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EHR Q&A: Is EMR or EHR a Requirement

Posted on April 14, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Brenda asked:
As a private OT clinic that does not contract with medicare/ medicaid, are we required to use electronic medical records? We do submit claims to private insurance companies electronically.

Answer:
The short answer is no.

In fact, NO ONE is REQUIRED to use EMR whether they take Medicare or Medicaid. However, if you take Medicare or Medicaid, then you have to be a “meaningful use” of a “certified EHR” in order to: 1. Get the EHR Incentive money and 2. Avoid the government penalties for not being a meaningful user of an EHR.

Some might argue that the work to show meaningful use is not worth the effort compared to the incentive money you receive. Plus, the penalties for not using an EHR are not that big of an issue (see this post on the EMR penalties ) Although, there are plenty of people arguing on the other side. For example, Meaningful Use is relatively easy (at least in Stage 1) and the penalties are going to be a major issue for their clinic since they have such a large Medicare or Medicaid population.

Then, there are the doctors that are leaving Medicare and Medicaid behind completely (see this doctor as an example). The argument here is that Medicare and Medicaid are the lowest paying payers out there and now they’re going to penalize them even more so they might as well just stop taking them. We’ll see how many adopt this strategy.

One word of Caution…
There’s a possibility that insurance companies will hop on board the requirement of an EHR and Meaningful Use (see this post about private insurance and meaningful use ). I’m sure they’re keeping a keen eye on how well it goes for the government before making any decisions. My gut feeling is still that they won’t wholesale take the governments approach to EHR and meaningful use. Instead, they may require some sort of electronic documentation or reporting requirements which are more easily performed with an EMR. Essentially it will be an extension of their requirement to have claims submitted electronically.

Despite the myth that EMR is a requirement, so far no one can require you to use an EMR. They can only provide incentives and penalties if you don’t (which only the government has done to this point). Although, there’s always the aspirational goal that Bush and Obama have made of Full EHR by 2014.

The longer answer is…EMR is not a Requirement….yet?

Be sure to check out all the EMR Stimulus Questions and Answers posts.

EHR Incentive Q&A: Do modular certified EMR’s qualify for meaningful use and also qualify for full incentive payouts?

Posted on March 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Chris asked the following question:
Do modular certified EMR’s qualify for meaningful use and also qualify for full incentive payouts?

Answer:
Modular certified EHR software can qualify for meaningful use and the EHR incentive payouts. Although, they can’t do it on their own. Although, if you combine the modular certified EHR with other modular or full certified EHR software, then you can qualify. Clear as mud huh?

The good thing is that you can go to the ONC CHPL website and select the certified EHR software which you use and it will tell you if combined it meets the criteria.

So, for example, maybe you have a modularly certified EHR that is certified for everything but ePrescribing. You could then also purchase a certified ePrescribing software and together they would be considered a complete certified EHR that would qualify you for the EHR incentive money.

At least this is my understanding of the intent. I’m sure there are going to be lots of little intricacies without clear answers.

UPDATE: There was some discussion in the comments about whether you had to have a complete EHR or only one that had the modules you use to show meaningful use. Thanks to Jim Tate for finding the HHS reference that says you do have to have a complete EHR even for the modules which you’ve excluded or menu set objectives which you didn’t select.

EMR Stimulus Question and Answer: Has Anyone Gotten Paid Yet?

Posted on December 6, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I got a good question from Gene about whether anyone has gotten a check for the adoption of EMR yet. You can see the full question and my answer below. Also, be sure to check out the other EMR Stimulus Question and Answers I’ve done.

Has any doctor actually received any money from the government regarding the use/adoption of an EMR? OR does this not come until 2013

Short Answer: No

Longer answer: Medicaid is getting close to cutting the first checks. Medicare takes 90 days of meaningful use, so the first checks won’t be cut until after the first quarter of 2011. So, we won’t have to wait until 2013, but the EMR stimulus has taken a while to be put in place.

I guess this wasn’t one of the “shovel ready” ARRA projects that we heard all about.

EMR Stimulus Question and Answer: What if my EMR Vendor Doesn’t Certify?

Posted on December 2, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Pamela sent me the following EMR stimulus question in response to my post about Doctor’s having no choice with meaningful use:

Can we show meaningful use without a certified EMR or would we still be penalized since our EMR vendor has no intention on becoming certified?

The current HITECH law requires meaningful use of a certified EHR. So, you have to use a certified EHR to get the EMR stimulus money and to avoid the Medicare penalties. They have been looking at doing site certifications so you could show that you’ve put together everything to satisfy the certified EHR portion. However, so far I’ve only seen the site certification really apply to hospitals. I haven’t seen a site certification for smaller doctors offices (yet?).

