Q&A Transcript from Meaningful Use Stage 2 Regulatory and Consulting Overview Webinar September 12th, 2013 EH = Eligible Hospital EP = Eligible Provider MU = Meaningful Use Pro EHR = Allscripts Professional EHR™ Ent EHR = Allscripts Enterprise EHR™ SCM or Sunrise = Sunrise Clinical Manager™ PQRS = Physician Quality Reporting System, formerly known as the Physician Quality Reporting Initiative (PQRI) CQM = Clinical Quality Measures CMS = Centers for Medicare & Medicaid Services ONC = Office of the National Coordinator for Health Information Technology EHR = Electronic Health Record ARRA = American Recovery and Reinvestment Act HITECH = Health Information Technology for Economic and Clinical Health Act (part of ARRA) CPOE = Computerized Physician Order Entry QRDA = Quality Reporting Document Architecture NIST = National Institute of Standards and Technology PACS = Picture Archiving and Communication System PHR = Personal Health Record CCDA = Consolidated Clinical Document Architecture ________________________________________________________________ Q: Can you report on Medicaid the same time the calendar quarter is being reported for Medicare? A: There is no issue with demonstrating Medicare and Medicaid during the same calendar quarter. I would validate your state Medicaid guidelines. For EPs (Eligible Providers), you can only participate in one program at a time. Since EPs participate independently, you could have any number of EPs demonstrating MU for Medicare and Medicaid simultaneously. In fact, the measures for demonstrating MU (Meaningful Use) are identical for the two programs. For EHs, you can participate in both programs simultaneously. ________________________________________________________________ Q: When we start the patient portal, the 90 day period can be the first quarter of 2014 right? A: The 90 day period can be any calendar quarter in 2014 for eligible providers. All measures must be demonstrated in the same reporting period per EP or EH (Eligible Hospital), and that reporting period must fall within a single program year. The reporting period for Medicare is one

calendar quarter, the reporting period for Medicaid is 90 days or 3 months. For EHs, the 2014 program year is aligned with the federal fiscal year, 10/1/13 – 9/30/14, and for EPs it is aligned with the calendar year, 1/1/14 – 12/31/14. Please see the timeline chart for further information. ________________________________________________________________ Q: Is this going to continue with the "overview" of MU, which we should all know the facts by now or will you be telling me what Allscripts has planned for Stage 2 and whether or not they have certified Pro EHR (Allscripts Professional EHR™) for Stage 2? A: Pro EHR version 13.0 is certified for MU Stage 2. This webinar is an overview. We will be holding product specific webinars in the near future. ________________________________________________________________ Q: Is there documentation on CMS website (or anywhere) about the Medicare 2014 calendar quarter reporting period? A: Yes-. You can also refer to our timeline chart. ________________________________________________________________ Q: is Pro EHR 12.1 /3 a 2014 version? A: Allscripts Professional EHR™ 13.0 is the 2014 Edition certified version. ________________________________________________________________ Q: I assuming we can use our 2011 certified edition to report in the upcoming January for 2013 MU. i.e., we do not have to purchase the 2014 before January, correct? A: You will need to meet the 2014 guidelines, as well as, demonstrate on the 2104 certified version for your attestation. You must have your certified 2014 edition installed and in use by the time you start demonstrating MU in 2014. ________________________________________________________________ Q: I believe the payments have been reduced do to the sequestration - that occurred earlier in the year to all programs. Can you validate this? A: You are correct; but the basis for calculating the foundational amounts hasn't changed. ________________________________________________________________ Q: Would a "2014 Edition"/ product be Allscripts' SCM (Sunrise Clinical Manager), 5.7? A: For SCM the certified 2014 edition is 6.1.

________________________________________________________________ Q: Our organization has gotten conflicting information on if they can attest to PRQS (Physician Quality Reporting System) measures in place of CQM (Centers for Medicare & Medicaid Services). We have read the information out on CMS (Centers for Medicare & Medicaid Services) and there is not clear guidelines on this. Can anyone on the call answer this question? Thanks! A: In order to substitute the PQRS CQMs for the MU CQMs (thereby only submitting one set of CQMs), the EHR (Electronic Health Record) you are using must be certified to directly submit CQMs to the PQRS system. Allscripts EHRs do not yet have that capability, although we are in the process of achieving that certification. ________________________________________________________________ Q: If we are currently using the 2011 edition, and plan to upgrade to the 2014 edition Q4 of this year, what will be the impact on our reports/reporting? A: For Pro EHR, there will be no impact. You will be able to generate reports via the 2011 reporting system for as long as you need to, and then shift to the 2014 edition reports as desired. ________________________________________________________________ Q: Does that also obtain to Stage 2 (regarding exclusions no longer counting for menu objectives)? A: Yes, beginning in 2014 you may not claim an exclusion for a menu item unless there are no other menu objectives for which you can meet the requirements. ________________________________________________________________ Q: in 2013 we are completing a full year of MU, so when 2014 comes around (which we report for the following year 2015) we only have to do 90 days for Stage 2 for the year of 2014? A: You will only need to report for one calendar quarter for 2014 Stage 2 for Medicare and 90 days / 3 months for Medicaid based on state-specific requirements ________________________________________________________________ Q: Is a Patient Portal required for Stage 1? A: Based on 2014 guidelines, a patient portal will be required for both Stage 1 and Stage 2. A portal is not specifically required by the regulation, but you need to use a certified EHR to meet the requirement, and the Allscripts provided certified process is use of a portal. ________________________________________________________________ Q: Please clarify the comment just made regarding a portal being necessary for stage 1. A: Based on 2014 guidelines, a patient portal will be required for both Stage 1 and Stage 2.

