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eRx Incentive Program: Significant Hardship Exemption Application Deadline

June 28, 2012 Leave a comment

June 30, 2012 is the deadline for applications for significant hardship exemptions to avoid next year’s penalties for noncompliance with the Centers for Medicare and Medicaid Services’ (CMS) e-Prescribing (eRx) Incentive Program.  Only those who are eligible for the program need to get significant hardship exemptions to avoid penalties; all ineligible professionals are automatically exempt.

The vast majority of ACR’s members are ineligible for this program and therefore do not need to take any action to avoid the penalties. However, if any ACR members are concerned they may be eligible, they can apply for the significant hardship exemption by following the instructions on CMS’ website.

Any erroneous eligibility determinations by CMS should be contested by contacting CMS’ Help Desk Support.

Note that the eRx Incentive Program is effectively unrelated to the EHR Incentive Program, despite the similar titles and some degree of crossover in the regulatory terminology used in both programs.  The eligibility requirements for these two programs are completely different.

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Categories: Medicare

CMS Guidance Now Reflects ONC’s New Concept of ‘Hybrid’ Certification Criteria

June 27, 2012 Leave a comment

On June 27, the Centers for Medicare and Medicaid Services (CMS) released new EHR Incentive Program guidance in the form of a frequently asked question to reflect the HHS Office of the National Coordinator’s new concept of “hybrid” certification criteria.

As a reminder, ONC’s recent FAQ (6-12-025-1) identified five Inpatient certification criteria that could substitute for similar Ambulatory certification criteria in Eligible Professional (EP)-appropriate certified EHR technology.  EPs who choose to leverage the new flexibility still need technology certified for all non-hybrid Ambulatory criteria as well, which calls into question the usefulness of this limited flexibility.

The new CMS FAQ can be accessed by searching for FAQ number “6421 on the CMS FAQ page.  Be sure to select the “FAQ #” option below the search field.

Categories: EHR, meaningful use, Medicare

ONC Releases Guidance on New Concept of ‘Hybrid’ Certification Criteria; CHPL Update Coming Tomorrow

June 25, 2012 1 comment

Earlier today, the HHS Office of the National Coordinator for HIT (ONC) announced new guidance on “hybrid” inpatient and ambulatory certification criteria, as well as an update (Version 2.1) to the Certified HIT Product List (CHPL) web application.  ONC regulates the technology requirements of the EHR Incentive Program, including the HIT certification criteria, standards, and implementation specifications, as well as the product testing/certification process.

ONC’s new FAQ (6-12-025-1) identifies five Inpatient certification criteria that are the same or more comprehensive than the related Ambulatory certification criteria, and can therefore serve as substitute criteria in Eligible Professional (EP)-appropriate certified EHR technology.  This is a significant departure from the previous paradigm in which the Inpatient criteria were applicable only to Eligible Hospital (EH)-appropriate products.

EPs who use this option will still need to have technology certified for the other (nonequivalent) Ambulatory criteria; a fact which severely limits the usefulness of this new flexibility.  This guidance is marginally useful to vendors of products that are being submitted for testing/certification for use in both versions of the program, as there are now five fewer Ambulatory criteria that need to be tested/certified to achieve the goal.

The announced update to the CHPL web app will go live tomorrow, June 26.  Version 2.1 will feature improved cart, navigation, and search functionality.

Categories: EHR, meaningful use, Medicare

ACR Submits Nominations for the HIT Policy Committee and HIT Standards Committee

June 11, 2012 Leave a comment

On June 11, the American College of Radiology formally submitted the nominations of Keith J. Dreyer, DO, PhD, FACR, FSIIM for the HIT Policy Committee (HITPC), and John Anthony Carrino, MD, MPH for the HIT Standards Committee (HITSC).  These committees are administered by the HHS Office of the National Coordinator for HIT (ONC) and are subject to the Federal Advisory Committee Act.  The HITPC roster is only partially appointed by the HHS/ONC, with additional seats being appointed by the  Government Accountability Office (GAO) and some others identified by the establishing statute.