Just be aware that some are suggesting that the penalties will never be imposed. Basically, they say that ONC will just keep delaying those penalties for one reason or another and that they’ll never actually be enforced. Plus, don’t be surprised if they make exceptions for certain medical specialties. For example, if not a single chiropractor (or some small number) shows meaningful use of a certified EHR, then it seems reasonable that ONC could look at making an exception for those specialty groups.

It’s also worth taking a look at this post I did which gave an example of the EMR stimulus Medicare penalties. They don’t amount to as much as you’d think.

I imagine we’ll see quite a few faced with this situation. This will become even bigger when some EMR vendors decide to deal with meaningful use stage 1, but choose not to prepare for meaningful use stage 2. Allscripts will be doing this with their now sunsetted EMR acquisition, Peak Practice. Basically, they’re going to make it work for meaningful use stage 1, but then users will have to switch to a different Allscripts EMR for meaningful use stage 2. That will make for a tough decision for someone who has to switch EMR software to get more stimulus money and avoid the penalties.

I have a strong feeling that EMR and HIPAA is going to make a switch from talking about selecting and implementing EMR to switching EMR software over the next 5 or so years. Not a fun subject for providers to consider, but many are actually doing it now.

EMR Stimulus Q and A: EMR Stimulus Money and Dentists

Posted on November 18, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I must admit that the following question is one that I don’t have a very good answer to. However, I’ll offer what I know and hopefully the readers of the site can also chime in with their thoughts in the comments of this post. This question was posted in the comments of my previous EMR Stimulus question and answer post.

Can you help out another reader with a pressing question? Where can I find a good listing of EHRs for dentists? I’m looking specifically for ONC certified products that cater to dental practices and I’m coming up short so far. I know that DDS/DMDs can qualify for incentives under ARRA and they’ll be dinged on the Medicare side if they don’t use EHRs, but how are they supposed to comply if the software’s not out there for them? I’ve talked to several vendors with ONC certification who basically said they’re ignoring dentists in their outreach/software development (due to the larger potential market for internal medicine/general practice, the specialization required for dental systems, etc). A lot of dentists have PMS that they mistakenly believe are full EHRs, but it seems like there is a huge market out there for dental EHRs that is being ignored.

There was some discussion in the comments of the post where the above questions and comments were posted about whether Dentists do in fact qualify for EMR stimulus incentives. My understanding was that they could qualify. This of course assumes that they have enough Medicare and they were meaningful users of a certified EHR (as with everyone else). Although, I believe dentists are considered eligible providers (I’m sure someone will correct me in the comments if I’m wrong).

Unfortunately, I haven’t seen any EHR list by ONC or anyone else for that matter that has EHR software for dentists. Of course, I posted a link to the official ONC-ATCB certified EHR list before. So, watching that list might be the place to start. Although, that list is going to grow between now and the end of the year quite quickly. I won’t be surprised if that list is at least double or triple the size that it is now.

I must admit that I don’t know many of the dentist specific EHR, so I couldn’t go through the list to find the EHR software that is a certified EHR for dentists. If someone else does and wants to share it in the comments, I’ll post that list for others to see too.

I have heard of one dentistry software called Dentrix. I asked my friend who does some work with them about their take on the EHR stimulus money for dentists. He said that he’s asked for more info himself and the only answer he gets is that they need to talk to Dentrix Enterprise. I guess they have multiple versions of their software. Sounds like they are a bit like Allscripts with a ton of different EHR packages depending on size of the office. Unfortunately, Dentrix didn’t answer mine (and others) request on Twitter for information about the EHR stimulus for dentists.

One thing is certain. Dentists that try for the EHR stimulus money will likely be happy to evoke the exception clause for some of the meaningful use requirements that don’t apply to them.

EMR Stimulus Question and Answer: Time Period for Medicare Allowable Charges

Posted on November 9, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You know how I love when readers ask me questions. Especially when I can use them to create a blog post. Why you ask? Because then at least I know I’m making one reader happy. Although, if one reader had the question, it’s also quite likely that MANY more had the same question. On that note, the following is a question sent to me by Radhika:

To qualify for EMR stimulus money we need $24,000 in allowable medicare charges per physician. I am not sure whether we have to show the $24,000 over a period of 1 year or 90 days. Can you please clarify?

This is a great question. The short answer is you have the entire year to accrue the $24,000 in allowable Medicare charges that’s required to get the full EMR stimulus money in year 1 (you get paid 75% of your Medicare allowable charges up to the cap for that year).

The confusion between the 90 days and the full year stems from the meaningful use requirements. While the allowable charges can be accrued for the entire year, you only have to show meaningful use for 90 days (at least for meaningful use stage 1) of the year.

I heard one person tell me that means they can wait until October 1st to start showing meaningful use. While this is technically true, you are a brave person if you don’t start showing meaningful use until that date. I’d personally shoot for April or May. That way if you run into any troubles, you still have some room to correct any mistakes.