________________________________________________________________ Q: The online access for Stage 1 changes...do we get credit for having Portal and sending the invitation or is credit only counted when a patient has actually activated their portal account?

A: You get a point towards the 50% numerator when you issue a "countable" invitation - i.e., an email or

postcard, but not a poster in your office.- if a patient is provided information to create an account on the

healthcare organization’s patient portal, that the patient can be counted in the numerator for Report #1

for EPs who have seen the patient within the reporting period.

________________________________________________________________ Q: I'm new to this (dropped in my lap, hah). If we attested to Stage 1 (90 days) at the end of 2012, we are now on Stage 1 (full year)...is that correct? A: Yes, you've got it. ________________________________________________________________ Q: I would like clarification on what was just said about Patient Portal being required for Stage 1. We are advised by our HITECH (Health Information Technology for Economic and Clinical Health Act) contact that we did not need it until Stage 2 A: Based on 2014 guidelines, a patient portal will be needed for both Stage 1 and Stage 2. MU1 objectives were replaced by the MU2 objective for MU1 in 2014. ________________________________________________________________ Q: Is Intuit going to be ready? A: Allscripts Patient Portal™, powered by Intuit Health is certified as part of Allscripts complete EHR 2014 Edition certifications for Enterprise EHR 11.4.1 and Professional EHR 13.0. ________________________________________________________________ Q: A portal is required for those EPs attesting as a First year Stage 1?? A: Based on the 2014 guidelines, yes. ________________________________________________________________ Q: Will we cover which objectives apply only to portals and not to the EHR? A: The details can be found in the deck used for this webinar. Download it here. ________________________________________________________________ Q: When is Pro EHR going to have more CQMs certified? Currently there are only 13 certified for the 2014 version. This is not enough to choose from at this point.

A: More information to come in solution specific webinars. Professional EHR will have virtually all CQMs certified in time to demonstrate MU in 2014. ________________________________________________________________ Q: there seems to be overlap on how we could attest for some of the core and menu objectives (portal versus EHR). A: Some measures require both a portal and an EHR: Electronic copy of health information, and secure messaging, and depending upon your approach, Patient education. ________________________________________________________________ Q: When do the new Medicaid patient volume calculations apply? A: 2014. ________________________________________________________________ Q: Is that true if EP is attesting Stage 1 in 2013? I didn't think so. A: Yes; all EPs will be in Stage 1 of MU in 2013. ________________________________________________________________ Q: Do you have CMS rulings on that can be sent out outlining the changes for the 2014 guidelines? A: We will review during this presentation. Additionally, the recording of this presentation is available for replay. ________________________________________________________________ Q: What is CPOE? A: Computerized Physician Order Entry ________________________________________________________________ Q: Not clear on the answer regarding portal requirements. This is 9/2013 and we are told now that for Stage 1 a portal is required! A: If your demonstration period is for the 2013 calendar year, a portal is not required. However, a portal will be required for Stage 1 in 2014 based on the 2014 guidelines. ________________________________________________________________ Q: So to clarify in 2013, for Stage 1 we don't need a patient portal, but for 2014, for Stage 1 we do need a patient portal. But in 2014, we only report 90 days for Stage 1. Is this right? A: Based on guidelines applicable to 2103, you do not need a patient portal for a core measure. However, based on 2014 guidelines, a patient portal will be required. You will only need to demonstrate 1 calendar quarter for 2014.

________________________________________________________________ Q: Please clarify the "submitting CQM electronically"?? Is he referring to using the CQM for PQRI as well? A: No. CQMs are slated to be submitted electronically in QRDA (Quality Reporting Document Architecture) format beginning in 2014. However, the government is still defining the actual submission mechanism, so stay tuned. ________________________________________________________________ Q: Are these slides will available on the ClientConnect? A: Yes, and they will be emailed to you as well. ________________________________________________________________ Q: What’s EP stand for? A: Eligible Provider. EH stands for Eligible Hospitals. ________________________________________________________________ Q: If you've attested for meaningful use once then are you exempt from the penalties down the road? A: No. Penalties for non-participation begin in 2015. The only exception is if you haven’t attested for the first time by 10/1/14 (EPs) or 7/1/14 (EHs), in which case you get an early penalty! ________________________________________________________________ Q: On CPOE, is that 60% Med AND 30% Lab, etc. or it is 60% Med OR 30% Lab. It makes a big difference if each patient needs to just have one of them or needs all three. A: It is AND – all three order types must be achieved. ________________________________________________________________ Q: Will the Patient Portal that comes with Pro EHR meet the minimal requirements for Meaningful Use? A: You will need to have either the FollowMyHealth portal from Allscripts (Jardogs), or the Allscripts Patient Portal, powered by Intuit Health. ________________________________________________________________ Q: Does the Medicare reporting period for EPs specifically have to be a quarter in 2014? Or can it be any 90 days in the year? A: For EPs, the Medicare reporting period has to be a full calendar quarter, beginning on 1/1/14, 4/1/14, 7/1/14, or 10/1/14. ________________________________________________________________

