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Meaningful Use and the Costs of Noncompliance

Meaningful Use and the Costs of Noncompliance

It is something of an understatement to note that the U.S. health care legal landscape is currently experiencing a degree of transition and uncertainty. There is no shortage of changes to discuss, debate, and, perhaps, grow apprehensive about. One development that has been the radar of many physicians for several years now – and brought into new relief by more recent changes such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – is the Meaningful Use concept introduced by the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Meaningful Use” relates to physicians’ use of certified electronic health records (EHR) technology in the interest of interoperability and efficient electronic exchange of health information. The Centers for Medicare & Medicaid Services (CMS) offers an incentive program which offers incentive payments to eligible professionals and eligible hospitals who join and comply. Participation involves making “Meaningful Use Attestations” regarding compliance. Both compliance and noncompliance with Meaningful Use goals can represent a significant cost to physicians: compliance, as bringing a practice’s technological infrastructure up to the appropriate standards does not come cheaply; noncompliance, as those who choose not participate in CMS’s incentive program, face reductions in their Medicare and Medicaid payments. These reductions equal a 3 percent decrease in 2017.

It appears that noncompliance with Meaningful Use standards carries more of a bite than some observers may have thought. In June of 2017, the Office of the Inspector General (OIG) released a report that Medicare made hundreds of millions of dollars’ worth of incentive payments to Meaningful Use attesters who failed to meet the necessary requirements. The OIG estimated a total of approximately $730 million dollars in inappropriate payments – more than ten percent of the total payments. CMS’s blunder largely resulted from its failure to conduct adequate documentation review, thus rendering the self-attestations of professionals prone to abuse. Note, too, that CMS is not the only authority to make inappropriate EHR incentive payments: the OIG faulted Texas in August 2015 for making such wrongful payments in an amount over $15 million through its Medicaid program.

This does not, of course, amount to a windfall for the physicians who received the wrongful payments. The OIG’s recommendation to CMS includes directing CMS to recover the wrongful payments it has identified (a small sample of the total), and to seek to identify, and then recover, the rest of the inappropriately directed federal funds. As is characteristically the case, government overpayments cannot be retained by the recipient. Thus, the takeaway from CMS’s improper Meaningful Use largesse should not be an observation that the government has, up till now, not been adequately reviewing Meaningful Use documentation. Instead, it should be that one can, of course, expect such mistakes to be corrected when discovered and that it is even more important to get Meaningful Use compliance correct now. What has been done in the past by a physician may not actually have sufficed. Additionally, part of OIG’s recommendation to CMS was to educate eligible clinicians on proper Meaningful Use documentation requirements. Physicians should look for and take advantage of such education.

This need to double down on one’s Meaningful Use efforts comes at a time when the reimbursement system is shifting to MACRA. The Medicare EHR Incentive Program is no longer a standalone program –it has been combined through MACRA with the Physician Quality Reporting System and the Physician Value-based Payment Modifier into a single program, the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). Although hospital and Medicaid Meaningful Use programs are unaffected by MACRA, clinicians will make their Medicare Meaningful Use attestations through the QPP. This program still focuses on the use of Certified EHR Technology to support interoperability and healthcare quality objectives. The meaningful use measures are calculated and compensated somewhat differently under MIPS; one significant change is that a hybrid scoring system has replaced the previous all-or-nothing approach.

Although the manner of reporting Meaningful Use has changed somewhat, it has not become either less important or markedly simpler. Getting up to speed on the technological, administrative, and reporting features of establishing Meaningful Use now – when there is some clemency as far as timing goes worked into the transition period – is certainly advisable. The need to establish the goals of interoperability, efficiency, and care coordination that Meaningful Use seeks to advance is a need that is unlikely to diminish. The fact that CMS is now beginning to seek hundreds of millions of dollars in wrongful incentive payments only highlights that Meaningful Use compliance is an issue worth following in the always changing health care landscape.

Chris Thompson is an attorney with Burr & Forman LLP. Chris practices exclusively in the firm’s Health Care Practice Group. Burr & Forman, LLP, is an official Bronze Partner with the Medical Association.

Posted in: MACRA

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CMS Extends Meaningful Use Reporting Deadline to March 13

CMS Extends Meaningful Use Reporting Deadline to March 13

The Centers for Medicare & Medicaid Services (CMS) has postponed the deadline for the attestation to Meaningful Use by eligible professionals (EPs) participating in the Medicare EHR Incentive Program. The old deadline of Feb. 28 has been postponed to Monday, March 13, 2017, at 11:59 p.m. PT.

If you participate in the Electronic Health Records (EHR) Incentive Program, you must attest to the 2016 program requirements by March 13, 2017, to avoid a 2018 payment adjustment. If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.

Medicare’s EHR Incentive Program, or Meaningful Use, is expected to be phased out for physicians this year, but physicians must still report on the Meaningful Use measures for 2016 to avoid a 3 percent penalty in 2018. CMS expects about 171,000 physicians to be penalized this year for failure to attest to Meaningful Use for 2015.

