They may be reused, but some of the slides had minor modifications needed. CMS will post a corrected, 508-compliant version on our website as soon as possible. It is not permissible to reproduce the CMS logo or the CMS EHR Incentive Program logo. (Source: HITRC collaborative) (Posted 8/23/10)

ASAP, but no guaranteed timeframe. (Source: HITRC collaborative)

(Posted 8/23/10)

Medicare EHR Incentive: Hospitals and eligible professionals can register for the program starting in January 2011. More information on registration and attestation will be made available later in the year. Once the programs begin, a link on the Registration web page on http://cms.gov/EHrIncentivePrograms/ will be available. Providers can use this central website to get information about the program and link to the programs’ online registration system. Medicaid EHR Incentive: The registration process will be the same for the Medicaid EHR Incentive Incentive Program as for Medicare EHR Incentive. A link on the Registration web page on http://cms.gov/EHrIncentivePrograms/ will be available when the program begins. Eligible Providers under the Medicaid EHR Incentive Incentive Program can register at this site whether or not their state has initiated their program yet and CMS will pass their information on to the state once the state initiates their program. CMS has no control over the timeframe for States to offer the Medicaid EHR Incentive incentive program. (Source: CMS EHR Incentive Program Script for Regional Extension Centers) (Posted 8/6/10)

1. In order the register, providers will need to have: PECOS Enrollment – All Medicare EHR Incentive EPs and all EHs must have enrollment information in PECOS to register for the EHR Incentive Programs. PECOS is the Medicare EHR Incentive Provider Enrollment, Chain, and Ownership System and manages, tracks, and validates enrollment data for Medicare EHR Incentive providers and suppliers. If a provider has never enrolled in PECOS, they will need to do so (http://www.cms.gov/Medicare EHR IncentiveProviderSupEnroll/). If an EP or hospital enrolled in Medicare EHR Incentive before November 2003 and has not updated their enrollment information since then, they will also need to enroll through PECOS. If an EP or hospital enrolled in Medicare EHR Incentive after November 2003 or enrolled before November 2003 and has updated its Medicare EHR Incentive enrollment information since November 2003, no further action is required. Providers can check to see if they are enrolled in PECOS at http://www.cms.gov/Medicare EHR IncentiveProviderSupEnroll/. Medicaid EHR Incentive: Medicaid EHR Incentive eligible professionals who are participating in the Medicaid EHR Incentive EHR incentive program are not required to enroll in PECOS.
2. A National Provider Identifier (NPI). Providers can begin to apply for a NPI at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart; Hospitals will also need a CMS Certification Number (CCN)
3. Most providers will also need an active web user account in the National Plan and Provider Enumeration System (NPPES).

   (Posted 8/6/10)

There is nothing preventing this. Anyone doing this on behalf of providers would need to have an Identity & Account (I&A) Management user ID/pw for NPPES. (Source: HITRC collaborative)(Posted 8/23/10)

Yes. More than 80% of all unique patients seen by the eligible professional or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. (Source: pg. 44371 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations) (Posted 8/6/10)

Yes, if there are errors like that, a provider will need to correct at the registration module in the NLR. An updated file will be sent to the State. (Source: HITRC collaborative)(Posted 8/23/10)

50% of the patients have to have 100% of the demographic data entered. This is limited to unique patients "seen" by the EP. (Source: pg 44342 Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations) (Posted 8/16/10)

Denominator: Number of unique patients age 2 or over seen by the EP (POS 21 or 23) during the EHR reporting period. Numerator: The number of patients in the denominator who have at least one entry of their height, weight and blood pressure are recorded as structured data. Threshold: The resulting percentage must be more than 50 percent in order for an EP, to meet this measure. (Source: pg 44343 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations) (Posted 8/16/10)

