! Discuss why now is a good time to adopt EHR. ! Pointers for those who don t yet have an EHR. ! Patient can go online

Transcription

1 2/28/11 Objectives! Detail a roadmap for how to get reimbursed by the government under ARRA for adopting an EHR! Discuss why now is a good time to adopt EHR Meaningful Use Early 2011 David Epley, M.D. & Paul Rychwalski, M.D.! Pointers for those who don t yet have an EHR ARRA The Promise of EHR! Patient can go online! Under the American Recovery and Reinvestment Act (ARRA), health-care providers stand to gain Medicare and Medicaid incentive payments worth $14 billion to $27 billion starting next year if they use health IT in a "meaningful" way.! Review certain medical test results! Immunization lists! Summaries of their office visits! Make appointments! Request medication refills The Promise of EHR ARRA! Physician! Relief from burdensome paperwork!? replaced by burdensome key-stroking?! Digitized checks and balances that help to improve quality! Assist with coding automatically and billing! American Recovery and Reinvestment Act 2009! The stimulus package! $59 Billion investment in healthcare initiatives, including $19 Billion in health information technology (HITECH)! Preventing costly medical errors and needless duplication of tests. 1

2 2/28/11 HITECH Act of 2009 What is HITECH?! Goal is to save lives and lower health care costs by:! Health Information Technology for Economic and Clinical Health Act of 2009! Requiring the government to take a leadership role in developing standards for nationwide electronic exchange of PHI (Protected Health Information)! Investing $20 billion in Heath Information Technology (HIT) and Medicare/Medicaid incentives! Saving the government $10 billion by improving quality of care and reducing medical errors! Strengthening Federal privacy and security law regarding PHI What Does it Mean for Me? MEDICARE INCENTIVES! Qualifying physicians who demonstrate meaningful use of a certified EHR/EMR are eligible to receive incentive payments through increased reimbursements from the medicare and medicaid programs. MEDICAID INCENTIVES Medicare EP= ELIGIBLE PRACTICIONER Medicare EP= ELIGIBLE PRACTICIONER HPSA = HEALTH PROFESSIONS SHORTAGE AREA HPSA = HEALTH PROFESSIONS SHORTAGE AREA 2

3 2/28/11 Medicare! Payments will equate to 75% of total medicare allowable capped at the numbers in the table.! Must meet 125% of billings over $44,000 over 5 years! Year one incentive = $18,000; charges must be > $24,000! Those in a Health Professions Shortage Area get an additional 10%! Must accept Medicare Medicaid! Payments based upon patient mix and qualifying IT expenses up to the maximums on the table! 30% of patients need to be medicaid! 20% for pediatricians; only eligible for 66% of max payments! Cap for funds; once they are paid out of the overall pool, the incentives are over! Medicaid E-Rx E-PRESCRIBING INCENTIVES NOTE THE YEAR THAT THIS STARTS! E-Prescribing More on E-Rx! A qualified system must:! Generate a complete active medication list! Select medications, print Rx s, electronically transmit, conduct alerts! Provide cost information, therapeutic alternatives! Provide formulary information, eligibility, and authorization requirements! G8553 code needs to be reported! You only need to report 25 times total for the year!! Your medicare charges must be 10% of all eligible charges! EHR and e-rx incentives are exclusive; you won t get both 3

4 2/28/11 AAOE E-Rx Incentives! Hopefully you are already using erx...! aaoesite/! The incentives are PER PHYSICIAN regardless of the size of the group! Meaningful Use! Final Rule July 13, Eye MD s report on:! A core set of 15 meaningful use objectives! An additional menu set of objectives at the physician s discretion! Core clinical quality measures using a certified EHR! Core set of 15 objectives! 3 additional quality measures chosen from 38 by the physician (only 4 relate to eye care!)! Core set continued! Menu set of Measures 4

5 2/28/11! Menu set continued! Core and alternate core clinical quality measures for all physicians! Ophthalmology specific additional quality measures...sound of snoring... What if I don t... Which EHRs Qualify?! CMS acknowledges that some meaningful use objectives are not applicable to ophthalmology practice! In some instances a practitioner would not have any eligible patients or actions for the measure denominator and would therefore be excluded from having to meet that measure! e.g. Entering a 0 into the measure set will not disqualify practitioners from eligibility! Office of the National Coordinator (ONC) to administer program guided by HIT Policy and Standards Committee! ONC-ATCB (Authorized Testing and Certification Body) to establish criteria based upon standards released in June 2010 (45 CFR part 170). 5

