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Eligible Professionals: Deadline to Submit Hardship Exception Applications Approaching

Here’s the latest email from CMS on the hardship exception deadline:

Are you a Medicare provider who was unable to successfully demonstrate meaningful use for 2013? CMS is accepting applications for hardship exceptions to avoid the upcoming Medicare payment adjustment for the 2015 reporting year.

Payment adjustments for the Medicare EHR Incentive Program will begin on January 1, 2015 for eligible professionals.

However, you can avoid the adjustment by completing a hardship exception application and providing supporting documentation that proves demonstrating meaningful use would be a significant hardship for you. CMS will review applications to determine whether or not you are granted a hardship exception.

CMS has posted hardship exception applications on the EHR website for:

Applications for the 2015 payment adjustments are due July 1, 2014 for eligible professionals.  If approved, the exception is valid for one year.

New Hardship Exception Tipsheets
You can also avoid payment adjustments by successfully demonstrating meaningful use prior to the payment adjustment. Tipsheets are available on the CMS website that outline when eligible professionals must demonstrate meaningful use in order to avoid the payment adjustments.

May 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Meaningful Use Stage 2 Delayed Until 2015 (Unless You Don’t Want to Wait)

Big news coming out of HHS today, CMS issued a proposed rule that changes the EHR certification requirements, firms up the meaningful use stage 3 delay that was announced previously, and most importantly delays the meaningful use stage 2 requirement until 2015. I guess one could argue that it’s not a delay since you can still attest to MU stage 2 in 2014 if you’d like (some already have), but for practical purposes this is a delay in the enforcement of meaningful use stage 2 for many organizations.

It looks like CMS and ONC was listening to the backlash against meaningful use stage 2 and the potential fallout. This isn’t quite blowing up meaningful use, but it’s a step in that direction. Here’s the chart that ONC put out that shows the new timelines:
New Meaningful Use and EHR Certification Timelines - Meaningful Use Stage 2 Delay

It’s worth noting that this is just a proposed rule, but there were usually very few drastic changes between proposed rules and final rules in the past. Sure, there could be a few tweaks, but I bet this goes into place essentially as it stands.

This will be a relief to hundreds of EHR vendors that are behind on becoming 2014 Certified. I expect most will continue with their 2014 Certified plans, but many of their users will likely opt to stick with the simpler meaningful use stage 1 objectives and measures. What’s not clear to me is if the attestation process will stay the same (ie. self attestation in MU stage 1) or not. I’ve asked HHS and will update the post (see update at the bottom of the post) once I hear from them.

What do you think of these changes? What impact will this have on you and your organization?

Here’s another email that CMS sent out:

CMS and ONC Release NPRM Allowing CEHRT Flexibility and Extending Stage 2

Today, CMS and ONC released a notice of proposed rulemaking (NPRM) that would allow providers participating in the EHR Incentive Programs to use the 2011 Edition of certified electronic health record technology (CEHRT) for calendar and fiscal year 2014.

The NPRM will grant flexibility to providers who are experiencing difficulties fully implementing 2014 Edition CEHRT to attest this year. The proposed rule would allow providers to use EHRs that have been certified under the 2011 Edition, a combination of the 2011 and 2014 Editions, or the 2014 Edition.

Beginning in 2015, all eligible providers would be required to report using 2014 Edition CEHRT.

2014 Participation Options
Under this proposal, valid only for the 2014 reporting year, providers would be able to use 2011 Edition CEHRT for either Stage 1 or Stage 2, would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and use the 2013 definition CQMs.

Providers currently working on Stage 1 in 2014 would be able to demonstrate:

  • Stage 1 (2013 Definition) using 2011 Edition CEHRT, or using a combination of 2011 and 2014 Edition CEHRT; or
  • Stage 1 (2014+ Definition) using 2014 Edition CEHRT.

Providers currently working on Stage 2 in 2014 would be able to demonstrate:

  • Stage 1 (2013 Definition) using 2011 Edition CEHRT, or using a combination of 2011 and 2014 Edition CEHRT;
  • Stage 1 (2014+ Definition) using 2014 Edition CEHRT; or
  • Stage 2 (2014+ Definition) using 2014 Edition CEHRT.

UPDATE: Here’s the response I got from CMS about the reporting periods:

Reporting periods are not changing.

For 2014 Only
Because all providers must upgrade or adopt newly certified EHRs in 2014, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month (or 90-day) EHR reporting period in 2014:

Medicare eligible professionals beyond their first year of meaningful use must select a three-month reporting period fixed to the quarter of the calendar year for eligible professionals. Providers must attest to these reporting periods no later than February 28, 2015 at 12 am ET.

