Your Top EHR, Meaningful Use Questions Answered – Part II

A few months ago, we posted some of our readers' top questions on the topics of EHRs and meeting meaningful use with answers directly from CMS. 

In response, several of you sent us new questions to ask the Federal agency on your use of the technology and how to be in the best position to receive federal incentive payments. So we asked CMS to address your latest concerns and here are your answers.

If there are still unanswered questions, let us know and we'll go to CMS to get you the exact answers once again. Post your questions in the comments section below.

Q. Where is CMS on guidelines regarding e-prescribing when it comes to “meaningful use?” How can I meet this as an objective absent set standards?
A. First, it’s important to note that e-prescribing is an important component of the meaningful use criteria but not every eligible professional (EP) will need to include e-prescribing as part of the meaningful use reporting (otherwise known as “attestation”). CMS issued meaningful use standards for e-prescribing on December 21, 2010, and any EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from the e-prescription reporting requirement. The measurement guidelines specify that more than 40 percent of the “permissible prescriptions” (defined by the Department of Justice) must be transmitted electronically using the eligible professional’s EHR system.

Additional details and specifications can be found here on the CMS EHR website. 

Q. How do I calculate 30 percent Medicaid volume by practitioner: number of unique patients/total number of patients; number of visit encounters/total visits by provider; or number of visit encounters where part or whole paid by Medicaid/total visit encounters?
A. For the Medicaid EHR Incentive Programs, the answer depends on the state. Per Section 485.306 of the EHR Incentive Programs Final Rule (found here), States must identify (in their State Medicaid Health IT Plans) the methodology they have selected for measuring patient volume for EPs.

The first allowable methodology is based on patient encounters. Here is how it is calculated per the Final Rule:
(1) EPs. To calculate Medicaid patient volume, an EP must divide:
(i) The total Medicaid patient encounters in any representative, continuous 90-day period in the preceding calendar year; by
(ii) The total patient encounters in the same 90-day period.
(2) Needy individual patient volume [for EPs practicing predominantly in an FQHC or RHC].
To calculate needy individual patient volume, an EP must divide-
(i) The total needy individual patient encounters in any representative, continuous 90-day period in the preceding calendar year; by
(ii) The total patient encounters in the same 90-day period.

The second allowable methodology is based on patient panels. Here is how it is calculated:
(1) EPs. To calculate Medicaid patient volume, an EP must divide:
(i) (A) The total Medicaid patients assigned to the EP’s panel in any representative, continuous 90-day period in the preceding calendar year when at least one Medicaid encounter took place with the Medicaid patient in the year prior to the 90-day period; plus
(B) Unduplicated Medicaid encounters in the same 90-day period; by
(ii) (A) The total patients assigned to the provider in that same 90-day period with at least one encounter taking place with the patient during the year prior to the 90-day period; plus
(B) All unduplicated patient encounters in the same 90-day period.
(2) Needy individual patient volume [for EPs practicing predominantly in an FQHC or RHC].
To calculate needy individual patient volume an EP must divide-
(i) (A) The total Needy Individual patients assigned to the EP’s panel in any representative, continuous 90-day period in the preceding calendar year when at least one Needy Individual encounter took place with the Medicaid patient in the year prior to the 90-day period; plus
(B) Unduplicated Needy Individual encounters in the same 90-day period, by
(ii) (A) The total patients assigned to the provider in that same 90-day period with at least one encounter taking place with the patient during the year prior to the 90-day period, plus
(B) All unduplicated patient encounters in the same 90-day period.

For purposes of calculating EP patient volume, a Medicaid encounter means services rendered to an individual on any one day where-
(i) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service; or
(ii) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid all or part of the individual’s premiums, copayments, and cost-sharing.

Also, a state may submit to CMS for review and approval through the SMHP an alternative for the options above, so long as it meets the criteria laid out in Section 495.306 of the Final Rule.

Q. “Meaningful use” seems geared mainly toward primary-care physicians. What can a specialist do to meet meaningful use when it seems some of the reporting requirements are beyond our scope?
A. Great question. CMS has tried hard to make sure that everyone who is eligible can participate in the EHR Incentive Programs. The meaningful use objectives provide “exclusions” for those eligible professionals who may not be able to meet certain measures that are outside of their scope of practice. Each objective has different thresholds and exclusions. For more information, see the individual meaningful use specifications in this one document.

Q. Will my Regional Extension Center steer me to a specific EHR vendor or let me select from a list of certified systems? Does CMS have contracts with any specific vendors?
A. CMS does not have contracts with specific vendors. A list of all products certified for the EHR Incentive programs is available on the Office of the National Coordinator of Health IT’s Certified Health IT Product List (CHPL) at http://www.healthit.hhs.gov/CHPL. The Regional Extension Centers can offer technical assistance, guidance, and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records (EHRs). Regional Extension Center may be able to help a provider in identifying important factors and considerations during this process.

Q. If I am denied incentives for not properly meeting "meaningful use," is there an appeal process? Will I be told exactly why I was denied and / or how to appeal?
A. At this time, there is no information available on the appeals process for the Medicare EHR Incentive Programs. CMS plans to release information about the appeals process at a later date and you should watch the CMS website: https://www.cms.gov/EHRIncentivePrograms and listerv: https://www.cms.gov/EHRIncentivePrograms/65_CMS_EHR_Listserv.asp for more information and updates.

Q. What is the status of the Medicaid EHR Incentive Program? Is it available in my state right now? If not, when will it be online?
A. Each state is proceeding with their Medicaid EHR Incentive Program individually and many states are already online. Currently, there are about 14 states with functioning programs and 43 states with EHR and/or Health Information Technology websites. Many more states are expected to begin their Medicaid EHR Incentive Programs within the next few months and even more are expected by the end of the summer. Each state has a publically available Medicaid State Plan with their program details and monthly updates on the status of each state’s program can be found at the CMS EHR website.

Do you have more questions when it comes to EHRs and meaningful use? Let us know. Post your comment below or e-mail your inquiry to keith.martin@ubm.com and we'll get you the answers you need.