Q: Please clarify how many menu items an EH has to select for Stage 2. It was 3. Is it now 2? Please provide reference. A: You must complete 3 menu items, unless you can claim exemptions for more than 3, in which case you must complete as many as you can. In other words, you must complete all possible menu items up to a maximum of three. ________________________________________________________________ Q: We've completed 90 days of Stage 1. We need to do a year now. With the 2014 rules, does that mean we can just do 90 days again? A: Medicare participants must complete a calendar quarter in 2014; Medicaid participants must complete 90 days (or 3 months in some states) in 2014. ________________________________________________________________ Q: When did these guidelines come out? We had some training yesterday in the office and were told portals were not required for Stage 1 and to forget about until Stage 2. A: These rules are part of the final rules for 2014, issued a year ago. ________________________________________________________________ Q: We completed Stage 1 and attested and received money for 2012. Are we required to do Stage 1 and attest again for 2013? A: Yes. In 2013 you must demonstrate Stage 1 for the full year. Q: Does the Enterprise I from Allscripts measure the number of patients that are offered access to the patient portal via the button in the patient banner? A: This is a product-specific question, and depends on the portal you are using (FollowMyHealth or Allscripts Patient Portal ________________________________________________________________ Q: Is the Symantec product utilized by Allscripts to analyze Security and Risk Analysis approved by NIST (National Institute of Standards and Technology)? A: This product, which has been discontinued, was only a questionnaire to guide qualified security auditors through the process: filling it out SN was considered completion of a Risk Assessment, but it did not constitute a security audit. ________________________________________________________________

Q: Summary of Care - Can this be done from one system to another, i.e., Allscripts to Epic????

Q: if we have an Allscripts EHR installed and configured does that mean we have attested for MU1? Is that a standard service you offer as part of an implementation? Or do we need to submit for MU1 attestation? A: No, installing the software is required, but you must use it in a meaningful way (“Meaningful Use”) and complete all core items and the correct number of menu items for your program year. ________________________________________________________________ Q: how do I show immunization submission for the year? A: This is a “yes/no” attestation: you must confirm that you completed this measure. We strongly recommend that you retain all correspondence and screenshots regarding this (and other MU) measures. ________________________________________________________________ Q: Slide 33 has Syndromic Surveillance listed as an EH Core measure only, but isn't it an EP Core measure also? A: No, Syndromic Surveillance is a Menu item for EPs (listed later in the deck). ________________________________________________________________ Q: How is Pro EHR accommodating the patient requested health information? A: Patient information is provided to the patient via the certified portal you are using (FollowMyHealth or Allscripts Patient Portal (Intuit)). ________________________________________________________________ Q: Is the electronic note a shared measure or specific to each EP? A: It is a shared measure. Given the structure of the measure, it is possible that more than one EP could get credit if they share a patient in the denominator ________________________________________________________________ Q: Electronic Notes is a Menu item for hospitals as well A: Correct. ________________________________________________________________ Q: I was recently out on ClientConnect and still only see the measures specific to our app Ent EHR for MU1. Will the MU2 documents be released soon or am I just not seeing them? A: If your documents are not there, they will be posted shortly. ________________________________________________________________

Q: Do you need to have a link to the PACS (picture archiving and communication system) of outside entities or is this just required for EP's who own imaging? A: The image measure is a menu item, i.e., it is optional. ________________________________________________________________ Q: Are physicians required to do the Cancer Registries? A: No, this is a menu item. ________________________________________________________________ Q: So if we attested 90 days in 2012 and will attest 365 in 2013 we will not need a portal until MU2. Correct? A: Based on the guidelines, you are correct, because a portal is required for both Stage 1 and Stage 2 in 2014.- SN Contradictory statement ________________________________________________________________ Q: please define "structured" A: “Structured” in general means data that is stored as values in fields, rather than free text or scanned images. ________________________________________________________________ Q: What version of Pro EHR is considered "2014 certified"? A: Professional EHR 13.0 ________________________________________________________________ Q: for stage 1 we completed the immunization reporting not syndromic reporting- are we required to do both now for stage 1 changes and or in stage 2? A: Beginning in 2014 (for EPs), Immunization Registries will become a core (required) measure, but Syndromic Surveillance will remain a menu (optional) measure. ________________________________________________________________ Q: Can you still register for 2013 and report stage one from October 1 through the end of 2013? A: Yes. ________________________________________________________________ Q: Where can we find information on which domain a CQMs belong to? A: This information is on ClientConnect. ________________________________________________________________

Q: Syndromic Surveillance: Who do we contact to get an exception letter to claim the exclusion? We are a specialty office and will do neither the immunization nor syndromic reporting for Public Health measures. Are exception letters even required from the government? A: If you do not participate in this reporting, then you can document this fact yourself. You do not require a letter from the registry for this purpose. ________________________________________________________________ Q: If an EP opts out of Medicare in 2013 but reported on Stage 1 in 2012, what happens? A: They will forfeit their incentive for 2013. When they restart in 2014, they will be at Stage 2. ________________________________________________________________ Q: Who will I need to speak with in regards to making sure my practice is on the right track as of now? This MU was just handed to me recently. I can run reports and know how to read them, but just need a yes, that were headed in the right direction A: Email MUServices@allscripts.com to engage our consulting services team. They can get you on the right track and ensure that you have the knowledge, tools, and system set-up you need to be successful. ________________________________________________________________ Q: The electronic information to be available within 3 days on line at patient request to see is to my read not the whole chart but just updated labs, tests results etc...per CMS: "Diagnostic Test Results – All data needed to diagnose and treat disease. etc." A: Yes, the provider has discretion over what to share. It’s never anticipated that the entire chart would be made available. ________________________________________________________________ Q: Will there be an Infobutton in WAND? A: Wand currently does not have Infobutton, but it is a planned addition. ________________________________________________________________ Q: One of the first slides it mentioned that for an EP you would attest a 90day period within a calendar year and then actually attest the following year correct? A: This is true for program year 2014. Reporting periods are 1 calendar quarter for Medicare, and 90 days / 3 months for Medicaid, in 2014, with attestations to be completed in the first two months of PY 2015. ________________________________________________________________ Q: What is MU Consulting?

