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Meaningful Use Potpourri – Meaningful Use Monday

Posted on December 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

We’ve been publishing Meaningful Use Monday for exactly two years today. Most of the posts have been written by the wonderful Lynn Scheps from SRSsoft and I think they represent a wonderful asset to those interested in meaningful use. That’s close to hundred posts on the subject of meaningful use and EHR incentive money. Hopefully readers have found it as useful as I have in understanding the complexities of meaningful use.

Considering how much we’ve posted about meaningful use, I think it’s time to move meaningful use out of a featured space on the site. Don’t get me wrong, I’m sure there are many more meaningful use posts to come. In fact, it’s likely a post a week will still be about meaningful use and the EHR incentive money in one way or another. However, I hope that we can also help many doctors move past meaningful use to actually meaningfully using EHR and other healthcare technology. For example, I’m planning a series of posts on the benefits of EHR in the current environment. I expect it to drive some really interesting conversation.

Before I end the Meaningful Use Monday series to a more random assortment of meaningful use posts, I thought I’d provide a potpourri of meaningful use thoughts. I think you’ll find them interesting.


This is an interesting title since the article says that most won’t be able to show meaningful use and then goes on to list the statistics for how many doctors are using EHR. So, they’re using EHR, but they don’t have the capability to show meaningful use? To me EHR adoption is the more important number. I also like that EHR vendors have all applied the same CCD standard for data portability. I’m ok if many doctors forgo meaningful use. Although, we’ll see how that plays out if the penalties indeed go into effect.


This is music to my ears. I’ve been preaching this message for a long time. The odd part is that this article references the same studies and data as the first. What is clear from the numbers is that EHR adoption is up. That’s a good thing for healthcare since we need widespread EHR adoption to take the next step to technology adoption in healthcare.


I don’t think this is true, depending on how you define “apply.” I know very few doctors who have applied to meaningful use and not gotten paid. If you know of stories that say otherwise, I’d love to hear them. This is particularly true in meaningful use stage 1. We might see more meaningful use payment rejections in stage 2 and 3, but so far the money has basically flowed out. I think this is by design. The worst thing for ONC would be many doctors working towards meaningful use and then not getting paid.


Yep, meaningful use stage 2 is still getting tweaked. It’s hard to keep up.


Almost a third of the way there. I love this “shovel ready” part of the ARRA economic stimulus package. Makes me laugh to think about it.

New Opportunities to Avoid ePrescribing Penalty for 2013 – Meaningful Use Monday

Posted on November 5, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

According to the 2013 Medicare Final Rule released last week, there are new ways to avoid future payment adjustments under the MIPPA ePrescribing rule for those who have not already taken the necessary steps to avoid them: 1) The exemption request period has been reopened and 2) meaningful use will satisfy the ePrescribing requirements according to specific timetables.

1) CMS is offering a second chance to physicians who missed the June 30 deadline for requesting an exemption to the 2013 ePrescribing penalty (1.5%) under the original 4 categories. Between November 1, 2012 and January 31, 2013, physicians can go to the Quality Reporting Communication Support Page and request an exemption based on one of the following justifications:

  • Inability to electronically prescribe due to local, State, or Federal law or regulation (i.e., prescribe predominantly controlled substances)
  • Prescribed fewer than 100 prescriptions between January 1 and June 30, 2012
  • Insufficient high speed internet access (i.e., rural area)
  • Insufficient available pharmacies that accept electronic prescribing.

2) In the interest of harmonizing the various government programs that contain ePrescribing components, CMS now will provide two additional ways to avoid the 2013 MIPPA penalties:

  • Achieve meaningful use during 2013
  • Demonstrate intent to participate in the EHR Incentive Program and adopt Certified EHR Technology by January 31, 2013

This information will be retrieved by CMS from the information in its EHR Incentive Program’s Registration and Attestation System, rather than by having providers request an exemption as in #1 above.

