Tag: Meaningful Use

Former CFO heads to prison on Meaningful Use fraud

The former chief financial officer of a now closed Texas hospital, Joe White, has been sentenced to federal prison after admitting to meaningful use fraud, U.S. Attorney John M. Bales announced June 17.

U.S. District Judge Michael Schneider sentenced White, 68, to 23 months in prison.

White, of Cameron, Texas, pleaded guilty on Nov. 12, 2014 to making a false statement that Shelby Regional Medical Center in Center, Texas, was a meaningful user of electronic health records, when the hospital did not meet the requirements of the federal EHR Incentive Programs.

Schneider also ordered White to pay restitution in the amount of $4,483,089 to the meaningful use program, administered by the Centers for Medicare & Medicaid Services.

According to information presented in court, White was the CFO for Shelby Regional Medical Center in Center, Texas, in addition to other hospitals owned and operated by Tariq Mahmood, MD.  White oversaw the implementation of electronic health records for the hospital and was responsible for attesting to the meaningful use of electronic health records in order to qualify to receive incentive payments under the incentive program, according to a U.S. Attorney news release.

On Nov. 20, 2012, White knowingly made a false statement to falsely representing that the hospital was a meaningful user of electronic health records, when the hospital did not meet the meaningful use requirements.  As a result, Shelby Regional Medical Center received $785,655 from the program. In total, hospitals owned by Mahmood were paid more than $16 million under the incentive programs.

According to reports, the hospital continued to rely on paper records even as White attested to meaningful use .

White was indicted by a federal grand jury on Jan. 22, 2014.

“The granting of EHR funds to individual and institutional providers was intended to modernize medical record storage and access,” said Mike Fields, special agent in charge of the Dallas region’s HHS Office of Inspector General, said in a press statement. “Unfortunately, there are individuals and institutions like Mr. White and his hospital whose only intent for EHR funds was to enrich themselves.”

“The EHR Incentive Program was designed to enhance the delivery of excellent medical care to all Americans and especially for those citizens who live in underserved, rural areas like Shelby County,” U.S. Attorney Bales added. “There is no doubt that Mr. White understood that purpose and yet, he intentionally decided to steal taxpayer monies and in the process, undermine and abuse this important program.”

The case was investigated by the U.S. Department of Health and Human Services’ Office of the Inspector General, the Texas Office of the Attorney General Medicaid Fraud Control Unit and the FBI.

OIG has periodically called attention to the potential for fraud in the Meaningful Use EHR Incentive Program. In October 2012, the agency announced it would look at incentive payments CMS made beginning in 2011 to identify payments to providers that should not have received incentive payments  – those that did not meet the meaningful use criteria.

Doctors Administrative Solutions offers hand-held Quality Reporting Assistance Plans for both Meaningful Use and PQRS. Inquire with a Region Manager today, and learn more about how DAS helps doctors get back to being doctors again.

Groups Praise, Urge Caution for Meaningful Use Modifications

Several groups have submitted comments on CMS’ proposed meaningful use modifications for 2015 through 2017, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 6/15).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Details of Proposal

In April, CMS released a proposed rule that would shorten Medicare and Medicaid meaningful use attestation for eligible professionals and hospitals to a 90-day period in 2015.

Overall, the proposed rule would:

  • Realign the reporting period starting in 2015 to allow hospitals to participate on the calendar year instead of the current fiscal year period;
  • Reduce the number of meaningful use objectives to improve advanced use of EHRs; and
  • Remove redundant measures and those that have become widely adopted.

In addition, the proposed rule would change Stage 2 meaningful use requirements related to patient engagement. Specifically, CMS proposed reducing the requirement for patients to use technology to electronically download, view and transmit their medical records from 5% of eligible providers’ patients to just one patient (iHealthbeat, 4/13).

Comments on the proposed modifications were due June 15 (iHealthbeat, 5/28).

American Medical Group Association Comments

The American Medical Group Association in its comments praised CMS for easing the program’s reporting requirements, as well as for proposing a shorter 90-day reporting period.

AMGA CEO Donald Fisher said, “This proposed rule reflects that CMS has been sensitive to the struggles that the health care industry has had with meaningful use by simplifying some of the reporting requirements through 2017.”

The group also urged CMS to help strengthen the health IT infrastructure to support future data sharing requirements (AMGA release, 6/15).

College of Healthcare Information Management Executives Comments

Russell Branzell, president of the College of Healthcare Information Management Executives, in his comments called for a middle ground on patient engagement. He wrote that rather than requiring every specialist to demonstrate that patients can “view, download and transmit” their health information, those data should be aggregated into a single location for patients.

