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Relief May Be in Sight for Some Penalty-Threatened ePrescribers – Meaningful Use Monday

Posted on June 6, 2011 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.

Some physicians—most notably, surgeons and pain-management specialists—have expressed concern that they will be unfairly subject to the 2012 ePrescribing penalties, based on the fact that their opportunities to ePrescribe are limited by the nature of their practices. The Proposed ePrescribing Rule published in the Federal Register on June 1 offers a potential remedy for these providers.

 The rule, which amends the (MIPPA) 2011 ePrescribing rule, affords providers several new arguments they can use to request a “hardship exemption” from the 2012 penalties. (These are in addition to the already existing reasons, i.e., rural areas that lack high speed internet access and/or rural areas that lack pharmacies that accept ePrescriptions.) The new justifications include:

      1)   Inability to ePrescribe due to local, State, or Federal law, (i.e., providers who predominantly prescribe controlled substances).

      2)   Inability to count the ePrescriptions towards the Medicare incentive program, (i.e., providers who predominantly prescribe post-surgery—visits that are not included in the specified CPT denominator codes.

How does this relate to Meaningful Use Monday? The rule also reconciles the EHR (meaningful use) incentives and the Medicare ePrescribing incentives to some extent, in an attempt to harmonize the differing ePrescribing requirements and eliminate duplicate work for providers. (See “Meaningful Use, ePrescribing, and PQRS: Need for Harmonization” and “Meaningful Use Measures: ePrescribing.”) The Proposed Rule accomplishes this through two provisions:

      1)   Providers who successfully demonstrate meaningful use in 2011, which includes ePrescribing, would be exempt from the 2012 ePrescribing penalties. (Note, however, that these providers will be trading the 1% 2011 ePrescribing bonus for avoidance of the 1% 2012 penalty.)

      2)   ePrescribing software that is ONC-certified would be deemed also certified for the purpose of the Medicare ePrescribing program.

If you’d like to submit a comment to CMS on this proposed rule (file code CMS-3248-P), you can do so by July 25.

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.

More Meaningful Use Clarifications and Maximizing EHR (ARRA) and ePrescribing (MIPAA) Incentives

Posted on December 7, 2010 I Written By

John Lynn is the Founder of the 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 and 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 love the smart readers from this site. They always keep me in line and do a good job clarifying the details of meaningful use for me and you. A few such comments were made on my years for meaningful use post. I thought they were worth sharing since I know that many of you don’t go back and read the great comments people make on my posts (I’ll forgive you for now).

Lynn Scheps from SRSsoft wrote the following comment about a benefit to not showing meaningful use in 2011 and electing to wait until 2012. It’s a way to maximize your incentive money. Although, you will need to implement your EHR quickly to maximize them. Here’s Lynn’s comment:

There is an additional benefit to electing 2012, instead of 2011, as an EP’s first EHR incentive payment year (an unintended consequence of the legislation, no doubt!) In that case an EP can still collect the ePrescribing (1%) bonus for 2011, while potentially qualifying for the maximum ($44K) in EHR incentives. An EP cannot collect under both MIPPA (ePrescribing) and ARRA (EHR incentives) during the same reporting period.

There was also some discussion on the idea of skipping a year of meaningful use and the impact of such a choice. Lynn offers the following comments in response to skipping a year of meaningful use.

In response to Wes Kemp’s comment about the 90-day reporting period and the consequences of skipping years, note that the rules differ under Medicare and Medicaid. Under Medicare, 90 days is sufficient for an EPs FIRST PAYMENT YEAR, regardless of what calendar year that is. For all subsequent payment years, the EP must report on the full year. After the first payment is received by the EP, every year is considered a payment year, whether or not an incentive is earned. So, while an EP can skip a year, he/she forfits the money for that year. Payment amounts are governed by the year in which they are received, not by what year it is for the EP. (p. 44319 of Final Rule.)

Wes Kemp also offered some insights on the Medicaid program and its requirements for meaningful use, attestation and it highlights some interesting differences between the Medicaid and Medicare EMR stimulus (I’ll admit that I don’t know as much about the Medicaid side):

Yes, requirements are more relaxed under Medicaid, than Medicare for MU incentives. My posts relate to MediCAID, since that is my current client’s need. So, with that in mind:

Yes, John, under MediCAID, an EP can attest and then apply for the funds the very next day – no reporting period / requirements in first year. 90 consecutive days reporting in year 2 is required, and full-year reporting for all subsequent participation years.

For subsequent years, the targets are clear enough that EPs will be aware of whether or not they have complied just by reading the data before submitting it. The measures are listed, from which a certain number are selected to report. The denominator / numerator are clearly defined…as are the % targets for each measure. So an EP is able to monitor and strive to achieve the required % of encounters counseled about smoking, for example.

Indeed there are items still to be defined. Optometrists are not specifically included as EPs under the MediCAID MU rules – however, I have been told more than once by ONC that for FQHCs they will be, this is not yet written anywhere that I am aware of. Also, for larger clinics, tracking all the MU measures by EP will require significant effort; especially if EPs come & go during the reporting year.

I think I might invite smart people like Lynn and Wes to do a regular post talking about more details of meaningful use. There’s so many questions still out there about meaningful use. Some we know the answer to, but there’s a lot of things we still don’t understand. Hopefully together we can share what we learn about meaningful use and the EMR stimulus.