Important Dates in the Life of a Meaningful EHR User – Meaningful Use Monday

Posted on October 8, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Here’s a look at some of the important dates to know for those looking to attest for Meaningful Use:

October 3, 2012: Last date to start the 90-day reporting period to earn an $18,000 EHR incentive payment for 2012, and to be eligible for the maximum total of $44,000. (The potential total drops to $39,000 in 2013.) Physicians do not have to be registered by this date—they can register at any time before they attest.

January 1, 2013: First day of the 365-day, 2013 reporting period for any provider who earned his/her first incentive payment in 2011 or 2012.

February 28, 2013: Last date to register and to attest for the 2012 EHR incentive. (Happily, no one has to spend New Year’s Eve attesting!) But remember, the entire reporting period has to have occurred within 2012.

October 3, 2013: For EPs whose first EHR payment year will be 2013, last day to start the 90-day reporting period and earn a $15,000 2013 incentive.

2013: EPs who successfully demonstrate meaningful use in 2013 will not be subject to the 2015 payment adjustment.

October 1, 2014: For EPs whose first incentive year is 2014, this is the last date to submit a successful meaningful use attestation and avoid the 2015 payment adjustment.

A Fun (and Educational) Look at Privacy and Security – Meaningful Use Monday

Posted on September 24, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

One of the most common sources of confusion about the meaningful use requirements is the Privacy and Security Risk Analysis measure. As I discussed in a past Meaningful Use Monday post, according to CMS, practices that are HIPAA compliant are likely in pretty good shape on this measure. For those physicians, what’s needed is documentation of the steps that were taken to review HIPAA compliance, the deficiencies identified, and what was done to remediate these exposures. (For more information, see the meaningful use chapter in ONC’s “Guide to Privacy and Security of Health Information.”)

This begs the question, “What exactly is HIPAA compliance?” I recently came upon the “Privacy and Security Training Game” that was created by ONC’s Chief Privacy Officer and couldn’t resist playing. While a lot of the information provided is quite basic for those with expertise in the privacy and security arena, as you progress through the game, the questions become more challenging. It’s definitely a fun way to introduce staff to the issues and increase awareness about the importance of safeguarding patient information.

Check out all of the past Meaningful Use Monday posts.

Final Rule for Stage 2 Brings Some Changes to Stage 1 – Meaningful Use Monday

Posted on September 10, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Although Stage 2 requirements don’t become effective until 2014, the Final Rule for Stage 2 contains some changes that apply—or can apply—to providers before then, and some that will apply to all physicians in 2014, even those still in Stage 1. These changes fall into 3 categories in terms of timing:  those that are effective in 2013, those that can be adopted in 2013 at the physician’s discretion, and those that are implemented in 2014.

Effective 2013:

  • Conducting a test of the EHR’s capability to exchange clinical information (Stage 1 Core Measure 14) will be dropped from the requirements. It will be replaced in Stage 2 by measures that require actual and ongoing exchange of information.
  • A new exclusion for the ePrescribing requirement is being added for physicians who have no pharmacy within 10 miles that accepts electronic prescriptions.

At Physician’s Discretion in 2013 (and required in 2014):

  • The Vital Signs measure will be restructured to separate the reporting of height and weight from the reporting of blood pressure. This is good news for those specialists who consider some, but not all 3 of the vital signs, relevant to their practice. Along with this change in the measure are revised minimum ages: blood pressure reporting will be required for patients age 3 and over instead of age 2, and height (or length) and weight will be required for all patients, even those under 2.
  • An alternate calculation for CPOE will help physicians—again, likely specialists—who do not prescribe frequently enough to meet the Stage 1 (30%) threshold. The denominator will be limited to “medication orders created by the EP during the EHR reporting period,” instead of “unique patients with at least one medication in their medication list.”

