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Meaningful Use Frequently Asked Questions

What is Meaningful Use?

The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:

  • The use of a certified EHR in a meaningful manner, such as e-prescribing.
  • The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
  • The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

What are the Requirements & Objectives?

Why Electronic Health Records?

Electronic health records can improve care by enabling functions that paper medical records cannot deliver:
  • EHRs can make a patient's health information available when and where it is needed - too often care has to wait because the chart is in one place and needed in another. EHRs enable clinicians secure access to information needed to support high quality and efficient care.
  • EHRs can bring a patient's total health information together to support better health care decisions, and more coordinated care.
  • EHRs can support better follow-up information for patients - for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided and reminders for other follow-up care can be sent easily or even automatically to the patient.
  • EHRs can improve patient and provider convenience - patients can have their prescriptions ordered and ready even before they leave the provider's office, and insurance claims can be filed immediately from the provider's office.

Electronic health records can provide many benefits for providers and their patients:

  • Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room.
  • Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors' offices, hospitals, and across health systems, leading to better coordination of care.
  • Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.
  • Currently, most health care providers still use medical record systems based on paper. New government incentives and programs are helping health care providers across the country make the switch to electronic health records.

What are the technical capabilities required for certified EHR technology?

Standards and Certification Criteria for Electronic Health Records: Issued by the Office of the National Coordinator for Health Information Technology, this rule identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

What are Quality Measures?

Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care. A "quality measure means" a standard for measuring the performance and improvement of population health or of health plans, providers of services, and other clinicians in the delivery of health care services A "clinical quality measure" is a mechanism used for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in an optimal time frame.

Why are Measures Important to CMS?

Measuring the quality of patient care helps to drive improvements in health care

CQMs help identify areas that require improvement in care delivery, identify differences in care among various populations, and may improve care coordination between health care providers.

How are they developed?

The Measures Management System is a set of processes and decision criteria used by CMS to oversee the development, implementation, and maintenance of healthcare quality measures. CMS recognizes the need for quality measures of the highest caliber, maintained throughout their life cycle to ensure they retain the highest level of scientific soundness, importance, feasibility, and usability. Through the use of a standardized process with broadly recognized criteria, the Measures Management System ensures that CMS will have a coherent, transparent system for measuring quality of care delivered to its beneficiaries.

The Measures Management System has been developed in collaboration with the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, the National Committee for Quality Assurance (NCQA), the American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) and other measure stakeholders.

The Measures Management System (http://www.cms.gov/MMS/)

How are they used?

CMS uses quality measures in its quality improvement, public reporting, and pay-for-reporting programs for specific healthcare providers.

How are they collected or reported?

Data on quality measures are collected or reported in a variety of ways, such as claims, assessment instruments, chart abstraction, registries.

Who are Eligible Professionals?

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

Who is an Eligible Professional under the Medicaid EHR Incentive Program?

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

What are the Eligible Professionals Incentives?

How do Eligible Providers receive Incentives?

In order to receive their Provider Incentive payment, Eligible Professionals must complete the following:

  • Reporting Period: The reporting period for the EHR Incentive program using a certified EHR is any continuous 90 day period during the first payment year. Please note that although the measure specifications assume a full calendar year you should only calculate the denominator and numerator from the first day of the 90 day reporting period to the last day of the 90 day reporting period.
  • Report from the table of 44 clinical quality measures which includes, 3 Core, 3 Alternate Core, and 38 additional CQMs.
  • Core CQMs - Eligible Professionals must report on 3 required core CQMs, and if the denominator of 1 or more of the required core measures is 0, then Eligible Professionals are required to report results for up to 3 alternate core measures.
  • Eligible Professionals also must also select 3 additional CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is acceptable to have a '0' denominator provided the Eligible Professional does not have an applicable population.

In sum, Eligible Professionals must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures. A maximum of 9 measures would be reported if the Eligible Professional needed to attest to the 3 required core, the three alternate core, and the 3 additional measures.

Medicare Eligible Professionals:

The Medicare EHR Incentive Program for eligible professionals starts in 2011 and will continue through 2016. Depending on the first year they participate, eligible professionals can participate for up to 5 years throughout the duration of the program. The last year to begin participation in the Medicare EHR Incentive Program is 2014.

  • To qualify for Medicare EHR incentive payments, Medicare eligible professionals must successfully demonstrate meaningful use for each year of participation in the program.
  • Incentive payments are made based on the calendar year. The reporting period for the first year is any 90 continuous days during the calendar year. The reporting period for all subsequent years is the entire calendar year.
  • For calendar years 2011-2016, eligible professionals who demonstrate meaningful use of certified EHR technology can receive up to $44,000 over 5 years under the Medicare EHR Incentive Program. See the payment table below for more information.
  • To receive the maximum EHR incentive payment, Medicare eligible professionals must begin participation by 2012.
  • Important! For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment adjustment to their Medicare reimbursement. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%.
  • Medicare eligible professionals who also qualify as a Medicaid eligible professional must choose between the Medicare and Medicaid incentive programs when they register. Not sure which program to register for? Find more information in the EHR Incentive Programs Overview page.
  • Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.
(https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp)

Medicaid Eligible Professionals:

The Medicaid EHR Incentive Program is offered and administered voluntarily by states and territories. States can start offering their program to eligible professionals as early as 2011. The program continues through 2021. Eligible professionals can participate for 6 years throughout the duration of the program. The last year to begin participation in the Medicaid EHR Incentive Program is 2016.

