PrognoCIS™ EMR

Meaningful Use – Stage 1, 2011 edition Reports, Dashboards, & CMS Attestation

For additional information regarding PrognoCIS, including Meaningful Use, please visit our Client Resource Center from your Home Page ( ).

v2b12

Revised: February 2014 – CMS updated screens (v2b12) Bizmatics, Inc. 4010 Moorpark Ave., Suite 222 San Jose, CA 95117

Housekeeping Bullets • Q&A will follow the presentation

– Please save your questions until the end

• Some features are dependent upon certain settings/configuration

– Local admin user

– Contact Bizmatics Technical Support or your Implementation Manager

• During webinar the GTM Chat window will be hidden

• All attendees will be muted when webinar begins; to mute yourself:

– On GTM Navigation Toolbar, click the microphone icon ( )

– On phone, click the Mute button or take off speaker if applicable

If we experience technical difficulties or are disconnected: The webinar will continue for scheduled duration Please stay on-line for the caller to re-connect All webinars are repeated if you must leave early

Identity & Access Management Account https://ehrincentives.cms.gov/hitech/login.action

EHR Certification #: #30000001SWUGEAS

Upon registering for participation in the EHR Incentive Program with CMS, an Identity and Access Management Account will be established by CMS for the provider. Each Eligible Provider (EP) must register for and receive a unique IAM User ID & Password with CMS based upon individual credentials as a medical professional. This IAM login will be your access to the attestation and incentive status tracking once you begin.

IMPORTANT REMINDERS

• MU is applicable to all patients regardless of payer.

• Each provider must report separately for reporting period under individual NPI (regardless if billed as group)

• Phase 1 extended through 2013; Phase 2 set to start 2014

• https://www.cms.gov/EHRIncentivePrograms

Medicare EHR Incentive Program The Medicare program for Eligible Providers runs from 2011 – 2016. The maximum benefit a provider can receive over that duration is $44,000.00 to be distributed as per the pre-determined payment schedule published by CMS. Failure to begin attestation for the year 2012 may result in $3000.00 reduction for a 2013 attestation (1st year).

EHR Incentive Benefit Schedules

Medicaid EHR Incentive Program The Medicaid program is offered and administered voluntarily by states and territories from 2011 – 2021. The maximum benefit a provider can receive over the duration of participation is $63,750.00 to be distributed as per the pre-determined payment schedule published by CMS. Please visit https://www.cms.gov/apps/files/statecontacts.pdf to verify specific requirements for your state if applicable.

https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage

1st Year of Participation • Medicare = 90-days, consecutive within calendar year • Medicaid = adopt/implement EHR (no data submission required)

The Reporting Period

2nd Year of Participation • Medicare = 365 days within calendar year • Medicaid = 90-days, consecutive within calendar year

The actual 90-days chosen will be declared during the attestation process with CMS. If the initial 90-day attestation is rejected, a new attestation for a different 90-day period within the same year must be submitted (you cannot re-file for the same 90-days).

Subsequent Years of Participation • 365-days each subsequent year of participation thru 2016 (Medicare) or 2021 (Medicaid)

Deadline: March 31, 2014 11:59pm, EST

Note: Medicaid may vary by state.

Attestation Values There are two types of values that may be reported to CMS during attestation:

• Numerical representation of patient population • Affirmative or Negative confirmation of EHR functionality

Numerator / Denominator These measures are defined as requiring a minimum % of patients seen to comply with the specific criteria out of all patients who qualify for the criteria. The denominator is the total number of potentially-compliant patients; whereas the numerator represents the actual number of compliant patients based on the criteria defined. Performed At Least Once Other measures require a confirmation that the functionality exists and that you have performed or tested the feature at least once. These are identified by attesting Yes or No and do not have a minimum % requirement of patients seen. Note: This may require the assistance of your project manager or technical support to complete the required testing.

Measure %-Y/N

Providers are receiving their ARRA reimbursements regularly!

