Important information about 2016 and 2017 Medi-Cal EHR incentive program attestations, including delays for groups The California Department of Health Care Services (DHCS) has extended the attestation deadline for the Medi-Cal electronic health record (EHR) incentive program reporting for the 2016 program year. The deadline has been pushed to May 23, 2017. After that date, DHCS will only accept 2017 attestations. Eligible providers should be aware that 2016 is the last year that they can sign up for the program. Providers who have not received at least one incentive payment by the end of the 2016 reporting year won’t be able to receive any EHR incentive program payments in the future. As a result of 2016 program year extension, attestations for 2017 will not be accepted until after 2016 reporting closes on May 23, 2017, at 6 p.m. Group administrators should, however, be aware that while the State Level Registry (SLR) does currently allow groups to enter membership for the 2017 program year, DHCS strongly advises against doing so until the 2016 program year closes for two reasons: If a group needs to reopen its 2016 attestation for any reason (for example, to add providers) the SLR will require that the 2017 attestation also be reopened, resulting in a great deal of work and data reentry for the group administrator and SLR staff. Group administrators will not be able to enter a 90-day representative period for 2017 using the “last 12 months” option until May 23, 2017, when new code is deployed for 2017 attestations. DHCS also strongly recommends that groups delay submission of their 2017 attestations until most of their provider attestations have been reviewed and approved for 2016, so that they are relatively certain that it will not be necessary to reopen their 2016 group attestation. Click here for more information about Medi-Cal EHR incentive program reporting. Contact: Medi-Cal.EHR@dhcs.ca.gov or (916) 552-9181. May 22, 2017 General, Managed Care, Medi-Cal Electronic Health Record, Meaningful Use, Medi-Cal 0 0 Comment Read More »
DHCS extends reporting deadline for 2016 Medi-Cal meaningful use The California Department of Health Care Services (DHCS) has announced that it will extend the deadline for Medi-Cal meaningful use reporting for the 2016 program year. The deadline has been pushed back one month to May 2, 2017. After that date, DHCS will only accept 2017 attestations. The Medicaid Electronic Health Record (EHR) Incentive Program provides funding to Medicaid (Medi-Cal in California) providers and hospitals to adopt, implement, upgrade and make meaningful use of certified EHR technology. Eligible providers should be aware that 2016 is the last year that eligible providers can sign up for the program. Providers who have not received at least one incentive payment by the end of the 2016 reporting year won’t be able to receive any EHR incentive program payments in the future. DHCS's announcement comes a week after the Centers for Medicare and Medicaid Services also extended its 2016 reporting deadline for Medicare meaningful use. A few other reporting changes were also announced for 2017. DHCS will only accept meaningful use reporting for Stage 2 this year and all clinicians can report Stage 2 no matter how many times they have submitted Stage 2 attestations in the past. Providers will also have the option to report Stage 3 meaningful use beginning October 24, 2017. Providers who have previously attested to meaningful use will be required to use a full year reporting period for clinical quality measures in 2017. Providers who have never attested to meaningful will be able to able to use 90-day reporting periods. Click here for more information about Medi-Cal meaningful use reporting. March 2, 2017 Medi-Cal Electronic Health Record, EHR, Meaningful Use, Medi-Cal 0 0 Comment Read More »
2017 Medicare EHR payment adjustment reconsideration forms due February 28 Eligible physicians who have been identified as being subject to Medicare electronic health record (EHR) payment penalties in 2017 (based on the 2015 reporting period), and believe that determination to be in error, have until February 28, 2017, to submit a reconsideration form to the Centers for Medicare and Medicaid Services (CMS). The reconsideration form can be downloaded from the CMS website. For reconsideration instructions, click here. If you have questions about the reconsideration process, please email pareconsideration@provider-resources.com. For more information on payment adjustments and hardship applications, or for information on reporting requirements, please visit the CMS EHR Incentive Programs web page. February 23, 2017 Medicare CMS, EHR, Electronic Health Record, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Cloud computing providers need to sign business associate agreements, says OCR The U.S. Department of Health and Human Services Office of Civil Rights (OCR) recently released updated guidance on the use of cloud computing for the storage or transmission of electronic personal health information (ePHI). The new guidance clarifies that cloud service providers are considered "business associates" under HIPAA, even if the provider only stores encrypted data and doesn't have a decryption key to view the data. This means that if a covered entity (or business associate) uses a cloud service provider to maintain ePHI without entering into a business associate agreement, the covered entity (or business associate) is in violation of HIPAA. “As a business associate, a cloud service provider providing no-view services is not exempt from any otherwise applicable requirements of the HIPAA Rules,” OCR said. “However, the requirements of the rules are flexible and scalable to take into account the no-view nature of the services provided by the [cloud service provider].” Cloud service providers generally offer online access to shared computing resources with varying levels of functionality ranging from data storage to complete software solutions (e.g., an electronic health record system), platforms to simplify the ability of application developers to create new products, and entire computing infrastructure for software programmers to deploy and test programs. The guidance also includes answers to several other common questions related to cloud computing and HIPAA. To read the guidance in its entirety, click here. For more information, see CMA On-Call document #3301 "Physician Use of Mobile Devices and Cloud Computing." CMA On-Call documents are available free to members in CMA's online health law library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page in the CMA Resource Library. November 1, 2016 EHR, Managed Care Health Information Technology (HIT), Electronic Health Record 0 0 Comment Read More »