He added, “I definitely want patient data made accessible to patients or those taking care of them. But I don’t want to get every note out of some subspecialty office” (Pittman et al., “Morning Health,” Politico, 6/16).

Consumer Partnership for eHealth Comments

Meanwhile, a group of 50 advocacy groups organized by the Consumer Partnership for eHealth and the Consumer-Purchase Alliance in its comments expressed disappointment, saying CMS’ proposal to reduce patient engagement requirements would undermine patient engagement efforts (Clinical Innovation & Technology, 6/15). Specifically, CPeH said, “CMS’ proposed amendments constitute a dramatic retreat from essential efforts to make patients and family caregivers true and equal partners in improving health through shared information, understanding and decision making” (“Morning eHealth,” Politico, 6/16).

Debra Ness — president of the National Partnership for Women & Families, which was part of the coalition — said the groups “urge CMS to keep the existing patient engagement thresholds.”

Meanwhile, Bill Kramer, co-chair of the Consumer-Purchase Alliance, noted that maintaining efforts to give patients and caregivers “electronic access to and use of their health information” is key to achieving interoperability in the U.S. health care system (Clinical Innovation & Technology, 6/15).

Healthcare Information and Management Systems Society Comments

The Healthcare Information and Management Systems Society in a letter to CMS supported the agency’s proposal to ease reporting requirements but urged CMS to be cautious moving forward with other proposals, Health Data Management reports.

Among other things, HIMSS recommended that CMS:

  • Phase-in the new thresholds for the Patient Electronic Access Objective;
  • Reconsider the “unrealistic goal” of the 2016 hospital electronic prescribing requirement; and
  • Take into account the timing of the release of the final rule in terms of the “short turnaround in meeting” its requirements (Slabodkin, Health Data Management, 6/16).

Meaningful Use Hardship Exemption Requests Due July 1

Notice: Meaningful Use Hardship Exemption requests are due by July 1, 2015.

Providers who attempt to attest to meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs may find some obstacles standing in the way. Various hardships may come into play to prevent some healthcare providers from receiving incentive payments from the Centers for Medicare & Medicaid Services (CMS). Under the EHR Incentives Programs, providers who do not meet certain meaningful use requirements will obtain a payment penalty from CMS next year.

However, CMS does offer an opportunity for providers to file hardship exemptions and, after reviewing the applications, may decide on exempting some providers from the payment penalties. CMS recently announced that Medicare eligible professionals may be able to avoid the payment penalty starting on January 1, 2016 by filing hardship exemption applications by July 1 at the latest.

Providers can find all the pertinent information about the hardship exemption application on the CMS website under the EHR Incentive Programs section. The instructions for filing the application can be found here.

To access the hardship exemption application for individual eligible professionals, CMS offers this document. If filing a hardship exemption as part of multiple Medicare eligible professionals, a different application is offered.

The website also offers providers some examples that would qualify them to be exempt from the EHR Incentive Programs. There are some specific circumstances that CMS would consider while other issues may not qualify a provider for the exemption.

Providers filing for the exemption need to illustrate a particular circumstance keeping them from attesting to meaningful use requirements that is completely out of their control. Additionally, providers will need to map out exactly how the issue impaired their practice from meeting meaningful use regulations.

Certain categories under the hardship exemption will need additional documentation from eligible healthcare professionals. In order for CMS to consider a hardship exemption from the payment penalty, it is vital to apply by July 1.

A few key healthcare professionals, however, will not need to apply and will be exempt from the program penalties immediately. These eligible professionals include:

1) A newly practicing eligible professional

2) Hospital-based providers, specifically those who perform more than 90 percent of their services in an inpatient setting or emergency department

3) Specific specialists such as anesthesiologists, pathologists, radiologists, and those practicing nuclear medicine

For the providers listed above, CMS will be looking at Medicare data to determine whether an exemption for the payment penalty can be granted automatically. The exemption applications need to be submitted electronically or sent by direct mail no later than 11:59 p.m. ET on July 1, 2015.

To be clear, this exemption will only be valid for the following year. In subsequent years, if providers are still unable to meet meaningful use requirements due to a hardship, additional applications must be filed for the corresponding years.

It is also important to mention that there are certain healthcare providers (Medicaid-only healthcare workers, those with no claims to Medicare, or hospital-based staff) who cannot participate in the Medicare EHR Incentive Program and will not be considered Medicare eligible professionals. These individuals will not be affected by payment adjustments and do not need to apply for any exemptions.