Effective 2014:

  • Currently, in Stage 1, if a provider attests to an exclusion for any menu measures, these measures can be counted towards the menu requirement. In Stage 2, this will no longer be true—excluded measures will not satisfy the menu requirement if there are other measures on which the provider could report instead. This will also apply to providers who are still reporting under Stage 1 in 2014—a change which those providers will likely perceive as inequitable since it did not apply to the earlier attesters. Those physicians who qualify for multiple exclusions—specialists, once again—will find that the menu set is really no longer a menu, as they will be left with few, if any, choices. 

So, while physicians do not have to focus on Stage 2 just yet, they should consider whether they might benefit from the 2013 changes described above.

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

Posted on August 27, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Without delving into all the specifics detailed in the 672-page Final Rule for Stage 2, what is important to comprehend—for now—is how Stage 2 raises the bar set by Stage 1 and how it intensifies the focus on health information exchange and patient engagement.

The following are some highlights of Stage 2:

  • The Final Rule not only confirms 2014 as the earliest effective date for Stage 2 (as expected), but it provides additional leeway for providers and for vendors by limiting the Stage 2 reporting period to 90 days in 2014, instead of a full year.
  • EPs must meet or exclude all 17 core measures and must meet—not “meet or exclude”—3 of the 6 menu measures. (Unlike Stage 1, exclusions of menu measures do not count unless the EP cannot find 3 relevant menu measures.)
  • All Stage 1 menu measures except syndromic surveillance become core measures.
  • 5 new menu measures have been added: access to imaging results, family history, progress notes, reporting to cancer registries, and reporting to specialized registries.
  • Stage 2 increases most Stage 1 thresholds.
  • CPOE is expanded to include lab and radiology orders, in addition to prescriptions.
  • Patient portals play an important role as a means of providing patients with access to their medical records. Physicians will have to ensure that at least 5% of the patients they see actually view, download or transmit their health information and that over 5% of the patients seen send them a secure e-mail message containing clinical information, (i.e., not just a request for an appointment.)
  • Clinical summaries of office visits must be available to patients within 1 day, instead of the 3-day timeframe in Stage 1.
  • The Stage 1 measure requiring a test of the ability to exchange clinical data with another provider has been dropped effective 2013, in favor of a more robust 2014 Stage 2 requirement for ongoing exchange of a significantly more extensive data set.
  • EPs will report on 9 of 64 clinical quality measures, and after the provider’s first incentive year, the CQM data must be submitted electronically, rather than by attestation.
  • In an effort to streamline the reporting process, Stage 2 offers opportunities for batch reporting by group practices and for consolidated CQM reporting for PQRS and meaningful use.
  • Penalties and hardship exemptions are defined, establishing October 1, 2014 as the latest date by which an EP can attest for the first time and avoid a 1% payment adjustment in 2015.

More information about Stage 2 will follow in future Meaningful Use Monday posts.

Planning for Stage 3 is Underway – Meaningful Use Monday

Posted on August 20, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

At the HIT Policy Committee’s meeting on August 1st, the Meaningful Use Workgroup presented its preliminary recommendations for meaningful use Stage 3. Giving plenty of advance warning regarding its intentions for Stage 3, the Policy Committee hopes to avoid the type of timing issues that led to the postponement of Stage 2. The committee plans to send its final recommendations to HHS by May 2013, well in advance of the earliest timeline for Stage 3—2016. In light of this schedule, the initial recommendations are being formulated before we know how Stage 2 will be finalized and before we can fully evaluate Stage 1. Hopefully, as the planning process advances, the committee will have the time to take into account the experience of participating providers. 

As outlined in the preliminary recommendations, Stage 3 would intensify Stage 2’s emphasis on interoperability and patient engagement and expand on care coordination, quality and safety, and population health. It would foster a new model of care that is team-based, outcome-oriented, and geared toward population management. To accomplish this, it would include—among other requirements —expansion of clinical decision support, including tracking of compliance; electronic management of referrals; and enabling patients to update or correct information that is in their chart. 

Lest you think that a plan for Stage 3 means that the end is now in sight, sit back and take a deep breath. The plan envisions a Stage 4!

