EHR Medicare Stg1 BegGuide PDF

01
BEGINNER
» An Introduction to:
MEDICARE EHR
INCENTIVE PROGRAM
FOR ELIGIBLE PROFESSIONALS
Last Updated: April 2014

TABLE OF CONTENTS
HOW TO USE THIS GUIDE............................................................................................ 1
1. PROGRAM BASICS.................................................................................................... 4
What is the EHR Incentive Program?...........................................................................................................................................................................................................................4
What requirements do you have to meet?................................................................................................................................................................................................................7
Program options...........................................................................................................................................................................................................................................................................10
2. HOW TO PARTICIPATE............................................................................................ 18
Eligibility...............................................................................................................................................................................................................................................................................................18
Registration......................................................................................................................................................................................................................................................................................22
3. MEANINGFUL USE.................................................................................................. 25
What do you have to do for meaningful use?....................................................................................................................................................................................................25
How will certified EHR help you?.................................................................................................................................................................................................................................26
Core objectives..............................................................................................................................................................................................................................................................................33
Menu objectives............................................................................................................................................................................................................................................................................48
Clinical quality measures......................................................................................................................................................................................................................................................61
4. ATTESTATION: HOW YOU REPORT TO CMS.............................................................. 68

What is attestation?...................................................................................................................................................................................................................................................................68
Steps to follow...............................................................................................................................................................................................................................................................................69
After you attest.............................................................................................................................................................................................................................................................................. 72
5. RESOURCES LIBRARY............................................................................................. 73
6. GLOSSARY............................................................................................................. 75
An Introduction to the Medicare EHR Incentive Program for Eligible Professionals i

HOW TO USE THIS GUIDE
This guide is intended to provide eligible professionals with a simple overview of the Medicare
EHR Incentive Program. Each step of the program is explained in this guide to help health care
professionals understand the basics of the program and determine how to successfully participate.
Hyperlinks to the CMS website are included throughout the guide to direct you to more information
and resources.
Table of contents
The table of contents is interactive. Simply click on a chapter to read that section, and then click on
the chapter title to return to the table of contents.
An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 1

Icons
This guide includes special icons to better help you understand the program and find resources.
While reading the guide, please note the following:
• The “i” icon inside of a computer screen is intended to alert the reader that there
are additional resources on the specific topic being discussed.
• The “checklist” icon alerts the reader to the stage of the program that is discussed
in that section.
Please also keep in mind that screen shots of user guides and videos can be clicked so the
reader can easily locate those resources and review them.

Resources
The resources section located at the end of the guide contains all of the tools CMS has created to
help eligible professionals learn more about the EHR Incentive Programs. Next to each resource
there is a description to help the reader determine if it will be useful to their needs. The resources
are grouped in the following categories:
• An EHR Incentive Program • Eligibility

Overview • Registration
• Other CMS Programs • Attestation
• Certified EHR Technology • Meaningful Use
Please note: This guide was prepared as a service to the health care industry and is not intended to grant rights or impose
obligations. The information provided is only intended to be a general summary. It is not intended to take the place of either the
written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for
a full and accurate statement of their contents.

CHAPTER 1: PROGRAM BASICS
What is the EHR Incentive Program?

The EHR Incentive Program provides incentive payments for certain healthcare providers to use
EHR technology in ways that can positively impact patient care.
What is an EHR? An electronic health record (EHR)—sometimes called an

electronic medical record (EMR)—allows healthcare providers to record patient
information electronically instead of using paper records. However, EHRs are
often capable of doing much more than just recording information. The EHR
Incentive Program asks providers to use the capabilities of their EHRs to achieve
benchmarks that can lead to improved patient care.
It’s important to know that the EHR Incentive Program is NOT a reimbursement program for
purchasing or replacing an EHR. Providers have to meet specific requirements in order to receive
incentive payments.
1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

BASICS PARTICIPATE USE HOW YOU REPORT LIBRARY
TO CMS
Approaching Deadlines for the
Medicare EHR Incentive Program
This guide refers to a number of important program milestones. As you move through the
guide, please note the following key dates.
Date Milestone
January 1 Reporting period begins for eligible professionals
February 28* Last day for eligible professionals to register and attest to receive an
incentive payment
October 3 Last day for eligible professionals to begin 90-day reporting period to
demonstrate meaningful use
December 31 Reporting year ends for eligible professionals.
Please note these dates are not applicable to everyone and may be different depending on
your program participation. Visit the CMS eHealth interactive timeline [http://cms.gov/eHealth/
downloads/Timeline_091213_FINAL.pdf], and the interactive tool My EHR Participation Timeline
[http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Participation-
Timeline.html] for more information.
*2014 date extended to Mar 31

TO CMS
Other CMS programs
CMS has a number of quality improvement and incentive programs, but the EHR Incentive
Program is a separate incentive program with different requirements. The EHR you use and the
information you submit for other programs may not meet the requirements of the EHR
Incentive Program.
CMS QUALITY IMPROVEMENT PROGRAMS
• Medicare EHR Incentive Program
• Medicaid EHR Incentive Program

• Physician Quality Reporting System (PQRS)
• Medicare Improvements for Patients and Providers Act (MIPPA) e-Prescribing
Incentive Program

TO CMS
What requirements do you
have to meet?
To receive an EHR incentive payment, CMS has established the objectives

providers have to show that they are for
“meaningfully using” “meaningful use”

their EHRs by meeting thresholds for that everyone must meet to receive
a number of objectives. an incentive payment.

TO CMS
What is meaningful use?
In other words, it’s not enough just to own a certified EHR. Providers have to show
CMS that they are using their EHRs in ways that can positively affect the care of
their patients.
To do this, providers must meet all of the objectives established by CMS for this
program. Then they will be able to demonstrate MEANINGFUL USE of their EHRs
and receive an incentive payment.