EPs, eligible hospitals, and CAHs should attempt to identify one other entity with whom to conduct a test of the submission of electronic data. This test must include the transfer of either actual or ‘‘dummy’’ data to the chosen other entity. The testing could occur prior to the beginning of the EHR reporting period, but must occur prior to the end of the EHR reporting period and every payment year would require its own, unique test as infrastructure for health information exchange is expected to mature over time. (Source: pg 44361 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations) (Posted 8/16/10)

To be considered an ‘‘exchange’’ for this objective and measure the clinical information must be sent between different legal entities with distinct certified EHR technology or other system that can accept the information and not between organizations that share certified EHR technology. CMS will accept a yes/no attestation to verify all of the above for EPs, eligible hospitals, and CAHs. (Source: Pg 44362 Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations) (Posted 8/16/10)

Yes. More than 80% of all unique patients seen by the eligible professional or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. (Source: pg. 44371 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations) (Posted 8/6/10)

In the proposed rule, we defined structured data as data that has a specified data type and response categories within an electronic record or file. We have revised that definition for the final rule as discussed below. Comment: Some commenters requested clarification on what constitutes structured data. Response: The distinction between structured data and unstructured data applies to all types of information. Structured data is not fully dependent on an established standard. Established standards facilitate the exchange of the information across providers by ensuring data is structured in the same way. However, structured data within certified EHR technology merely requires the system to be able to identify the data as providing specific information. This is commonly accomplished by creating fixed fields within a record or file, but not solely accomplished in this manner. After consideration of the public comments received, we finalize the meaningful use objective or EPs at § 495.6(e)(2)(i) and eligible hospitals and CAHs at § 495.6(g)(3)(i) as proposed. (Source: pg 44346 Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations) (Posted 8/18/10)

At a minimum, a summary of care record should contain the following elements:

• Diagnostic Test Results
• Problem List
• Medication List
• Medicine Allergy List

(Sources: MU Final Rule: 44632 Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations and Certification Final Rule pg 44363 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations). (Posted 8/18/10)

ASAP, but no guaranteed timeframe. (Source: HITRC collaborative) (Posted 8/23/10)

To qualify for meaningful use, you will have to utilize a pharmacy that does participate in e-prescribing. The threshold was lowered from 75% in the proposed rule to more than 40% in the final rule. EPs who order less than 100 medications during the EHR reporting period can request exception. (Posted 8/6/10)

The average annual growth rate should be for discharges (see 1903(t)(5)(B), referring to the annual rate of growth of the most recent 3 years for “discharge data.”) We agree that the sources are different. Hospitals would probably have to use MMIS or auditable hospital records to get accurate discharge data rate of growth. (Source: HITRC collaborative) (Posted 8/23/10)

The payment will go to the TIN selected. If they need to change that information (before attesting), they may do so, however, the provider should keep in mind that where they meaningfully use is the important factor. If they leave the practice after meaningfully using (or AIUing), but prior to payment, that’s between the EP and the practice. (Posted 03/03/11)

Section 1848(o)(1)(A) of the Act, as amended by section 4101(a) of the HITECH Act, provides for incentive payments to EPs who are meaningful users of certified EHR technology during the relevant EHR reporting periods. Section 1848(o)(1)(A)(i) of the Act provides that EPs who are meaningful EHR users during the relevant EHR reporting period are entitled to an incentive payment amount, subject to an annual limit, equal to 75 percent of the Secretary’s estimate of the Medicare EHR Incentive allowed charges for covered professional services furnished by the EP during the relevant payment year. (Source: Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations 44442) (Posted 8/26/10)

The payment year is the year for which the payment is made (see 42 CFR 495.4 and the definition of “First, second, third, fourth, fifth, or sixth payment years.”). So, the questioner is correct that if the EHR reporting period is in CY 2013, the payment year also refers to 2013. Using the patient encounters from the year preceding the payment year, when the EP is AIU, or in the first year of MU, when the EHR reporting period is 90 days, allows the EP to receive an incentive early in the payment year, such as when their EHR reporting period occurs during the first 90 days of CY 2012). (Source: HITRC collaborative) (Posted 8/23/10)