Medicare eligible professionals in their first year of meaningful use may select any 90 day reporting period.

Medicaid eligible professionals can select any 90-day reporting period that falls within the 2014 calendar year.

May 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

The Shift from Fee for Service to Outcomes-Driven Care Means Huge Opportunities

Sadly there’s no video of a presentation that Shahid Shah recently did, but the slide deck embedded in this post is well worth a look. I believe it was the keynote presentation at the VAR Healthcare event. The presentation is chock full of insights into what’s happening in healthcare and healthcare IT.

May 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

National Nurses Week Infographic

It’s National Nurses Week, and so I thought it was appropriate to share this Future of Nursing infographic from Norwich University. I of course was most interested in the nursing technology section.

National Nurses Week

May 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Obamacare and Nursing Quality Infographic

Everyone knows I love infographics. API Healthcare put one out with a bunch of data from a nurse staffing survey that they did with Harris Poll. In the poll they wanted to understand the perceived impact of healthcare reform on the quality of patient care provided at hospitals. I think you’ll enjoy.

API Healthcare Harris Survey Nursing Quality Infographic

April 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

FHA Supports Open Source Governance and Code Management of CONNECT

The Federal Health Architecture (FHA) is working with Open Health Tools (OHT) to migrate the governance and code management of CONNECT, an open source software solution that enables secure health information exchange (HIE), to their open source community. OHT, a 501(c)(6) non-profit organization that governs open source communities and provides a framework for individuals, vendors, and government to collaborate on health IT projects, has selected CONNECT as one of their projects.

This is a key milestone for the CONNECT program that and the beginning of a fruitful collaboration with the open source community and FHA. FHA looks forward to supporting the community’s efforts, through OHT, to implement a governance structure that provides a mechanism for community participants– including health information exchanges, vendors, providers, and academia – to expand their contributions to the CONNECT program and have a meaningful voice in its future evolution. FHA will continue to contribute to the development of CONNECT to ensure that there are versions of this program that support the unique requirements of the federal health community.

FHA anticipates that CONNECT will continue to be a core component of the rapidly growing interoperability ecosystem, allowing organizations nationwide to support better, more cost effective care for all U.S. citizens.

CONNECT development began in 2007 as a federated program managed by FHA and its federal partners, including the Department of Health and Human Services, Department of Defense and Department of Veterans Affairs, and Social Security Administration. Over the following seven years, CONNECT grew and evolved to meet nationwide requirements to enable secure, efficient HIE among the federal partners, states and private organizations. FHA engaged with members of the public and private communities to develop CONNECT, with the existing codebase including contributions from 15+ organizations.

CONNECT is distributed under the BSD 3-Clause (Modified BSD) License. See opensource.org/licenses/BSD-3-Clause for further license details.

As an open source capability, CONNECT is available to anyone to download and tailor to their unique needs. FHA encourages industry to join in the development of the CONNECT community and contribute to the evolution of CONNECT.

For more information about FHA, visit www.healthit.gov/fha or contact federal.health@hhs.gov. For more information about CONNECT, visit the CONNECT Community Wiki at wiki.connectopensource.org.

April 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Last Day for Medicare Eligible Professionals to Register for 2013 EHR Incentive

Today is the last day to register for the 2013 EHR incentive money. If you haven’t done so already, you’ll want to go and do that now. Unlike ICD-10, I don’t see this being delayed.

Here’s an email from CMS with details of the deadline:

If you are an eligible professional, today is the last day you can register and attest to demonstrating meaningful use for the 2013 Medicare EHR Incentive Program. You must successfully attest by 11:59 p.m. Eastern Daylight Time, to receive an incentive payment for your 2013 participation.

CMS extended the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program to allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year.

Medicaid Eligible Professionals
Eligible professionals participating in the Medicaid EHR Incentive Program need to refer to their state deadlines for attestation information.

Payment Adjustments
Payment adjustments for eligible professionals will be applied beginning January 1, 2015, to Medicare participants that have not successfully demonstrated meaningful use. For more information, visit the payment adjustment tipsheet for eligible professionals.

You must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to payment adjustments.

Resources

Plan Ahead
Review important dates for the EHR Incentive Programs and all CMS eHealth programs using this Interactive Timeline.

March 31, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

The Job Killing ICD-10 Delay Program

I thought I’d offer a little of my own spin in the headline since those in DC only like to read spin. Unfortunately, I don’t think those in DC will really hear the message and I believe the ICD-10 delay will be passed. I still think that most of congress is voting on the SGR part of the bill and not the ICD-10 delay, but this vote will support the many doctors who don’t want ICD-10 implemented at all ever. This is a strong and large group of doctors that congress does care about.

