Stage 2 – 2014 Edition
- MU-EP-Stage 2-System Requirements
Please contact your Evident Sales Account Manager. They will review the sales matrix with each site to ensure that each required application or interface has been purchased.
- MU-EP-Stage 2-Objectives
Evident certified our EP software to meet 2014 Meaningful Use certification in 2013.
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
You must retain ALL relevant supporting documentation to support attestation data for Meaningful Use objectives and clinical quality measures for six years post-attestation.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
The universal feeds do not include the internal mapping and/or translations utilized to meet the implementation guidelines/criteria outlined in the Meaningful Use objectives and therefore cannot be used for Meaningful Use attestation.
- MU-EP-Stage 1-Misc.
- MU-EP-Stage 2-Misc.
For questions regarding provider eligibility, we highly recommend referencing the CMS website and following up with your state Medicaid office. Evident is not permitted to discuss or recommend provider eligibility with a site.
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
To validate EP attestation for these objectives, CMS and its contractor may request additional supporting documentation.
A few examples of suggested documentation are listed:
- Drug-Drug/Drug-Allergy Interaction Checks and Clinical Decision Support: One or more screenshots from the certified EHR system that demonstrate the enabling of the interventions during the EHR reporting period selected for attestation.
- Report clinical quality measures: Report from the certified EHR system to validate all clinical quality measure data entered during attestation.
- Protect Electronic Health Information: Documentation of security risk analysis of the certified EHR technology was performed prior to the end of the reporting period.
- Drug Formulary Checks: One or more screenshots from the certified EHR system that are dated during the EHR reporting period selected for attestation.
- Generate Lists of Patients by Specific Conditions: Report from the certified EHR system that is dated during the EHR reporting period selected for attestation. Patient-identifiable information may be masked/blurred before submission.
- Immunization Registries Data Submission, Reportable Lab Results to Public Health Agencies, and Syndromic Surveillance Data Submission :
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Dated screenshots from the EHR system that document a test submission to the registry or public health agency (successful or unsuccessful). Should include evidence to support that it was generated for that EP’s system.
- A dated record of successful or unsuccessful electronic transmission (e.g, screenshot from another system, etc.). Should include evidence to support that it was generated for that provider.
- Letter or email from registry or public health agency confirming the receipt (or failure of receipt) of the submitted data, including the date of the submission, name of parties involved, and whether the test was successful.
- Exclusions - Documentation to support each exclusion to a measure claimed by the EP.
- MU-EP-Stage 1-Misc.
- MU-EP-Stage 2-Misc.
At this time there is not an online presentation for Patient Portal education. We have instructional documents that can be emailed to site contacts, and we will be happy to perform a WebEx to explain the functionality of the Patient Portal.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
Orders need to be placed as soon as possible. The minimum lead time for all interface orders is 90 days. Interfaces must be purchased in production prior to the start of the Meaningful Use reporting period.
- MU-EP-Stage 1-Objectives
- MU-EP-Stage 2-Objectives
According to the CMS Stage 1 Specification Sheets, an EP may be excluded from recording and charting changes in vital signs if "…[the EP] either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice."
For 2014 and beyond, additional exclusions will be added to the Stage 1 measure. According to the specification sheet, the 2014 exclusions may include "any EP who: a.) sees no patients 3 years or older is excluded from recording blood pressure b.) believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them c.) believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure d.) believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight."
For additional information, please refer to the CMS website.
- MU-EP-Stage 1-System Requirements
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-System Requirements
- MU-EP-Stage 2-Interfaces
Interfaces are configured on an AR basis – meaning the company, all directories/sub-directories and associated setup for the HIS functionality must be in place and then the interface configuration in Linux, in the software tables and in the Interface Management System (IMS) can be set up. Each company has an ARID and a FACID which drive the interface configuration as all HL7 messages must contain these identifiers to ensure the data in the message is routed appropriately. Interface setup/configuration/maintenance and support all starts with an order as we have to schedule and allocate the appropriate resources to make the interface work, as well as ensure documentation reflects what is set up and expected to be supported/managed with software updates and changes.
- MU-EP-Stage 2-Objectives
There will be an audit log incorporated into the Version 1900 software for the View, Download & Transmit core objective for Stage 2.