Yes, it should say FY, which is what is used throughout the preamble and regulation. (Source: HITRC collaborative) (Posted 8/23/10)

There is nothing preventing this. Anyone doing this on behalf of providers would need to have an Identity & Account (I&A) Management user ID/pw for NPPES. (Source: HITRC collaborative)(Posted 8/23/10)

It is based on all of your patient population. (Posted 8/6/10)

The States will account for this separate, as it is not part of the Medicaid PV. They should ask if they are qualifying because they practice predominantly, then they would ask for this info. Different states will collect the information in different ways. E.g., Kentucky is all electronic, but some states are requiring faxing of forms in the near term until the program is more mature. (Posted 03/03/11)

The State may choose one of the two options listed below (or both options), or a State proposed alternative, if approved by CMS. Option 1 – Regular Medicaid EHR Incentive [Total (Medicaid EHR Incentive) patient encounters in any representative continuous 90-day period in the preceding calendar year/ Total patient encounters in that same 90-day period] * 100 Option 2 – Considers Medicaid EHR Incentive Managed Care [Total (Medicaid EHR Incentive) patients assigned to the provider in any representative continuous 90-day period in the preceding calendar year, with at least one encounter taking place during the calendar year ending the start of the 90-day period] + [Unduplicated (Medicaid EHR Incentive) encounters in the same 90-day period]/[Total patients assigned to the provider in that same 90-day period, with at least one encounter taking place during the calendar year preceding the start of the 90-day period] + [All unduplicated encounters in that same 90-day period]* 100 (Source: pg 44487 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations) (Posted 8/16/10)

We will allow clinics and group practices to use practice or clinic Medicaid EHR Incentive patient volume (or needy individual patient volume, insofar as it applies) and apply it to all EPs in their practice under three conditions: 1) The clinic or group practice's patient volume is appropriate as a patient volume methodology calculation for the EP (for example if an EP only sees Medicare EHR Incentive, commercial, or self-pay patients, this is not appropriate calculation); 2) there is an auditable data source to support the clinic patient volume determination; and 3) so long as the practice and EPs decide to use one methodology in each year (in other words, clinics could not have some of the EPs using their individual patient volume for patients seen at the clinics, while others use the clinic-level data). The clinic or practice must use the entire practice's patient volume and not limit it in any way. EPs may attest to patient volume under the individual calculation or the group/clinic proxy in any participation year. Furthermore, if the EP works in both the clinic and outside the clinic (or with and outside a group practice), then the clinic/practice level determination includes only those encounters associated with the clinic/practice. (Source pg 44489 Federal Register /Vol. 75, No. 144 /Wednesday, July 28, 2010 /Rules and Regulations) (Posted 8/16/10)

First, it is important to note that when discussing 2013, CMS stated that it expects to engage in another cycle of rulemaking for that year. Under our current rules, the 90-day period has to be in the next calendar year 2013. Payment year is defined in 42 CFR 495.4 as a calendar year beginning with CY 2011, and for Medicaid EHR Incentive, the first payment year is the first calendar year for which the EP receives an incentive payment. The second payment year is then the second calendar year for which the EP receives the incentive payment. Because each payment year is tied to a separate calendar year, and because for Medicaid EHR Incentive, for the first year of demonstrating MU the EHR reporting period must be a continuous 90-day within the calendar year (with all subsequent years having an EHR reporting period equal to the full CY), the EHR reporting period must occur within the year of payment. Thus, the EHR reporting period is any 90-day period within CY 2013 in the example provided above. As for what stage of meaningful use the EP must show in CY 2014, CMS stated that it expects to engage in future rulemaking to address this issue. (Source: HITRC collaborative) (Posted 8/26/10)

