CMS Publishes New FAQ on the 2015 Hardship Exception Application for the Medicare EHR Incentive Program

Visit the CMS Website for Additional Guidance on Submitting a Hardship Exception Application for the 2015 EHR Reporting Period

The Centers for Medicare & Medicaid Services (CMS) has released a new frequently asked question (FAQ) that indicates providers who submit a hardship exception application may still attest to the Medicare Electronic Health Record (EHR) Incentive Program for the 2015 EHR Reporting Period.

FAQ #14357 - If I submit a hardship exception application by the March 15, 2016 deadline, does that mean that I cannot attest for the 2015 EHR reporting period and possibly receive an incentive payment?

No. Submission of a hardship exception application does not prevent providers from attesting and receiving an incentive payment if meaningful use requirements are met.

Attestation for the 2015 EHR reporting period is currently open. We urge providers to try to attest by the March 11, 2016attestation deadline. If they attest successfully, they will avoid the payment adjustment in 2017 and may also be eligible to receive an EHR incentive payment.

However, if providers cannot attest for a 2015 reporting period— or if they believe their attestation may be unsuccessful—then they may apply for a hardship exception to avoid the payment adjustment in 2017. The application will not prevent providers from earning an incentive if their attestation is successful. The deadline to submit a hardship exception application is March 15, 2016 for eligible professionals and April 1, 2016 for eligible hospitals.

For More Information

Please visit the Payment Adjustments and Hardship Information page on the CMS website.

ICD-10 News: Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims

Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims

As you submit electronic claims for services, remember that:

• Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10


• Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can use ICD-9

How to Use ICD-10 Qualifiers
Use ICD-10 qualifiers as follows (FAQ 12889):

• For ASC X12 837P 5010A1 claims, the HI01-1 field for the Code List Qualifier Code must contain the code “ABK” to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code “ABF” for the Code List Qualifier Code to indicate up to 11 additional ICD-10 diagnosis codes that are sent.


• For ASC X12 837I 5010A1 claims, the HI01-1 field for the Principal Diagnosis Code List Qualifier Code must contain the code “ABK” to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code “ABF” for each Other Diagnosis Code to indicate up to 24 additional ICD-10 diagnosis codes that are sent.


• For NCPDP D.0 claims, in the 492.WE field for the Diagnosis Code Qualifier, use the code “02” to indicate an ICD-10 diagnosis code is being sent.

Updates to CMS FAQ System

Learn How to Directly Link to FAQs with the Updated System

The updated FAQ system allows users to share direct links to specific questions and answers in the frequently asked questions (FAQs) section.

Locating FAQs

There are a few different ways to find the FAQ you need. To browse by topic, click “ Electronic Health Records Incentive Programs” on the FAQ page’s blue navigation panel. If you would prefer to search by keyword, enter terms into the Search box in the upper left hand corner.

The Search box also allows users to perform searches by FAQ number. FAQs are still searchable by using its old FAQ number, which is listed after the word “Keywords” below the answer of the FAQ, or by using its new FAQ number, which can be found at the very bottom of the FAQ in parentheses.

When searching by new FAQ number, be sure to select the “FAQ #” option by clicking the circle and highlighting it in blue. Please note that you cannot search by old FAQ number in the “FAQ # Search” box. Instead, search by old FAQ numbers in the “Text Search” box.

Sharing FAQs

Once you have located your desired FAQ, a unique link to the web page will be displayed in the address bar. Using this link, you can go directly to the FAQ. For example, if you want to share the FAQ on “How and when will incentive payments for the Medicare Electronic Health Record (EHR) Incentive Programs be made?”, you can use the hyperlink to share and direct yourself to the FAQ again in the future. 

Want more information about the EHR Incentive Programs?

Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

New Medicare FAQ for CAHs

CMS Has Added an Important New FAQ for CAHs on Costs for Certified EHR Technology

We want to help keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS has recently revised an FAQ with new guidance that discusses whether critical access hospitals (CAHs) in the Medicare EHR Incentive Program can include costs for capital leases of certified EHR technology. Take a minute and review the new FAQ below. 

Question: Can a Critical Access Hospital (CAH) include costs to lease/rent certified EHR technology in the Medicare EHR incentive payment? 

Answer: Under the statute and the regulations, the CAHs EHR incentive payment shall only include reasonable costs for the purchase of certified EHR technology to which purchase depreciation (excluding interest) would apply. There are two types of lease agreements that a CAH may enter into to administer their EHR system… an operating lease or a capital lease. 

For the rest of this FAQ, visit the CMS FAQ system and search for it by FAQ number. Type in 3387 in the “FAQ # Search” box found at the top, left side of the FAQ page.  Choose the “FAQ #” option by clicking the circle and highlighting it in blue.

