Meaningful Use Eligible Professionals Eligible Providers (EPs) who are participating in the EHR Incentive Program either under Medicare or Medicaid must complete at least 2 years under Stage 1 before they can advance to Stage 2. Along with certain clinic-level properties and configuration, some individual settings are required for each provider. Based on these settings, each provider can track his/her performance on the ARRA Dashboard for the specific reporting period. The required settings are grouped as follows. This whole process will take less than 30 minutes to fully enable. Encounter Type MU Details Provider-level MU Settings Clinic-level MU Settings Encounter Type MU Details Note: Every encounter type must have at least one value designated under the MU Details frame. 1. Select Settings Configuration Clinic Enc Types 2. Select each Encounter Type individually 3. Define the applicable MU Details as follows
MU Settings a. Office Visit select for every encounter type that is billed with an E&M Code which designates it is an office visit. Per CMS definition, this can include Tele-med encounters. b. Seen by Eligible Provider select for every encounter where the patient is physically seen by the Provider. If an encounter is created for a patient who sees the nurse only and not the physician, this option would not be selected for that encounter type. Note: This is relevant for all measures of meaningful use where it is defined specifically as unique patients seen by provider. c. Exempt from MU Reporting select for every encounter that is not considered for meaningful use in the context of a private practice (e.g.: Hospital encounters, Surgery, etc.) The MU Settings master has 2 components (a) Provider and (b) Clinic. To access the profile, select Settings Configuration Workflow MU Settings.
Provider Tab Note: Every provider must have these values defined based upon their specific participation in MU. 1. Click to select the Provider 2. Select each Provider individually 3. Define Meaningful Use Details for the provider a. Select Stage define which stage of the Meaningful Use program this provider is currently participating in. Note: If this value is not defined, the ARRA dashboard will display empty with all squares grayed-out, and no data will be recorded for the provider. i. None this is the default value for all providers until the correct stage is selected. When this value is set, no meaningful use data will be captured, and the reports and dashboards will be blank system-wide for the provider. ii. Stage 1 the first 2 years of participation must be Stage 1 iii. Stage 2 applicable once a provider has reported at least 2 years under Stage 1 b. Reporting Period indicate the calendar date range of the reporting period for the provider, the requirement of which is based upon the program and participation year for the provider. i. Medicare 1 st year attesters any consecutive 90-day period in calendar year ii. Medicare beyond 1 st year must correspond to calendar year quarter 1, 2, 3, or 4 iii. Medicaid attesters (any year) any consecutive 90-day period in calendar year c. Applicable Core Set Measures define the measure number for each core set measure for which the provider does not qualify to exclude measure-wide as per CMS requirements. Any measure number omitted from this field will display grayed-out on ARRA Dashboards and be excluded from all MU reporting. d. Applicable Menu Set Measures define the measure number for each menu set measure for which the provider does not qualify to exclude measure-wide as per CMS requirements. Any measure number omitted from this field will display grayed-out on ARRA Dashboards and be excluded from all MU reporting. e. Attestation Date once the EP has attested, please enter the applicable calendar date.
4. Define Vitals Details, eprescription, NQF, Immunization Information, & Syndromic Surveillance for the provider. Notes: The Vital Details, eprescription, Immunization Information, and Syndromic Surveillance sections apply to the ability of the provider to exclude himself/herself from the measure entirely as per provision within the CMS requirements. If a measure can be excluded on a case-by-case basis, it should not be flagged as an exclusion at this level. The NQF section defines which individual Clinical Quality Measures are enabled for the provider. a. Vital Details select the level of exclusion is applicable to you as an individual provider based on your scope of care to the patient and the patient s age. b. Exclude Electronic Prescribing of Controlled Substance (EPCS) Stage 2 Only i. For Stage 1 providers, this box is disabled as EPCS is not applicable. ii. For Stage 2 providers, this box is enabled and active for all providers by default. Note: If you have chosen to not participate in EPCS, this box should be selected to exclude controlled substance medications. c. NQF displays the 9 Clinical Quality Measures that are enabled for this provider. d. Immunization Information this box should be selected for providers who do not administer vaccinations. e. Syndromic Surveillance this box should be selected for providers who do not report syndromic data to public health departments as per local law.
