MU Stage 2 and ICD-10: Regulatory Update

Dr. Denise W. Hines, PMP, FHIMSSDirector-Outreach & Education

GA HIT Regional Extension Center

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

MedicaMedicarere

First Calendar Year in which the EP First Calendar Year in which the EP Receives an Incentive PaymentReceives an Incentive Payment

Calendar Year

2011 2012 2013 2014 2015 & Later

2011 $18,000

2012 $12,000 $18,000

2013 $8,000 $12,000 $15,000

2014 $4,000 $8,000 $12,000 $12,000

2015 $2,000 $4,000 $8,000 8,000 $0

2016 $2000 $4,000 $4,000 $0

Total $44,000 $44,000 $39,000 $24,000 $0

3

Medicare Incentive Program

The Goals for Meaningful Use

2011-2012

2013-2014

2015-2016

Stage 2

Stage 3

Stage 1

Stage 1 Meaningful UseRequirements:• 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 dataEligible 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

Stage 2 Meaningful UseMeaningful 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

Stages of Meaningful UseMeaningful 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

1st YearStage of Meaningful Use

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

2011 1 1 1 2 2 3 3 TBD TBD TBD TBD

2012 1 1 2 2 3 3 TBD TBD TBD TBD

2013 1 1 2 2 3 3 TBD TBD TBD

2014 1 1 2 2 3 3 TBD TBD

2015 1 1 2 2 3 3 TBD

2016 1 1 2 2 3 3

2017 1 1 2 2 3

Meaningful Use Payment Years

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

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).

Resources

GA-HITREC ICD-10 Toolkit877-658-1990www.ga-hitrec.org

CMS Incentive Programswww.cms.gov/ehrincentiveprograms

GA Medicaid Incentive Programwww.dch.georgia.gov/ehr

GA HIE

Email: hitt@dch.ga.gov

ICD-10

www.cms.gov/icd10

HIMSS ICD-10 Playbookhttp://www.himss.org/ASP/topics_icd10playbook.asp

QUESTIONS ????