Recap: PrognoCIS Activity

1. Use CPOE for entering medication orders 2. Drug/drug and drug/allergy Interaction checks 3. Maintain up-to-date problem list of current/active diagnoses 4. E-prescribing of permissible prescriptions 5. Maintain active medication list 6. Maintain active medication allergies list 7. Record specific defined demographics 8. Record and chart specific defined vital signs 9. Record smoking status for patients 13 years or older 10. Report ambulatory clinical quality measures to CMS or to the state 11. Implement at least 1 clinical decision support rule for specialty & track it 12. Provide patients with an electronic copy of their health information 13. Provide patients with clinical summaries for each visit 14. Sharing of key clinical information amongst care providers & other agencies 15. EHR technical security to protect electronic health information

1. Drug Formulary Checks 2. Clinical Lab Test Results 3. Patient Lists by Conditions 4. Patient Reminders 5. Timely Electronic Access to PHI 6. Patient-specific education resources 7. Medication Reconciliation for patients transitioned from other provider of care 8. Summary of Care Record to other providers of care for patients transitioned 9. *Submit electronic data to immunization registries 10. *Submit electronic syndromic surveillance data to public health agencies

PrognoCIS Requirements:

Enable e-prescribing Define applicable properties Train applicable staff who use EMR Monitor dashboard or tabular reports Perform applicable “only-once” test files Complete required reporting period

Menu Set Measures

Core Set Measures

15 Core Set measures are mandatory 5/10 Menu Set measures must be selected

Meaningful Use Tabular Report Use this tabular report to monitor your compliance for all measures during the reporting period. This is the source of what you will use for attestation.

Reports a Tabular a Meaningful Use by Provider x 90-day Period

CQM (CS-10) also requires % reporting

Things to Remember:

CS = Core Set, all 15 mandatory MS = Menu Set, report 5 out of 10 Percentage must exceed Min Req. 0.00 is valid for:

Excluded measures Menu Set not being reported

Meaningful Use Tabular Report - Lists When totals are not reaching the required thresholds, and you need to know the underlying patients, there are a series of detail reports available by measure.

Reports a Tabular a List of Patients…

Shows patients in the Denominator but not in the Numerator. These

Lists are only applicable for measures that are not time/date sensitive.

Clinical Quality Measures • 44 total Clinical Quality Measures have been defined • EP must attest to a minimum of 6 (w/a possible maximum of 9^)

• 3 mandatory Core measures (NQF0421, NQF0013, NQF0028) • 3 alternate Core measures if applicable (CMS will prompt you) • 3 any other measure of remaining 38 available (user choice)

0 is an acceptable value for Phase 1. There is no dashboard equivalent of CQM.

Note: This measure is actually

deleted in 2013; you must still report data.

This report takes approximately 45 min – 1 hour to generate; please run ahead of your attestation so it is ready for you. It must be ran for each provider.

Meaningful Use Dashboard Graphically displays same data as Meaningful Use tabular report.

arra.cs.required.measures / arra.ms.required.measures

All measures being reported should show in the green unless exclusion

applies.

N/A for CQM – CS10

Dashboard Features While viewing the dashboard, shortcut links are available to enable you to easily view the numerator/denominator values as well as detailed definition of each measure.

View Details displays the definition & minimum percentage required by CMS.

Tooltip summarizes the numerator and denominator values for the specific measure.

Dashboard is provider & date specific (Note: Previous results default.)

Use <ALT> <TAB> to toggle between

CMS & PrognoCIS.

CMS Activity

Any time after you have completed the reporting period, you can submit your attestation on-line with CMS. During this process, you must key the actual numerical values (i.e.: “numerator” & “denominator”) or attest positively (i.e.: answer Yes) as applicable for each measure. You must also indicate whether or not you are excluding yourself as applicable.

https://ehrincentives.cms.gov/hitech/login.action

What to do on CMS:

Register for the program Login to the IAM account provided Follow attestation prompts to complete Agree to legal statements Submit attestation

Medicaid attesters, please check with your state Intermediary

for specific requirements.

The Attestation Process

You must register before you can attest.

http://www.cms.gov/EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide.pdf

• Click Attest button to display the Topics TOC • The Action options will change based upon the status and year of attestation.

Example of Year 2.

Topic 1 - Attestation Information • Verify registration information

• Note: If applicable, the EHR Certification # may be edited at this point.

• Specify date range for initial reporting period (will default for subsequent years) • Questionnaire will immediately launch with Core Set then prompt each section thereafter

Date range defaults for

Year 2.

Click Save & Continue. to save your answers & scroll

to the next topic or suspend until later.

Topic 2 - Core Set Measures

Declare exclusion if applicable Declare that your data is based only upon your EHR records Enter the Numerator Enter the Denominator Click Save & Continue button

% Numerator / Denominator with Exclusion

Example of Measure w/Exclusion

Patient Records Reported • Answer only when prompted

• Typically associated with measures that have exclusions available

• Applicable when attestation year crosses over multiple EHR or when you have used EHR for only part of the calendar year for which you are attesting • Applicable when data you are entering reflects only those records maintained within PrognoCIS and thus reflected on our reports and dashboards

Additional Questions w/Exclusion

% Numerator / Denominator without Exclusion

Core Set Measures w/o Exclusion

Example of Measure w/o Exclusion

Multi-criteria Exclusions

Example of Multiple Exclusion Criteria

If you take the 1st exclusion, the 2nd one

will not prompt.