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
To ensure you are prepared for a potential audit, save any electronic or paper documentation that supports your attestation. The primary documentation that will be requested in all reviews is the source document(s) that the EP used when completing the attestation. This document should provide a summary of the data that supports the information entered during attestation. Ideally, this would be a report from the certified EHR system. You should retain a report from the certified EHR system to validate all clinical quality measure data entered during attestation, since all clinical quality measure data must be reported directly from the certified EHR system.
This primary document will be the starting point of most reviews and should include, at minimum:
- The numerators and denominators for the measures.
- The time period the report covers.
- Evidence to support that it was generated for that EP (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.) .
Although the summary document is the primary review step, there could be additional and more detailed reviews of any of the measures, including review of medical records and patient records. The EP should be able to provide documentation to support each measure attested, including any exclusions.
- MU-EP-Stage 2-Objectives
EPs participating in Stage 2 are required to report three Meaningful Use objectives from the menu set of six. Starting in 2014, meeting the exclusion criteria will no longer count as reporting a Meaningful Use objective from the menu set. An EP must meet the measure criteria for three objectives in Stage 2, or report on all of the menu set objectives through a combination of meeting exclusions and meeting the measures.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
No, the email triggers, statistic tracking, etc. require use of the Thrive Patient Portal to meet the View, Download & Transmit objective.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
Only the public health agencies or an authorized entity of the state can provide exemption or exclusion status. This documentation must be stored with the rest of your attestation information for audit purposes. It is also recommended that the facility provide a copy of the exclusion to Evident for audit/tracking purposes.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
Meaningful Use auditing is performed by Figliozzi and Company. If you are selected for an audit, your facility will receive a letter from them with the CMS and EHR Incentive Program logos on the letterhead.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
A Health Information Exchange (HIE) or Regional Health Information Organization (RHIO) is not required to certify for Meaningful Use and may not meet the federal requirements that are included in the Meaningful Use audits. Keep in mind that the interface is typically developed per the HIE/RHIO specifications, not the federal guidelines. Given this, Evident recommends that you confirm with the RHIO/HIE, and with the state to whom the reportable data is sent, that use of the HIE/RHIO for attestation to the public health reporting objectives will comply with federal regulations and standards and ensure you pass an Meaningful Use audit should one be issued for your facility.
- MU-EP-Stage 1-Objectives
- MU-EP-Stage 2-Objectives
According to the CMS Stage 1 specification sheets, an EP may be excluded if "[the EP] does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period." For additional information, please refer to the CMS website.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
Syndromic Surveillance interfaces typically send demographic data as well as the patient’s chief complaint. It is Evident’s recommendation that each facility transition the chief complaint field in the Census tab to a required field, thereby ensuring it’s included with every registration.
- MU-EH-Stage 2-System Requirements
- MU-EH-Stage 2-Objectives
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 2-System Requirements
- MU-EP-Stage 2-Objectives
- MU-EP-Stage 2-Interfaces
No – Initially, CMS indicated plans to require electronic submissions for Clinical Quality Measure (CQM) data but no specifications were provided and the electronic submission requirement was later retracted. The current process for submitting Quality Measures remains acceptable. More information is available on the CMS website.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
If you are selected for an audit you will receive a letter from Figliozzi and Company with the CMS and EHR Incentive Program logos on the letterhead. The request letter will be sent electronically from a CMS email address and will include the audit contractor’s contact information.
- MU-EP-Stage 2-Objectives
In Stage 2, CPOE for medication order entry threshold has been increased to 60%, and CPOE laboratory and radiology orders have been added with a threshold of more than 30% orders recorded in a Certified EHR Technology (CEHRT).
- MU-EH-Stage 2-System Requirements
- MU-EP-Stage 2-System Requirements
Please contact your Evident Sales Account Manager. They will review the sales matrix with each site to ensure that each required application or interface has been purchased. Once this is reviewed, and all items are purchased, your facility will be assigned to a Meaningful Use Representative for further direction and discussion.
- MU-EP-Stage 1-Misc.
- MU-EP-Stage 2-Misc.