EMR Stimulus Q&A: Chiropractor’s and Meaningful Use e-Prescribing Requirement

Posted on August 16, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Pauline Murphy asked the following EMR stimulus question:
If a chiropractor does not write perscriptions, does he still have the same e-prescribing requirements for “meaningful use”? How does that work, does anyone know?

Amanda Doss from Computer Link offered this answer:
No, the chiropractor would not have the same e-prescribing requirements for Meaningful Use. Page 61 of Meaningful Use discusses the “inapplicability” of measures to various provider types.

Basically, your chiropractor will have a denominator of “zero” for that measure. Also, on page 99 of Meaningful Use, you find (talking about e-prescribing) “this objective and associated measure do not apply to any Eligible Provider who writes fewer than one hundred prescriptions during the EHR reporting period.”

Good question and a great answer. I’m going to have to dive into page 61 some more and see how else it might apply.

Check out some of the previous EMR Stimulus Question and Answers.

EMR Stimulus Q&A: Do You Have to Use a CCHIT Certified EHR Vendor?

Posted on July 26, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

AK sent me the following EHR Certification question:

Is it necessary to get CCHIT certified vendor just because you want to qualify for incentives or regardless you MUST go for a certified solution?

Because I make the case that one should go with the one that provides the most amount of value.

You only need to use a certified EHR (doesn’t have to be CCHIT certified either, but HHS Certified) if you want to get the EMR stimulus money. The only caveat is that if you don’t show “meaningful use” of a “certified EHR,” then in a few years there are 1-5% Medicare penalties for not using one and showing meaningful use. However, many people strongly believe that those penalties will actually never be implemented. Of course, that part is just conjecture and may or may not happen.

So, there’s nothing forcing physicians to use a certified EMR solution. More and more people are doing as you describe, ” go with the one that provides the most amount of value.” They make the valid argument that if you get $44k in EMR stimulus money and lose $50k in productivity then you would have been better to go with an EMR that can’t get you stimulus money, but still maintains or even improves your productivity (among other EMR benefits).

At one of my EMR stimulus speaking engagements, a physician came up to me after the presentation and asked, “If I don’t accept Medicare or Medicaid, then do I care about meaningful use or certified EHR?” The easy answer was, nope. He can just decide on the right EMR without having to worry about government requirements.

Some have suggested that insurance companies might impose the certified EMR or meaningful use requirements, but I personally think that’s pretty unlikely.

ARRA Q&A: Are imaging costs recoupable under the HITECH act?

Posted on June 23, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Corey sent me the following question:

Are imaging costs recoupable under the HITECH act?

Corey,
There are 2 major sections to receive stimulus money from the HITECH act. One is through Medicare and the other is through Medicaid. The Medicare related stimulus money doesn’t have any provisions on how you use the money you receive. It is paid out as a bonus on your Medicare reimbursement. So, you could use the EMR stimulus money that’s paid out through Medicare for anything you want, including imaging costs.

Medicaid on the other hand has to be for qualified expenses (or some similar term like that). I personally haven’t seen any details on what HHS will consider an expense that can qualify for the stimulus money. Plus, I won’t be surprised if each state has different definitions of what expenses will qualify under Medicaid. I have mixed feelings on whether imaging costs will be covered by the Medicaid section of the HITECH act. I guess I could see it going either way. If I’ve missed where this is specified, please let me know in the comments.

Check out the previous EMR and HIPAA EHR Stimulus Question and Answers and please send us other questions you might have in the comments.

EMR Stimulus Question and Answer

Posted on June 11, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Question: My EMR claims to have all of the capabilities they will need to demonstrate meaningful use and qualify for ARRA incentives. Does that mean I will get the EMR stimulus money?

First of all, you might want to consider another EMR vendor. If they are saying this, then they are trying to mislead you and make more sales. No EMR vendor can claim that they have “all of the capabilities” for you to show meaningful use and qualify for the EMR stimulus money.

Why can I say this? Because the details for Meaningful Use are still not final. We don’t know what you’re going to have to do to show meaningful use and so how can an EMR vendor claim to have all of the capabilities? Short answer is that they can’t. So, go and read their press release again and see if they’re just telling lies or if there was a disclaimer of some sort (ie. according to the interim final rule).

On to the other point of you getting EMR stimulus money. Certainly your EMR will have to be a certified EHR (that’s still not defined either). Your EMR will also have to have the capabilities to show meaningful use. However, at the end of the day, YOU’re the one that’s going to have to see patients and Use the EMR in a way that all of the meaningful use criteria are met. If you do this to the satisfaction of CMS, then you’ll get the stimulus money.

Certainly you can’t meet meaningful use without the EMR vendor. However, the EMR vendor alone can’t qualify you for meaningful use either. It takes 2 to tango. Just remember that it’s much easier to tango when you have a great partner. A lousy partner makes it no fun for anyone.

Check out previous EMR stimulus Questions and Answers.