Want more information about the EHR Incentive Programs?/

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

New Meaningful Use FAQ for EPs

CMS Has Added an Important New FAQ for EPs on Using Hospital EHR Modules for Meaningful Use

We want to help keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS has recently added a new FAQ that discusses the ability for eligible professionals (EPs) in the EHR Incentive Programs to use hospital EHR modules to achieve meaningful use. Take a minute and review the new FAQ below.

 

Question: Can an EP use EHR technology certified for an inpatient setting to meet a meaningful use objective and measure?

 

Answer: Yes. For objectives and measures where the capabilities and standards of EHR technology designed and certified for an inpatient setting are equivalent to or require more information than EHR technology designed and certified for an ambulatory setting, an EP can use the EHR technology designed and certified for an inpatient setting to meet an objective and measure.  There are some EP objectives, however, that have no corollary on the inpatient side. As a result, an EP must possess Certified EHR Technology designed for an ambulatory setting for such objectives.  Please reference ONC FAQ 12-10-021-1 and 9-10-017-2 and CMS FAQ 10162 for discussions on what it means to possess Certified EHR Technology, ONC FAQ 6-12-025-1 for a list of affected capabilities and standards, and how that relates to the exclusion and deferral options of meaningful use.

 

You can find this FAQ in the CMS FAQ system (CMS FAQ system) by searching for it by FAQ number. Type in 6421 in the “FAQ # Search” box found at the top, left side of the FAQ page.  Choose the “FAQ #” option by clicking the circle and highlighting it in blue.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Update on CMS FAQ System

Learn How to Use CMS' Updated FAQ System to get on the Path to Payment for the EHR Incentive Programs

CMS has upgraded the frequently asked questions (FAQs) section of their website. The EHR Incentive Programs’ FAQs are now incorporated in the same page as other CMS program FAQs.

New and Old FAQ Numbers

CMS has tagged FAQs in the new system with two sets of FAQ numbers. You can now identify an FAQ by its old FAQ number (listed after the word “Keywords” below the answer of the FAQ) or its new FAQ number (at the very bottom of the FAQ in parentheses).

Finding FAQs

There are a few different ways to find EHR Incentive Programs FAQs:

1. Click on the Topic: Electronic Health Records Incentive Programs on the blue navigation panel  on the left side of the FAQ page
   
   
   
   1. Click on the Subtopic of your choice, such as “Getting Started” or “Registration and Attestation,” to see the FAQs related to that area of the programs
   
   
   
   


2. Search for your FAQ in the system
   
   
   
   1. Enter a search term such as “EHR” in the Search box on the top, left side of the FAQ page.
   
   
   2. Use the new FAQ numbers
      
      
      
      1. Enter the new FAQ number in the “FAQ # Search” box found at the top, left side of the FAQ page.  Choose the “FAQ #” option by clicking the circle and highlighting it in blue.
         
         
         
         • If you have already read an FAQ and noted the new number (in parentheses at the bottom of the FAQ), use that number as a reference to quickly find it again
         
         
         
         
      
      
      
      
   
   
   3. Use the old FAQ numbers
      
      
      
      1. Enter the old FAQ number (listed after “Keywords” below the FAQ answer) in the “Text Search box” found at the top, left side of the FAQ page. Choose the “Text” option.
         
      
      
      
      
   
   
   
   

Note: You cannot search by old FAQ number in the “FAQ # Search” box. However, you can search by old FAQ numbers in the “Text Search” box.

You can also download a PDF of all the FAQs for the EHR Incentive Program. Go to the FAQ page on the EHR Incentive Programs website and click the link under the Downloads section at the bottom of the page.

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Updated FAQs Added to the EHR Website

CMS Has an Updated FAQ about Attesting with Multiple Certified EHRs

We want to help keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS has recently updated an FAQ on attesting with multiple certified EHRs. Take a minute and review the updated information below.

 

Question: For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? 

 

Answer: EPs, eligible hospitals, and CAHs should look at the measure of each meaningful use objective to determine the appropriate calculation method for individual numerators and denominators.  The calculation of the numerator and denominator for each measure is explained in the July 28, 2010 final rule (75 FR 44314).

 

For objectives that require a simple count of actions (e.g., number of permissible prescriptions written, for the objective of "Generate and transmit permissible prescriptions electronically (eRx)"; number of patient requests for an electronic copy of their health information, for the objective of "Provide patients with an electronic copy of their health information"; etc.), EPs, eligible hospitals, and CAHs can add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure.

For objectives that require an action to be taken on behalf of a percentage of "unique patients" (e.g., the objectives of "Record demographics", "Record vital signs", etc.), EPs, eligible hospitals, and CAHs may also add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure. Previously CMS had advised providers to reconcile information so that they only reported unique patients. However, because it is not possible for providers to increase their overall percentage of actions taken by adding numerators and denominators from multiple systems, we now permit simple addition for all meaningful use objectives.

Please keep in mind that patients whose records are not maintained in certified EHR technology will need to be added to denominators whenever applicable in order to provide accurate numbers.

