MU Stage 2 and ICD-10: Regulatory Update

1. MU Stage 2 and ICD-10: Regulatory Update Dr. Denise W. Hines, PMP, FHIMSS Director-Outreach & Education GA HIT Regional Extension Center

2. 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 3rd last day to begin 90 reporting period in 2012 & receive full payment

3. Medicare Incentive Program 3

4. The Goals for Meaningful Use 2015-2016 2013-2014 Stage 3 2011-2012 Stage 2 Stage 1

5. 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

6. 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

7. 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

8. Meaningful Use Payment Years

9. 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

10. 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).

11. 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.gov ICD-10 www.cms.gov/icd10 HIMSS ICD-10 Playbook http://www.himss.org/ASP/topics_icd10playbook.asp

12. QUESTIONS ????