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MU Stage 2 and ICD-10: Regulatory Update Dr. Denise W. Hines, PMP, FHIMSS Director-Outreach & Education GA HIT Regional Extension Center
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CMS EHR Incentive Programs Over $20-27B Available –271,105+ care providers registered 180,515 Medicare physicians 86,708 Medicaid Clinicians 3,884 Hospitals –$7 Billion+ paid to eligible providers & hospitals –132,511+ hospitals and doctors received payment –1 out of every 5 Medicare eligible providers or 18% are meaningful users of EHRs –1 out of every 4 Medicare & Medicaid eligible provider has made a financial commitment to an EHR –55% of eligible hospitals have received EHR incentive payment for meaningful use – October 3 rd last day to begin 90 reporting period in 2012 & receive full payment
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Medicare First Calendar Year in which the EP Receives an Incentive Payment Calendar Year 20112012201320142015 & Later 2011$18,000 2012$12,000$18,000 2013$8,000$12,000$15,000 2014$4,000$8,000$12,000 2015$2,000$4,000$8,0008,000$0 2016$2000$4,000 $0 Total$44,000 $39,000$24,000$0 3 Medicare Incentive Program
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The Goals for Meaningful Use Data capture and sharing Advanced clinical processes Improved outcomes 2011- 2012 2013- 2014 2015- 2016 Stage 2 Stage 3 Stage 1
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Stage 1 Meaningful Use Requirements: Use of a certified EHR in a meaningful way Use of a certified EHR for electronic exchange Use of a certified EHR to submit clinical quality data Eligible Professionals (EPs) Must meet 15 core requirements + 5 menu requirements Quality measures required for reporting for EPs – 3 core + 3 menu Eligible Hospitals and Critical Access Hospitals Must meet 14 core requirements + 5 menu requirements Quality measures required for reporting - 15 measures for hospitals Reporting Period Any consecutive 90 days for first year One year subsequently Status- - Effective until 2014 –Providers can receive 3 payments under Stage 1 2011, 2012, 2013
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Stage 2 Meaningful Use Meaningful Use Stage 2 –Delayed to allow vendors time to implement new functionality –Builds on stage 1 with increased thresholds Exchange of information required Electronic access for patients Updates to quality measures to align with other programs Submission to registries Record patient family health Record imaging results inside EHR Status- –Final released August 23, 2012 –Attestation for Hospitals start Oct. 31,2013 –Attestation for Professionals start Jan. 1, 2014 –Blue Button Initiative
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Stages of Meaningful Use Meaningful Use Stage 3 –Ready by 2015 and required by 2016 –Builds upon Stages 1 and 2 with increased thresholds –Creation of collaborative care models with patients –Enhanced bi-directional exchange with public health agencies: Immunization, lab, and syndromic surveillance data –Demonstrate improvement in patient outcomes Patient access to self management tools, upload data Bi-Directional communication among care team, patients, and family members Status- –HIT Standards & Policy Committees working on Stage 3 Recommendations –CDC convened a “Stage 3 Sprint Group” to develop an implementation guide for PH entities
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1st Year Stage of Meaningful Use 20112012201320142015201620172018201920202021 20111112233TBD 2012112233TBD 2013112233TBD 2014112233TBD 2015112233TBD 2016112233 201711223 Meaningful Use Payment Years
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ICD-9 to ICD-10 ICD-9 is 30 years old, outdated and obsolete, inconsistent with current medical practice Covered entities must move from using ICD-9 to ICD-10 to submit claims on and after the compliance date For hospital inpatient only, does not affect CPT codes (outpatient) Different structures: –ICD-9 is mostly numeric with 3 to 5 digits. –ICD-10 is alphanumeric with 3 to 7 characters. Contains “one to many” matches ICD-10 must be done to issue claims and to get paid Original date for compliance was Oct. 1, 2013 to Oct. 1, 2014 Final rule on October 1, 2014 compliance date issued on 8/24/2012-Effective 11/5/2012
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The Year to Watch: 2014 ICD-10 Effective Last year to enter the CMS EHR Medicare Incentive Program ACA-Health Insurance Exchanges (HIX) New standards for electronic funds transfer and remittance advice transfers EP attest for MU Stage 2 Alignment of CMS quality measurement programs- Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).
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Resources GA-HITREC ICD-10 Toolkit 877-658-1990 www.ga-hitrec.org CMS Incentive Programs www.cms.gov/ehrincentiveprograms GA Medicaid Incentive Program www.dch.georgia.gov/ehr GA HIE Email: hitt@dch.ga.govhitt@dch.ga.gov ICD-10 www.cms.gov/icd10 HIMSS ICD-10 Playbook http://www.himss.org/ASP/topics_icd10playbook.asp
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QUESTIONS ????
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