 

To report clinical quality measures, EPs who practice in multiple locations that are equipped with certified EHR technology should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters at those locations. To report clinical quality measures, eligible hospitals and CAHs that have multiple systems should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters in the relevant departments of the eligible hospital or CAH (e.g., inpatient or emergency department (POS 21 or 23)).

Website Update 

CMS is in the process of making upgrades to the www.CMS.gov website.  If you encounter problems accessing information while on the site, please try refreshing the page or check back later.  CMS is working to correct the site to ensure any issues are temporary.

Please also note that the EHR Incentive Programs’ FAQs were reorganized during the CMS.gov website upgrade. The EHR Incentive Programs’ FAQs are now incorporated in the same page as other CMS program FAQs. To navigate the EHR Incentive Program FAQs you must go to the FAQ page https://questions.cms.gov/, and click “Electronic Health Records Incentive Programs” on the blue navigation pane on the left-hand side.

We appreciate your understanding and apologize for any inconvenience.

 

Want more information about the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

We've Posted New FAQs to the EHR Website

We want to keep you updated with the latest information about the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Fifteen new FAQs on meaningful use, payment information for eligible hospitals, eligibility, and additional information for eligible hospitals have been added to our website. Take a minute and review these new FAQs.

Payment Information for Critical Access Hospitals

• What cost report data elements are used in the EHR incentive payment calculation for Medicare Subsection (d) Hospitals? Read the answer.


• How are Medicare EHR Incentive Payments Calculated for Critical Access Hospitals (CAHs)?  Read the answer.


• What costs can be included in the CAH's Medicare EHR incentive payment? Read the answer.

And even more new FAQs for Critical Access Hospitals:

FAQ # 10716. FAQ # 10719. FAQ # 10721. FAQ # 10722. FAQ # 10723.

FAQ # 10724. FAQ # 10725. FAQ # 10726. FAQ # 10727.

Meaningful Use

• If my certified EHR technology is capable of submitting batch files to an immunization registry using the standards adopted by the Office of the National Coordinator of Health Information Technology (HL7 2.3.1 or 2.5.1, and CVX), is that sufficient to meet the Meaningful Use objective "submit electronic data to immunization registries" for the Medicare and Medicaid EHR Incentive Programs? Read the answer.


• If my certified EHR technology only includes the capability to submit information to an immunization registry using the HL7 2.3.1 standard but the immunization registry only accepts information formatted in the HL7 2.5.1 or some other standard, will I qualify for an exclusion because the immunization registry does not have the capacity to receive the information electronically? What if the immunization registry has a waiting list or is unable to test for other reasons but can accept information formatted in HL7 2.3.1, is that still a valid exclusion? Read the answer.

Eligibility

• How does CMS define pediatrician for purposes of the Medicaid EHR Incentive Program? Read the answer.

Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

How do I Get Paid for EHR Incentive?

How do I get paid for the Electronic Health Record (EHR) Incentive Programs?

Payments for the Medicare and Medicaid EHR Incentive Programs are distributed based on each year of participation, and follow a specific payment schedule. Located below are payment details on the Medicare and Medicaid EHR Incentive Programs. For an overview, see the Medicare Learning Network (MLN) Matters Special Edition article (SE1111) – Medicare Electronic Health Record (EHR) Incentive Payment Process.

Medicare EHR Incentive Program

• Eligible professionals (EPs): EPs can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for EPs who provide services in a Health Professional Shortage Area (HPSA).To get the maximum incentive payment, Medicare EPs must begin participation by 2012.


• Eligible hospitals and critical access hospitals (CAHs): Incentive payments to eligible hospitals and CAHs may begin as early as 2011, and are based on a number of factors, beginning with a $2 million base payment.

Medicaid EHR Incentive Program

• EPs: The Medicaid EHR Incentive Program is voluntarily offered by states and territories. EPs can receive up to $63,750 over the six years that they choose to participate in the program. Medicaid EPs must initiate the program by 2016.


• Eligible hospitals: Medicaid hospitals that qualify for incentive payments may begin receiving incentive payments as early as FY 2011. Hospital payments are based on a number of factors, beginning with a $2 million base payment. Medicaid hospitals must initiate the payments by 2016.

IMPORTANT NOTE: Medicare Administration Contractors (MACs), carriers, and Fiscal Intermediaries (FIs) will not be making Medicare EHR incentive payments. CMS has contracted with a Payment File Development Contractor to make these payments.

DON'T: Call your MAC/Carrier/FI with questions about your EHR incentive payment.

INSTEAD: Call the EHR Information Center

• Hours of Operation: 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays.


• 1-888-734-6433 (primary number) or 888-734-6563 (TTY number).

A revised FAQ on payment for the EHR Incentive Programs has been posted to the EHR website
Question: For the 2011 payment year, how and when will incentive payments for the Medicare EHR Incentive Program be made?

Answer: For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year. Read the rest of the answer to this FAQ here.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website at http://www.cms.gov/EHRIncentivePrograms for the latest news and updates on the EHR Incentive Programs.