According to CMS, a hospital-based EP is defined as an EP who furnishes more than 90% of their services in either an inpatient or emergency department of a hospital and does not qualify for Medicare or Medicaid EHR incentive payments.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
No, the third party systems do not have to be certified since the Thrive EHR is the certified product for attestation. However, if Thrive is using data received from a third party system to meet interoperability requirements, all data elements and formatting must comply with the implementation guidelines needed to attest. For instance, in order for Thrive to transmit lab results to the public health agencies in the manner outlined in the implementation guide, ie: structured and with LOINC/SNOMED-CT, that information must be received from any laboratory vendor that sends results to the HIS.
- MU-EP-Stage 2-Objectives
No, this cannot be turned off. This is a requirement for Stage 2 and it is also a requirement of SureScripts. The EHR must check every possible prescription for the existence of a relevant formulary.
- MU-EP-Stage 2-Objectives
Users will no longer be able to add alpha characters within the height, weight and blood pressure field. According the Stage 2 specification sheet for Recording Vital Signs, the only information required to be inputted by the provider is the height and weight, and/or blood pressure of the patient. The certified EHR technology will calculate the BMI and growth chart is applicable to a patient based on age.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
Technically, yes. We can convert HL7 v2.3 to v2.5.1 but all of the required data elements must be included in the v2.3 message for it to be successfully updated to the public health agency.
- MU-EP-Stage 2-Objectives
The path to edit the clinical monitoring checks will remain within Table Maintenance for Stage 2.
- MU-EP-Stage 2-Objectives
Yes, reporting for Drug-Drug and Drug-Allergy Interactions Checks become more detailed in Stage 2. Sites must attest that severity level intervention checks are adjustable by users with the appropriate privileges.
- MU-EH-Stage 1-Attestation
- MU-EH-Stage 2-Attestation
- MU-EP-Stage 1-Attestation
- MU-EP-Stage 2-Attestation
Your facility will need to contact CMS for payment information.
- MU-EP-Stage 2-Objectives
The sites will be responsible for this setup.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
Yes, CMS conducts random pre-payment audits to validate submitted attestation as well as post-payment audits.
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 2-Interfaces
Yes, all public health interfaces must be successful ongoing submissions from the certified EHR to the registry for the entire reporting period. (Note: some exclusions apply). If your state is exempt, your state will need to provide your facility with a letter of exemption.
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
Transmission depends on the public health agency. Some states utilize Public Health Information Network Messaging System (PHIN-MS), File Trasnfer Protocol (FTP) or batch transmissions and others that require real-time updates – all via an HL7 v2.5.1 message. For immunization reporting, the software is designed with logic that automatically generates a message in the background so charting of immunizations is all that the staff need to do to initiate. There is setup in the software at the item level to ensure administration charting includes lot number and expiration date.
- MU-EP-Stage 2-Objectives
Yes, users must first select a Destination with Medication Reconciliation (i.e. Clinic Discharge) before selecting "No Active Meds" to receive credit within the numerator on the statistics report.
- MU-EP-Stage 2-Objectives
Typically the alert is sent to the person that needs to take action upon the alert. If the nurse needs to perform an action for an alert, the nurse can subscribe to that alert and receive it instead of the provider. Or the alert can be sent to both and just be informational for the physician. Some of the alerts that are triggered at account creation will remove themselves as the nurse records the missing information. Each alert is different and can be subscribed to independent of the others.
- MU-EH-Stage 1-Objectives
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 1-Objectives
- MU-EP-Stage 2-Objectives
According to the final rule, an Eligible Hospital or Critical Access Hospital may be exempt if they do not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction’s immunizations registry or immunization information system during the EHR reporting period. Evident recommends each facility contact the state public health agency for confirmation of exclusion - and to request a letter of exclusion (for auditing purposes).
- MU-EP-Stage 1-System Requirements
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-System Requirements
- MU-EP-Stage 2-Interfaces
No, clinics that are considered to be departments of the hospital (housed within the hospital AR) are not required to purchase an additional immunization interface. Separate interface orders are needed for each additional clinic AR.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
Evident is doing everything we can to encourage interoperability opportunities, to accelerate development and to deploy our piece of the integration progression in a timely manner. Every interface requires the coordination of three different organizations: Evident (the EHR vendor), the third party vendor and the facility, along with the various timelines of each group. In addition, it is the responsibility of the facility to validate every interface. While it may only take a week or two to actually deploy the interface, the testing and validation process can take much longer.