However, I can’t help but highlight the thousands of coders that will be affected as well. In the link above I quoted a coder who’d paid for the ICD-10 course and now it’s wasted money (and it’s not like coders have a lot of excess income).

Add to that story this story from an educator who switched their educational program to ICD-10. If the ICD-10 delay happens, then all of those newly trained ICD-10 professionals won’t be able to find a job. Read more below from Kelly Fast, MS, RHIA, CMT:

I am a program director of an HIT program in candidacy with CAHIIM. The program began in the summer of 2012. We anticipated we would have graduates this year, the year of the implementation. We went with the assurances from HHS that there would not be another delay. All of our coding curriculum has been taught with ICD-10 (with a nod to ICD-9 from a historical perspective). We now have graduates. As we are all aware, it is so difficult for new graduates to secure coding positions. This delay, if it happens, will definitely not be a competitive advantage for our students! We went with the implementation date sticking and the training in ICD-10 being a positive thing for our students in the workplace. It is so disappointing that this is even being considered.

From the perspective of how many students this will affect nationally — there are over 17,000 students in CAHIIM accredited health information programs.

I think of our students — our job is to prepare them as best we can for the workplace! Are our students going to be given a break on their student loans until October of 2015? I think not. Are our students going to have their loans forgiven when the skill they have gone into debt to learn is a distant memory to them, due to no fault of their own? Again, I think not.

To all students — keep practicing, practicing! At some point the new classification system will be implemented and you will have the opportunity to shine!

So far, AHIMA is keeping the implementation date for the RHIT exam with ICD-10 the same. That is one silver lining for the students. But, yes, this looming delay will have far, far reaching effects. We will be evaluated as a program as to how many of our students pass the exam. So thank you AHIMA for so far not pushing out the date of the switch of the exam from 9 to 10 for the RHIT. Also, we will be evaluated on how many of our students are able to become employed in healthcare. That one will definitely not be helped by any delay.

Also, we had scheduled an area ICD-10 training for next month on our campus. That will be postponed if the Senate passes this bill intact. Just the time and effort in getting all of the leg work done for that has been a lot, and it will all have to be repeated. When you are coordinating large gatherings of people, it isn’t as simple as reworking the dates. When I think about multiplying that effort for training rescheduling over and over for organizations all across the country…wow.

Here’s another personal story that illustrates the personal impact of the ICD-10 delay:

I’d like to chime in as a student about to graduate from an HIT associate degree program. Thank you for all your posts. Like all of you I am shocked by this turn of events. I am a single mom who enrolled in this program after my divorce which pulled the rug from under me and put my kids and I out of our home and, after being a stay at home mom, left me with no income. I’ve worked hard, sacrificed, and have been excited to enter this field that would be a perfect fit for me and would allow me to get back on my feet. I am only trained in ICD10 since the college I attend stopped teaching 9 because of the switch that was supposed to happen this year. I was planning on getting certified and entering the workforce this fall. I need to start earning an income or we could be out on the street. Where will this leave people like me? Congress apparently could care less how they mess with peoples lives. I too have contacted my senator. I pray they will hear us.

Unfortunately, I’m afraid the Congress looks more at the macro and political impact of this bill instead of the personal impact this will have on many people. I hear we’ll have to wait until Monday for the Senate to vote on the bill.

March 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

BREAKING: Possible ICD-10 Delay … Again – AHIMA Call for Action

UPDATE: It looks like this bill has passed the house with a voice vote. I believe it still needs to be passed by Congress and not be vetoed by the President.

UPDATE 2: Late on 3/31/14, the Senate passed the bill which delays ICD-10 by a vote of 64 – 35. Barring a veto from the President, the bill will go forth and the ICD-10 implementation date will be moved to October 1, 2015. All of the discussion for the bill was around the SGR fix with no conversation around the ICD-10 delay. It’s unlikely that the President would even consider a veto of this bill.

A bill that would adjust the SGR (Sustainable Growth Rate) was introduced to the US House and Senate with a 7 line provision that would effectively delay ICD-10 another year until October 1, 2015. Here’s the section of the bill:

The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.

This is really interesting news after the discussion we’ve been having in this Why ICD-10? post. No doubt there are a lot of strong feelings on both sides. Some really want a delay and some really want it to keep going forward. I wonder if Congress will get a mix bag of calls from both sides of the debate which won’t sway them either way.

AHIMA is definitely on the side of those calling for no delay to ICD-10. They sent out the following call to action to their community:

Call Congress Now to Request Removal of Delay Provision

Again, this bill is expected to go to the House floor tomorrow for a vote. AHIMA urges members and other stakeholders to contact their representatives in Congress today and ask them to take the ICD-10 provision out of the SGR bill.