 

To learn more about how DAS is helping practices alleviate the stress of Meaningful Use reporting, schedule a free consultation with a Region Manager today.

Sound Off: Is Penalty Phase Under Meaningful Use Requirements Fair?

Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, the majority of healthcare providers have been focused on implementing EHR systems and health IT tools as well as meeting meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. More recently, Stage 2 Meaningful Use requirements have been modified in a proposed ruling by the Centers for Medicare & Medicaid Services (CMS) and various stakeholders have been welcomed to submit comment on the proposal.

The College of Healthcare Information Management Executives (CHIME) made an official announcement last month applauding CMS for developing these modifications to the Stage 2 Meaningful Use requirements, as they are positioned to assist providers in meeting these regulations safely and effectively over the coming years.

One of the new changes includes the EHR reporting period, which CHIME approves of due to it helping keep physicians engaged in the program and keeping the healthcare sector moving toward increased EHR interoperability and care coordination.

CHIME also supports the drop in the patient engagement measure asking for 5 percent of patients to view, download, and transmit their electronic health information through portals. However, there is one issue that CHIME finds unfavorable.

“We are disappointed, however, by a missed opportunity to remove the largest remaining barrier to long-term programmatic success: namely, the need to address the program’s “pass/fail” construct,” the CHIME announcement stated. “Now that we are well into the penalty phase of the program, we do not believe providers who make good-faith efforts should be penalized for missing 1 percent on one threshold. Rather, policymakers should acknowledge providers who invest resources to become meaningful users, but fall short of perfection, by limiting penalties to those providers who clearly did not make the effort.”

Nonetheless, Stage 2 Meaningful Use requirements continue to play an important role in the healthcare industry, as the electronic prescribing objectives under the regulations may actually reduce the occurrence of adverse, drug-related events in diabetic patients, reports HealthITAnalytics.com.

A new study published in the Journal of the American Medical Informatics Association (JAMIA) attempted to discover whether the e-prescribing measure under Stage 2 Meaningful Use could lead to reduced rates of adverse drug events among their diabetic patients.

The study shows that between physicians who use e-prescribing often versus those on a lower threshold, 5 percent of high electronic prescribers had at least one patient with an adverse drug event while 6.5 percent of low e-prescribers had one or more patients that experienced a negative drug reaction. The researchers also discovered that high electronic prescribers were usually younger females who work in metropolitan regions.

Essentially, e-prescribing may lead to lower risk of hospital or emergency department visits along with less adverse events of antidiabetic medication. Stage 2 Meaningful Use could be key toward reducing poor patient health outcomes.

With more push toward value-based care payments, reduced medical errors, and attestation to meaningful use requirements, healthcare providers would benefit from the implementation and regular use of electronic prescribing software.

 

Are you struggling with Meaningful Use or PQRS reporting requirements? DAS can help alleviate the pain with customized reporting assistance plans… request more information on our site, and a Region Manager will contact you directly to see how DAS can assist!

EHR Incentive Programs Modified in New Proposed Ruling

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on April 10 announcing specific modifications to the EHR Incentive Programs. The most important aspect of these modifications is the change to the reporting period in 2015 to a 90-day period in line with the calendar year and a similar EHR reporting period for the following year.

Previously, the meaningful use requirements would pose a financial penalty on eligible providers and hospitals that did not meet the objectives of the EHR Incentive Programs for a full calendar or fiscal year. CMS also proposed changing the reporting year for hospitals from the fiscal to the full calendar year in order to have both eligible professionals and hospitals reporting during the same time period.

Another area that the modified proposed rule affects is the patient action measures, which are part of the Stage 2 Meaningful Use requirements regarding patient engagement. The proposed rule simplifies the meaningful use regulations by removing certain reporting mandates that have become redundant or duplicative due to a variety of improvements in EHR function since the inception of the Medicare and Medicaid EHR Incentive Programs.

Comments to this proposed rule need to be sent to CMS electronically, by regular mail, via express mail, or by courier no later than 60 days after the publication of the ruling. The modifications bring greater focus to the advanced use of EHR systems and attempt to align the Stage 1 and Stage 2 Meaningful Use requirements from 2015 to 2017 with the Stage 3 Meaningful Use regulations, which are expected to be reported to CMS starting in 2018.

The document explains that the meaningful use stages under the EHR Incentive Programs continue to have an important goal of increasing EHR interoperability among providers and hospitals. In order to reduce redundancy, CMS is modifying the number of objectives and measures that providers need to meet to demonstrate meaningful use of EHR technology.

