Lessons Learned From Medicare EHR Registration and Attestation for Eligible … · 2011-01-14 ·...
Transcript of Lessons Learned From Medicare EHR Registration and Attestation for Eligible … · 2011-01-14 ·...
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Lessons Learned From Medicare EHR Registration and Attestation for Eligible Providers (EPs)
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Size – 120 providers with over 550 employees Multi-specialty group in various locations
with career physicians, new physicians, and everything in between
Over 400 customized encounter forms Numerous work flow differences Various degrees of interest and “buy in”
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Need a Meaningful Use Team to prepare for the work ahead
Need to select which EHR Program to participate
Need various publications and reports to Understand program requirements Analyze your compliance and make adjustments to
forms, reports, processes, and workflows Track your progress
Need to Develop and Implement Training Select a Reasonable Go-Live Date
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Don’t delay, this is likely to take far more time than expected and involve members across the organization. This is not simply an IT function.
Most organizations will need an assessment period to analyze current EMR functions and organizational workflows.
The analysis assessment will likely reveal the need to revise or develop new workflows, implement training, and assign responsibility.
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Successful meaningful use implementation will require individuals from across the organization and commitment to the project from the governing body Assign a Project Manager from the Executive Team to
coordinate and organize all efforts▪ strong knowledge of clinical operations and care delivery
▪ ability to effectively communicate with a diverse group of individuals
▪ ability to analyze data, define goals, assign tasks, and meet deadlines
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Team should consist of a committee of representatives from: Information Technology
Clinical
Operational
Financial
Physician(s) for advice and beta testing Team must commit to a routine schedule of
meetings.
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Need a Meaningful Use Team to prepare for the work ahead
Need to select EHR Program Need various publications and reports to Understand program requirements
Analyze your compliance and make adjustments to forms, reports, processes, and workflows
Track your progress Need to Develop and Implement Training Select a Reasonable Go-Live Date
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Source: CMS
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MEDICARE
Must be a Physician (MD, DO, DDM/DDS, optometrist, podiatrist)
Must have Part B Medicare allowable charges
Incentive is 75% of max allowable Part B charges up to $24,000 (or a total of $18,000) for 1st year
Must not be hospital based Required enrollment in Provider
Enrollment, Chain and Ownership System(PECOS)
MEDICAID
Must be a Physician, NP, Certified Nurse-midwife, or Physician Assistants in a FQHC or RHC
Must meet patient volume requirements of 30% for 1st year payment of $21,250
Pediatricians eligible at 20% for a reduced 1st year payment of $14,167
Must not have 90% or more encounters in a hospital or ED
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MEDICARE
Pays up to $44,000 over a 5 year period
Program spans 2011 -2016 Must meet meaningful use
measures in year one Must participate in
consecutive years Year 1 – Stage One:
90 consecutive days Year 2 – Stage One:
Full calendar Year Stage Two and Three:
Expected in 2013 & 2015 Medicare payment reductions
MEDICAID
Pays up to $63,750 over a 5 year period
Program spans 2011-2021 Does not have to be consecutive
year participation Year 1: Adopt, Implement or
Upgrade Meaningful Use in later years No Medicaid payment
reductions
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Choose program carefully, Medicaid has higher incentives and less requirements.
Once you have submitted Attestation you are locked into that specific program for the year.
May switch between programs once after having received an incentive payment, but the switch must occur before 2015.
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Need a Meaningful Use Team to prepare for the work ahead
Need to select which EHR Program to participate
Need various publications and reports to Understand program requirements Analyze your compliance and make adjustments to
forms, reports, processes, and workflows Track your progress
Need to Develop and Implement Training Select a Reasonable Go-Live Date
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Start with CMS Website for EHR Incentives https://www.cms.gov/EHRIncentivePrograms EHR Timeline
Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals
Medicare Registration User Guide for Eligible Providers
Attestation User Guide for Eligible Professionals
Medicare and Medicaid EHR Incentive Program Webinar for Eligible Professionals
Clinical Quality Measures Webinar
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Contains critical information for each objective Describes what each Eligible Provider (EP) has to
do to demonstrate Meaningful Use Now provides links to FAQs 25 Meaningful Use Objectives Required to meet 20 of the objectives
15 required core set (all)
▪ Includes Clinical Quality Measures –CQMs
5 menu set, that may be chosen from a list of 10, one must be a public health measure
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Source: CMS
Specification SheetFor Core Measure 1
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Specification SheetCore Measure 1 Page Two
Source: CMS
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Source: CMS
Q&A from the Link on Specification Sheets
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Need a Meaningful Use Team to prepare for the work ahead
Need to select which EHR Program to participate
Need various publications and reports to Understand program requirements Analyze your compliance and make adjustments to
forms, reports, processes, and workflows Track your progress
Need to Develop and Implement Training Select a Reasonable Go-Live Date
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GE “Using Centricity Electronic Medical Record Meaningful Use Reports” v 9.5 (9/2011) Used a combination of GE reports Custom Reports
▪ Enabled us to capture data /obs terms from numerous customized forms
▪ Ability to run reports on our own database which is a copy of the MLO (EMR) database
Crystal Reports to run the reports by physician
Created an Excel spreadsheet to consolidate the data for comparison and tracking (Physician Scorecard)
Created Weekly Self Assessment Tool
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Source: GE
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Source: GE
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Internal Self Assessment Tool
Team meet weekly to review and analyze our progress
▪ Identify each measure and the ability of the system to report on the data.
▪ Conduct assessments frequently.
▪ What do the reports reveal – how close are you to achieving the measures needed?
