Meaningful Use Frequently Asked Questions and Definitions

Federal law mandates that Medicare Eligible Professionals, Eligible Hospitals and Critical Access Hospitals that do not successfully demonstrate Meaningful Use in 2015 and later will incur a payment adjustment in their Medicare reimbursement. In accordance with the HITECH Act of 2009, failure of these providers to adopt Meaningful Use of a certified EHR technology will result in cuts in Medicare reimbursement payments by 1% in 2015, 2% in 2016, and 3% for 2017 and beyond. The EHR Incentive Program was included in the HITECH Act to help qualified Medicare and Medicaid providers avoid these penalties.

1. What is “Meaningful Use”?

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 describes three main components of Meaningful Use:

  • The use of Certified Electronic Health Records (EHRs) in a meaningful manner, such as e-prescribing.
  • The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
  • The use of certified EHR technology to submit clinical quality reports and other measures as required by the Centers for Medicare and Medicaid Services.

Simply put, “Meaningful Use” means providers need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity by Wyoming EqualityCare/Medicaid and the Centers for Medicare and Medicaid Services.

2. What is Certified Electronic Health Record Technology?

Certified Electronic Health Record (EHR) technology are products that have been tested and certified under the Office of the National Health Information Technology Coordinator (ONC) in accordance with the standards, implementation specifications, and certification criteria set forth in the ONC’s Final Rule.

CLICK HERE for a list of Certified EHR Technologies.

3. How are Medicaid Meaningful Use Requirements met?

To qualify for incentive payments, Meaningful Use requirements must be met in the following ways:

  • Medicaid EHR Incentive Program - Eligible Professionals and Eligible Hospitals may qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation. They must successfully demonstrate meaningful use for subsequent participation years.
  • Adopted: Acquired and installed certified EHR technology. (For example, can show evidence of installation.)
  • Implemented: Began using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.)
  • Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)

4. What is the Criteria for Meaningful Use?

The criteria for Meaningful Use will be staged in three steps over the course of the next five years:

  • Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing.
  • Stage 2 (expected to be implemented in 2013), and
  • Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making.

5. What are the requirements for Stage 1 of Meaningful Use?

Meaningful Use includes both a Core Set and a Menu Set of Objectives that are specific to Eligible Professionals or Eligible Hospitals.

6. What can be learned from these Meaningful Use Objective Specification Sheets?

The Meaningful Use Objectives Specification Sheets for the Medicare and Medicaid EHR Incentive Programs bring together critical information on each objective to help Eligible Providers and Eligible Hospitals understand what they need to do to demonstrate Meaningful Use successfully. Each specification sheet covers a single eligible professional Core or Menu Set Objective in detail, including information on:

  • Meeting the measure for each objective.
  • How to calculate the numerator and denominator for each objective.
  • How to qualify for an exclusion to an objective.
  • In-depth definitions of terms that clarify objective requirements.
  • Requirements for attesting to each measure.

The Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals and Hospitals/Critical Access Hospitals were designed to assist each respectively in demonstrating Meaningful Use successfully and to help them understand the specific requirements of each objective.

7. What are “Clinical Quality Measures”?

To demonstrate Meaningful Use successfully, Eligible Professionals, Eligible Hospitals and CAHs are required to report specific Clinical Quality Measures respectively.

EPs must report on 9 of the 64 approved CQMs

· Recommended core CQMs – encouraged but not required

o 9 CQMs for the adult population

o 9 CQMs for the pediatric population

o NQF 0018 strongly encouraged since controlling blood pressure is high priority goal

in many national health initiatives, including the Million Hearts campaign

· Selected CQMs must cover at least 3 of the National Quality Strategy domains

Eligible Hospitals and CAHs must report on 16 of the 29 approved CQMs

Selected CQMs must cover at least 3 of the National Quality Strategy domains

SOURCE: Centers for Medicare and Medicaid Services

For the meaningful use objective of “capability to exchange key clinical information” in the Medicare and Medicaid EHR Incentive Programs, what forms of electronic transmission can be used to meet the measure of the objective?