  • To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use in subsequent participation years.
  • For calendar years 2011-2021, participants can receive up to $63,750 over 6 years under the Medicaid EHR incentive program. EHR incentive payments are made by the state based on the calendar year. See payment table below.
  • Medicaid eligible professionals who also qualify as Medicare eligible professionals must choose between the Medicare and Medicaid EHR Incentive Programs when they register. Not sure which program to register for? Find more information in the Overview page.
  • Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.

Who are Eligible Hospitals?

What is an Eligible Hospital under the Medicare EHR Incentive Program?

  • "Subsection (d) hospitals" in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)
  • Critical Access Hospitals (CAHs)
  • Medicare Advantage (MA-Affiliated) Hospitals

What is an Eligible Hospital under the Medicaid EHR Incentive Program?

  • Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume
  • Children's hospitals (no Medicaid patient volume requirements)

What are the Eligible Hospitals Incentives?

Eligible hospitals and Critical Access Hospitals (CAHs) will qualify for incentive payments under the Medicare EHR Incentive Program if they successfully demonstrate meaningful use of certified EHR technology.

  • Eligible hospitals and CAHs that adopt and successfully demonstrate meaningful use of certified EHR technology can begin receiving incentive payments for any year from federal fiscal year (FY) 2011 to FY 2015.
  • Incentive payments to eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment.
  • The law defines a payment year for eligible hospitals and CAHs in terms of federal fiscal year (FY) beginning with FY 2011. However, a hospital does not have to begin receiving incentive payments in FY 2011.
  • Hospitals can begin receiving EHR incentive payments in any year from FY 2011 to FY 2015, but payments will decrease for hospitals that start receiving payments in 2014 and later.
  • Hospitals that do not successfully demonstrate meaningful use of certified EHR technology beginning in FY 2015 will be subject to payment adjustments.

How do Medicaid Eligible Hospitals receive Incentives?

Medicaid Eligible Hospitals:

Eligible hospitals will qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology during the first participation year or successfully demonstrate meaningful use of certified EHR technology in subsequent participation years.

  • Medicaid hospitals that qualify for EHR incentive payments may begin receiving incentive payments in any year from FY 2011 to FY 2016.
  • While the law defines a payment year in terms of a federal fiscal year (FY) beginning with FY 2011, a hospital does not have to begin receiving incentive payments in FY 2011.

How Can I Attest?

Medicare eligible professionals, eligible hospitals and critical access hospitals will have to demonstrate meaningful use through CMS' web-based Registration and Attestation System (https://ehrincentives.cms.gov/) In the Medicare & Medicaid EHR Incentive Program Registration and Attestation System, providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR system will provide a report of the numerators, denominators and other information. Then you will need to enter that data into our online Attestation System. Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System–immediately after you submit your results you will see a summary of your attestation, and whether or not it was successful. The Attestation System for the Medicare EHR Incentive Program will open on April 18, 2011.

For the Medicaid EHR Incentive Program, providers will follow a similar process using their state's Attestation System. States' scheduled launch dates for their Medicaid EHR Incentive Programs: (http://www.cms.gov/apps/files/statecontacts.pdf)

When can I attest?

To attest for the Medicare EHR Incentive Program in your first year of participation, you will need to have met meaningful use for a consecutive 90-day reporting period. If your initial attestation fails, you can select a different 90-day reporting period that may partially overlap with a previously reported 90-day period. To attest for the Medicare EHR Incentive Program in subsequent years, you will need to have met meaningful use for a full year. Please note the reporting period for eligible professionals must fall within the calendar year, while the reporting period for eligible hospitals and critical access hospitals must fall during the Federal fiscal year.

April 18, 2011, is the earliest an eligible professional, eligible hospital or critical access hospital can attest that they have demonstrated meaningful use of certified EHR technology under the Medicare EHR Incentive Program.

Under the Medicaid EHR Incentive Program, providers can attest that they have adopted, implemented or upgraded certified EHR technology in their first year of participation to receive an incentive payment. Medicaid EHR Incentive Program participants should check with their state to find out when they can begin participation.

What can I do now to prepare for attestation?

Visit our Registration page and get registered for the EHR Incentive Programs right now. If you haven't previously registered, you can complete the registration and attestation process at the same time.

Also, review our Attestation User Guides, which provide step-by-step instructions for login and completing attestation. You can find separate Attestation User Guides for eligible professionals and eligible hospitals in the Resources section below.

Finally, you can enter your information in our Meaningful Use Attestation Calculator prior to submitting your attestation to see if you would be able to meet all of the necessary measures to successfully demonstrate meaningful use and qualify for an EHR incentive payment. (http://www.cms.gov/apps/ehr/)

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