6 2/28/11 Temporary Certification! A temporary program of certification has been developed by the ONC! Organizations can become ATCB certified to test EHRs! If you have an EHR, ask your vendor if they are certified Is my ehr certified? Search by vendor or product Add your ehr to the cart Click get button to get id number Write down and save this number 6

7 2/28/11 Are You Behind in " Adopting EMR?! 44% of American doctors have some element of electronic health record (EHR) working in their offices! 6% have a fully functional EHR*! 2% of hospitals with fully operational EMR systems * April 2010 issue of the Journal Health Affairs So you need an EHR?! Choosing now is important to take full advantage of the stimulus package, but risky not knowing which EHRs will be certified-- what do I do?! Academics; you re stuck (your hospital will choose for you)! hold out for usable system or work to make the ophthalmology module usable by you! Private Practice! Choose an EHR that works for your practice style! Make sure the company is on board with the process Choosing an EHR Another lecture entirely, but... Choosing an EHR Another lecture entirely, but... 7

8 2/28/11 Hard Dollar Benefits Tips for Choosing an EHR Capture lost charges IF charges are now being lost 1% - 5% revenue gain! Ease of use! Ophthalmology-specific functions Reduce defensive downcoding IF downcoding is prevalent 5% - 11% revenue gain! Easy big picture assessment Reduce claims denials & delays Increase preventive and management services Reduce transcription IF denials or delays are common IF new services are profitable AND capacity exists IF dictating AND willing to change day A/R speedup 5% revenue gain $5K - $15K/yr costs cut! Certified EHR! Patient handouts, scanned documents, faxing capability, referral letters! Connects to visual fields, topographer, etc.! E-prescribing Top 10 Mistakes Timeline for EHR! 12 months to meaningful use (rush schedule):! Month 1; Analyze practice workflow and review EHRs! Month 2; Select an EHR and sign contract! Months 3-6; Begin preparing staff and discussing changes! Work with EHR vendor to plan installation and go live! Ensure your technology backbone will be in place Timeline for EHR! 12 Months to Meaningful Use! Months 6-9; Installation, customization, training and go live! Months 9-12; Begin use of EHR--collect and review data, report clinical measures, perform internal adjustments to improve results Which EHR Do I Choose?! This timeline works for small groups or solo practices; larger groups or Hospitals require an extended timeline 8

9 2/28/11 How Do I Choose?! Product demos on site or at meetings! Be prepared Research, Evaluate, Test Drive!! Know your practice style & workflow and write it down! Know your IT infrastructure! Know your equipment connectivity needs! Ask to see live patient demonstrations/site visits How Do I Choose?! Ask your EHR Vendors to show you:! Templates and tools to help with workflow! Ability to customize templates, progress notes, letters, etc. to your practice style! How the EHR reports quality clinical measures! E-Rx modules and how they work! References; local and/or national Why not Wait?! Let them work out the bugs! 70% of medicare payments will be received in the first 2 years! Starts in 2011!! Medicaid payment process can be started as late as 2015 for full payment More Considerations! An EHR is key, but there are other considerations! Does the EHR talk to your PM software?! Servers: critical for large Hospitals, Universities and Group Practices! Internet connection! Fax modules! E-prescribing module 9

10 2/28/11 Preparing Your Staff! Involve staff in the EHR selection process! Encourage staff and colleagues to attend EHR webinars and watch online demos to become familiar with how to document in an EHR! Choose and EHR that best fits your practice style and office flow! Listen to physicians experiences with EHR implementation and learn from them Once You Have Chosen! The most important thing you can do once you ve chosen your EHR is listen to your vendor and follow their instructions!!!!!! They ve done this before, you haven t! Put in the up-front, painful hours needed to customize the system to your practice style! Super painful and time-consuming, but will allow you to go live with little slow-down to your practice! What if I Choose the Wrong One? Patient Satisfaction! Most EHRs are adaptable and changeable! You may end up spending much more time setting up preferences, rewriting screens and functions! You will have a lower patient flow OR longer days BUT! In the end, your wrong EHR will still work for you.! More doctors are adopting electronic health records, but as billions of federal funds go to expand health care IT, patients (i.e. taxpayers) need to tell doctors how it's working for them The Point Government incentives make now the time to think about investing in EHR technology. Choose an EHR that fits your practice needs but conforms to the HITECH requirements. Give yourself time to get this done. LEARN TO TYPE The Message! Incentives will help offset the expense to your practice or institution, but they will not cover your costs.! Uncertainty remains about how EHRs will qualify.! Early adoption doesn t guarantee government reimbursement, but gives you a chance to meet deadlines.! The transition to EHR is not going away, and it will benefit our patients in the long run. 10

