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MU Stage 2: Your Questions Answered

The government’s EHR Incentive Program is complex and confusing, but there are options for 2014 reporting that may be relevant for you. Focusing on questions that I have received from readers like you, here are the options you may want to consider:

Q: We’re supposed to be attesting to Stage 2 this year, but we’re not ready. Can we go back to Stage 1?

A: Under normal circumstances, you cannot choose your Stage. If you started the program in 2011 or 2012, you are scheduled to report on Stage 2. (For those who began in 2013, you’re all set for Stage 1 this year.) However, the Centers for Medicare & Medicaid Services (CMS) recently issued a Final Rule offering the potential for an option. For early adopters – those who started the program in 2011 or 2012 — who are having challenges with Stage 2 reporting because of vendor issues in updating EHR systems, the recent CMS announcement points to a possible route to delay Stage 2 reporting. In order to take advantage of the so-called “Flexibility Rule,” CMS reveals that eligible professionals must attest to being “unable to fully implement 2014 Edition CEHRT [certified electronic health record technology] for a reporting period in 2014 because of issues related to 2014 Edition CEHRT availability delays.” CMS goes on to describe those delays as “one or more delays related to the development, certification, testing and release of an EHR product by the EHR vendor which then results in the inability for a provider to fully implement…” Any eligible professional experiencing one or more of these delays may choose the “flexibility” option.

Q: What are the criteria for the new flexibility option that CMS extends to those who are “unable to fully implement 2014 Edition CEHRT”?

A: You must be experiencing one or more of the following challenges:

  • Waiting for software updates;
  • Experiencing delayed or missing updates;
  • Software presenting problems with functionality;
  • Software itself rendering a provider unable to reliably use the software;
  • Software does not yet contain all required components; or
  • Inability to train staff, test the updated system or put new workflows in place.

So, even if you installed a 2014 Edition CEHRT system, you may still be eligible to revert back to Stage 1 if the system (or any part of it) is giving you one or more of these problems.

Q: Those are pretty broad criteria. Are there any reasons that we cannot use the new flexibility option?

A: CMS outlines four broad reasons that will not allow you to use the Stage 2 reporting delay option:

  • Financial issues being experienced by the eligible professional;
  • His or her inability to meet one or more measures;
  • Staffing changes or turnover; or
  • Inaction or delay in implementation.

There is one exception, however. If you are having a problem with the criterion dedicated to the summary of care record being transmitted during transitions of care, the eligible professional can indeed seek an exemption on the basis of this criterion alone.

Q: Do we need to prove any of this?

When you attest, you’ll simply choose the option. There is no additional documentation required at the time of the attestation. However, CMS recommends that you gather and maintain documentation for six years to support your action in the event of an audit. Audits will be on a “case-by-case” basis. While CMS provides no specifics about the documentation, I would suggest retaining all communications and correspondence regarding the challenges you experienced related to your EHR system. I also recommend creating a written documentation – a “note to the file,” if you will – to clearly support your choice of using an option.

Q: You keep mentioning “options.” What exactly are the options?

A: It’s easier to display them in a chart, so feel free to email me and I’ll send you one. However, here are the options from which you may choose if you are scheduled to demonstrate Stage 2 this year.

  • 2013 Stage 1 criteria and 2013 clinical quality measures (CQMs) using the 2011 Edition of CEHRT;
  • 2013 or 2014 Stage 1, or 2014 Stage 2 criteria and 2013 or 2014 CQMs using a combination of 2011 and 2014 Editions of CEHRT; or
  • 2014 Stage 1 or 2 criteria and 2014 CQMs using the 2014 Edition of CEHRT.

Q: Will this be an option for 2015?

A: In the August 29 Final Rule, CMS makes it very clear that there will be no flexibility or alterations to the program in 2015. However, Congress has already stepped in. On September 16, two members of the House of Representatives introduced a bill – the Flex IT Act – to reduce the reporting period to 90 days in 2015. If passed, the bill would only apply to the period of reporting, not to the stage.

Q: Do we have to be prepared to report in the final quarter, October 1 through December 31, 2014?

A: CMS has clarified that you can return to any quarter in 2014, and report on it. So, if you can successfully attest to meaningful use based on your January 1 to March 31, 2014 performance, go for it!

Q: What is the final day to report?

A: It depends on what you want to do. Through February 28, 2015, you can report your 2014 performance, which will allow you to achieve the 2014 bonus payment AND avoid the 2016 penalties. If you solely want to avoid the penalties, you actually have until July 1, 2015, to declare a hardship and avoid the 2016 penalties.

Q: We don’t want to fool around with this. What is the penalty?

If you did not report in 2013, or as of 0ctober 1, 2014, all of your Medicare reimbursement is subject to a 1% penalty in 2015. Failing to report for the 2014 reporting period means being penalized in 2016 penalty, which is 2%. As noted above, you have until next summer to declare a hardship, however.

Woodcock & Associates: Changing the Way You Work