- MU-EP-Stage 2-Objectives
Yes, EPs will be able to adjust what information is made viewable on the Continuity of Care Document (CCD) for a patient. According to the Stage 2 Clinical Summaries objective, "If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary."
- MU-EP-Stage 2-Objectives
There are no parameters to the amount of Family Health History that must be entered. The Stage 2 Specification Sheet for the Family Health History objectives states that the measure is a minimum and not a limitation to the amount of health history that can be recorded.
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
For information and/or instructions on where to submit your public health-related data, please contact your local or state public health agencies and immunization registries.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
Yes, states will have separate audit processes for their Medicaid EHR Incentive Program. For more information about these audit processes, please contact your state Medicaid Agency.
- MU-EP-Stage 2-Objectives
There will be an option for the user to select No Known Family History. According to the Stage 2 objective for Family Health History, "For patient who are asked about their family health history, but do not know their family history, it is acceptable for the provider to record the patient's family history as 'unknown'."
- MU-EP-Stage 2-Objectives
Yes, the user will be able to mark "No Known Family History" within the Family Health History application. According to the Stage 2 objective for Family Health History, "For patient who are asked about their family health history, but do not know their family history, it is acceptable for the provider to record the patient's family history as 'unknown'."
- MU-EP-Stage 2-Objectives
Yes, Evident has programmed functionality to create patients lists within the Report Dashboard in order to comply with the Stage 2 Patient Lists objective.
- MU-EP-Stage 2-Objectives
Users can run one all-inclusive report that can pull information from existing templates. Users will also have the ability to exclude certain patient demographic information.
- MU-EP-Stage 2-Objectives
According to the Stage 2 objective for Clinical Summaries, "in the event that a clinical summary is offered to and subsequently declined by the patient, that patient may still be calculated in the numerator." There will be a field incorporated in the MP-EHR visit screen that will allow a user to enter whether or not a patient accepted a copy of their clinical summary.
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
Once the audit is concluded, the EP will receive an Audit Determination Letter from the audit contractor. This letter will inform the EP whether they were successful in meeting Meaningful Use of electronic health records. If, based on the audit, an EP is found not to be eligible for an EHR incentive payment, the payment will be recouped. CMS may also pursue additional measures against EPs who attest fraudulently to receive an EHR incentive payment. Punishment may involve imprisonment, significant fines or both. Convictions also may result in exclusion from Medicare participation for a specified length of time. Medicare fraud may also result in civil liability.
- MU-EP-Stage 2-Objectives
Yes, the medications section has been improved from the original Continuity of Care Document (CCD). Discontinued medications do not default to pull to the CCD but can be included if the user chooses. Information within the CCD is listed in a table format, making it much easier to read. Medications are no longer listed by the date that they were entered.
- MU-EP-Stage 2-Objectives
The provider will receive a notification icon on their home screen that there is a message from a patient. Selecting the icon will launch the provider into the message screen to address the patient's message. If there is more than one message, the provider will be taken to the account list screen. In this screen, visits with messages attached to them will appear. The visits in bold will indicate there are new messages on this visit. Visits with messages will remain on the account list until deleted by the provider.
- MU-EP-Stage 2-Objectives
Patients will log in to their Patient Portal accounts and access the Message Center. The patient should see their name and list of patients for whom the patient is an authorized representative. There will be an icon with a numeric indicator showing how many messages are in the patient's inbox.
- MU-EP-Stage 2-Objectives
Yes, the Continuity of Care Document (CCD) will be able to be exported to a flash drive or CD. The Clinical Summaries objective can be met through one of these methods, or by printing the summary or making it available through the Patient Portal.
- MU-EP-Stage 2-Objectives
Per the Stage 2 Specification Sheet for Clinical Summaries, sites must provide paper copies of the clinical summaries to patients upon request.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
CMS has an appeals process for EPs, EHs and CAHs that participate in the Medicare EHR Incentive Program. Providers may contact the EHR Information Center through a toll free number, 888-734-6433, between 9 a.m. and 5 p.m. EST, Monday through Friday, for general questions on how to file appeals and the status of any pending appeals. States will implement appeals processes for the Medicaid EHR Incentive Program. Medicaid program participants should contact their State Medicaid Agency for more information about these appeals.