11 2/28/11 Applications What do I do now that I have my EHR? ALL THIS STUFF IS IN THE REGISTRATION USER GUIDE AS PART OF YOUR HANDOUTS FOR THIS WORKSHOP! Online applications have begun:! 20_RegistrationandAttestation.asp! Payments are to start in May 2011.! Step 1 /hitech/login.action You ll need your login... /hitech/login.action Need your nppes login Enter your Npi information 11

12 2/28/11 NPPES Login Info! Your practice manager may have this information! You may already have a login and now know it! This is a time-consuming and frustrating process, and must be done 9-5 EST on a weekday... Error; must contact the enumerator Who the h&*l is the enumerator? Call M-F 7am to 5pm Est 5 Tabs to Navigate! Home! Registration! Attestation! Status! Account Management Welcome screen /hitech/welcome.action! Click the Registration tab Registration page /hitech/registration.action 12

13 2/28/11 Start registration /hitech/registration.action Incentive program questionnaire /hitech/registration.action Personal information and select payment /hitech/registration.action Choose EIN or SSN /hitech/registration.action Business address and phone /hitech/registration.action Begin submission (Click begin submission ) /hitech/registration.action 13

14 2/28/11 Verify registration /hitech/verify.action Registration disclaimer /hitech/disclaimer.action You ve done it!! You are now registered to receive reimbursements! Submission receipt" /hitech/receipt.action Failed Registration! If your registration failed, there could be many reasons! Read the instructions on the screen and contact the appropriate department! A registration ID will be assigned to your submission for reference Failed registration :( 14

15 2/28/11 Status summary /hitech/statussummary.action Attestation: April 2011 Must return to attest /hitech/attestation.action Upgrade Your EHR! Be sure to update to the most recent version of your EHR that is certified! This may simply be a software update or could be much more extensive; contact your vendor for details Are you people crazy?! No, no we are not...! We know it sounds ridiculous to receive a small monetary reimbursement, but if you are already adopting EHR, why not get at least a little back?! Bad news: the cost of adopting an EHR will FAR outweigh the reimbursement from the government! Get back what you can from them! This is a high priority for the US Government--not just Obama, but Bush before him, and is likely to continue with future Presidents Final Thoughts Final Thoughts! There are many positives to adopting EHR--more legible charts, better documentation, coding assistance, better continuity of patient care, avoid medical mistakes, access to charts from anywhere, improved communication with referral sources, more! You are more likely to qualify for Medicare incentives than Medicaid incentives! You should apply for Medicaid only if you know your mix is at least 30% Medicaid, or if your state considers pediatric ophthalmologists under the umbrella of pediatrician for purposes of Medicaid reimbursement (20% medicaid mix): contact your state Ophthalmological Society for more information 15

16 2/28/11 Thank you! K. DAVID EPLEY, MD PAUL J. RYCHWALSKI, MD 16

17 REGISTRATION USER GUIDE For Eligible Professionals Medicare Electronic Health Record (EHR) Incentive Program DECEMBER 2010 ( ver4)

18 CONTENTS Step 1... Getting started 3 Step 2... Login instruction 5 Step 3...Welcome 6 Step 4... Registration instructions 7 Step 5... Reason for this registration 8 Step 6...Incentive program questionnaire 9 Step 7... Personal information 10 Step 8... Business address and phone 11 Step 9...Topics for this registration 12 Step 10...Verify registration 13 Step Registration Disclaimer 14 Step 12...Submission receipt 15 Step Status Summary/Detail 17 Questions/Help Acronym translation Disclaimer The Centers for Medicare & Medicaid Services (CMS) is providing this material as an informational reference for physicians and non-physician practitioners-providers. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare program is constantly changing, and it is the responsibility of each physician, non-physician practitioner, supplier or provider to remain abreast of the Medicare program requirements. Medicare regulations can be found on the CMS Web site at Medicare EHR Incentive Program User Guide Page 2

19 Step 1 Getting Started This is a step-by-step guide for the Medicare Eligible Professionals (EPs) Electronic Health Record (EHR) Incentive Program. The page layout consists of the registration screen with written instructions to the right, as well as helpful tips at the bottom. To get started, click on the link at the top of the page or type the website into your computer s browser. STEPS Enter the EHR Incentive Program URL (located at the top of the page) into your web browser Click CONTINUE to start the registration process TIPS To determine your eligibility, click on the CMS website For a list of Eligible Professionals (EPs), click on the next to Eligible Professionals Medicare EHR Incentive Program User Guide Page 3