CS-10, Clinical Quality Measures CS-10 originally required you to report a numerators/denominators for minimum of 6/maximum of 9 NQF measures. This requirement was eliminated in 2013.

.

Effective for 2013 attestation

% Numerator / Denominator must still be entered later on

In the process

Topic 3 - Menu Set Measures Upon completing CS-15, you will be

prompted to select five menu measures.

MS-9 & MS-10 are presented first - then MS-1 thru 8

Select 5 out of 10 - 1 of which must be either MS-9 (Immunization Data Submission) or MS-10 (Syndromic Surveillance Data Submission).

Only those 5 selected will prompt for response.

The first selected Menu Set measure will reflect either #9 or #10 (whichever one you choose). Answer according your state or local requirements for the specific data submission type. Note: You may or may not be able to select the exclusion for either measure based upon your state Immunization Registry status or Public Health Depart- ment requirements locally.

MS-9 Immunization Data MS-10 Syndromic Data

The last measure numerically prompts first.

Note: The first question prompted sequentially will actually be either MS-9 or MS-10 (whichever one you chose) and then the other 4 menu measures will follow numerically.

Menu Set Measures w/Exclusion

If you take the 1st exclusion, the 2nd one

will not prompt.

MS-9 / MS-10 Multi-criteria Exclusions

MS-9 – State-specific; availability of registry MS-10 – Local PHD-specific; availability to accept e-PHI

Take exclusion 1 if you do not perform immunizations (MS-9) or are not under local law to report syndromic data to your public health department (MS-10).

Take exclusion 2 when you do perform immunizations (MS-9) or must report syndromic data to your public health department (MS-10); however, the state or PHD does not have an applicable electronic information system. If there is an electronic system in place, you must also perform a test export of the functionality from PrognoCIS.

Note: If Exclusion 1 is taken, you will not be prompted for Exclusion 2.

Note: If Exclusion 2 is taken (Part a), you will not be prompted for Part b.

If you answer No to the a-question, you must answer Yes to

the b-question.

• States w/Registry Available • Florida – currently in production

• Illinois – currently in production • Maryland – currently in production

• Virginia • New Jersey • Washington • Michigan • Georgia • Nevada • Pennsylvania • New Mexico

• N/A at state level – exempt from reporting at this time • California • North Carolina

Known Immunization Registry Status by State

If your state has a Registry system, you must arrange for a test file to be sent by PrognoCIS to that Registry.

Public Health Department statuses are not known as they are localized. If MS-10 is applicable for your practice, please contact your PHD to verify if they accept data

electronically then provide us the contact details.

PQRS Pilot Screen

NOTE: If you select Option 1, you

will not be able to complete your attestation.

This refers to PQRS as part of Meaningful Use. PrognoCIS has implemented PQRS as a separate module & thus it is not part of your MU attestation. Note: Although measure 10 was deleted for 2013, the CMS Attestation System still requires you to enter the data. Even if you enter zeroes, you will not be penalized as to your incentive if approved.

https://www.cms.gov/MLNProducts/downloads/EHRIncentivePayments-ICN903691.pdf

Effective for 2013 attestation

% Numerator / Denominator must still be entered later on

In the process

Topic 4 – Core Clinical Quality Measures

Remember: CQM % values are displayed on their own report, which

must be run in advance.

For Phase 1, a zero is acceptable.

The first three CQM on the report; e.g.: NQF-0013, NQF-0041, NQF-0028

Upon completing Menu Set measures, you will be prompted for the 3 core CQMs.

Topic 5 - Alternate CQMs

If not prompted, then you do not need to report these values. The Topics screen will show N/A.

Unless these are required, you may not see this; but if it displays,

read it carefully.

Alternate CQM (cont’d) – Revised Oct. 2013*

*This slide may not apply to all attesters. It is conditional upon Core CQM values.

When alternate CQM are required (due to reporting 0-denominator for a core CQM), the system invokes a loop wherein you must select

Save & Continue twice for each alternate measure to save the attestation.

Once you click the button a 2nd time, then

it returns you to the CQM selection screen. Repeat for each one.

Topic 6 – Additional CQMs

Select any 3 from the remaining measures.

All remaining CQMs will display. Scroll through and select any 3 of choice. The system will then prompt for numerator and denominator values for only those three.

Verify then Submit.