- MU-EP-Stage 2-Objectives
Yes, each provider will be required to have a minimum of five Clinical Decision Support (CDS) interventions activated during the entire reporting period.
- MU-EP-Stage 2-Objectives
After the initial setup, it will be the site's responsibility to keep each intervention up to date. The websites that the users are being launched to will not be able to be changed due to the National Quality Forum (NQF) that is attached to the intervention.
- MU-EP-Stage 2-Objectives
This is part of the behavior and role setup in security. ( ie: Physicians Group vs. Nursing Group)
- MU-EP-Stage 2-Objectives
Yes, this is also part of the role setup in security.
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 2-Objectives
As with Meaningful Use Stage 1, each facility will have to review or conduct a security risk analysis of the certified EHR prior to the end of the reporting period. A new review must occur for each subsequent reporting period. Parameters of the risk analysis are defined in 45 CFR 164.308(a)(1) created by the HIPAA Security Rule.
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 2-Objectives
Yes, there are some Meaningful Use Stage 1 objectives that have been incorporated into Meaningful Use Stage 2 objectives. In order to meet the new Stage 2 objectives, the previous Stage 1 objectives must be met.
- MU-EH-Stage 1-Objectives
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 1-Objectives
- MU-EP-Stage 2-Objectives
The Meaningful Use Stage 1-2011, Stage 1-2014 and the Meaningful Use Stage 2 Statistics Reports are now found under the following path: Hospital Base Menu > Other Applications And Functions > Word Processing > AdHoc Report
These new reports will now be listed under the middle column.
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 2-Objectives
No. The final rule states that in order to meet the Clinical Decision Support objective, Drug-Drug and Drug-Allergy interactions have to be turned on for the entire reporting period in addition to four clinical support interventions related to four or more clinical quality measures.
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 2-Objectives
According to CMS, “accessible through Certified EHR Technology” is defined as either incorporation of the image and accompanying information into Certified EHR Technology, or as an indication in Certified EHR Technology that the image and accompanying information are available for a given patient in another technology with a link to that image and accompanying information.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
The Centers for Medicare and Medicaid Services do not process appeals for provider’s, hospital’s or CAH’s who dispute the amount of their EHR inventive payment. After an EP successfully attests, a monthly report determines whether the allowable claims threshold for the program participation year has been met. After the close of the incentive payment year, incentive payments are made based on 75% of Medicare allowed charges for covered professional services furnished during the payment year that have been successfully submitted by the EP. After a hospital or critical access hospital successfully attests, an initial incentive payment is issued based on the latest available cost report which is then reconciled when the cost report is finalized.
Here is the CMS Frequently Asked Question regarding appeals regarding the dispute of the amount of the incentive payment.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
Figliozzi and Company is who will be performing audits for CMS. If you are selected for an audit, you will receive a letter from them with the CMS logo attached. If you have a question regarding this, questions can be directed to Peter Figliozzi at (516) 745-6400 x302 or at pfigliozzi.com. Their website is http://www.figliozzi.com. This email and letter will come to the person that has registered as the administrator or individual that has filled out the attestation information on the CMS website.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
If your facility or provider is in an audit, an initial email will come to the person who registered on the CMS website for the attestation. If that person leaves your facility, or changes, the hospital/provider will need to go back to the CMS website and update the email address.
- MU-EP-Stage 1-Attestation
- MU-EP-Stage 2-Attestation
Yes. For 2014 only, all providers are only required to demonstrate Meaningful Use for a 3-month EHR reporting period, regardless of their stage. For Medicare providers, this 3-month reporting period is fixed to the quarter of the calendar year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS). The 3-month reporting period is not fixed for Medicaid EPs that are only eligible to receive Medicaid EHR incentives, where providers do not have the same alignment needs. CMS is permitting this one-time, 3-month reporting period in 2014 only so that all providers who must upgrade to 2014 certified EHR technology will have adequate time to implement their new, certified EHR systems.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
To ensure you are prepared for an audit, save the electronic or paper documentation that supports all of your attestation (including any exclusions). This includes the values you have entered in the Attestation Module. Hospitals should also maintain documentation that supports their payment calculations. If based on an audit, a provider or hospital is found to not be eligible for an EHR incentive payment and has not met attestation, the payment will be recouped. Initial audit review will be conducted by the auditor at their location. Additional information may be required or needed during or after the initial review process and in some cases, an onsite review at the provider’s location could follow. A demonstration of the EHR system could be requested during the onsite-review.