Go to our website now and use your zip code to look up phone numbers for your representatives and senators in Congress. http://capwiz.com/ahima/callalert/index.tt?alertid=63161891

Phone Script Available Below for Use in Contacting Your Legislator:

“Hello Representative XX/Senator XX, my name is XXX and I am a concerned member in your district, as well as a healthcare professional. I am calling to voice my opposition to the language in the SGR patch that would delay ICD-10 implementation until October, 2015. CMS estimates that a 1 year delay could cost between $1 billion to $6.6 billion. This is approximately 10-30% of what has already been invested by providers, payers, vendors and academic programs in your district. Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished. I urge you, Representative XX/ Senator XX to oppose the ICD-10 delay and let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district as well as delay the positive impact for patient care.”

My question is if they delay ICD-10, will ICD-10 ever happen? A strong argument will then be made to move straight to ICD-11. Although, all of those people who spent hours coding their applications for ICD-10 won’t like that change.

Like many people, I’m somewhere in the middle on this. Some certainty would be the most valuable thing. I’m certain that HHS wants ICD-10 to go forward. That’s certain. However, congress may have different ideas.

March 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

ICD-10 Frequently Asked Questions (Including Update on Revised CMS-1500 Form)

The following is a guest blog post by Dana Deardorff.

Are you concerned about the upcoming changes in coding? The following are answers to frequently asked questions that will help you prepare for the changes ahead. Please note the deadline for the first significant change is April 1, 2014.

What does ICD-10 stand for?

ICD-10 is an abbreviation. It stands for the International Classification of Diseases, 10th Revision. It is used when referring to either the Clinical Modification (ICD-10-CM) or Procedure Coding System (ICD-10-PCS).

How will ICD-10-CM be used?

ICD-10-CM will replace ICD-9-CM codes, Volumes 1 and 2. It will be used when reporting clinical setting diagnoses.

How will ICD-10-PCS be used?

ICD-10-PCS will be used by hospitals to report inpatient procedures.

Who has to convert to ICD-10?

Health care providers, clearinghouses, payers and physicians all are required to convert to ICD-10. This is not optional and includes any HIPAA covered entity.

What will happen if I don’t convert to ICD-10 by the October 1st deadline?

If you submit ICD-9 codes after October 1, 2014, those transactions will not be accepted. Those transactions will be denied. This will cause you to lose out on reimbursements. You may need to apply for a line of credit to prepare for cash flow disruptions that may occur due to noncompliance problems. This will help protect you from negative impact if your medical practice partners do not convert to ICD-10 in time.

What is the deadline for the ICD-10 conversion?

The deadline is October 1, 2014.

What is this April 1, 2014 deadline I keep hearing about?

The April 1 deadline is for the revised CMS-1500 form used for submission of paper claims. The CMS-1500 form is an intricate part of the ICD coding system. The new form (version 02/12) is replacing version 08/05. As of April 1, 2014 providers need to use version 02/12 of the CMS-1500 form. The old form will no longer be accepted.

How is the revised CMS-1500 form tied into the ICD-10 transition?

Physicians will notice that the revised CMS-1500 form provides fields for the new ICD-10 codes. However, your payors may not have made the transition from ICD-9 to ICD-10. Physicians should use ICD-9 codes until you have confirmed that the payor has made the transition to ICD-10. After October 1, 2014, your payors should have all made the transition to ICD-10, and you should be able to use the new codes from that date forward.

What is different about the revised CMS-1500 form?

The revised CMS-1500 form:

* Provides fields and indicators for both ICD-9 and ICD-10 codes

* Provides documentation space for up to 12 diagnosis codes

* Offers qualifiers to aid in the identification of provider roles in the furnishing of services

* Uses letters instead of numbers as diagnosis code printers

You will want to upgrade your practice management software or order 02/12 forms immediately if you have not done so already. Discard any 08/05 forms after April 1, 2014.

When should physicians start using the revised CMS-1500 form?

Providers can start using the revised form on January 1, 2014, but all providers must switch to using the revised form as of April 1, 2014. Your (PM) Practice Management/EMR/EHR practice vendor can help you determine what you need to do to remain in compliance as you transition to ICD-10.

About Dana Deardorff of MediPro
MediPro is a full-service medical billing software company offering practice management (PM) software, electronic health records (EHR) and electronic medical records (EMR) from McKesson and IMS.

Since 1995, MediPro, Inc. has been a nationally recognized, award-winning medical billing software company offering practice management systems and electronic health record solutions. MediPro’s mission is to deliver and support integrated solutions to the healthcare community. MediPro recognizes the need for a comprehensive, interactive and cost-effective suite of applications that are customized to address the specific needs of healthcare offices.

March 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.