A: We have a consulting services team that you can engage to help you achieve MU2. If you are interested in MU Consulting Services, email MUServices@allscripts.com or fill out this form. ________________________________________________________________ Q: Have the patient-specific educational materials offered from Allscripts been updated? A: We will be making the content provided by Medline Plus available through InfoButton. ________________________________________________________________ Q: How do we know that our patient information is compliant with this infobutton? A: We provide MedlinePlus. If you wish to add your own content, you are responsible for its quality. ________________________________________________________________ Q: So we could expect to rec funds with a few month after that 90days A: Normally that is the case. ________________________________________________________________ Q: If we are reporting for our first time for a 90 day period in 2013 for MU Stage 1 (report by end of Feb 2014), I do NOT need a portal? But for reporting MU Stage 1 during a quarter in 2014, I will need a portal? A: Correct. ________________________________________________________________ Q: what are the multiple programs used to determine the 7.5% penalty for EPs? A: Whether an individual EP is participating; whether they are ePrescribing, whether they are participating in PQRS; whether 75% of US providers are participating in MU. ________________________________________________________________ Q: We have providers that work 1 day per week at our clinic, 4 days at a different clinic and Hospital duty. This incorporates 3 different EMR' how are they supposed to attest with multiple EHR's? A: This is a challenge. You will have to take the reports from each system, and total the numerators and denominators for each measure at the end of the reporting system. Email MUServices@allscripts.com to engage our consulting team for assistance. ________________________________________________________________ Q: For the Medicaid Eligibility changes that were shown earlier, is this for attestation starting in 2014? A: Yes. ________________________________________________________________

Q: Can we get more information in the future about electronically submitting CQM's from Allscripts? I'm still a bit confused about this concept. A: CMS requires that CQMs be submitted electronically in a format known as QRDA (Quality Reporting Document Architecture). CMS has stated its intent to allow for the batch submission of multiple providers, but has not yet finalized the testing for this. They also have not yet specified the method by which QRDA files will be submitted: e.g., uploads, emails, etc. The industry awaits closure so that we can make this available. ________________________________________________________________ Q: Our hospitals are expecting to attest to Stage 2, Year 1 in 2014. Is the latest date to attest without penalty also July 1, 2014? Where can I locate CMS guidance to support this? A: Yes. Visit the CMS website to review the regulation, or consult their FAQs regarding Registration and Attestation: https://questions.cms.gov/faq.php?id=5005&rtopic=1979&rsubtopic=7697 ________________________________________________________________ Q: At the beginning of meaningful use stage 2 there was something like if 75% providers were not using EHR then there would be a 5% cut across the board anyway? A: No, if 75% of providers are not using MU by 2015, then the secretary has the discretion to augment the penalty, which is expected to be 1%. ________________________________________________________________ Q: When does stage 2 start? A: You begin Stage 2 at the later of these two events: in your third program year of MU, or the 2014 program year. The earliest anyone can begin Stage 2 is program year 2014. ________________________________________________________________ Q: Immunization Registry Question: For EEHR, when will the EHR be able convert the ACK messages from CIR and display it? A: Please attend our EEHR-specific workshops. They are currently in the planning stages but we will be announcing dates and locations in the near future. ________________________________________________________________ Q: We attested for Stage 1, have been audited, and falled the audit. Where do we go from here to attempt to reattest for Stage 1? A: If you have exhausted your appeals, then you must simply move on to your next program year. ________________________________________________________________ Q: Under what circumstances would an EP be required to demonstrate for both Medicare AND Medicaid?

A: EPs can only participate in one program at a time, and can only switch once. ________________________________________________________________ Q: Are there any glaring issues with 13.0 which would make it feasible to hold off on upgrading? A: No. ________________________________________________________________ Q: We finished stage 1 at the beginning of 2013 and just received our first payment. So I understand that Stage 2 will start in 2014. I am little confused about the time frame. Do we have to start Jan 2014 the stage 2? Is it just for 90 days again or a year? A: No. You complete two years of Stage 1 before proceeding to Stage 2. So for you, in 2014 you will do one calendar quarter of Stage 1 (assuming you are Medicare), and the do a full year of Stage 2 in program year 2015. ________________________________________________________________ Q: What about outside clinics? I have a few physicians that work in outside clinics, but are actually hired by those hospitals and use their EHR system at those clinics. Do those numbers need to be used in our denominator for our clinic's EHR? A: No. ________________________________________________________________ Q: If we are attesting in 2014 but for the 2013 payment year, are we still allowed to follow 2013 guidelines since he is in the 2013 payment year? A: That is correct. The rules apply to the program year, not the attestation period. ________________________________________________________________ Q: Which version of Pro EHR will be capable of receiving PACS images? A: 13.0 – however, you will also need an interface to your PACS system. ________________________________________________________________ Q: We are currently on version 9.2. Is it possible to jump to Pro 13.0 from our current version, or do we need to take smaller steps? A: Please consult with your Allscripts representative about your options. Log a case or contact insidesales@allscripts.com to begin the upgrade process. Each organization is slightly different, but we can assess where you are right now and the upgrade path you need to take. ________________________________________________________________ Q: Is there a release date for the PRO EHR 2014 Edition 13.0?