Any provider or hospital that finds themselves in an audit of their EHR incentive payment, should retain the information found here.
Below are the links to the Evident Audit documentation:
Meaningful Use Audit Stage 1 - 2014 Eligible Hospitals
Meaningful Use Audit Stage 2 - 2014 Eligible Hospitals
Meaningful Use Audit Stage 1 - 2014 Eligible Professionals
Meaningful Use Audit Stage 2 - 2014 Eligible Professionals
Here is also the link to the Frequently Asked Questions regarding Auditing by CMS.
- MU-EH-Stage 1-Interfaces
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 1-Interfaces
- MU-EP-Stage 2-Interfaces
No. If the patient has not had any vaccines administered since their last visit, no new entry should be added to the immunization entry menu. Each entry made in this menu creates a record that is subsequently sent to your immunization registry via the public health interface. Each record should contain the vaccine that was received by the patient, or an explanation as to why the patient did not receive a vaccination. For example, CVX code 998 is utilized in the CPSI software to document that no vaccine was administered due to evidence of immunity. Evidence of immunity indicates that a person has plausible evidence that they have already developed immunity to a particular disease and further immunization against the disease is not likely to provide benefit. When a user selects "No vaccine administered" (CVX 998) in immunization entry, the Evidence of Immunity field should be addressed to attach an applicable SNOMED code and description to indicate that a patient is immune to a specific disease.
In summary, if the patient has not received any vaccines at any other facility since their last visit at your facility, no entry should be made in the immunization entry menu.
- MU-EH-Stage 1-Objectives
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 1-Objectives
- MU-EP-Stage 2-Objectives
Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the numerator for the measure of the CPOE objective if they can enter the order per state, local and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that CPOE occurs when the order first becomes part of the patient's medical record and before any action can be taken on the order. Each provider will have to evaluate on a case-by-case basis whether a given situation is entered according to state, local and professional guidelines, allows for clinical judgment before the medication is given, and is the first time the order becomes part of the patient's medical record.
- MU-EH-Stage 1-Attestation
- MU-EH-Stage 2-Attestation
- MU-EP-Stage 1-Attestation
- MU-EP-Stage 2-Attestation
Your facility would have to contact CMS to determine the error and re-attest with the correct information.
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 2-Interfaces
No, the Meaningful Use criteria surrounding this objective do not specify inclusion of the physician signature in the order message. Additionally, 42 CFR 410 indicates documentation by the treating physician (i.e.: in the summary of care/progress note) that he/she intended for the test to be performed will satisfy the authorization requirement without the need for the signature of the ordering physician. The industry standard on electronic orders is to include the ordering physician in the HL7 transaction as acceptable authorization for the test to be performed.
- MU-EH-Stage 2-Objectives
- MU-EP-Stage 2-Objectives
Recently, we have been provided with the following correspondence from CMS. While problems, medication list and medication allergy list are the key components to populate the numerator of the summary of care measure, CMS now states they will be looking for the CCD to have all of the below elements populated below, if known. If your facility has attested, Evident recommends that your facility reviews all of the patients in your attestation period contained in the numerator, and make sure the data elements below are documented If known, since this information has recently been made available to us.
We apologize for any inconvenience this FAQ has caused but want to make sure you are aware of recent CMS information. Please also note that any FAQs that are released after the final rule are regarded as “sub-regulatory guidance” by CMS and must be followed within a reasonable amount of time. CMS also communicates the updated FAQs to auditors who utilize the information for Meaningful Use audits.
FAQ response from CMS:
Thank you for your recent inquiry. Below is the information you requested regarding the meaningful measures for transitions of care. Our response focuses on the measure for eligible hospitals (EHs), but the eligible professional (EP) measure is essentially the same.