Reminder: 2016 is last year to start Medi-Cal EHR Incentive Program The Medicaid Electronic Health Record (EHR) Incentive Program provides funding to Medicaid (Medi-Cal in California) providers and hospitals to adopt, implement, upgrade and make meaningful use of certified EHR technology. Eligible providers should be aware that 2016 is the last year that eligible providers can sign up for the program. Since the program began in 2011, more than 20,000 Medi-Cal professionals have qualified, receiving more than $500 million in incentive payments. Professionals can individually receive up to $63,750 in incentive payments over six years, with the largest payment of $21,250 in the first year for signing a contract or other binding agreement to acquire certified EHR technology. The EHR does not have to be installed in the first year to receive this payment, and the payment does not have to be returned if the professional does not subsequently demonstrate meaningful use of the EHR. Professionals who subsequently demonstrate meaningful use of the EHR receive $8,500 yearly for up to five years. The program is open to physicians, dentists, optometrists, nurse practitioners, certified nurse midwives and physician assistants (who work in Federally Qualified Health Centers or Rural Health Clinics) who can demonstrate that 30 percent or more of their or their group’s encounters or panel patients during a 90-day period in the previous calendar year can be attributed to Medi-Cal patients. Pediatricians, however, can qualify with a 20 percent Medi-Cal patient volume. (Pediatricians with 20 to 29 percent Medi-Cal patient volume will only qualify for two-thirds of the total incentive.) Many professionals do not need to supply encounter or patient information because the California Department of Health Care Services (DHCS) is able to “prequalify” them using state databases. Deadline to start the program This year—2016—is the last year to start the program. Those who have not received at least one incentive payment by the 2016 program year won’t be able to receive any EHR incentive program payments in the future. DHCS urges all professionals who have not yet participated, but who may be eligible, to submit an application as soon as possible. New applications are being accepted now and the final deadline for new applications is March 31, 2017. As part of this application, professionals must submit proof of a contract or other binding agreement for certified EHR technology, signed before or on the date of application. The website for submitting an application, the State Level Registry, can be accessed at http://medi-cal.ehr.ca.gov. There you will also find detailed information about the program and how professionals can obtain assistance and certified electronic health records. September 12, 2016 Medi-Cal EHR, Certified EHRs, Electronic Health Record, Medi-Cal 0 0 Comment Read More »
Deadline to file for meaningful use hardship exemption is March 15 In mid-December, Congress adopted a last-minute bill that gives CMS the authority to grant a blanket exemption for all eligible physicians who apply for the exemption from the 2015 meaningful use penalties. This action prevents the Centers for Medicare and Medicaid Services (CMS) from implementing Medicare payment penalties for physicians who fail to demonstrate meaningful use of a certified electronic health record (EHR) system in 2015. New rules released last year state that eligible professionals must attest that they met the requirements for stage 2 meaningful use for a period of 90 consecutive days during calendar year 2015. However, CMS did not publish the updated regulations for stage 2 meaningful use until October 16, 2015. As a result, eligible professionals were not able to report until fewer than the 90 required days remained in the calendar year. CMS had previously stated that it would grant hardship exemptions for 2015 if providers were unable to attest due to the late publishing of the rule, but law at that time only authorized it to grant such exemptions on a case-by-case basis. This new law grants CMS the authority to make an automatic exemption IF it receives a hardship exemption application. It also streamlines the exemption process, alleviating burdensome administrative issues for both physicians and the agency. Under the new law, physicians are still required to file for a hardship exemption to avoid a payment adjustment for 2015 no later than March 15, 2016. CMA has just published a new resource titled, "Meaningful Use Hardship Exception Frequently Asked Questions" available FREE for CMA members at www.cmanet.org/ces (top of the page) and is also available in the CMA resource library. The resource is not available to non-members. Physicians are urged to preemptively file for a 2015 hardship exception to avoid penalties in 2017. Physicians are encouraged to apply even if they are uncertain whether they will meet the program requirements this year. CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the hardship will not prevent a physician from earning an incentive; it simply protects a physician from receiving a meaningful use penalty. Therefore, physicians who believe that they met the meaningful use requirements for the 2015 reporting period should still apply for the hardship protection. Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017. The application is available on the CMS website and can be downloaded by clicking here. Physicians are encouraged to apply for a hardship under the “EHR Certification/Vendor Issues (CEHRT Issues)” category (option 2.2.d in the application). The American Medical Association (AMA) has published a fact sheet that includes step-by-step instructions on how to apply for the hardship exemption. The deadlines for submitting applications for hardship exceptions are: Eligible physicians: March 15, 2016 Eligible hospitals: April 1, 2016 CMA and AMA worked frantically the last few weeks of 2015 to get the bill passed authorizing this blanket exemption. CMA extends a huge thank you to Majority Leader Kevin McCarthy (R-CA) and Minority Leader Nancy Pelosi (D-CA) for agreeing to keep the House in session and pass the bill on unanimous consent. For more information on the EHR incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015." February 9, 2016 Medicare Electronic Health Record, Meaningful Use, Medicare, EHR 0 0 Comment Read More »
Physicians urged to preemptively file for meaningful use hardship exemptions Because of a delay in the publication of regulations governing the Medicare meaningful use program, physicians are being urged to preemptively file for a 2015 hardship exemption to avoid penalties in 2016. Physicians should apply for an exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty. In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use stage 2 for a period of 90 consecutive days during calendar year 2015. Unfortunately, however, the Centers for Medicare and Medicaid Services (CMS) did not publish the updated regulations for stage 2 meaningful use until October 16, 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year. CMS has stated that it will grant hardship exemptions for 2015 if eligible providers are unable to attest due to the late publishing of the rule. However, under current law, CMS can only grant such exemptions on a case-by-case basis. This means that many eligible professions will be required to apply for exemptions and that CMS will have to act on each application individually. CMS has approved over 85 percent of hardship exemptions in the past. Hardship applications will be available in early 2016 at www.cms.gov/EHRIncentivePrograms. The California Medical Association (CMA) and the American Medical Association are also supporting new legislation in Congress to streamline the hardship exemption process. The legislation, H.R. 3940 – the Meaningful Use Hardship Relief Act of 2015 – would grant CMS the authority to grant blanket hardship exceptions to physicians, hospitals and other affected providers for 2015, alleviating burdensome administrative issues for both providers and the agency. CMA will continue to monitor this situation. For more information on the electronic health record (EHR) incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015." December 7, 2015 Medicare EHR, Meaningful Use, Medicare, CMS, Electronic Health Record 0 0 Comment Read More »
New CMS rule changes meaningful use requirements The Centers for Medicare and Medicaid Services (CMS) this week published new rules for the current and final stages of the electronic health record (EHR) incentive program. In publishing the rule, CMS acknowledged the difficulties physicians have experienced with meeting meaningful use requirements. The regulations announced are intended to ease the reporting burden for providers, support interoperability and improve patient outcomes. While the modified rules for years 2015-2017 are final, the stage 3 portion of the final rules were released with the opportunity for public comment, with the expectation that CMS will revise stage 3 in the coming months. Major provisions of the final rule include: In 2015-2017, eligible professionals will be responsible for 10 objectives including one public health reporting objective, down from 18 total objectives in prior stages in 2015-2017. Medicare providers switching EHR vendors or who have other technology difficulties are encouraged to apply for a hardship exception. The reporting period is reduced from a full calendar year to 90 days for all providers in 2015, for new participants in 2016 and 2017, and for any provider who begins stage 3 in 2017. While eligible professionals are voluntarily able to begin stage 3 in 2017, CMS emphasizes that all providers will be required to comply with stage 3 requirements beginning in 2018 using 2015 certified EHR technology. The 60-day public comment period will allow CMS to gather additional feedback about the way these rules will interact with the Medicare payment reform legislation passed earlier this year (the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA). MACRA, which replaces the sustainable growth rate formula, establishes a merit-based incentive payment system. Achieving meaningful use will be a component of physicians’ compensation under the MACRA payment scheme. The final rule synchronizes reporting under the EHR incentive programs to end the separate stages of meaningful use in order to transition physicians to the new payment scheme under MACRA. While CMS made significant changes to the meaningful use program, the California Medical Association (CMA) continues to advocate for greater reform to make the program less burdensome. For more information on the federal EHR incentive program and meaningful use, see CMA On-Call documents #4301, "Electronic Health Records: Federal Incentive Program"; #4302, "Meaningful Use of Electronic Health Records"; and #4305 "EHR Meaningful Use: Stage 2." These and other On-Call documents are available free to members