A: It is already generally available. ________________________________________________________________ Q: to clarify a prior Q/A...do we need EHR version 13.0 in order to report for the 2013 reporting period? (work done in 2013 and reported in 2014). A: The version that is required is determined by the reporting period, not the attestation period. So since you demonstrated MU in 2013, you do not need version 13.0 to report on that work – you will need 13.0 for your 2014 reporting period. ________________________________________________________________ Q: How much are the standard workshops for EP? A: The workshops are still in the planning process, but we will be announcing dates, locations, and pricing in the near future. ________________________________________________________________ Q: Is Allscripts considering a reporting package for Pro EHR for NCQA Patient Centered medical Home? We have a very hard time getting the reports we need to meet the PCMH Elements. A: Please consult with your Allscripts representative – we have solutions that can assist with this. ________________________________________________________________ Q: Are there costs for the workshops? A: There will be a fee for the workshops. They are still in the planning process, but we will be announcing dates, locations, and pricing in the near future. ________________________________________________________________ Q: We are on full year of stage 1 this year. Next year we would have to do 90 days of stage 2. We don’t know that we will make it for stage 2. Can you clarify what would happen if we do not attest? Can we skip stage 2 90 days and do a full year in 2015? A: If you skip a year under the Medicare program in 2014, you forfeit that year’s incentive. In this case, you would start your Year 2 of Stage 2 in 2015. With Medicaid, you can skip a year (or more) without penalty. ________________________________________________________________ Q: What version of EHR is required for Stage 2 and patient portal? A: Pro: 13.0 – EEHR: 11.4.1 – Sunrise: 6.1 ________________________________________________________________ Q: In light of HIMSS' and other organizations recent recommendation for a Stage 2 delay, do you feel that we will see that come to fruition and what is the deadline for that decision?

A: The HIMSS proposal was to add two additional quarters to report on MU, extending the time you would have to demonstrate to 18 months. The proposal did not call for a delay in the start, only in an extension of the finish. We believe that this proposal could succeed, but CMS and ONC have many wrinkles to iron out, so we don’t consider it a “done deal.” ________________________________________________________________ Q: Does the "Imaging Result" menu objective require that both the image and report be available via link through the EHR, or just the report? A: Just the image (though you will want the report as well). SN Access to both narrative and imaging data must available to the user when it exists ________________________________________________________________ Q: We are in the process of going provider based billing- if we do this will our Ambulatory side still report EP or fall under the EH standards? A: The factor that determines EP/EH is the Place of Service (POS): if the POS is 21 or 23 (Inpatient or ED), then you use the EH program. If the physicians are providing ambulatory care, they would not fall under the EH standards. ________________________________________________________________ Q: I see lots of info, correspondence for Pro for EP's for MU 2 but very little on ClientConnect or EP's using SCM?? Will more be added?? A: You should check the Sunrise product communities on ClientConnect. Thank you for bringing this to our attention. ________________________________________________________________ Q: Is there a webinar on the actual "how to" set up and do your reporting in Pro EHR? The actual click by click instructions on how to get the reports/results of patient charting for meaningful use? A: There will be solutions specific webinars in the near future. There are also step-by-step instructions on ClientConnect. ________________________________________________________________ Q: Regarding Patient Portal, to attest for 2013 Stage 1 (full year)...do we have to have portal running? A: Not until 2014. ________________________________________________________________ Q: CPOE has to be entered by any licensed healthcare professional per state guidelines? Do you know what the state of KY deems a licensed professional? A: You would have to check with your state. ________________________________________________________________

Q: Will state Medicaid follow the same rule regarding the portal? A: Yes. ________________________________________________________________ Q: when is 2014 do you have to have the pt. portal? Jan 1? A: You have to have your patient portal active during your reporting period. However, since your patients must actually be using the portal, and since it takes time to build patient engagement, we recommend getting your portal up and running as soon as possible. ________________________________________________________________ Q: For the Menu measure 3, will the radiology interpretation note (in addition to the x-ray image) also need to accessible electronically - Our physicians now include their x-ray interpretation within their note - so will I need a separate note for this now? A: A separate note will not be required. All that is required for MU is that an image is accessible. SN Access to both narrative and imaging data must available to the user when it exists _____________________________________________________________ Q: We have attested 2011 and 2012, but not all physicians passed their audits. Since they did not pass, do they have to do stage 1 again? A: For 2013, yes. ________________________________________________________________ Q: Can we claim an exclusion for both public health measures if they truly do not apply to our practice? A: In Stage 2, Immunization Registries is a Core requirement, so you could claim an exclusion for that. However, Syndromic Surveillance is a menu item, so you would have to complete 3 other menu items. ________________________________________________________________ Q: If the patient registered for the portal prior to the actual attestation calendar timeframe do they count in your 5% A: Yes. ________________________________________________________________ Q: For 2011 Stage 1 90 day we do not have to have Portal we can provide on CD or Flash drive correct? A: Correct. Also, in Stage 2, clinical summary can be provided through PHR, portal on the web site, secure email, electronic media such as CD or USB fob, or printed copy. ________________________________________________________________

Q: 2013 stage 1 year two..... Portal or not??? A: Portal not required. ________________________________________________________________ Q: What about ultrasounds where there are many images? A: At least one image would have to be available per order. ________________________________________________________________ Q: This presentation is from Allscripts though, do you have the CMS rulings about the portal being needed for stage 1 ‘based on the 2014 guidelines’? A: Yes, and this presentation is based on the CMS guidelines.- You can visit their site and see their guidance here: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html ________________________________________________________________ Q: If we have reported and attested for Medicaid, would we still be subject to the penalty for not reporting Medicare by 10/1/2014? A: No, penalties don’t begin until 2015. ________________________________________________________________ Q: I came in a little bit late. Where do I find the patient portal? A: Our Surround Solutions Team can tell you all about your options for patient portal. You can contact them at surroundsolutions@allscripts.com. ________________________________________________________________ Q: Do we log a case in regard to a patient portal? Our clinic just went live with PRO in June. A: Our Surround Solutions Team can tell you all about your options for patient portal. You can contact them at surroundsolutions@allscripts.com. ________________________________________________________________ Q: Do you have to upgrade to the version by a certain time?? A: You have to be on the 2014 Edition certified solution by the time you begin your demonstration of MU. However, we recommend going live on it at least a couple of months in advance so that you can adjust your workflows, etc. ________________________________________________________________ Q: If you fax a letter to the referring provider will that count for MU.