For the purposes of the “capability to exchange key clinical information” measure, exchange is defined as electronic transmission and acceptance of key clinical information using the capabilities and standards of certified EHR technology (as specified at 45 CFR 170.304(i) for eligible professionals and 45 CFR 170.306(f) for eligible hospitals and critical access hospitals). There are many acceptable transmission methods for conducting a test of the electronic exchange of key clinical information with providers of care and patient authorized entities (see FAQ #) To meet the measure of this objective a provider must:

use certified EHR technology to generate a continuity of care document (CCD), continuity of care record (CCR), and electronically transmit the CCD/CCR.

To complete step 2, an eligible professional, eligible hospital, or critical access hospital may use any means of electronic transmission according to any transport standard(s) (SMTP, FTP, REST, SOAP, etc.) regardless of whether it was included by an EHR technology developer as part of the certified EHR technology in the eligible professional’s, eligible hospital’s, or critical access hospital’s possession.

Please note that the use of USB, CD-ROM, or other physical media or electronic fax would not meet the measure of this objective and has been addressed in another FAQ (see FAQ #10638) If the test involves the transmission of actual patient information, all current privacy and security regulations must be met.

The definition of ‘Needy Patient Encounters’ is:

    1. Received medical assistance from Medicaid or the Children’s Health Insurance Program. (or a Medicaid or CHIP demonstration project approved under section 1115 of the Act).
    2. Were furnished uncompensated care by the provider.
  1. Were furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.

According to the Final Rule: In determining the ‘‘needy individual’’ patient volume threshold that applies to EPs practicing predominantly in FQHCs or RHCs, section 1902(t)(2) of the Act authorizes the Secretary to require the downward adjustment to the uncompensated care figure to eliminate bad debt data. We interpret bad debt to be consistent with the Medicare definition, as specified at § 413.89(b)(1). In order to remain as consistent as possible between the Medicare and Medicaid EHR incentive programs, States will be required to downward adjust the uncompensated care figure. Under Medicare, bad debts are amounts considered to be uncollected from accounts and notes receivable that were created or acquired in providing services. ‘‘Accounts receivable’’ and ‘‘notes receivable’’ are designations for claims arising from the furnishing of services, and are collectible in money in the relatively near future.”

To further explain, if a patient has an agreement with the provider before the services are rendered, on a sliding scale or charity case, the encounter can be counted. If the patient does not have an agreement and does not pay for services rendered, the encounter cannot be counted in the 30% patient volume, due to this encounter being considered “bad debt.”

What is uncompensated care and can it be used to calculate charity care?

Uncompensated Care is a calculated figure, using Charity Care and Bad Debt to determine the actual amount of Uncompensated Care.

Final Rule – Section 495.310 (h) Approximate proxy for charity care. If the State determines that an eligible provider’s data are not available on charity care necessary to calculate the portion of the formula specified in paragraph (g) (2) (ii) (B) of this section, the state may use that provider’s data on uncompensated care to determine an appropriate proxy for charity care, but must include a downward adjustment to eliminate bad debt from uncompensated care data.

Please clarify the definition of Nurse Practitioner.

As long as “Registered Nurse with APN (Advanced Practice Nurse)” appears on the license, a CNS (Clinical Nurse Specialist) is eligible for the EHR incentive program.

Please clarify how a PA is considered a lead PA for a RHC.

"As stated in the statute at 1903(t)(3)(B)(v), regarding the program eligibility for PAs, PAs are eligible when they are a ‘‘physician assistant insofar as the assistant is practicing in a rural health clinic that is led by a physician assistant or is practicing in a Federally qualified health center that is so led.’’ These conditions on PAs’ eligibility apply whether the PA is qualifying because they meet Medicaid patient volume requirements or if they are qualifying because they practice predominantly in an FQHC or RHC. Since this language requiring that a PA must be leading the FQHC or RHC is derived from statute, we have no flexibility to change or remove it. However, we agree that we have the authority to interpret what it means for a PA to lead an FQHC or RHC, and we believe a PA would be leading an FQHC or RHC under any of the following circumstances:

    1. When a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, we would consider the PA as the primary provider);
    2. When a PA is a clinical or medical director at a clinical site of practice; or
  1. When a PA is an owner of an RHC. We agree that FQHCs and RHCs that have PAs in these leadership roles can be considered ‘‘PA-led.’’

The Wyoming Medicaid Office can assist with determining a RHC being PA led.

Please clarify the payment schedule for Medicaid eligible hospitals.