As adopted by CMS, the Stage 1 and Stage 2 objectives require hospitals that transition their patient to another setting of care or provider of care or refer their patients to another provider of care (including long-term care) to provide a summary care record for more than 50 Percent or transitions of care and referrals.
For the Stage 1 measure, CMS did not specify the contents of the summary of care record. While the hospital can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably expected to do so. However, beyond the CMS requirements, in order to meet this objective and its measures, the hospital must use the capabilities and standards of certified EHR technology (CEHRT) established by the Office of National Coordinator for Health IT (ONC), specifically, the standards found at 45 CFR 170. 205(a)(1) and (2). The ONC has defined the content of a summary of care record to include at a minimum, diagnostic results, problem list, medication list, medication allergy list, and procedures.
For the Stage 2 measure, CMS specifies that the summary of care record must include the following elements:
* Patient name.
* Referring or transitioning provider's name and office contact information (EP only).
* Procedures.
* Encounter diagnosis
* Immunizations.
* Laboratory test results.
* Vital signs (height, weight, blood pressure, BMI).
* Smoking status.
* Functional status, including activities of daily living, cognitive and disability status
* Demographic information (preferred language, sex, race, ethnicity, date of birth).
* Care plan field, including goals and instructions.
* Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider.
* Discharge instructions
* Current problem list (Hospitals may also include historical problems at their discretion).
* Current medication list, and
* Current medication allergy list.
If the provider does not have the information available to populate one or more of the fields listed, either because they can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, laboratory tests), the provider may leave the field(s) blank. The only exception to this is the problem list, medication list, and medication allergy list. In the event that there are no current or active diagnoses for a patient, the patient is not currently taking any medications, or the patient has no known medication allergies, confirmation of no problems, no medications, or no medication allergies would satisfy the measure of this objective. In circumstances where there is no information available to populate one or more of the fields listed previously, either because the eligible hospital or CAH can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, laboratory tests), the eligible hospital or CAH may leave the field(s) blank and still meet the objective and its associated measure.
Beyond the CMS requirements, in order to meet the Stage 2 objective and its three measures, the hospital must use the capabilities and standards of certified EHR technology (CEHRT) established by the Office of National Coordinator for Health IT (ONC), specifically, the standards found at 45 CFR 170.314(b)(2), (g)(1), (g)(2). The ONC has defined the content of a summary of care record to include “at a minimum, the Common MU Data Set and the following data expressed, where applicable, according to the specified standard(s):
(A) Encounter diagnoses. The standard specified in § 170.207(i) or, at a minimum, the version of the standard specified § 170.207(a)(3);
(B) Immunizations. The standard specified in § 170.207(e)(2);
(C) Cognitive status;
(D) Functional status; and
(E) Ambulatory setting only. The reason for referral; and referring or transitioning provider’s name and office contact information.
(F) Inpatient setting only. Discharge instructions.”
For further information regarding the certification and standards criteria, you should contact the ONC at:
• (202) 690-7385;
• E-mail: onc.request@hhs.gov; or
• Visit its Web site at http://healthit.hhs.gov.
The purpose of providing the summary of care records is to assure that the provider to whom the patient is transferred or referred obtains the most recent information on the patient that may be crucial to his/her care. A summary of care record that does not include the required contents as defined by the ONC could not be counted in the numerator of the measure.
The tracking number for this inquiry is 330002. If you have further questions, please visit the CMS Medicare & Medicaid EHR Incentive Programs Website located at http://cms.gov/EHRIncentivePrograms/. You will find accurate and up-to-date information about the programs, including eligibility, payment amounts, requirements, upcoming events and more. Bookmark the above link and check back often to learn more about these programs, or contact the EHR Information Center at (888) 734-6433.
The Medicare and Medicaid EHR Incentive Programs listserv provides timely, authoritative information about the programs, including registration and attestation updates and details about the payment process. The listserv messages are another CMS resource to provide you with the latest news about the Incentive Programs. On average, two messages are sent per week. Information on how to join the listserv can be found at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentiveProg....