Clinic Tab Note: These values apply to all providers within the practice in the context of Meaningful Use. 1. Dashboard frame a. Meaningful Use On select this check box to enable meaningful use logic system-wide b. Show Dashboard select this check box to display the system-level ARRA Dashboard icon c. Show Encounter Level Dashboard select this check box to display the encounter-level ARRA Dashboard icon, which will automatically invoke when closing the encounter 2. Vital Tests frame a. Height display or define Test Code for the applicable vital sign bullet with Numeric result type that the user documents the patient s height in inches b. Weight display or define Test Code for the applicable vital sign bullet with Numeric result type that the user documents the patient s weight in pound c. Blood Pressure display or define Test Codes for the vital sign bullets with Numeric result type that the user documents the patient s blood pressure in two distinct, separate numbers Note: Blood Pressure must be entered as two separate numbers. A single, fractional input is not acceptable per current certification requirements. 3. Smoking Tests frame a. Display or define Test Codes for the Smoking History bullets that the user documents the patient s smoking history status. b. For Stage 1, any element(s) the user defines is acceptable c. For Stage 2, user must document using the system-provided element Smoking Status (MU), which is automatically added to all Smoking History templates Note: Stage 2 requires that the response be mapped to a valid SNOMED Code. These codes are automatically associated to this default element.
4. Define Immunization Information & Syndromic Surveillance settings as applicable for the clinic. Note: These settings are applicable at the clinic-level for any Eligible Provider who administers vaccines or is required to report syndromic data. Providers who qualify to exclude either measure must define the exclusion under the Provider tab as outlined above. a. Immunization Information select the appropriate status of the State Immunization Registry and level of activity based on that status for the EP to comply with the measure. b. Syndromic Surveillance select the appropriate status of the Public Health Agency and level of activity based on that status for the EP to comply with the measure 5. View the Others pane, which displays indicators of system-wide features that has relevance with meaningful use compliance at a functional level. These values are displayed FYI and are actually defined elsewhere at the system-level.
Setup Required Tab This tab allows you to track the status of system interfaces and/or request these as applicable by directly contacting the Meaningful Use Engineering Team. a. Define Interface Details options as applicable. The Status will display the current level of activity as per the implementation of the specific feature. a. Immunization Registry 2.5.1 select the check box to request that an HL7 interface of Immunization Data be enabled with your state registry for EP who administer vaccines b. Generate Immunization Test File (Stage 1 Only) select the check box to request Engineering to submit a test file on your behalf to the state registry as applicable. Note: This option applies only for Stage 1 attesters who are not already in production with a State Immunization Registry. c. Lab Result 2.5.1 select the check box to request that an HL7 interface of Laboratory Results be enabled with your Lab Vendor. d. Secure email (N2N) select the check box to request the practice be setup with Surescripts for a secured email/messaging domain for processing Summary of Care requests. b. Contact Email: allows you to enter your direct email address so that Engineering can reply as needed to your requests. Click the send email button after selecting the desired check box(es) above.
Frequently Asked Questions Regarding Meaningful Use 2014 For all requirements, guidelines, and FAQs, please visit the official CMS resources available online at: http://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/. Common Questions Q-01 How do I identify which stage I should report? A-01 Eligible Providers (EP) must complete at least 2 years under Stage 1 before they can advance to Stage 2. The ability to move on to Stage 2 is not contingent upon payment of the incentive, as long as the EP reports on the measures required for a minimum of 2 years. Q-02 What Reporting Period should I select for reporting? A-02 EP must choose a reporting period based on the EHR Incentive program (Medicare or Medicaid) and participation year; i.e.: Medicare first year attesters can select any consecutive 90 days in calendar year 2014. To avoid the payment adjustment in 2015, you must begin your reporting period by July 1 and attest by October 1, 2014. Medicare beyond first year must select a three-month reporting period fixed to any calendaryear quarter (e.g.: Q1: Jan-Mar, Q2: Apr-Jun, Q3: Jul-Sep, or Q4: Oct-Dec). Medicaid attesters of any participation year can select any consecutive 90 days in calendar year 2014. Note: For calendar year 2014, both Stage 1 and Stage 2 requires a three-month or 90-day reporting period regardless of participation year. Q-03 Why is my ARRA Dashboard grayed out and how can I enable it? A-03 When the ARRA Dashboard is grayed out, it is an indication that the MU Settings have not been configured for the Provider. Once the Stage and Reporting Period are defined for the EP, the dashboard will be enabled and reflect data in conjunction with the other settings for the provider and the clinic. Q-04 Smoking status is not showing counts, even if I answer Smoking test under Social History. A-04 As per 2014 compliance, smoking status needs to be recorded along with SNOMED code. During V3B1 upgrade, a new test Smoking Status (MU) is automatically added to each active Social History template. Q-05 If an EP participated in the Medicaid EHR Incentive Program in 2012 and then skipped 2013, can he/she report in 2014? A-05 Yes. Medicaid providers are not required to participate in consecutive years of the Program. EP who skip a year of participation will resume the progression where they left off. All providers are required to meet two years of Stage 1 before proceeding to Stage 2; regardless of not participating in consecutive years. (Note: There is an exception for EP who began MU in 2011; as Stage 2 is not available for anyone until 2014; hence a user may have 3 years of Stage 1.)