The proposed ruling document discusses how the requirement mandating that more than 5 percent of patients view and download their health information is causing undue burden on healthcare providers. CMS offers a major change to this requirement through the years 2015 to 2017. Under the modified proposed ruling, only one single patient will need to view, download, or transmit their medical information to a third party.

Additionally, CMS proposes the secure electronic messaging objective under Stage 2 Meaningful Use requirements to no longer have a 5 percent threshold but instead have a yes/no reporting requirement asking providers to attest to the statement: “The capability for patients to send and receive a secure electronic message was enabled during the EHR reporting period.”

Another modified proposal CMS put forward is to perform a security risk analysis including addressing data encryptions in certified EHR technology and adopting security updates as necessary during the EHR reporting period.

CMS hopes that these modifications will provide more flexibility to eligible hospitals and providers attempting to meet meaningful use requirements under the EHR Incentive Programs.

Medicaid Eligible Providers Growing, But Medicare EPs Attesting at Higher Rate

Medicaid eligible professionals are registering to participate in the Meaningful Use program at a higher level than was initially anticipated by the federal government. However, Medicare EPs have higher MU attestation rates than Medicaid registrants, according to new data from the Office of the National Coordinator for Health Information Technology.

ONC’s Dawn Heisey-Grove told an April 7meeting of the Health IT Policy Committee that more EPs have registered with the Medicaid program than was originally estimated. Presenting data from the Medicare and Medicaid EHR Incentive Programs through February 2015, Heisey-Grove said the estimate from the Stage 2 Meaningful Use rule published in 2012 projected 145,000 Medicaid EPs, but the actual number is 176,000 Medicaid EP registrants—and registration rates have not yet plateaued.

The original estimate for Medicare EPs was 393,000 and the actual number is 369,000 registrants. And, while the total number of EPs registered for both Medicare and Medicaid was initially projected to be 538,000, that number now stands at 546,000 actual registrants.

“Most of that increase is by Medicaid professionals,” Heisey-Grove observed. “If you look at registration as a marker of intent to participate in the program, we see an ongoing increasing trend in that participation rate. However, we also note that Medicaid professionals are participating at a higher level than was originally anticipated and that will have impacts as we look through the program going forward, because Medicaid providers are on different timelines than Medicare.”

According to Heisey-Grove, Medicaid EPs can begin the Meaningful Use program as late as 2016 and receive incentive payments with final year incentive payments paid through 2021, while 2014 is the last year for Medicare EPs to begin the program and receive incentive payments with 2016 as the final year that incentives may be paid.

Nonetheless, Heisey-Grove also reported to the HIT Policy Committee that EPs registered with the Medicare program have higher Meaningful Use attestation rates than Medicaid registrants, and that less than half of Medicaid EPs attest to MU in the year immediately following receipt of an “Adopting, Implementing and Upgrading” payment. “Only about 32 percent of all Medicaid registered eligible professionals have achieved Meaningful Use compared to 86 percent of the Medicare providers,” she said.

While Medicare EPs are scheduled for Stage 2 two years after they have first attested to Meaningful Use, Medicaid EPs also need two years of Stage 1 before they can progress to Stage 2 but they may skip years between attestations. Yet, that flexibility granted to Medicaid EPs is not serving them well.

“Of all the [176,000] Medicaid registered providers, only 8 percent of them are actually scheduled to attest to Stage 2 in 2014,” said Heisey-Grove. By comparison, 9 in 10 EPs scheduled for stage 2 in 2014 were registered with the Medicare program.

Paul Egerman, a member of the HIT Policy Committee, suggested that the lack of Meaningful Use success achieved to date by Medicaid EPs has to do with the fact that “a lot of the Medicaid providers are practicing in practices or practice environments that have much less of an infrastructure than their [Medicare] counterparts.” Egerman continued: “This program is helping the rich get richer. People who have the IT structures are able to get more of the incentive money than the institutions of the poorer population because they do not have that same capability.”

Heisey-Grove replied that “this population needs extra assistance” and ONC is looking at ways to get it to them. She added that providers who receive assistance from Regional Extension Centers (RECs)—which target the Medicaid eligible professional population—are much more likely to achieve Meaningful Use than Medicaid EPs that don’t receive that assistance.

Sixty-two RECs across the country help primary care and underserved providers navigate the complex EHR adoption process from vendor selection and workflow analysis to implementation and Meaningful Use. According to ONC, the REC network includes 54 percent of all rural providers, 80 percent of all critical access hospitals, and 83 percent of all community health centers.

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