20 Step 1 - Continued Once you have clicked on the you will be presented with a list of professionals who are eligible to participate in the program. STEPS Review the list of Eligible Professionals (EPs) Click CONTINUE to start the registration process TIP Eligible Professionals (EPs) may not be hospital based. This is defined as EPs seeing 90% or more of their Medicare covered services in: Hospital Inpatient setting (Place of service 21) Emergency Department setting (Place of service 23) Medicare EHR Incentive Program User Guide Page 4

21 Step 2 Login Review the Login Instructions for Eligible Professionals. STEPS Enter your National Plan and Provider Enumeration System (NPPES) web user account, user ID and password to log into the registration system. Click LOG IN TIPS Contact the PECOS Help Desk if you cannot remember your password-(866) / TTY(866) , To locate your NPI number, visit: User name and password are case sensitive Medicare EHR Incentive Program User Guide Page 5

22 Step 3 Welcome If your login was successful you will receive the Welcome Screen. STEPS Click on the REGISTRATION TAB to continue registering for the EHR Incentive Program. TIPS The Welcome screen consists of five tabs to navigate through the registration and attestation process. Home Registration Attestation (available 4/04/2011) Status Meaningful Use information: Account Management. Medicare EHR Incentive Program User Guide Page 6

23 Step 4 Registration Follow the registration instructions below. STEPS Click on REGISTER in the Action column to continue the registration process. TIPS Resubmit, Modify, Cancel and Reactivate are the available Action web links for returning users Only one action can be performed at a time on this page If the user selects the Action web link of Register or Resubmit they will be directed to the Topics for Registration screen Medicare EHR Incentive Program User Guide Page 7

24 Step 5 Reason for this Registration Review and follow the registration instructions below. STEPS Click on START REGISTRATION to continue with the Topics for this Registration. TIPS Data required for this registration is grouped into three topics. All three must be completed Check marks will appear in the completed column to indicate that the topics are complete When all topics are checked completed user can select BEGIN SUBMISSION Medicare EHR Incentive Program User Guide Page 8

25 Step 6 Incentive Program Questionnaire Review and follow the Incentive Program Questionnaire instructions below. STEPS Select Medicare and click on APPLY Select your Eligible Professional Type. Click Yes or No at do you have a certified EHR? If yes, enter the EHR Certification Number if you have it. The number will be required at Attestation, but is not required at Registration. Click SAVE AND CONTINUE TIPS For the certified health IT product list visit; Follow the instructions on the website to locate your CMS EHR Certification Number Certification numbers are assigned by the Office of the National Coordinator You must enter your certification number when Attesting for the EHR Incentive Program Medicare EHR Incentive Program User Guide Page 9

26 Step 7 Personal Information Follow the instructions below regarding your personal information. STEPS Select where your payment will go in the Payee TIN Type. Click APPLY SSN Payee TIN Type indicates that the provider receives the payment. EIN Payee TIN Type indicates the group receives the payment.(choose Group Name if selecting EIN). Click APPLY Enter Group Payee NPI Click SAVE AND CONTINUE TIPS The EP can only receive the payment themselves if they have not reassigned all of their Medicare benefits to another entity in PECOS. Medicare EPs can elect to have their payment go to another entity by selecting Payee TIN Type of EIN. (Choosing this option will activate a list of entities list that the EP reassigned Medicare benefits to in PECOS Medicare EHR Incentive Program User Guide Page 10

27 Step 8 Business Address and Phone Be sure to complete all requested information. STEPS Review the Business Address & Phone information and revise if applicable. Enter your address and confirm the address. Click SAVE AND CONTINUE TIPS Data on this page is pulled from the provider s practice location stored in NPPES Address and Phone number can be changed. However, the data is not sent back to NPPES This is the information that will be posted on the EHR Incentive Program website once you receive payment The business address cannot be a P.O. Box address. Medicare EHR Incentive Program User Guide Page 11

28 Step 9 Topics for this Registration Be sure to complete all the topics below. STEPS Click on BEGIN SUBMISSION to continue the registration process. TIP Check marks indicate that the topics are completed Medicare EHR Incentive Program User Guide Page 12