▪ Are changes needed to the encounter forms, to the reports?
▪ Who should be capturing the data required (registration, MA, nurse, physician, IT dept)?
▪ Are changes are needed to workflows in the clinics?
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Meaningful Use Self Assessment 1/14/11
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Need a Meaningful Use Team to prepare for the work ahead
Need to select which EHR Program to participate
Need various publications and reports to Understand program requirements Analyze your compliance and make adjustments to
forms, reports, processes, and workflows Track your progress
Need to Develop and Implement Training Select a Reasonable Go-Live Date
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Develop training and implement company-wide On-line training tool with quiz for all employees
Frequent e-mails about a specific Meaningful Use Measures with Tips & Tricks
Posted training materials on the Meaningful Use Section of our Intranet
Indentified EMR Super Users at every location that were available to assist with new encounter forms, new features, and new processes
Departmental Training
Individual Training
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On Line Training
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On Line Training: Sample Question for Measure 1. Each Measure has information and important points to recall
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One of several screen shots for on line training. Measure 1 CPOE
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Each Measure has one simple quiz question.
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Need a Meaningful Use Team to prepare for the work ahead
Need to select which EHR Program to participate
Need various publications and reports to Understand program requirements Analyze your compliance and make adjustments to
forms, reports, processes, and workflows Monitor your progress
Need to Develop and Implement Training Select a Reasonable Go-Live Date
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Pick a Go-Live Date that is
Reasonable
Well-supported by all members of the MU Team as well as administration and physician leadership
Each provider will qualify individually for a 90 day consecutive reporting period
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Develop a tool to assess progress and to indentify continued areas of need for additional training and support We developed a Physician Scorecard which reported
on the percentage scores for each measure by each provider
Posted results every two weeks Enabled the team to identify the measures that
presented the most challenges by specialty or by location and provide more customized training and assistance
Friendly competition
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Meaningful Use Physician Scorecard
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Use Comment box to state measure objectivesand tips
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Core Measures in Green, Menu Measures in BlueTracked an overall Pass/FailPercentage Score for each measurePass/Fail by each measure
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Register early – allows you work out issues so you are prepared for Attestation when you reach compliance
Decide if provider or 3rd party designee will be Registering and Attesting on the provider’s behalf
If using 3rd party designee, they need to register in the Identity & Access (I&A) System and be issued a User ID / Password and be linked to each eligible provider (EP)
Designee will request access to EP’s account, an email is sent to the EP to approve access request, notification is sent to designee that access has been approved
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Email stating your request to assign EP to 3rd party designee was approved.
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National Provider Identifier (NPI) National Plan and Provider Enumeration System
(NPPES) User ID/Password Must be enrolled in Provider Enrollment, Chain
and Ownership System (PECOS) Payee Tax Identification Number –if you are
reassigning benefits Payee NPI – if you are reassigning benefits EHR Certification Number (may register without
this number but required at attestation) http://onc-chpl.force.com/ehrcert
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Spurce: CMS
Log in under the designee. Every EP assigned to the designee will be listed. Select one to register.
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Carefully select individual(s) for I&A privileges. Great deal of responsibility to Register and Attest
correctly. For large groups, may wish to choose several
employees to obtain I&A privileges. Decide which program you are likely to
participate in Medicare or Medicaid. May modify your registration prior to attestation but
once you submit for attestation you are locked in the program selected for that year.
Print Registration Page for records.
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Source: CMS
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All your hard work has paid off! EHR reports reflect that provider(s) have met
all Stage One Meaningful Use Requirements for a consecutive 90 day reporting period
You are ready for Attestation
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Use EMR reports to determine when each eligible provider has met all Meaningful Use measure requirements for a consecutive 90 day reporting period
We entered data directly from Physician Scorecard
CMS provides an Attestation Worksheet
Does not include Clinical Quality Measures (CQMs)
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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During Attestation, Core Measure 10 will ask if you plan to record CQMs.
The reporting section for CQMs will appear after you have completed all core and menu measures.
Required to report on 3 core set CQMs up to 3 alternate core set CQMs and 3 additional set CQMs
If you report a zero denominator for any of the 3 core measure, you then report on an alternate core CQM to supplement.
Report a minimum of 6 CQMs and up to maximum of 9 It is acceptable to report zero in the denominator provided that is
the value displayed on a report calculated by the certified EHR. Download NQF Measures from http://www.qualityforum.org
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS
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Source: CMS link to Quality Forum
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Source: CMS Link to Quality Forum
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Source: CMS Link to Quality Forum
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Meaningful Use Core Measures Meaningful Use Menu Measures Clinical Quality Measures Attestation Statements Attestation Disclaimer Submission Receipt Accepted Attestation – print receipt for records Rejected Attestation – choose Summary of Measures to
review your entries, correct issues, resubmit attestation information▪ You may submit an attestation for a different reporting period
during the first payment year. It may be one day later 90 day consecutive reporting period. Recalculate N/D.
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Source: CMS
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Typically 4 – 8 weeks after Attestation is accepted We successfully Attested to 90 physicians on 7/15 Received Payment on 9/29/11 for 85 physicians Five physician payments were held with a status of
“provider has not reached the max threshold amount” Payment was sent once the condition was met If a physician doesn’t reach the max threshold amount of
$24,000 in Allowable Medicare Part B Charges by the end of the calendar year, CMS will pay 75% of the amount of charges around Feb of the following year. Example: $20,000 allowable charges, CMS will provide incentive bonus of $15,000 ($20,000 x 75%)
Monitor Payment Status on line by provider
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