CMS did not explain why it was pushing back the deadline for 2016 attestation. However, the agency did not specify until November that the reporting period for Meaningful Use was 90 days in 2016, rather than the original full calendar year. No hardship exceptions were granted for 2016 because of the tardy announcement of the reporting period, so it may be possible CMS wants to give EPs every opportunity to attest before the window closes.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate Meaningful Use to avoid the Medicare payment adjustment. You may demonstrate Meaningful Use under either Medicare or Medicaid.

Attestation Resources

Attestation Batch Upload Webpage

Posted in: CMS

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Five Secrets to Preventing Provider Cardiac Arrest Secondary to Meaningful Use 2 — There’s a Diagnosis Code for This!

Five Secrets to Preventing Provider Cardiac Arrest Secondary to Meaningful Use 2 — There’s a Diagnosis Code for This!

Editor’s Note: This article was originally published in the 2015 Inaugural Issue of Alabama Medicine magazine

Kill two or three measures with one click. Clinical Decision Support Rules, PQRS and Clinical Quality Measures can be managed simultaneously.

Here’s an example of what I mean: Meaningful Use 2 requires the smoking status of all patients 13 years and older to be documented. The Physician Quality Reporting System also requires Providers who select this measure for reporting to screen patients for tobacco use who are 18 years or older and to provide them with cessation counseling if they are tobacco users.

Build a clinical support decision rule to remind you to record the tobacco status of patients 13 years of age (automatic pop-up). You’ve knocked out recording the smoking status of the patient and core measure number 5. The patient then tells you that he or she smokes two packs a day and loves it. At that point, you revel in the opportunity to save a life and conquer measure number 13. Suddenly, you realize that you have just performed PQRS measure number 226, and you do your proverbial happy dance.

If you get that queasy feeling of being “unsure” when you attest to performing a Security Risk Analysis, ask a professional for advice. You can be audited for up to six years – you may be all for doing it yourself to save money, but unless you are a physician as well as a Certified Information Systems Security Professional (CISSP), you could miss something critical. Additionally, the cost for inadvertently allowing a hacker to successfully hack in to your EHR, violate patient privacy, sell your patients’ information to the highest bidder, and give you five minutes of fame in the local news is much higher than the fee for allowing a truly certified professional to prevent this from happening.

Encourage secure messaging with patients by incorporating it into your workflow. The Provider is not the sole individual allowed to manage these messages. Imagine the angry patient who has been sitting in your exam room for 45 minutes, waiting to see you. Unfortunately, you did not anticipate six walk-ins that day and are running a little behind schedule. Fortunately for you, your clinical staff is utilizing the patient engagement template created specifically for this all too common occasion. Medical Assistant Molly walks into the exam room and pulls up the patient’s record. She explains kindly that Mr. Doe can now send the physician a secure message through the patient portal. Mr. Doe does not have an email or know how to set up his portal. No problem! She can assist with that as well. The MA then helps the patient send a secure message stating “Dear Dr. Awesome, thanks for showing me how to contact you via secure message.”

Sending information to a public health registry requires teamwork between both parties involved. Unlike Meaningful Use 1, failed testing does not meet the measure in Meaningful Use 2. Ongoing submission to a registry is the rule. Take heart. Most health departments have a special section set up on their websites for meaningful users. They have the ability to accept submission of things liked diabetes diagnoses, cancer cases and immunizations, and if they don’t, you are probably excluded from the measure. Contact the local health department and find out who is managing Meaningful Use on their end. There are forms to be filled out, calls to vendors and registries to be made, but in the end, Providers will be able to submit vital information to health departments electronically. Some EHRs have a one-directional interface. In this case, make sure the Practice Administrator submits the information at least weekly, and follows-up to insure effective transmission. A bi-directional interface allows for automated transmissions with limited time devoted to monitoring processes.

Qualified professionals can assist the Provider with CPOE. Some EHRs do not recognize orders placed by another “qualified professional” if they are not linked with the Provider. If the number of patients being prescribed medications or for whom labs/radiology are ordered is increasing daily — but the meaningful use stats are not adding up — the problem might be as simple as selecting the supervising provider.
In order to keep your clicking fingers from getting worn out, I suggest creating a “favorites” page of labs, medications and imaging most commonly ordered. This will cut down on the time it takes to rummage through the endless options available in EHRs.

The information in this article is not intended as tax or legal advice. Please consult your tax advisor for specific information regarding your individual situation.

bronzemvpContributed by Patti G. Perdue, CPA.CITP, Jackson Thornton. Rebecca Hanif, CCS, CPCO, CPC, also contributed to this article. Jackson Thornton is a Certified Public Accounting and Consulting Firm and an official partner with the Medical Association.

Posted in: Management

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