Meaningful Use

Medicare, Medicaid EHR Incentive Programs

The American Recovery and Reinvestment Act of 2009 authorized the Medicare and Medicaid programs to make incentive payments to eligible professionals, hospitals and critical access hospitals for the meaningful use of electronic health records. Meaningful use has been defined by the Medicare program to include achievement of a selection of objectives and quality of care measures that will be implemented in a series of three stages, each requiring an increasingly sophisticated level of data collection and use. Medicaid will accept the Medicare-determined achievement of meaningful use to qualify eligible hospitals and professionals for Medicaid incentive payments.

Medicare meaningful use Stage 1 requires CAHs and other hospitals to meet 14 core objectives and five of 10 menu objectives, and eligible professionals to meet 15 core objectives and 5 of 10 menu objectives to qualify for an incentive payment to offset the cost of purchasing and implementing electronic health records. The first incentive payment year for meaningful use Stage 1 was federal fiscal year 2011.

Medicare meaningful use Stage 2 requirements were printed in the September 4, 2012 Federal Register (click here to access document) and will become effective in federal fiscal year 2014. CAHs, other hospitals, and eligible professionals that have met Stage 1 requirements for at least two years will be required to meet Stage 2 in 2014. Hospitals and eligible professionals have two years within a meaningful use stage before moving to the requirements of the next stage. An exception has been implemented for all who first met Stage 1 requirements in federal fiscal year 2011: they will be allowed to first achieve Stage 2 requirements in 2014, as are those who first met Stage 1 requirements in federal fiscal year 2012. Meaningful use Stage 2 requirements for CAHs and eligible hospitals require achievement of 16 core objectives and 3 of 6 menu objectives. Eligible professionals must meet 17 core objectives and 3 of 6 menu objectives.

CAHs, eligible hospitals and professionals are required to report on selected clinical quality measures to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs. Reporting in the first year of Stage 1 is completed by attestation and in subsequent years, beginning in 2013, clinical quality measures reporting will be completed electronically. Meaningful use Stage 1 requires CAHs and eligible hospitals to report on 15 clinical quality measures. Eligible professionals are required to report on three core or alternates and an additional three from a selection of 38 clinical quality measures.

Meaningful use Stage 2, and any second year Stage 1 CAHs, eligible hospitals and professionals who will complete their second year of Stage 1 in 2013 will be required to document achievement of an increased number of clinical quality measures. CAHs and eligible hospitals will document achievement of a minimum of 16 of 29 potential clinical quality measures from at least three of the six National Quality Strategy domains. Eligible professionals must report achievement of a minimum of nine of the 64 clinical quality measures from at least three of the six National Quality Strategy domains.

Medicare meaningful use Stage 3 requirements are expected to be developed and ready for implementation by federal fiscal year 2016.

Medicare will initiate payment reductions beginning in 2015 for CAHs, other hospitals, and eligible professionals who have not met meaningful use Stage 1 requirements. CAHs’ Medicare reimbursements will be reduced for the cost reporting period that begins in fiscal year 2015 and in subsequent years. Medicaid will not institute payment reductions.

Medicare and Medicaid Electronic Health Record Incentive Programs Information Resources

The Centers for Medicare and Medicaid Services has prepared and posted online the most thorough and clearly written documentation about the electronic health records incentive programs and associated requirements. The homepage for the incentive programs is accessed at: www.cms.gov/ehrincentiveprograms. You will be redirected to the homepage with a new URL. This is the go-to page for all questions regarding the incentive programs, especially for Medicare.

There are multiple references to Medicaid requirements on the CMS homepage but each state manages its own Medicaid program, including the Medicaid component of the electronic health records incentive program. In Illinois, go to http://www2.illinois.gov/hfs/medicalprovider/ehr/pages/default.aspx to access electronic health records incentive program information from the Illinois Department of Healthcare and Family Services.

The options menu on the homepage of the CMS Electronic Health Records Incentive Program offers descriptive information and links to a variety of documents that explain all aspects of the incentive program. Among the 15 topics listed in the options menu, the following likely will be the most useful:

  • Registration and Attestation – explanation of the registration and the meaningful use attestation processes for CAHs and eligible hospitals, and for eligible professionals plus direct links to appropriate registration and attestation pages. Multiple downloads are available on the Registration and Attestation page; several key documents can be accessed here:

1) Registration User Guide for CAHs and Eligible Hospitals

2) Medicare Registration User Guide for Eligible Professionals

3) Medicaid Registration User Guide for Eligible Professionals

4) Attestation User Guide for CAHs and Eligible Hospitals

5) Attestation User Guide for Eligible Professionals

6) Attestation Worksheet for CAHs and Eligible Hospitals

7) Attestation Worksheet for Eligible Professionals

  • Meaningful Use – explanation of the basic requirements for CAHs and eligible hospitals and professionals to meet the Stage 1 requirements; Stage 2 requirements are addressed separately and may be viewed by selecting ‘Stage 2’ from the options menu. Multiple downloads are available on the Meaningful Use page; several key documents can be accessed here:

1) Attestation Worksheet for CAHs and Eligible Hospitals

2) Attestation Worksheet for Eligible Professionals

3) All Stage 1 EHR Meaningful Use Specification Sheets for CAHs and Eligible Hospitals (Go to this link and select Meaningful Use from the Options menu; then scroll to Downloads section at the bottom of the page)

4) All Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals (Go to this link and select Meaningful Use from the Options menu; then scroll to Downloads section at the bottom of the page)

5) Stage 1 Changes Tipsheet

  • Clinical Quality Measures – explanation of basic requirements for documentation of adherence to clinical quality measures as required by meaningful use and the reporting process for Stage 1; Stage 2 requirements are addressed in the Stage 2 menu option. Multiple downloads are available on the Clinical Quality Measures page; a key document can be accessed here:

1) 2011-2012 Hospital and CAH Clinical Quality Measures

  • Stage 2 – thorough explanation of the newly released requirements for meaningful use Stage 2. Multiple links and downloads are available on the Stage 2 page; several key documents can be accessed here:

1) Stage 2 Overview Tipsheet

2) Stage 1 vs Stage 2 Comparison Table for Eligible Hospitals and CAHs

3) Stage 1 vs Stage 2 Comparison Table for Eligible Professionals

4) 2014 Clinical Quality Measures Tipsheet

  • Eligible Hospital Information – a go-to page for thorough documentation of CAH and eligible hospital incentive payment requirements. Multiple downloads and links are found on the page; several key documents can be accessed here:

1) All Stage 1 EHR Meaningful Use Specification Sheets for CAHs and Eligible Hospitals (Go to this link and select Meaningful Use from the Options menu; then scroll to Downloads section at the bottom of the page)

2) Hospital Attestation Worksheet

3) CAH Payment Tipsheet

  • Educational Resources – an important go-to page that includes links to every document referenced in the EHR Incentive Programs website
  • Frequently Asked Questions – all FAQs are available from the former EHR Incentive Program website and new FAQs frequently are added; note the new search process, especially if searching for earlier FAQs by using the originally assigned ID number