A: No. ________________________________________________________________ Q: I didn’t catch what was said about new EP’s being excluded. A: New physicians – those in their first or second year of the practice of medicine – can apply for an exclusion on an annual basis. ________________________________________________________________ Q: You just said the Image needs to be viewable when you just answered Brian’s question. This is only for EH not EP. Correct? A: No, this is a menu measure for both EHs and EPs. ________________________________________________________________ Q: For MU Security Assessment, which if I understood correctly must be done each year...do we have to be able to attest YES to everything in those assessments? In reviewing the LARGE number of requirements, I don't see how anyone could answer YES to all. A: You must have conducted a HIPAA Privacy and Security Risk assessment. This is a job best completed by a robust IT department or an outside consultant. ________________________________________________________________ Q: For providers that are first time participants in 2014, our understanding was their reporting period was by quarter. My understanding from what this presentation is that you can pick ANY 90 day period for these providers. Please clarify. Thanks A: You are correct – they may pick any continuous 90-day period in 2014. However, as first-time participants, they must complete both their 90 day demonstration and attest by 10/1/14 (EPs) or 7/1/14 (EHs) to avoid Medicare penalties. ________________________________________________________________ Q: We had problems this year during Stage 1 year 2. So I do not believe we would qualify in 2014. I know it’s not recommended but if you do skip a year would we then attest for year 2 Stage 1 in 2015? A: If you skip 2014, you will have to do Year 2 of Stage 2 – which will be a full year – in 2015. You should still attempt to complete Stage 2 in 2014, so that you will be prepared for 2015. ________________________________________________________________ Q: If we've already attested for Stage 1, what's the latest we can submit attestation for Stage 2? A: It depends on when you started MU. If your first year was 2011 or 2012, then you will begin Stage 2 in 2014. If your first year was 2013, then you will begin Stage 2 in 2015. ________________________________________________________________

Q: will the certified 2014 Edition of the Allscripts products allow for electronic submission of PQRS measures? A: Not directly – that is being considered for a later version. ________________________________________________________________ Q: Do you know, if one of my four physicians is non-compliant with all of this, does that ruin it for the group? A: No. MU for EPs is a provider-based incentive, so each provider succeeds or fails on their own. ________________________________________________________________ Q: If you are doing MU do you have to do PQRS also? A: Not necessarily, but usually. ________________________________________________________________ Q: If you do not meet MU in 2013, will you be assessed a penalty in 2015? A: No. Penalties begin in 2015, unless you have not made your first attestation by 10/1/14 (EPs) or 7/1/14 (EHs). ________________________________________________________________ Q: If getting vitals is not really a scope of our practice (dermatology) for stage 2 do we have to do all vitals or can we pick just blood pressure OR height & weight? A: You may select those relevant to your clinical practice. ________________________________________________________________ Q: For Patient Electronic Access measure, is there a clear definition of the minimum amount of health information that must be available in the Patient Portal? A: Yes. Please consult the documentation on ClientConnect. ________________________________________________________________ Q: What if we are using claims to report PQRS, is Allscripts capable for that. A: Yes, but at present this information is not submitted directly to PQRS by your EHR. ________________________________________________________________ Q: When is the last time to first attest for MU without having a penalty? I read Oct 2014 correct? A: Yes, for EPs the latest date you can attest is 10/1/14. ________________________________________________________________

Q: With the new Info button for patient education, will the patient education printed out from the data source still count for MU or must it come from the Info button? A: You can provide the content to the patient however you prefer, so long as the EHR guided you to that content SN via the Infobutton standard. ________________________________________________________________ Q: How do we get a connection set with our local health dept. to submit positive reportable test results? A: Please open a support ticket. ________________________________________________________________ Q: Which Enterprise EHR version meets 2014 guidelines? A: Version 11.4.1 is the certified version ________________________________________________________________ Q: Is the consulting service a free service? A: Some consulting is provided as part of your installation service with the MU Package. The rest is a paid service. ________________________________________________________________ Q: How do u know if u are going to use Medicare or Medicaid, can you just choose? A: In order to participate in Medicaid, 30% of your patients must be on Medicaid (20% for pediatricians). Otherwise, you would participate in Medicare. ________________________________________________________________ Q: So, stage 2 is not in effect in 2014? A: No, it is in 2014 for participants who started in 2011 or 2012. ________________________________________________________________ Q: If an audit is failed for year 1 stage 1, does the following year then become year 1 stage 1. A: Providers may contact the EHR Information Center through a toll free number, 888-734-6433, between 9 a.m. and 5 p.m. EST, Monday through Friday, for general questions on how to file appeals and the status of any pending appeals. I presume this information will be available there as well. ________________________________________________________________ Q: I thought v11.4.1 HF 1 was the certified version for ENT EHR? A: HF1 is required for ENT EHR; however, the certified version name is 11.4.1. If you upgrade in the very near future, HF1 will be added after the upgrade, otherwise it will be incorporated into your upgrade.