1. If It's a group practice, owned by the clinicians. The cost of purchasing and implementing an EHR system was $300,000 and there are 30 clinicians.
   1. Each eligible clinician reports $300,000; or ii. Each eligible clinician reports $10,000 ($300,000/30 clinicians = $10,000) as their contribution. This is the correct approach.
2. If It's a group practice, privately owned. The cost of purchasing and implementing an EHR system was $300,000 and there are 30 employee clinicians.
   1. Each eligible clinician reports $300,000; or
   2. Each eligible clinician reports $10,000 ($300,000/30 clinicians = $10,000) as their contribution. This is the correct approach.
3. The cost of purchasing and implementing an EHR system was $300,000 and there are 30 employee clinicians at an FQHC/RHC. These costs were paid for through a Federal grant.
   1. Each eligible clinician reports that the system cost $300,000; or
   2. Each eligible clinician reports the sum of the costs that s/he personally incurred to connect to the system, internet access, or any hardware, or software, or training expenses; or
   3. If all of the EHR software, licensing, training, hardware, internet and related software costs were paid by the FQHC with Federal funds, the eligible clinicians would report $0 as their contribution; or
   4. Each eligible clinician reports $10,000 ($300,000/30 eligible clinicians = $10,000) as their contribution. This is the correct approach. (Source: HITRC collaborative) (Posted 8/23/10)

States should make clear to providers when they attest for AIU what documentation they must maintain, and for how long, in case of audit. If States determine that certain provider types are a high risk for potential fraud/abuse for AIU, then they can ask for some verification of adopting, implementation or upgrading but CMS encourages that this be done in a targeted manner, with the most electronic and simple means possible and not in such a way that would be burdensome to providers. For AIU, a provider does not have to have installed certified EHR technology. The definition of AIU in 42 CFR 495.302 allows the provider to demonstrate AIU through any of the following: (a) acquiring, purchasing or securing access to certified EHR technology; (b) installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements; or (c) expanding the available functionality of certified EHR technology capable of meeting meaningful use 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. Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient. (Source: HITRC collaborative) (posted 8/23/10)

Our regulations did not address whether these non-EP encounters could be considered in the estimate of patient volume for the clinic. However, we believe a State would have the discretion to include such non-EP encounters in its estimates. Again, if these non-EP encounters are included in the numerator, they must be included in the denominator as well. States also must ensure that their methodology adheres to the conditions in 42 CFR 495.306(h), and specifically t 495.306(h)(4), which says: “(4) The clinic or group practice uses the entire practice or clinic’s patient volume and does not limit patient volume in any way.” (Source: HITRC collaborative) (Posted 8/23/10)

The payment year is the year for which the payment is made (see 42 CFR 495.4 and the definition of “First, second, third, fourth, fifth, or sixth payment years.”). So, the questioner is correct that if the EHR reporting period is in CY 2013, the payment year also refers to 2013. Using the patient encounters from the year preceding the payment year, when the EP is AIU, or in the first year of MU, when the EHR reporting period is 90 days, allows the EP to receive an incentive early in the payment year, such as when their EHR reporting period occurs during the first 90 days of CY 2012). (Source: HITRC collaborative) (Posted 8/23/10)

Yes, a State may, in its SMHP, use a methodology that allows the EP to count their initial costs, as one cannot upgrade that which one does not have (i.e. you have to have "version 1.0" in order to upgrade to "version 2.0") There is no prescribed timeframe. For example, if an EP expended $5000 in 2007 on an EHR and spends $2000 in 2010 for the newly certified version, his/her total costs would be $7,000. As the rule indicates that an EP must demonstrate 15% of the NAAC, which for the first participation year is $3,750, that EP would have clearly met that requirement. However, the EP cannot “carry-over” from year to year, and must demonstrate that s/he has met the 15% of the NAAC for each year. So, for participation years 2-6, the EP would need to attest to the State that they have expended at least $1500 towards their meaningful use of certified EHR technology. We provide examples in the preamble of the final rule (75 FR 44492-4), such as health information exchange transaction fees/monthly dues; costs associated with internet access; computer hardware; additional software upgrades; training/technical assistance fees, etc. (Source: HITRC collaborative) (Posted 8/23/10)

Yes, if there are errors like that, a provider will need to correct at the registration module in the NLR. An updated file will be sent to the State. (Source: HITRC collaborative) (Posted 8/23/10)