29 Step 10 Verify Registration Be sure to verify all your personal information. STEPS Review your registration information for accuracy and click SUBMIT to continue. TIP Click on PREVIOUS PAGE to revise your information. The topics for registration screen presents then click on MODIFY to modify your registration. Medicare EHR Incentive Program User Guide Page 13

30 Step 11 Registration Disclaimer Be sure to read the entire disclaimer. STEPS Read the disclaimer and click on AGREE or DISAGREE at the bottom of the page. TIP If DISAGREE is chosen, the user is directed to the Registration Instructions Page. To restart the process, click MODIFY in the Action column of the Registration Instructions Page Medicare EHR Incentive Program User Guide Page 14

31 Step 12 Submission Receipt (Successful Submission) Confirm that your registration was completed successfully. STEPS This completes your registration. PRINT this page for your records. You will not receive an confirmation from this registration. TIP You must submit your Attestation information to qualify for the EHR incentive payment (Attestation module will be available in April). Medicare EHR Incentive Program User Guide Page 15

32 Step 13 Submission Receipt (Failed Submission) STEPS Your registration has failed. Read the instructions on the screen and contact the appropriate department to correct your information. PRINT the receipt for your records The following are reasons that a submission failed with contact information: Reason(s) for Rejected status: Death Master File (DMF) (Medicare/Medicaid) validation failed The provider s Legal Name and Social Security Number are on the Social Security Administration s DMF. Contact Social Security office, (800) / TTY (800) Reason(s) for Issue Pending status: NPI Status in NPPES is in a Deactivated status. Contact the NPPES Help Desk for assistance. Visit; (800) / TTY (800) Enrollment Status in PECOS The Medicare enrollment in PECOS associated with this registration is not in an Approved status. Contact PECOS for help. Visit; (866) / TTY (866) OIG Exclusions in PECOS OIG Exclusions are associated with this provider s Medicare enrollment in PECOS. Contact PECOS for help. Visit; (866) / TTY (866) Hospital-based Professional You have been identified as a Hospital-based Eligible Professional in the CMS National Level Repository (NLR). A Hospital-based Professional is defined as one who furnishes ninety percent (90%) or more of his/ her allowed services in an inpatient hospital setting. This year you are not eligible to participate in the EHR incentive program. TIPS If any of the system validations fail, the registration will be set to a status of Rejected or Issue Pending. A registration ID number will be assigned to your submission Medicare EHR Incentive Program User Guide Page 16

33 Step 13 Status Summary Review all current and previous information related to your account. STEPS Click the STATUS tab to view registration summary. TIP Click Select in the Action Column to view detail. Medicare EHR Incentive Program User Guide Page 17

34 Step 13 Status Detail Review the details of your registration process. STEPS Registration details appear in the body of the screen. Click ADDITIONAL INFORMATION for, the registration status reason, Fiscal Intermediary (FI)/ Carrier/Medicare Administrative Contractor (MAC) and validations performed on registration. TIPS Registration status will read ACTIVE when all validations pass. Other registration statuses are, ISSUE PENDING, IN PROGRESS and REJECTED. The status reason is listed on the Additional Information page. Medicare EHR Incentive Program User Guide Page 18

35 Have Questions? There are many resources available to you. STEPS Click on the HELP LINK which is located on every screen. Resources Contact the EHR Information Center Help Desk for Questions concerning registration, (888) / TTY: (888) Hours of operation: Monday-Friday 8:30 a.m. 4:30 p.m. in all time zones (except on Federal holidays) NPPES Help Desk for assistance. Visit; (800) / TTY (800) PECOS Help Desk for assistance. Visit; (866) / TTY (866) TIP EHR Incentive Program; visit Medicare EHR Incentive Program User Guide Page 19

36 Acronym Translation CMS DMF EH EHR EIN EP FI FQHC I&A IDR LBN MAC MAO NPI NPPES NLR OIC PECOS RHC SSN TIN Centers for Medicare & Medicaid Services Social Security Death Master File Eligible Hospital Electronic Health Record Employer s Identification Number Eligible Professional Fiscal Intermediary Federally Qualified Health Center Identification & Authentication System Integrated Data Repository Legal Business Name Medicare Administrative Contractor Medicare Advantage Organization National Provider Identifier National Plan and Provider Enumeration System National Level Repository Office of the Inspector General Provider Enrollment, Chain and Ownership System Rural Health Center Social Security Number Tax Identification Number ACRONYMS Register for CMS Electronic Health Record Incentives Click Here Medicare EHR Incentive Program User Guide Page 20