HHS Releases New Rules for Meaningful Use Stage 3 of the Incentive Program

by | Published on Aug 5, 2015 | Insurance Verification and Authorizations

Incentive Program
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The United States Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) recently announced the release of the proposed rules for “Stage 3 of the Meaningful Use Incentive Program” for Medicare and Medicaid EHRs and the 2015 Edition of Health IT Certification Criteria to support the path to nationwide interoperability.

The two proposed rules aim to offer higher flexibility in healthcare operations by supporting better care provision, lowering costs and improving information sharing.

The proposed CMS rule of Stage 3 Meaningful Use specifies new criteria that eligible professionals (EPs), hospitals and critical care hospitals must fully meet in order to qualify for Medicaid EHR incentive payments. It also stresses on criteria that providers must meet to avoid Medicare payment adjustments based on program performance beginning in payment year 2018. In addition, the rule provides enhanced flexibility and simplifies requirements for healthcare providers by focusing on advanced EHR use and eliminating specific requirements that are no longer relevant. The 2015 EHR certification criteria include updated IT functionality and provisions that support the incentive programs.

As per the proposed rule, the meaningful use reporting period will be a full calendar year for both physicians and hospitals starting from the year 2017. The only exception will be made for Medicaid EPs and hospitals that are attesting to meaningful use for the first time, and these providers will have a 90-day period.

From 2018, CMS will promote electronic quality reporting for providers in the Medicaid incentive program. These providers can remain in either Stage 1 or Stage 2 or can attest even Stage 3 in 2017. However, from the beginning of 2018, all Medicare and Medicaid EPs and other hospitals will have to attest in Stage 3 (no matter which stage they were previously in). Furthermore, it is essential for all providers to adopt the 2015 edition EHR technology by 2018 (as they can use 2014 edition certified EHRs through 2017).

Stage 3 Meaningful Use – Ruling Highlights

  • About 25% of patients seen by eligible professionals (EPs) or discharged from a hospital or emergency department (ED) must actively engage with their EHRs.
  • About 35% of patients who get discharged from hospital emergency departments or are seen by eligible professionals must send a message through the EHR’s secure messaging function.
  • Healthcare professionals and hospitals must create a summary of care for patients (by using the electronic health record system) and electronically exchange it with other providers for more than 50% of referrals.
  • For nearly 40% of transitions of care, it is essential for the provider to include a summary of care from an EHR used by a different provider. In addition, for 80% of transitions of care, the provider must perform “clinical information reconciliation” that covers medications and allergies and problem lists.

Meaningful Use Stage 3 rules for the Medicare and Medicaid EHRs Incentive Programs are generally limited to the requirements and criteria for use in 2017 and subsequent years. CMS is planning to make additional changes to meaningful use beginning in 2015 through separate rulemaking. The comment period on the proposed “Stage 3 Meaningful Use” rule ends on May 29, 2015 and comments will be received on the certification criteria proposal until June 30, 2015.

The new Stage 3 rule features a more “simplified reporting structure,” in which all objectives and measures will replace the same in Stage 1 and Stage 2 criteria. However, the Stage 3 criteria will be relatively hard to achieve. Regardless of the severe complaints from physicians about the issues related to Stage 2 requirements for patient care summary and patient record sharing transitions, CMS is increasing criteria and adding new objectives that most physicians find arduous and time-consuming.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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