STOP

At this point, you may still modify your answers. Click the blue triangle next to the topic you want to review.

Review Your Answers!

Review Your Answers (cont’d)

Remember to correct any answers that have been

answered incorrectly.

At this point, you may still modify your answers by clicking the Edit button. Once you actually

submit the attestation, it may be rejected if information is incomplete or inaccurate.

Review (cont’d) – Revised Oct. 2013*

Do not be confused.

*These measures are part of the original 2011 edition published for Stage 1; however, as of Oct.

2013, Core Measures are revised.

Attestation Statements & Submission After the data has been submitted, you must electronically sign verification of the accuracy and indicate your agreement with the data submitted.

Agree then Submit

Disclaimer (after Submission) After completing all of the required measures, the Attestation System will automatically prompt you to verify and submit the data.

Agree to continue

Make sure when attesting to the Performed at least once measures that

you have actually executed the task. You are attesting here to the

truthfulness of all results reported.

After verifying and submitting your attestation, the system will allow you to print a receipt and to review your results.

Submit Your Attestation/Print Receipt

In addition to printing your receipt, you may review your data by clicking the Review Results button. If any measure is Rejected, your attestation may fail.

After verifying and submitting your attestation, the system will allow you to print a receipt and to review your results.

Viewing Results Status

At this point it is too late to modify results.

Click the arrow to review results & verify completeness of data entry for each measure; i.e.: status should = Accepted . Entered column must be populated, i.e.: % must exceed requirement Cannot = No

Menu Set Measures and Clinical Quality Measures can also be reviewed.

Viewing Results Status (cont’d)

3 Core Clinical Quality Measures + 3 Additional Clinical Quality Measures

Double-check

yourself!

Attestation Status Track your attestation through the system after it has been submitted & wait for the $!

CMS Audit Requirements http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf

Medicaid Agency audits are independent. See your intermediary for

more information.

Regarding CS-15, please be sure to have local, written documentation

of internal Risk Assessments in case of audit.

Ok, let’s summarize!… Complete the reporting period in PrognoCIS based on program requirements Login to CMS IAM account (https://ehrincentives.cms.gov/hitech/login.action) Select the Attestation tab & click the Attest button

• If resuming a previously started attestation, the label will read Modify Follow the screen prompts through each section, clicking Save & Continue button Read/sign acknowledgments and review your results Submit the attestation and print your receipt Collect your reimbursement from the US Government!

Important Reminders:

Each provider is responsible for own reporting Run CQM tabular report in advance Register with CMS first Attestation is between Eligible Provider & CMS Time-sensitive measures cannot be retroacted “At least once” tests must be executed within the reporting period

Deadline: March 31, 2014 11:59pm, EST

Note: Medicaid may vary by state.

Questions & Answers

Review Time!!!

Contact Us

Product & Customer Service Management

• Minal Dukle Technical Support Director mdukle@bizmaticsinc.com • Amit Tambe Technical Support Manager atambe@bizmaticsinc.com • Trapti Khatwani EMR Product Manager tkhatwani@bizmaticsinc.com • Malvika Tarnekar Billing Product Manager mdeshmukh@bizmaticsinc.com • Sheila Baldwin Billing Services Manager, EST sbaldwin@bizmaticsinc.com • Joseph Shanabarger Training Manager, EST jshanabarger@bizmaticsinc.com

Implementation/Training Project Managers

• Amy Norcom (503) 336-1801, PST anorcom@bizmaticsinc.com • Julia Shanabarger (727) 400-4915, EST julia@bizmaticsinc.com • Lynn Kripp (302) 444-4215, EST lkripp@bizmaticsinc.com • Mandy Chilson (916) 749-3788, PST mchilson@bizmaticsinc.com • Misha Chauhan (408) 759-1572, EST mchauhan@bizmaticsinc.com • Nandita Pai (408) 873-3030, PST npai@bizmaticsinc.com • Om Thakur (408) 850-1246, EST othakur@bizmaticsinc.com • Santosh Ogale (408) 850-1463, CST sogale@bizmaticsinc.com • Shweta Dukle (410) 609-6340, EST mrd@bizmaticsinc.com • Sridhar Babu (408) 850-1246, PST sbabu@bizmaticsinc.com • Siddhi Une (408) 873-3033, PST sune@bizmaticsinc.com • Terrence Gardner (415) 259-5556, PST tgardner@bizmaticsinc.com • Yolie Delgado (575) 644-6686, CST ydelgado@bizmaticsinc.com

Technical Support (408) 873-3030, 9am-9pm EST

Home Page Client Resource Center mu@bizmaticsinc.com