain to HIM Professionals

3. Medicare and Medicaid EHR Incentive Program Overview The American Recovery and Reinvestment Act of 2009 provides incentive payments for Medicare and Medicaid Eligible Hospitals and Eligible Professionals that are meaningful users of certified EHR technology. The EHR incentive programs are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 which amended the Social Security Act. Indian Health Service (IHS), Tribal and Urban Indian health programs (I/T/U) eligible hospitals and eligible professionals can receive EHR incentive payments if they meet requirements of the Medicare and/or Medicaid EHR incentive programs starting in 2011. For, Medicare they need to demonstrate meaningful use of certified EHR. For Medicaid, they need to adopt, implement and upgrade to a certified EHR in their first participation year.**Eligible hospitals and eligible professionals must take steps to receive payments. The IHS Resource and Patient Management System (RPMS) successfully passed all tests required for certification as a complete EHR for ambulatory and inpatient use, based on criteria established by the Office of the National Coordinator for Health Information Technology. I/T/Us that do not use RPMS EHR must ensure that their EHR is certified separately.

4. Meaningful Use

5. Meaningful Use: What is Meaningful Use? • Meaningful Use is using certified EHR technology to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • All the while maintaining privacy and security

6. Stage 3 2015+ Stage 2 2013-2014 Stage 1 2011-2012 Meaningful Use: Stages of Meaningful Use • 3 stages of Meaningful Use • Requirements will increase over time…more work lies ahead

8. Meaningful Use: Definition of A/I/U • Adopt: Acquire, purchase, or secure access to certified EHR technology • Implement: Install or commence utilization of certified EHR technology capable or meeting MU requirements • Upgrade: Expand the available functionality of certified EHR technology capable of meeting MU requirements at the practice site, including staffing, maintenance, and training or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria

9. EHR Certification

11. EHR Certification: EHR Certification Number* • Inpatient Certification #: 30000002ELL6EAI • Ambulatory Certification #: 30000002EJKDEAI *The number will be entered during CMS registration and attestation

12. Eligible professionals & Hospitals

13. Eligible Professionals: Medicare & Medicaid Comparison Medicare-only Eligible Professionals Medicaid-only Eligible Professionals Professionals may be eligible for both Medicare & Medicaid, but can only participate in one program at a time Could be eligible for both Medicare & Medicaid incentives

14. Eligible Hospitals: Medicare & Medicaid Comparison Hospitals only eligible for Medicare incentive Hospitals only eligible for Medicaid incentive Could be eligible for both Medicare & Medicaid (most hospitals)

15. Eligible Professional: Incentive Program Timeline

16. Eligible Hospital: Incentive Program Timeline

17. Medicaid FOREligibleprofessionals & hospitals

18. Eligible Professionals & Medicaid: Patient Volume Threshold * All Tribal clinics are deemed FQHC/RHC for the CMS incentive program

19. Eligible Hospital: Medicaid Patient Volume Requirement Medicare does not have a patient volume threshold

20. Incentives

21. Eligible Professionals: Summary of Medicare & Medicaid Incentives

22. Eligible Professionals: Medicare Incentive Payment Example

23. Eligible Professionals: Medicaid Incentive Payment Example

24. Eligible Hospital: Medicare & Medicaid Incentive Summary

25. Performance Measures

26. Eligible Professionals: Meaningful Use Requirements • STAGE 1: Meaningful Use Requirements • 20 total Performance Measures • 15 core performance measures* • 5 performance measures out of 10 from menu set* • 6 total Clinical Quality Measures • 3 core or alternate core • 3 out of 38 from menu set • * Most measures require achievement of a performance target

27. Eligible Hospital: Meaningful Use Requirements • STAGE 1: Meaningful Use Requirements • 19 total Performance Measures • 14 core performance measures* • 5 performance measures out of 10 from menu set* • 15 total Clinical Quality Measures • * Most measures require achievement of a performance target

28. Performance Measures

29. Performance Measures

30. Meaningful use Reports

31. Stage 1 Meaningful Use Reports Eligibility Patient Volume Report 3rd Party Billing Calculates: * EP Medicaid patient volume rates * group practice rates in lieu of calculating the rate for each individual EP * EH Medicaid patient volume rates Demonstrating Meaningful Use Clinical Quality Measures Report Clinical Reporting Calculates Clinical Quality Measures for EPs and EHs No targets for Stage 1 EPs: 6 total CQMs 3 core or alternate core 3 out of 38 from menu set EHs: 15 total CQMs Performance Measures Report PCC Calculates Performance Measures for EPs and EHs 1 out of 15 core Performance Measures: Submit CQMs to CMS EPs: 15 core EHs: 14 core EPs & EHs: 5 out of 10 menu No delay in data capture caused by data entry / coding Affects of Data Entry / Coding Medicaid: Patient Volume Report - Coding must be up to date so that a claim can be generated and paid Medicare : Allowable Charges Clinical Quality Measures Report - If coding isn’t up to date, CQM report results may be low

33. MU Reports: EP & EH Performance Reports

34. MU Reports: Clinical Quality Measure Report

35. WHAT DOES HIM REALLY NEED TO KNOW • Differences/commonalities between: • -CORE SET and MENU SETS • -PERFORMANCE MEASURES and CLINICAL QUALITY MEASURES • -MEASURES FOR EH/CAH versus EP • Reports that demonstrate reaching meaningful use • Measures that require attestation only • Effects of accurate and timely completion of coding queue on MU • Effects of inpatient coding and clinical documentation on reaching CQM • Effects of PCC errors on MU • Effects of complete and comprehensive patient registration on MU

36. Stage 2

37. Stage 2 – Proposed Rule • Proposed delay of Stage 2 until 2014 • Proposed new Performance Measures • Proposed increase in targets for some measures • Proposed moving menu set to core • Proposed new Patient Volume methodology • Proposed changes to Stage 1

38. Proposed Stage 2 Delay

39. Eligible Professionals: Meaningful Use Requirements

40. Eligible Hospitals: Meaningful Use Requirements

41. Stage 1 Core vs. Stage 2 NPRM

42. Stage 1 Core vs. Stage 2 NPRM

43. Stage 1 Menu moved to Stage 2 Core (NPRM)

44. Stage 2 NPRM Menu Set

46. Regional Extension Center

47. IHS Meaningful Use: Contact Information • Chris Lamer, Meaningful Use Project Lead, IHS Chris.Lamer@ihs.gov; (615) 669-2747 • Luther Alexander, MU Project Manager, DNCLuther.Alexander@ihs.gov; (301) 443-8114 • JoAnne Hawkins, MU Healthcare Policy Analyst, DNC JoAnne.Hawkins@ihs.gov;(505) 767-6600 x1525 • Cecelia Rosales, MU Requirements Manager, DNC Cecelia.Rosales@ihs.gov; (505) 767-6600 x1230

48. Questions?Discussion TimeSign up for the MU Listserv!http://www.ihs.gov/listserver/index.cfm?module=signUpForm&list_id=168More questions, contact us at:MeaningfulUseTeam@ihs.gov