One option is that States can employ an attestation model. We believe this might be similar to individuals reporting deductions on income taxes, for example. Providers could use worksheets to make a qualification determination, but are still subject to an audit by the State. CMS plans to develop templates for these worksheets to share with States. (Source: HITRC collaborative) (Posted 8/23/10)

No, this is not correct. The regulation is clear that the discharge-related amount must be calculated using a 12-month period that ends in the Federal fiscal year before the hospital’s fiscal year that serves as the first payment year. 42 CFR 495.310(g)(1)((i)(B). This statement also was made in the preamble, where we stated: “For purposes of administrative simplicity and timeliness, we require that States use data on the hospital discharges from the hospital fiscal year that ends during the Federal fiscal year prior to the fiscal year that serves as the first payment year” 75 FR 44498. In addition, the regulation indicates that the period that is used for the Medicaid EHR Incentive share is the same period as that used for the discharge-related amount. See 42 CFR 495.310(g)(2)(i) referring to “the 12-month period selected by the State.” Use of “the” in 495.310(g)(2) indicates that this is the same 12-month period that is used under 495.310(g)(1). In addition, we believe that using different periods for the Medicaid EHR Incentive share versus the discharge-related amount would lead to inaccurate estimates, as data would be drawn from inconsistent periods. (Source: HITRC collaborative) (Posted 8/23/10)

The setting in which a physician, nurse practitioner, certified nurse midwife, or dentist provides care is generally irrelevant to determining eligibility for the incentive program (except for purposes of determining whether an EP can qualify through “needy individual” patient volume). Setting is relevant for physician assistants, as they are eligible only when they are practicing at a Federally Qualified Health Center (FQHC) that is led by a PA or a Rural Health Center (RHC) that is so led. All providers must meet all program requirements prior to receiving an incentive payment (e.g. adopt, implement or meaningfully use certified EHR technology, patient volume, etc.). (Source: HITRC collaborative) (Posted 8/23/10)

Yes. We specify that the volume period needs to be any 90-day period in the preceding calendar year. The provider would also need to demonstrate A/I/U in order to qualify for an incentive payment. (Source: HITRC collaborative) (Posted 8/23/10)

This is correct for the Medicaid EHR Incentive EHR Incentive program. (Source: HITRC collaborative) (Posted 8/23/10)

For purposes of calculating the Medicaid EHR Incentive share, a patient cannot be counted in the numerator if they would count for purposes of calculating the Medicare EHR Incentive share. Thus, in this respect the inpatient bed day of a dually eligible patient could not be counted in the Medicaid EHR Incentive share numerator. (See 1903(t)(5)(C), stating that the numerator of the Medicaid EHR Incentive share does not include individuals “described in section 1886(n)(2)(D)(i).”) In other respects; however, the patient would count twice. For example, in both cases, the individual would count in the total discharges of the hospital. (Source: HITRC collaborative) (Posted 8/23/10)

There is nothing preventing this. Anyone doing this on behalf of providers would need to have an Identity & Account (I&A) Management user ID/pw for NPPES. (Source: HITRC collaborative) (Posted 8/23/10)

The EPs are legally attesting that they meet the requirements in order to receive payments. States could consider a model similar to that used for tax preparation, where a preparer (accountant) completes the information, but the individual still signs the forms. We recommend consulting with your legal department about your current rules for claims submissions, and ensuring that the EPs remain liable under the False Claims Act and other fraud, waste and abuse provisions. Furthermore, we want to ensure providers know that an attestation is being submitted on their behalf—as there may be EPs in multiple practices that want to direct the incentive to one particular practice. (Source: HITRC collaborative) (posted 8/23/10)

We did not set up parameters for this in the final rule. Only if there was an on-going aspect to that cost, not a one-time expenditure. States will have to define this clearly for their programs. (Source: HITRC collaborative) (Posted 8/23/10)

