Timeline for Eligible Professionals to Avoid Payment

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Transcript Timeline for Eligible Professionals to Avoid Payment

Meaningful Use
Jacqueline L. Candelaria
ABQ Area Program Analyst
April 25, 2012
What is Meaningful Use and how does
it affect us
• “Meaningful Use” simply put is using “CERTIFIED”
EHR technology in a meaningful way to:
Improve quality, safety, efficiency, and reduce
health disparities
Engage patients and families in their health care
Improve care coordination
All the while maintaining privacy and security
Meaningful Use
• CMS provides incentive payments to promote
adoption and meaningful use of a certified
EHR.
• Eligible providers can apply for Medicare OR
Medicaid
Eligible Providers
Eligible Providers (based on calendar year, CY)
Medicaid
Medicare
Starting Dates
Start by CY 2016. End by
2021.
Start by CY 2014. End by
2016.
Penalty if not enrolled by
2015.
Requirements for Year 1
Need: Adopt/Implement
/Update certified EHR
(Stage 1).
Need: Demonstrate MU
(15 + 5 objectives,
electronic exchange, 6
clinical measures)
Eligible Providers
[Choose Medicaid or
Medicare] not both
Include: MD, NP/Midwife,
DDS, PA in FQHC.
Need: >30% Paid Medicaid
patients.
Pay: up to $63,750/EP over
5 yrs.
Include: MD, DO,
DDS/DMD, DPM, OD.
Pay: up to $44,000/EP
over 5 yrs.
Timeline for Eligible Professionals to
Avoid Payment Adjustment
EP Payment
Adjustment
(CY)
Establish MU
for full CY-2
yrs. prior
or
EP Demonstrating MU
for 1st time in yr. prior to
payment adjustment
yr/continuous 90 days
reporting period
beginning no later than:
Or
Apply for an Exception
no later than:
2015
CY 2013 (with
submission 2
months
following
reporting
period)
July 3, 2014 (with
submission no later than
October 1, 2014)
July 1, 2014
2016
CY 2014
July 3, 2015 (Oct. 1 2015)
July 1, 2015
2017
CY 2015
July 3, 2016 (Oct. 1 2016)
July 1, 2016
2018
CY 2018
July 3, 2017 (Oct. 1 2017)
July 1, 2017
2019
CY 2019
July 3, 2018 (Oct. 1 2018)
July 1, 2018
Certified EHR
• RPMS/EHR is certified
• Dentrix 6.0 is not certified however if you
use both the RPMS/EHR and Dentrix you
are ELIGIBLE to participate (currently it
would be dual entry)
What are the requirements for
dentists to participate?
• Must meet same eligibility requirements as
other eligible EP’s
– 15 Core measures; 5 from menu set of their
choosing
– 6 CQM’s; 3 core and 3 from menu set of their
choosing
(Several MU objectives have exclusion criteria and
will need to evaluate whether they meet the
exclusion for each applicable objective as there is no
blanket exclusion by type of EP)
How can dental qualify for the EHR
Incentive Program
• Enter the problem list, medication list,
medication allergy data, etc. directly in the
EHR (RPMS)
– NOTE: If data is entered in the dental “front end”
package it does not pass through to RPMS and this
would not meet the MU criteria.
How can dentists participate
• Capture data such as demographics and vitals;
it is interfaced to the RPMS PCC database
• RPMS MU Performance measures reports
access this data from the PCC database and
not the EDR.
• When this procedure is followed CMS has
determined that no independent certification
of the IHS/EDR is necessary to achieve MU
Stage 2 CQM New Measure
• Proposed new measure:
–Children who have dental decay or
cavities
–Assesses if children aged 1-17 years
have had tooth decay or cavities in the
past 6 months
Performance Report
• MU is a team effort, patient registration,
nursing, pharmacy, laboratory, health
information management, IT and providers.
• See attached report on a dental provider
– NOTE: Dental Providers within the ABQ Area have
AIU’d for Medicaid and their facility will be
receiving a MU incentive payment of $21, 250.00
Take-Aways
 Medicaid EHR Incentive Program
Voluntary program for states to incentivize eligible providers to
meaningfully use CEHRT to improve health, improve care
delivery, and reduce per capita costs
 Provider eligibility is determined by type of provider, location
of service, and patient volume
 Providers register with CMS, and then attest through SMAs,
which may vary by state
 Medicaid provider may AIU in first participation year, but must
demonstrate MU thereafter
 Providers must report MU (functional) measures and CQMs
electronically by 2013