CMS official fields questions on 2014 CEHRT flex rule

The publication of the 2014 certified EHR technology final rule less than two weeks ago has prompted a slew of questions—which Elisabeth Myers, policy and outreach lead at the Centers for Medicare & Medicaid Services (CMS) attempted to address during an industry briefing on Sept. 10.

In the final rule, published on Aug. 29, eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the EHR incentive program. The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012, according to CMS.

“As confusing as [the final rule] looks, it’s actually a simple concept,” Myers said during the briefing hosted by the College of Healthcare Information Management Executives.

The definition of Meaningful Use (MU) has not changed, nor have clinical quality measures. She condensed it into one phrase: “Use the technology you have available to you, and the measures and objectives that the technology supports is what you report on.”

The biggest questions she has received thus far revolve around how reporting works in 2014 generally—which she said is now on a quarterly system. Numerous people have asked whether it is possible to use first or second quarter data when they attest, she said.

“You can attest to any quarter within the year,” she said. The attestation period for 2014 opened in January and stays open through the end of the fiscal year, which is Sept. 30. However, providers are offered an additional two months after that—until the end of November—to attest.

“That’s an important point to make,” she explained. Providers using 2014 edition software that experienced software problems can attest with data from the first quarter of the year if at that time they met the objectives and measures of MU.

“You can use data from any point of year even if you missed the early attestation deadline," she added, encouraging eligible providers to attest. “You want to get in the program this year.”

Myers also addressed the hardship exemption, which applies to eligible providers who are new to the program in 2014 but are unable to utilize certified EHR technology.  If granted, they can avoid a payment adjustment set to take place in 2015. She stressed that for an exemption to apply, it must be directly related to technology and software delays or problems--and not other causes like staff turnover.

The new rule is legally effective on Oct. 1, 2014, she said, and the agency plans to publish a registration and attestation guide as quickly as possible. The registration and attestation system will work with providers throughout the process. “[Providers] won’t have to figure out which measures they are attesting to if they know which technology they are working with,” she said.

Myers also took some time to address a common concern: the inability of an organization to meet the 10 percent transitions of care threshold if other providers do not have the technology to allow the exchange of data. There is flexibility that allows providers to attest that they couldn’t meet that threshold—but the onus is on them to demonstrate why they could not do it.

“There has to be an actual inability due to the software,” she said.