The average annual growth rate should be for discharges (see 1903(t)(5)(B), referring to the annual rate of growth of the most recent 3 years for “discharge data.”) We agree that the sources are different. Hospitals would probably have to use MMIS or auditable hospital records to get accurate discharge data rate of growth. (Source: HITRC collaborative) (Posted 8/23/10)

Yes. The CMS final rule clarifies the policy about calculating patient volume for Medicaid EHR Incentive providers with clinical practices in more than one State, both in terms of what is “Medicaid EHR Incentive patient volume” and about the cross-border issue. See 75 FR 44503, stating: “[W]e recommend that States consider the circumstances of border State providers when developing their policies and attestation methodologies. To afford States maximum flexibility to develop such policies, we will not be prescriptive about whether a State may allow a Medicaid EHR Incentive EP to aggregate his/her patients across practice sites, if the State has a way to verify the patient volume attestation when necessary. States will propose their policies and attestation methodologies to CMS for approval in their State Medicaid EHR Incentive HIT plans.” However, as stated in the final rule, EPs and hospitals are permitted to receive payment from only one State in a payment year (495.310(e)). (Source: HITRC collaborative) (Posted 8/23/10)

Yes, the State can submit to us for approval only the alternative methodology that meets the requirements of 495.306(g). As we stated in the preamble to the final rule, we believe most States will not submit alternative methodologies until after the first year of the program, allowing for alternatives to recognize evolving State and provider experience with patient volume estimate methodologies. We recommend that States consider the methodologies that were put forward in the final rule, prior to proposing only an alternative in their SMHPs. If a State alternative methodology is approved by us, we will post this methodology on our website, so that other States may adopt the methodology as well. (Source: HITRC collaborative) (Posted 8/23/10)

Physicians are one of the categories of eligible professionals. If they meet the other Medicaid EHR Incentive eligibility requirements, such as patient volume, AIU or MU of certified EHR technology, non-hospital based, etc, then the fact that they work at a tribally-operated facility and are direct hires or not is not relevant. We believe the questioner may be concerned about calculating net average allowable costs and/or ensuring that the EPs working in the facility are determined to have met their 15% responsibility. However, without more information on these aspects of the question, we cannot provide a response. (Source: HITRC collaborative) (Posted 8/23/10)

For the Medicaid EHR Incentive EHR Incentive Program, States will define “pediatrician” in a manner consistent with how they define the term for other purposes of their Medicaid EHR Incentive programs. (Source: HITRC collaborative) (Posted 8/23/10)

In establishing an encounter for purposes of patient volume, please see the regulations at 495.306(e)(2)(i)-(ii) at 75 FR 44579 . Furthermore, in estimating patient volume for any EP or hospital, we do not specify any requirements around billing, but rather we discuss patients. E.g., if a Physician’s Assistant (PA) provides services, but they are billed through the supervising physician, it seems reasonable that a State has the discretion to consider the patient as part of the patient volume for both professionals. However, this policy would need to be applied consistently. In this scenario, using services provided by the PA but billed under the physician in the physician’s numerator (e.g., Medicaid EHR Incentive encounters) also would increase the physician’s denominator (all encounters), because the State would need to adequately reflect the total universe of patients (both Medicaid EHR Incentive and non-Medicaid EHR Incentive) who the PA saw, but for whom the physician billed. In terms of meaningful use, because each eligible professional must demonstrate meaningful use him/herself, if the State could not distinguish between the physician’s claims and the PA’s individual claims, then this would not be an adequate audit methodology. (Source: HITRC collaborative) (Posted 8/23/10)

Almost all file transfers are daily. However, at first, States will just receive confirmation that the dually-eligible hospital attested, not the underlying info. Once we have a user interface for States, you will be able to look at the attestation module. (Source: HITRC collaborative) (Posted 8/23/10)