ONC published its call for nominations in the June 1, 2012 Federal Register. Aside from the initial establishment of these committees in 2009, ONC has not previously solicited HITPC or HITSC nominations from the public.   On May 11, 2012, GAO solicited nominations to fill an upcoming vacancy for one of the three GAO-appointed patient/consumer spots on the HITPC.

Categories: EHR, meaningful use, Medicare

EHR Incentive Program FAQ: Significant Hardship Exception Mechanism

A recent inquiry from an ACR member suggested the need for additional explanation about the concept of the “significant hardship exception” in the EHR Incentive Program (“meaningful use”).

This is what the law states:

The Secretary [of Health and Human Services] may, on a case-by-case basis, exempt an eligible professional from the application of the payment adjustment . . . if the Secretary determines, subject to annual renewal, that compliance with the requirement for being a meaningful EHR user would result in a significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient Internet access. In no case may an eligible professional be granted an exemption under this subparagraph for more than 5 years.”

CMS’ March 7, 2012 Notice of Proposed Rulemaking (NPRM or “proposed rule”) to update the requirements of the EHR Incentive Program included three categories/types of significant hardship exceptions, and opened for discussion (but did not actually propose) a fourth. The three categories are:

  1. During the calendar year that is 2 years before the payment adjustment year, the EP was located in an area without sufficient Internet access to comply with the meaningful EHR use objectives requiring internet connectivity, and faced insurmountable barriers to obtaining such internet connectivity. Applications requesting this exception must be submitted no later than July 1 of the year before the applicable payment adjustment year.
  2. The EP has been practicing for less than 2 years.
  3. During either of the 2 calendar years before the payment adjustment year, the EP faces extreme and uncontrollable circumstances that prevent it from becoming a meaningful EHR user. Applications requesting this exception must be submitted no later than July 1 of the year before the applicable payment adjustment year.
The discussed, but non-proposed, fourth category would be for EPs who meet all of the following three prerequisites:
  1. Lack of face-to-face or telemedicine interaction with patients, thereby making compliance with meaningful use criteria more difficult. Meaningful use requires that a provider is able to transport information online (to a PHR, to another provider, or to a patient) and is significantly easier if the provider has direct contact with the patient and a need for follow up care or contact. Certain physicians often do not have a consultative interaction with the patient. For example, pathologist and radiologists seldom have direct consultations with patients. Rather, they typically submit reports to other physicians who review the results with their patients;
  2. Lack of follow up with patients. Again, the meaningful use requirements for transporting information online are significantly easier to meet if a provider immediate contact with or follows up with or contact patients; and
  3. Lack of control over the availability of Certified EHR Technology at their practice locations.

The discussion in the NPRM included the possibility that the fourth category could potentially be limited to two years instead of the full five years allowed by the statute.  CMS did not include any information or data that would support a two-year maximum.

ACR met with ONC and CMS leaders in October 2011 to discuss a variety of meaningful use topics, including the problems faced by hospital-located (but not “hospital-based”) EPs.  Later, ACR, RBMA, MGMA, and HBMA met twice (in December 2011 and January 2012) with ONC/CMS staff and leaders after the CMS and ONC NPRMs were essentially drafted, but prior to completion of the OMB review process and public availability, to focus on the need for a significant hardship exception for hospital-located EPs.  Everyone involved in these meetings agreed that CMS and ONC appeared to understand the need for a significant hardship exception category for EPs located in hospital-owned facilities that are not enabling compliance by onsite EPs.  A couple months later, Marilyn Tavenner (Acting Administrator of CMS) sent the coalition a letter acknowledging CMS’ recognition of the problem.  One could guess that the fourth category perhaps has a decent chance of making it into CMS’ final rule (hopefully in an improved form).

As of this writing, CMS’ final rule has not yet been written, so no one could possibly know how the significant hardship exceptions will be finalized.  One can only know for certain that CMS must regulate within the confines of the statute.

Today, I had a voicemail from a member whose radiology group services two hospitals and five ambulatory imaging centers.  The radiologist said that the group’s billing company claimed that regulatory changes were taking place in the EHR Incentive Program that would exclude them from participation.  My assumption is the billing company representative was referring to the significant hardship exception concept, but that they fundamentally misunderstood CMS’ proposal as well as the current limitations of the law.

Categories: EHR, meaningful use, Medicare
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