in CMA's online health law library at www.cmanet.org/cma-on-call. October 14, 2015 Managed Care, Medi-Cal, Medicare EHR, Electronic Health Record, Meaningful Use, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Members of Congress urge HHS to pause meaningful use stage 3 The California Medical Association (CMA) and the American Medical Association (AMA) are urging the U.S. Department of Health and Human Services (HHS) to delay implementing stage 3 of the electronic health record (EHR) meaningful use program, as it is fraught with problems that need to be fixed before the next stage is implemented. CMA and AMA are also pushing for an automatic hardship exemption for physicians who were unable to successfully report in 2015. To that end, at AMA and CMA’s urging, Congress sent a bipartisan letter to HHS Secretary Burwell, asking her to delay stage 3 until the program can be reformed and tested, and the new Medicare payment system is implemented. Recently, the Medicare program made a stunning announcement that while 78 percent of physicians are using EHRs, more than 50 percent of eligible physicians will face meaningful use penalties under the EHR Incentive Program in 2015. The program was intended to increase physician use of technology to improve care and efficiency. Unfortunately, the program's unrealistic and unnecessary requirements are hindering participation in the program, forcing physicians to purchase expensive EHRs with poor usability that disrupt workflow, interfering with patient care and imposing administrative burdens. "Stage 2 requirements were adopted with untested standards and the (medical community has) learned the hard way that it was not ready," CMA and AMA wrote in the letter to HHS. "Thirty-eight percent of hospitals and only 11 percent of physicians who signed up for the EHR program met the stage 2 requirements in 2014. This low rate of success (even among California’s sophisticated early adopters) demonstrates the problems in the program.” It is a program problem, not a physician problem. Therefore, CMA is asking HHS to not move forward until it tests the unproven technology that stage 3 depends upon. Unfortunately, the proposed stage 3 rule, currently under review at the Office of Management and Budget, exacerbates current problematic policies of stage 2. "We should incentivize technology that enables interoperability and improved health outcomes rather than incentivizing technology that counts how many times a provider performs an activity," the letter says. AMA and CMA are also arguing that the stage 3 rules are premature. Under the new Medicare payment system that Congress enacted earlier this year, there are substantial changes to the quality reporting programs and meaningful use. CMA believes that the Centers for Medicare and Medicaid Services (CMS) needs to implement the new payment framework and meaningful use changes before moving to meaningful use stage 3. Otherwise, physicians could be forced to make EHR changes that could have been prevented if Medicare payment reforms were implemented first. CMA urging automatic hardship exemption for 2015 In April, at AMA and CMA’s request, CMS proposed modifications to stage 2 of the meaningful use program that would reduce the reporting period from a full calendar year to 90 days. Stakeholders believed this was necessary since many physicians could not update systems, change products, or accommodate Internet outages or other disruptions under a 365-day reporting program. The draft rule also reduced the number of measures and will only require one patient vs. 5 percent of patients to access a physician’s patient portal. Because CMS has yet to issue the final rule that would implement this change for the 2015 meaningful use program, many physicians who were counting on this flexibility will be subjected to financial penalties under the rules currently in place. Therefore, AMA is calling on the agency to create an automatic hardship exemption for physicians who did not have the opportunity to report successfully this year. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. October 14, 2015 Managed Care, Medicare Electronic Health Record, Regulatory Advocacy, EHR, Meaningful Use 0 0 Comment Read More »
AMA town hall to discuss meaningful use concerns On Tuesday, September 29, the American Medical Association (AMA) will hold a virtual town hall meeting to give physicians a chance to discuss concerns with poorly designed electronic health record (EHR) systems and the impact they have on patient care and government mandates. The U.S. government has spent some $25 billion on the program to promote a digital health infrastructure based on the power of EHRs to enhance patient care, improve productivity, and reduce costs. While 80 percent of physicians have adopted EHR technology, many physicians believe that the current meaningful use regulations threaten to turn the promise of EHRs into a pipe-dream. Many physicians say stringent government rules require EHR systems to serve too many functions and that the technology interferes with face-to-face discussions with patients, prohibits efforts to share important health care information between different systems and diverts resources away from patient care. During the live event, AMA will also discuss its ongoing initiatives to reframe federal regulations and encourage better designed EHRs that emphasize high-quality patient care as the primary focus. Physicians and others who are not able to participate in this event can still make their voices heard on this critical issue. Visit BreaktheRedTape.org to share thoughts and experiences about EHR problems and solutions. The virtual event will begin at 3 p.m. Register for the program here. Contact: Robert J. Mills, (312) 464-5970 or robert.mills@ama-assn.org. September 28, 2015 General EHR, Electronic Health Record, Meaningful Use, American Medical Association 0 0 Comment Read More »