Yes this is true for Medicare EHR Incentive providers. Section 1848(a)(7) of the Act provides that beginning in CY 2015, EPs who do not demonstrate that they are meaningful users of certified EHR technology will receive an adjustment to their fee schedule for their professional services of 99 percent for 2015 (or, in the case of an eligible professional who was subject to the application of the payment adjustment under section 1848(a)(5) of the Act, 98 percent for 2014), 98 percent for 2016, and 97 percent for 2017 and each subsequent year. (Source page 44316 Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations) (Posted 8/26/10)

There are a limited number of MAOs that CMS has identified as participating in the incentive program. Those MAOs will provide a list of EPs to CMS that are part of the MAO’s incentive payment. However, this does not mean that the EP is excluded from personally receiving an incentive payment. If an MAO EP submits a total of $24,000 or more in part B claims during the first payment year, then 75% of the value of the part B claims will be paid to the MAO. If an MAO EP does not submit a total of $24,000 or more in part B claims during the first payment year, then 75% of the value of the part B claims submitted on behalf of the MAO EP will be paid to the MAO. (Posted 03/03/11)

It is based on all of your patient population. (Posted 8/6/10)

Section 1848(o)(1)(A) of the Act, as amended by section 4101(a) of the HITECH Act, provides for incentive payments to EPs who are meaningful users of certified EHR technology during the relevant EHR reporting periods. Section 1848(o)(1)(A)(i) of the Act provides that EPs who are meaningful EHR users during the relevant EHR reporting period are entitled to an incentive payment amount, subject to an annual limit, equal to 75 percent of the Secretary’s estimate of the Medicare EHR Incentive allowed charges for covered professional services furnished by the EP during the relevant payment year. (Source: Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations 44442) (Posted 8/26/10)

Yes this is true for Medicare EHR Incentive providers. Section 1848(a)(7) of the Act provides that beginning in CY 2015, EPs who do not demonstrate that they are meaningful users of certified EHR technology will receive an adjustment to their fee schedule for their professional services of 99 percent for 2015 (or, in the case of an eligible professional who was subject to the application of the payment adjustment under section 1848(a)(5) of the Act, 98 percent for 2014), 98 percent for 2016, and 97 percent for 2017 and each subsequent year. (Source page 44316 Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations) (Posted 8/26/10)

For purposes of calculating the Medicaid EHR Incentive share, a patient cannot be counted in the numerator if they would count for purposes of calculating the Medicare EHR Incentive share. Thus, in this respect the inpatient bed day of a dually eligible patient could not be counted in the Medicaid EHR Incentive share numerator. (See 1903(t)(5)(C), stating that the numerator of the Medicaid EHR Incentive share does not include individuals “described in section 1886(n)(2)(D)(i).”) In other respects; however, the patient would count twice. For example, in both cases, the individual would count in the total discharges of the hospital. (Source: HITRC collaborative) (Posted 8/23/10)

The average annual growth rate should be for discharges (see 1903(t)(5)(B), referring to the annual rate of growth of the most recent 3 years for “discharge data.”) We agree that the sources are different. Hospitals would probably have to use MMIS or auditable hospital records to get accurate discharge data rate of growth. (Source: HITRC collaborative) (Posted 8/23/10)

The EPs are legally attesting that they meet the requirements in order to receive payments. States could consider a model similar to that used for tax preparation, where a preparer (accountant) completes the information, but the individual still signs the forms. We recommend consulting with your legal department about your current rules for claims submissions, and ensuring that the EPs remain liable under the False Claims Act and other fraud, waste and abuse provisions. Furthermore, we want to ensure providers know that an attestation is being submitted on their behalf—as there may be EPs in multiple practices that want to direct the incentive to one particular practice. (Source: HITRC collaborative) (Posted 8/23/10)

We are not currently aware of any additional funding sources for purchase of EHR software as you describe. (Posted 11/22/10)

KFMC will work with all eligible professionals who register for REC services presuming they meet the eligibility criteria, regardless of the 2011 ARRA certified vendor they choose to work with to achieve meaningful use. The resources and assistance provided by KFMC will be the same as for any eligible professional, which includes hardware selection, transition planning, etc. (Posted 03/03/11)