________________________________________________________________ Q: I am confused - so you do two reporting periods of stage 1 before you start stage 2? And are both stage 1 only 90 days - our first stage one was in 2013. A: Please consult the chart. For an initial attestation in 2013, you will do 90 days of Stage 1 in 2013, one calendar quarter of Stage 1 in 2014, and then begin Stage 2 in 2015 with a full year. ________________________________________________________________ Q: Any known changes in A/I/U requirements for Medicaid in 2014 reporting year? A: No, this part of the program is the same. ________________________________________________________________ Q: Still confused about Patient Portal & attesting in 2014 for 2013. Are you saying that to attest by 2/28/14 for full year of 2013 MU, that we would've had to have a Patient Portal in 2013? Or are you saying to attest for 2014, you have the portal in 2014? A: The rules apply to the program year you are demonstrating MU for, not when you attest. So for program year 2013, you don’t need a patient portal (even though you are attesting in 2014). ________________________________________________________________ Q: Please restate the information of how you certified the Protection of Health Information measure regarding overall General Encryption of data at rest i.e., on servers? A: When the SCM application is closed, the cache is cleared and there is no data remaining on the end user device that needs to be encrypted. This meets the MU2 requirement for encryption of data at rest. ________________________________________________________________ Q: We have a small Medicare population, interested in PQRS reporting to avoid 2015 penalty only, who do I contact about extracting data for PQRS reporting? A: Please open a support ticket. ________________________________________________________________ Q: Thank you! If CCD is Continuity of Care Document, what is CCDA? A: The CCDA is the new version of the CCD The difference is the “C” Consolidated Clinical Document Architecture (C-CDA) is the interoperable standard for integrating structured data into the EMR/EHR and sharing the data for Collaborative Care & HIE. ________________________________________________________________ Q: I am having trouble getting the exception letter for the syndromic surveillance data measure since we are a specialty office and we do not give ANY immunizations, I was told I can get a letter to keep on file, any suggestions?

A: Letters are typically granted by the registry when they cannot connect. In your case, since you don’t submit this kind of information, you don’t require a letter from the registry – you just need to document the fact that this is outside the scope of your practice. ________________________________________________________________ Q: Transition of care question - can it happen between our own doctors? We're an orthopedic practice - people don't typically transition out. A: Transitions of Care are between settings of care, and the sender must be on a different system than the recipient. ________________________________________________________________ Q: already attested for MU stage 1 for 90 days (2011) as well as full year for (2012)... Are we attesting for stage 2 one quarter for 2013? A: No, in 2013 you should be doing a full year of Stage 1. In 2014, you will demonstrate Stage 2 for one calendar quarter. ________________________________________________________________ Q: In relation to the CCDA, what are the requirements around how it gets to that particular group you are Transitioning to? A: 10% of the time it must be sent electronically via document exchange; the rest of the time it is up to you. ________________________________________________________________ Q: Did I understand correctly just now that we have to be on Allscripts Pro v13 by start of 2014? We are currently on Allscripts Pro v12.1. A: Almost correct – you have to be upgraded before you start demonstrating MU in 2014. ________________________________________________________________ Q: The electronic information to be available within 3 days on line at patient request to see is to my read not the whole chart but just updated labs, tests results etc...per CMS: "Diagnostic Test Results – All data needed to diagnose and treat disease. etc." A: You are correct. ________________________________________________________________ Q: Is Pro EHR version 13.0 available? A: Yes. ________________________________________________________________

Q: So for each stage, the first year you apply for the 90 days then the second year you apply for the whole year? Am I understanding that correctly? A: No. The only time you have a flexible 90-day reporting period is your first year of demonstrating MU; all subsequent reporting periods are a full year. The exception is 2014, when your reporting period will be one calendar quarter (for Medicare) or 90 days/3 months (for Medicaid). ________________________________________________________________ Q: Can you clarify "if you take 11.4.1 earlier, you get something a little extra vs. if you take it later, it will all be bundled together." Is Jim referring to the MU2 Package that has the eReferral and reporting platforms? A: No. 11.4.1 has a hotfix (HF1) that early upgraders will have added; the vast majority will have that hotfix incorporated into the base upgrade. The Meaningful Use package is a requirement for Enterprise and Professional; please be sure to order a license for each provider. ________________________________________________________________ Q: What changes will happen in portal install and implementation now that it is no longer part of Intuit, but done by Medfusion? A: Allscripts has two certified portal options for Pro EHR and Ent EHR: the FollowMyHealth portal and the Allscripts/Intuit portal. We have an additional option, Sunrise Portal, for Sunrise clients. Allscripts will manage the installation of any of those three portals. ________________________________________________________________ Q: Please clarify what is bundled in the 11.4.1 and when and when' it' is not bundled? A: 11.4.1 requires both a full patient portal (FollowMyHealth or Allscripts/Intuit) and the Meaningful Use Package – 2014 edition. The portal can be installed at any time; the MU Package installation is folded into your upgrade; please discuss with your Allscripts representative. ________________________________________________________________ Q: We had a new provider start with our practice this summer. Are we still able to get an AIU payment for this provider? A: Yes, if they had not received such a payment in a previous practice. ________________________________________________________________ Q: We have several physicians that met MU I in 2011, but did not in 2012. They will meet MU I in 2013. Will they attest for MU Stage II in 2014, even though it was not two consecutive years of Stage I? A: Yes. ________________________________________________________________ Q: Can you apply for PQRS incentive money and meaningful use incentive money

A: Yes. ________________________________________________________________ Q: What measure was being discussed when the comment was made about the image has to be viewable from within the application? A: Imaging results. ________________________________________________________________ Q: We upgraded to Pro EHR from MyWay at the end of 2013 and we attested for stage 1 in 2012. My question is, can we attest for stage 2 in 2013 with MyWay? A: No. MyWay is not certified under the 2014 edition – you will have to move to Professional. ________________________________________________________________ Q: As an EP, How can we identify if there are any registries in my state that can receive electronic submissions to meet Menu Measure 6? A: Please open a support ticket. ________________________________________________________________ Q: Do the Medical Assistants need to be certified? A: Medical assistants do not qualify for participation in MU. The CMS final rule for MU2 calls out that certified medical assistants can enter orders and have them count for CPOE. The certification has to be done be an organization other than the hiring organization. I think this is what the question is referencing. ________________________________________________________________ Q: Our office does not have patient portal in place because it was postponed by Allscripts due to the move to Pro from MyWay...how can we attest for stage 2 in 2013? A: You cannot demonstrate Stage 2 until 2014. You do not need to have a portal for demonstrating in 2013. ________________________________________________________________ Q: Medicaid Patient Panel, does the 90 days/3 months continue for years 2-6 or does it change to count a full previous year for patient panel? A: The Medicaid 90 days/3 months period is only for program year 2014. ________________________________________________________________ Q: We have a practice of about 40 or so providers, some who are individually attesting for the first time. Are an organization are all the providers in the same stage or do you attest for each provider in the stage each individual provider is in?

