CMS Final Rule

July 23, 2010

Over the past few years, the chiropractic market’s response to impending HITECH & ARRA regulations has left me feeling surrounded by carnival racketeers. Scare tactics and misleading information have abounded. This article will discuss some of my favorites – and where applicable – provide references to government documents. (If I don’t provide references, how do you know I’m not just another carnival hawker?)

At the end of December, 2009, when an interim rule was released addressing the concept of “meaningful use,” I had hoped that some of the myths that abounded might be dispelled by facts. It didn’t happen. As of this past July , the final rule is in place. It’s all spelled out in an 864 page document that’s available online to anyone who cares to search for it. And last week, I got my hopes up. I was excited to receive a widely disseminated email by a chiropractor who addresses a national audience. It purported to clear up “rumors floating around on this issue.”

Unfortunately, it noted that “To qualify for the stimulus income in 2011, you must have certified EHR software in place by the end of 2010.” We’ll discuss that remark. Why don’t we begin with the granddaddy of all the whoppers I’ve heard perpetuated at seminars because it relates to one of the biggest questions that may be on your mind: “How & when do I get my
share of this stimulus money?”

Then, let’s discuss what it takes to qualify for that money… and whether you should care. I had always thought that Burger King® was the “Home of the Whopper.” It turns out you can go to a chiropractic seminar near you to hear some variation of the following: “The stimulus money is running out… and WILL run out by the end of the year… so you’d better purchase this product right now to ensure you get your money. If you don’t hurry, there’ll be no money left for YOU!”

First of all, there isn’t a single health care provider in the entire United States who has received this stimulus money yet. According to page 451 of the Final Rule, Eligible Provider payments will be made on an annual basis. Here’s the most pertinent quote from page 451: “CMS will issue payments as soon as possible after a qualifying EP attested to meaningfully using a certified EHR system, hence the monthly payment cycle; however, an EP will only receive one incentive payment for each year he/she qualifies. For qualifying EPs whose allowed charges for the payment year do not reach the maximum thresholds, the single payment contractor will disburse an incentive payment in the following year.”

Basically, regardless of when you first qualify, you’ll receive a single annual payment that will be tied to your qualification date. And since this money was allocated via legislation, it won’t disappear. You’re not competing with other health professionals to receive your share.

My next favorite whopper is “We’re the only product in the industry that is certified by CCHIT.” There are myriad problems with this particular lie. First, you can discern whether any product is certified by visiting www.cchit.org and selecting “Looking for certified technology? Click Here” on the right side of the page. And just so you know, currently certified CCHIT products handle things such as prescriptions, ambulatory EHR, inpatient EHR, etc.

Does that sound like chiropractic software to you? And we haven’t even gotten to the good part yet. I’m going to make a bold statement and point out that – even if you DID manage to purchase a CCHIT certified product – that product still won’t qualify for the stimulus. Here’s a quote from CCHIT’s website: “The CCHIT Certified® 2011 certification program includes a rigorous inspection of integrated EHR functionality, interoperability, and security according to criteria independently developed by the CCHIT’s broadly representative, expert work groups using CCHIT’s published testing methods. This program tests products separately from the ARRA program ”

Reread the last sentence of the above quote. CCHIT just announced that “On Tuesday, July 20, we submitted our complete application to the Office of the National Coordinator to become an Authorized Testing and Certification Body (ONCATCB).”

So, you might be thinking: How is it possible for me to have purchased a product that’s certified for meaningful use when CCHIT isn’t certified to grant certifications? Excellent question! It’s a mouthful… but an excellent question nonetheless! And the answer is… it’s NOT possible. That will change over the next few months. But the fact is that the government standards for certification purposes are different than CCHIT’s current standards for the small group of specialties that they certify. Finally, “We guarantee you will get your stimulus money” is a fun
one.

This is a multistage, multiyear process. So, get it in writing! And that leads me to the most important thing you need to remember: purchasing a certified EHR product – once such certifications are available – does NOT guarantee that you have demonstrated meaningful use or that you’re entitled to so much as a single penny from CMS.

WHY? The key word in the phrase “meaningful use” is “use.” Let’s get back to that quote from the beginning of this article. You may have received email that noted “To qualify for the stimulus income in 2011, you must have certified EHR software in place by the end of 2010.” So, what’s the problem? At best, this is a partial truth. If you purchase a certified product, you still haven’t demonstrated the “use” part of “meaningful use.” Now, you’ve likely been brainwashed to believe that the “use” part is all about your electronic S.O.A.P. notes. Sorry. One of the first things our government is concerned with is the percentage of Medicare/Medicaid claims you submit electronically. If you’re still sending paper claims, the good news is that they’ve relaxed the percentage based threshold requirements somewhat in the final rule.

They’ve also provided more time for you to meet these requirements by moving electronic claims to Stage 2 of this three stage process in 2013. (This has more to do with new ANSI standards that take effect in 2011/2012 than anything else.) However, electronic claims are a key part of “meaningful use.” Next, your brand new, certified EHR contains a “Problem List” – but you don’t utilize it. That’s not unusual. Most chiropractors only use a fraction of the features offered by their software. Uh oh! There are “percentage thresholds” for most requirements. Thus, you are expected to actually obtain that information and place it into your electronic patient records. From page 67 of the final rule: “… the thresholds for maintaining an up-to-date problem list, medication list and medication allergy list are set at 80 percent. We believe these thresholds will create a baseline that ensures that EPs, eligible hospitals and CAHS are maintain a minimum percentage of patient records in certified EHR technology, and allows the provider community to advance toward the longer-term objective of capturing all patient data in certified EHR technology.”

Before we go any further, I should probably point out something else that seems to fly beneath the radar. If you don’t have Medicare (or Medicaid where applicable) patients, this entire program is of no value to you. Furthermore, if you only have 2 Medicare patients, don’t expect to reap the magic $$ that have been dangled in front of you in webinars, at seminars, etc. As an Eligible Provider, your NPI will be tracked (page 450 of the final rule) to determine what incentive payments – if any – you’ll receive. The incentive payments are based on the current feeforservice
system and paid out as a percentage of fees charged, up to a maximum annual amount, through 2016 (annual limits are spelled out on page 483 of the final rule). Now, for those of you who have
heard that you’ll be excluded from this program (yet another myth), chiropractors are specifically mentioned 10 times throughout the text. Comments include concepts such as “prescribing authority” and continue through tracking certain types of clinical data that a chiropractor (and other types of Eligible Professionals) would be unlikely to need.

Thus, your needs have been taken into consideration. So, let’s sum things up. In a nutshell, as a chiropractor with Medicare/Medicaid patients, you’re eligible – if you can demonstrate that you use technology in a “meaningful” way. Likelihood is high that your current computer system will allow you to demonstrate meaningful use. Many of the requirements involve reporting issues such as “provide patients with a copy of their health information (including diagnostic test results, problem list, medication lists, and allergies” And until the first organizations are certified to provide certifications, the rest is moot. However, if you like being scared, and you’ve spent the last few years worrying about S.O.A.P., page 152 of the final rule discusses pending requirements for X12 5010 (electronic billing standards) that will take effect by 2012.

The discussion doesn’t indicate whether you get to skate on the requirement if you use a clearinghouse for claims submission. I would bet that you do. But we’ll see. Source: Mike Norworth, MPN Software Systems