MU Attestation Audits – Meaningful Use Monday

Posted on July 30, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

By definition, attestation is based on the honor system—that is, at least until you find yourself the subject of an audit. CMS has launched its anticipated program, and some physicians who have received an EHR incentive payment recently received a letter from the designated auditing firm, Figloiozzi and Company

Although there is no way to predict which physicians will be audited, providing the information requested should not be too onerous a task for those “lucky” ones who are tapped. Providers are being asked to show proof that they possess a certified EHR and to substantiate the data they reported for the core and menu measures—specifically, via “a report from their EHR system that ties to their attestation.” Since all certified EHRs generate an automated measure calculation report and a clinical quality measure report, that documentation should be readily accessible. It would not surprise me if they are also asked to provide documentation of the security and risk analysis that the practice conducted to ensure HIPAA compliance. For suggestions regarding the type of data to retain to support your attestation, see the Meaningful Use Monday post, MU Attestation: Save Your Documentation.

Based on material published by the auditors and by CMS on its EHR Incentives website, it does not seem that the audits will be so detailed as to require site visits or reviews at the patient chart-level. My sense is that CMS is looking to identify failures to comply with the major requirements—adopting and using a certified EHR to meet the meaningful use measures and reporting accurately on the data generated by that EHR. 

(If you have been audited and would like to share your experience, please post a comment.)

Multi-Site Providers Who Don’t Have Certified EHR in All Locations – Meaningful Use Monday

Posted on July 16, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A reader asked how a physician meets meaningful use when some of his encounters occur at a nursing home where there is no certified EHR. Specifically, she wanted to know if the physician was expected to bring his own EHR (hardware and software) to the facility to document encounters there. The answer is “no”—he limits his reporting to encounters that take place in the clinic setting. 

A somewhat similar situation is faced by physicians who are affiliated with two (or more) different practices, where not all of the practices(s) are equipped with certified ambulatory EHR technology. In this case, the physician reports on the encounters where a certified EHR is available. The only caveat is that to be eligible for an EHR incentive, the physician must have at least 50% of his encounters at location(s) that do have a certified EHR.

If you have other questions you’d like answered about meaningful use or the EHR incentive money. Please send in your question on our contact us page.

Medicare EHR Attestation When Switching Practices Mid-Year – Meaningful Use Monday

Posted on June 25, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

This week’s post will answer a Medicare question posed by a reader in response to Jessica’s post last week on Medicaid EHR Attestation with Multiple Practices. The reader asked about a physician who switches from one practice to another in the middle of year 2, but the answer below would also apply to a physician who works part-time at two (or more) practices.

“What about a Medicare EP who successfully attested for year one with her former employer and now works with us. Neither employer has enough information to report a full 12 months of info for her. Do we still attest for year two and fail it all or can we skip a year? And is it ok for the first employer to receive the first payment and we claim the rest? So complicated! Thanks for any input/help!!!”

Although the situation does make it more complex to attest, it does not mean that she cannot earn an EHR incentive this year. Incentives are tied to the physician—not the group—via the physician’s individual NPI number, regardless of whether the payment was made directly to the physician or assigned to the group. Therefore, even if the physician assigned payment to his former group last year, it is perfectly acceptable for her to assign payment to her new group this year. 

A physician who successfully attested and earned an EHR incentive in 2011 must report for the full calendar year in 2012 in order to earn the second payment. However, the information does not have to come from just one practice for the entire year. As long as the physician uses a certified EHR at both practices, she would simply have to report on all of the meaningful use requirements with data from both practices, combining the numerators and denominators for each measure when attesting. (For an explanation of how to report, see read CMS’s FAQ #3609.) She would also have to enter both EHRs into the CHPL website and generate a different Certification ID Number. 

If for some reason, the physician does not elect to pursue the 2012 incentive, there is no need to attest and fail this year. She can simply forego the second payment and start again with the third year’s incentive next January.