A: The latter: each provider follows their own path through the MU stages. ________________________________________________________________ Q: Immunization Registry Question: For EEHR, when will the EHR be able convert the ACK messages from CIR and display it? A: We will be having solution specific webinars in the near future.- ________________________________________________________________ Q: If an EP opts out of Medicare in 2013 but reported on Stage 1 in 2012, what happens? A: They forfeit their 2013 incentive, and would proceed to Stage 2 in 2014. ________________________________________________________________ Q: I'm confused, so when is Stage 2 in effect? A: Stage 2 begins in your third year of MU, or in 2014, whichever comes later. So unless you began MU in 2013, you will start stage 2 in 2014. ________________________________________________________________ Q: Is 1st period for Medicaid 90 days as well? A: Yes. ________________________________________________________________ Q: I just started w/my provider and I need to complete stage 1 for him what is the cut-off date for stage 1 A: Their first year, they must demonstrate MU for any continuous 90 day period. This means they should start by 10/3, but ideally sooner. ________________________________________________________________ Q: In the professional clinical module it is the Accepted invitations and not just invites going out that seem to be counted in the reports. How would the system pull invites out only? That is visible in the Practice Management and not shown in Clinical. A: You may count any invitation, so long as it is “countable.” Many practices are sending out emails or postcards, which is a great idea. However, those invitations will not be known to the EHR, so you will have to document those invitations separately. ________________________________________________________________ Q: Can anyone email MUservices@allscripts.com for general questions or do you have to purchase the consulting services to reach out to these people A: Anyone can email MUServices@allscripts.com We also recommend posting your questions on ClientConnect. ________________________________________________________________

Q: Where can we find information on which domain a CQMs belong to? A: See the documentation on ClientConnect. ________________________________________________________________ Q: Does a part time provider attest? A: Yes. ________________________________________________________________ Q: So are you saying that if you have to appeal an audit, the chances of you meeting meaningful use after the appeal is very unlikely? A: No, appeals are difficult to win, but they can be won. However, even if you lose an appeal, you must continue to participate. Losing the appeal only means forfeiting that year’s incentive (plus perhaps a penalty if there was fraud, etc.) – it does not remove your obligation to participate in MU going forward. ________________________________________________________________ Q: If you run out of time where can I find more detailed description about the objective of this measure and how Allscripts certified it? A: You can find detailed information on ClientConnect. ________________________________________________________________ Q: Is the CCDA format available in version 13 of PRO? I was recently told it is not available. A: The CCDA format is supported in PRO 13.0 (and all 2014 edition certified EHRs). ________________________________________________________________ Q: SO, am I clear that we are doing this certification provider by provider or as a group. A: Provider by provider. ________________________________________________________________ Q: I understand that sequestration has effected MU $. How much has this cut incentives and how long will that last? A: MU payments have been reduced by 2% due to sequestration. It is unknown when this will end. ________________________________________________________________ Q: I can't remember if a Physician Assistant is considered an EP and if they need to attest to MU. We are Medicare only. A: PAs may only participate under the Medicaid program.

________________________________________________________________ Q: Is patient portal a separate product? Or is it integrated into the new proEHR 13.0? A: It is a separate product: either FollowMyHealth or Allscripts/Intuit. ________________________________________________________________ Q: We are a specialist practice & don't do immunizations. How do we comply? A: You would be able to claim an exclusion for this measure. ________________________________________________________________ Q: So I would just continue with full year stage 1 as I have done this year? A: You will need to demonstrate a calendar quarter in 2014. Depending on where you are in your MU journey, it may be stage 1 or stage 2. ________________________________________________________________ Q: If we're not PCPs, and don't give immunizations, can we claim an exclusion for the registry? A: Yes. ________________________________________________________________ Q: Are registries not a required item, like in Stage 1? A: Immunization registries are a Core (required) measure in Stage 2; they were a menu (optional) measure in Stage 1. ________________________________________________________________ Q: Imaging results are a stage II option - how do e work with our radiologists or hospitals to get interfaces or is there another pathway? A: Getting an interface is your best solution. ________________________________________________________________ Q: If stage 2 is not in effect in2014 when shoudl we attest? I was told we could not attest until 2014 for stage 2? A: You cannot attest for Stage 2 until 2014. However, you must still participate in MU at Stage 1 in 2013 in order to claim this year’s incentives. ________________________________________________________________ Q: can we have a list of the resources? A: They are at the end of the deck.

________________________________________________________________ Q: how much is the 13.0 upgrade and when is it available? A: There is no license fee for the 13.0 upgrade, and it is available now. Please open a ticket for more details. ________________________________________________________________ Q: Every time I do these webinars, my questions never get answered, what am I doing wrong? A: We had well over 300 questions come in during the webinar, and the team tries to answer as many as possible during the webinar. All questions will be answered as part of the Q&A document. ________________________________________________________________ Q: We attested 90 days in 2011 for Stage 1 and will we need to attest for 365 days in 2011 or 2012 or 2013 to complete Stage 1? A: If your first year was 2011, then you demonstrated for 90 days in 2011, and should have demonstrated Stage 1 for a full year in 2012 and 2013.