Q-06 If an EP fails to meet meaningful use during a participation year in the Medicare EHR Incentive Program, can he/she continue to participate and earn incentives for future years? A-06 Yes. Medicare providers who participate in the Medicare EHR Incentive Program and does not meet MU for one participation year is highly encouraged to continue to attest and earn incentive payments for future participation years. If an EP does not successfully attest for a given year, he/she will not receive an incentive payment for that year; however, receiving an incentive payment for a future participation year is based on the provider s ability to meet MU during that year and not based on success or failure in a previous year. Progression through the stages of MU will continue to follow the CMS timeline of two years for each stage regardless of success or failure in consecutive years. For example, if an EP reports 1 st year under Stage 1 successfully then fails the 2 nd year under Stage 1; upon reporting the 3 rd year, he/she will advance to Stage 2. Participation is not contingent upon success as to receiving the incentive payment for each year. Hence, the EP may be eligible to receive payment in the 3 rd year; however, it will be under Stage 2 although the second year of Stage 1 was not successful. Q-07 If an EP withdraws his/her attestation or an audit is initiated by CMS post-payment or pre-payment during 1 st year participation, can he/she start over again with year 1? A-07 If a provider registers to participate in the EHR Incentive Program for the first year then chooses to withdraw his/her attestation, the EP may have the opportunity to start over and repeat the first year if a CMS post-payment or pre-payment audit has not been initiated. If a provider withdraws during or after a CMS audit has been conducted, he/she forfeits the ability to re-attest as a Year 1 participant and must attest as a Year 2 participant in the next year. Once the provider has withdrawn and the audit has been initiated, the progression along the EHR Incentive Program time-line has begun and the provider would need to meet MU along this schedule in order to earn the associated incentive payments. Q-08 After the upgrade, my % of Patient Demographics went down on the ARRA Dashboard. A-08 As per 2014 compliance, Language/Race/Ethnicity needs to be recorded as per OSNC standards. If the value entered is not from the standard list then it will not be counted in the numerator. Some values converted over as Inactive and must be updated using values in the new master list for 2014. To view full lists of federally-defined standards, please visit the following reference sites: Language: http://www.loc.gov/standards/iso639-2/php/english_list.php Ethnicity: https://phinvads.cdc.gov/vads/viewvalueset.action?id=34d34bbc-617f-dd11-b38d- 00188B398520# Race: https://phinvads.cdc.gov/vads/viewvalueset.action?id=94e75e17-176b-de11-9b52-0015173d1785# Q-09 After the upgrade, when I click the Med Hx button to perform Medication Reconciliation, the check box is no longer available to get MU credit. A-09 As per 2014 compliance, Medication Reconciliation needs to be performed for every transition of care visit (and not for new patients 1 st visits only). Medication reconciliation is not based upon applicable Transition of Care status as follows: Stage 1 o Denominator mark visit on Current Medications Transition of Care frame as (a- Transition of Care New Patient, b-transition of Care with Summary of Care, or c-transition of
o Care without Summary of Care) Numerator for any applicable drug appearing in the Transition of Care frame, from the Reconcile pick list, select Add Stage 2 o o Denominator mark visit on Current Medications Transition of Care frame as (a- Transition of Care new Patient or b-transition of Care with Summary of Care) Numerator for any applicable drug appearing in the Transition of Care frame, from the Reconcile pick list, select Add or select No Known Transition of Care Medication check box Q-10 What are the required measures and how many are required for each Stage? A-10 For 2014 compliance, there are three categories of required measures; e.g.: Core Set, Menu Set, and Clinical Quality measures. The number required for an EP to report is based upon which stage. Stage 1 o 13 Core Set o o 5 out of 9 Menu Set 9 Clinical Quality Measures (NQF) Note: CQM are not divided as mandatory or optional; all EP who attest must report 9 NQF. Stage 2 o 17 Core Set o 3 out of 6 Menu Set Note: EP cannot claim exclusion for the 3 reported menu set measures if there are other measures for which he/she can successfully report without exclusion. If NONE of the menu measures apply to your scope of practice and you thus qualify to exclude all 6 of them, then you can select 3 and claim exclusion for each one. o 9 Clinical Quality Measures (NQF) Note: CQM are not divided as mandatory or optional; all EP who attest must report 9 NQF. Q-11 After the upgrade, the Clinical Summary is not the same as it was previously. Can this be customized as per the old format? A-11 As per 2014 compliance, the Clinical Summary must follow the CMS specifications for a CCD (Continuity of Care Document) and hence cannot be customized. However, prior to printing, downloading, or activating it to the portal, the EP can suppress specific data from the different sections of the Summary. The following data is required at a minimum: Patient name Provider's name and office contact information. Date and location of the visit Reason for the office visit Current problem list Current medication list Current medication allergy list Procedures performed during the visit Immunizations or medications administered during the visit Vital signs taken during the visit (or other recent vital signs) Laboratory test results List of diagnostic tests pending Clinical instructions
Future appointments Referrals to other providers Future scheduled tests Demographic information maintained within certified electronic health record technology (CEHRT) (sex, race, ethnicity, date of birth, preferred language) Smoking status Care plan field(s), including goals and instructions Recommended patient decision aids (if applicable to the visit) Q-12 What reports are available for Meaningful Use tracking in the upgraded version of PrognoCIS? A-12 PrognoCIS V3 contains a report category called Meaningful Use. All MU-related reports have been moved from the Tabular category to this new category. Within this category, there are classifications of individual reports based on their purpose and data contained within the output. o MU-Eligibility used for providers to determine their volume of Medicaid-eligible patients to determine eligibility for the Medicaid EHR Incentive Program o 2014-MU the report equivalent of the ARRA Dashboard, this report (which is based on stage) reflects all measures for the stage and the EP performance as to success or failure for each Core Set and Menu Set measure o Patient-Lists these reports are detailed at the patient-level and condition indicated. Both stage 1 and stage 2 has measures that require at least one Patient List be generated per each reporting period by each Eligible Professional o NQF-Measures QRDA (Quality Reporting Data Analysis) reports provide details of Clinical Quality Measures. Each individual NQF has patient-level details for that individual measure, and QRDA3-Cumulative for all NQF Measures provides a summary of all 64 individual measures Q-13 Is there a report of all patients who have failed any specific measure for either Stage 1 or Stage 2? A-13 Yes. There are tabular reports titled List of patients with. Not Done for both Stage 1 & Stage 2 that includes patient details that are not reflecting numerator criteria per the individual measure. Q-14 After the upgrade, the Vitals measure is not getting credited correctly although we are documenting them on each encounter. A-14 As per 2014 compliance, all 3 vital signs of Height, Weight and Blood Pressure need to be recorded as Numeric Result Type elements. If BP is entered as a single value in fraction format (e.g.: 140/85), it will not count towards the numerator. All databases include separate elements for BP Systolic and BP Diastolic; however, these may not be activated on all Vitals templates. Please verify that the elements are on the templates used and that the applicable Test Codes are defined under the Clinic tab of MU Settings. Q-15 For Stage 2, my Family History measure is not giving me correct credit. A-15 For Stage 2, the Family History measure is included in the numerator only when the documented problem has an appropriate SNOMED code associated to the problem and all 1 st Degree Relations; i.e.: Mother, Father, Brother, Sister, Son and Daughter.
Q-16 What is Patient declined MU Summary check box on the Encounter Close Screen, and if it is selected, will it give credit in the Clinical Summary numerator? A-16 Yes. The measure states that the Clinical Summary should be provided per patient request. Hence, if the patient declines to receive it, the provider still gets credit for providing it per that patient s preference (which is to not receive it at all). Q-17 I am adding Patient Education by clicking the, but it is not giving me credit in my numerator. A-17 As per requirement, the EHR must identify what education is to be distributed based on encounter-level triggers. There are two options that give numerator credit for Stage 1 or Stage 2: o Settings Configuration Clinic Education defined by trigger o PMH or Assessment ICD, Lab result, or Current Medication Note: Clicking the directly on the encounter is the equivalent of manually deciding what education to provide, which is not compliant.