Thank you,
The EHR Information Center
- MU-EH-Stage 1-Attestation
- MU-EH-Stage 2-Attestation
- MU-EP-Stage 1-Attestation
- MU-EP-Stage 2-Attestation
Yes, CMS created tip sheets for EPs, EHs and CAHs to assist with explaining Medicare reimbursement.
- MU-EH-Stage 2-Attestation
- MU-EP-Stage 2-Attestation
Per Centers for Medicare and Medicaid Services (CMS), there will be a new, revised timeline for Stage 2. This will be extended through 2016, and Stage 3 will begin in 2017 for those hospitals and providers that have completed at least two years in Stage 2. For those that are to start Stage 2 in 2014, this does not change when you start Stage 2, only that you will now be at Stage 2 for three years, instead of two. In the fall of 2014, it is expected that CMS will release a notice of proposed Stage 3 Rulemaking and corresponding ONC Standards will be released in the fall of 2014. The final rule for Stage 2 would then follow in 2015.
- MU-EH-Stage 2-Interfaces
- MU-EP-Stage 2-Interfaces
You should only select an exclusion option if your state agency has provided your facility with a letter of exclusion/exemption. If your facility has completed the state-required registration/onboarding and are waiting to begin implementation, you should select ‘Yes’ to attest. Keep in mind that the attestation requirements included with the public health reporting objectives include registration with intent to initiate ongoing submissions within 60 days of the start of the reporting period as well as the full/ongoing submissions.
- MU-EH-Stage 1-Audits
- MU-EH-Stage 2-Audits
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
CMS has an appeals process for eligible professionals, eligible hospitals and critical access hospitals that participate in the Medicare/Medicaid EHR Incentive Program. If your facility wishes to appeal they must complete the appropriate filing request found in the below link. The appeals submission process is time sensitive with a 30 day window for submission period. The filing request and supporting documentation must be submitted. The appeal will only be processed if all documentation needed is provided at the time of submission.
- MU-EH-Stage 2-Attestation
- MU-EP-Stage 2-Attestation
The Modified Stage 2 (2015-2017) final ruling that was released made changes to a few things for 2015-2017. Listed below are some of the high points:
- 2015 only: will now become a continuous 90-day reporting period that can range from Oct 1 2014 -Dec 31 2015.
- For hospitals, their reporting period has now been moved to a calendar year instead of a fiscal year.
- Actual attestation for 2015 cannot take place until Jan. 4, 2016 and will run through Feb. 29, 2016.
- 2016: the reporting period will be a 365-day calendar year and attestation will not take place until January - February 2017.
- 2017: the reporting period for modified Stage 2 will be a 365 day calendar year and attestation will not take place until January - February 2018.
- Stage 3 will not be mandatory until 2018.
Please note: There will no longer be core vs menu objectives or stages. All facilities will align into reporting the same objectives.
- MU-EH-Stage 1-System Requirements
- MU-EH-Stage 2-System Requirements
- MU-EP-Stage 1-System Requirements
- MU-EP-Stage 2-System Requirements
All EPs, EHs and CAHs must have EHR technology certified to the 2014 Edition EHR certification criteria that meets the Base EHR definition and would support the objectives, measures, and their ability to successfully report the Clinical Quality Measures (CQMs), for the Meaningful Use stage that they seek to achieve. CMS reiterates that an EP, EH or CAH must continue to possess all of a certified Complete EHR or certified EHR Module (i.e., the capabilities for which certification is required) in order to receive the benefit of such certification. An EP, EH or CAH cannot purchase or possess only “components” of a certified Complete EHR or certified EHR Module for the purposes of meeting the CEHRT definition. That is, unless independently certified, those “components” could not be used to meet the CEHRT definition.
- MU-EH-Stage 1-System Requirements
- MU-EH-Stage 2-System Requirements
- MU-EP-Stage 1-System Requirements
- MU-EP-Stage 2-System Requirements
Each facility should be running Version 19 (CMS 2014 version) in order to attest for Meaningful Use Stage 1 or Stage 2 in the fiscal year of 2014.
- MU-EP-Stage 1-Audits
- MU-EP-Stage 2-Audits
Yes, we recommend that you take screen shots of all objectives met through attestation in case of future audits.