TO CMS
How does the program work?
The EHR Incentive Programs consist of 3 stages of meaningful use.
Each stage will have its own set of requirements to meet in order to demonstrate meaningful use.
Eligible professionals always begin participating under Stage 1 requirements. Medicare eligible
professionals can refer to My Participation Timeline [http://cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Participation-Timeline.html] to see the years they will
demonstrate each stage of meaningful use.
The requirements in Stage 1 are focused on providers capturing patient data and sharing that data either
with the patient or with other health care professionals.
Improved outcomes
Advanced clinical
processes
Data capturing
and sharing
STAGE 3
STAGE 2
STAGE 1

TO CMS
PROGRAM OPTIONS
What kind of EHR do you need?

In order to capture and share patient data efficiently, providers need an EHR that
stores data in a structured format.
Get a certified EHR
Make sure you are
Structured data allows patient information to be easily retrieved and transferred, eligible
Register
and it allows the provider to use the EHR in ways that can aid patient care.
Meaningful use
Attest
CMS and the Office of the National Coordinator for Health Information Technology
(ONC) have established standards and other criteria for structured data that EHRs
must use in order to qualify for this incentive program.
To get an incentive payment, you must use an EHR that is certified specifically for
the EHR Incentive Programs. EHRs certified or qualified for other Medicare incentive
programs may not be certified for this program. Also, if you already own an EHR, it may
not be certified for use in the EHR Incentive Programs.

TO CMS
More about certified EHR
For more information

CERTIFIED EHR
For more information about certified EHR technology, visit the CMS website,
http://www.cms.gov/Regulations-and-Guidance/Legislation/
EHRIncentivePrograms/Certification.html. You can find a complete list of certified
EHR technology at the Certified Health IT Product List (CHPL) website,
http://healthit.hhs.gov/CHPL.

TO CMS
CHOOSING A PROGRAM:
Medicare or Medicaid?
The EHR Incentive Programs are available for Medicare and Medicaid eligible professionals.
Medicare EHR Medicaid EHR

Incentive Program Incentive Program
Although the two programs are similar in many ways, there are also some differences between them.
Providers must select either Medicare or Medicaid. They can only participate in one of the programs.

TO CMS
CHOOSING A PROGRAM:
Medicare or Medicaid?
Medicare EHR Incentive Program Medicaid EHR Incentive Program
Run by CMS Every state runs its own program
Maximum incentive amount is $43,720 Maximum incentive amount is $63,750

(across 5 years of program participation) (across 6 years of program participation)
Payment reductions begin in 2015 for No Medicaid payment reductions if you

providers who are eligible but choose not to choose not to participate
participate
In the first year, providers can receive an

incentive payment for adopting, implementing,
In the first year and all remaining years,
or upgrading a certified EHR.
providers have objectives they must achieve
to get incentive payments. In all remaining years, providers have
objectives to achieve, just like Medicare.

TO CMS

MEDICARE EHR INCENTIVE PROGRAM
This is a guide to the Medicare EHR Incentive Program. To learn more about differences
between the Medicare and Medicaid EHR Incentive Programs, visit the program
basics section of our website, http://www.cms.gov/Regulations-and-guidance/
Legislation/EHRIncentivePrograms/Basics.html.

TO CMS
How much will you get paid?
The amount of your incentive payment depends on when you begin participating in the program.
The incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap. The
table below shows the maximum incentive amounts broken down by the year you start participating
in the program.
As required by law, President Obama issued a sequestration order on March 1, 2013. Under these
mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible
hospitals will be reduced by 2%.
Medicare EHR Incentive Payment Schedule for Eligible Professionals
First Payment First Payment First Payment First Payment
Received in Received in Received in Received in
2011 2012 2013 2014
Payment Amount in 2011 $18,000
Payment Amount in 2012 $12,000 $18,000
Payment Amount in 2013 $7,840 $11,760 $14,700
Reduction ($160) Reduction ($240) Reduction ($300)
Payment Amount in 2014 $3,920 $7,840 $11,760 $11,760

Reduction ($80) Reduction ($160) Reduction ($240) Reduction ($240)
Payment Amount in 2015 $1,960 $3,920 $7,840 $7,840

Reduction ($40) Reduction ($80) Reduction ($160) Reduction ($160)
Payment Amount in 2016 $1,960 $3,920 $3,920

Reduction ($40) Reduction ($80) Reduction ($80)
TOTAL Incentive Payments $43,720 $43,480 $38,220 $23,520

TO CMS
How much will you get paid?
The total maximum incentive amount that you can be paid under the Medicare EHR
Incentive Program is $43,720 over five consecutive years of program participation. As
you can see, you receive the maximum incentive by starting in 2011 or 2012 . If you
don’t start by 2014, you are not eligible to receive any incentive payment under the
Medicare EHR Incentive Program.

TO CMS
Are there penalties?
Medicare eligible professionals who do not meet the requirements for meaningful
use by 2015 and in each subsequent year are subject to payment adjustments to
their Medicare reimbursements that start at 1% per year, up to a maximum 5%
annual adjustment.

TO CMS
CHAPTER 2: HOW TO PARTICIPATE
Eligibility
Get a certified EHR.
Make sure you are
How do you get started? eligible.
Register.
Meaningful use.
Before you do anything, make sure you are eligible for the program.
Attest.
The following are considered “eligible professionals” who can participate in the
Medicare EHR Incentive Program:
• Doctors of medicine or osteopathy

• Doctors of dental surgery or dental medicine
• Doctors of podiatry
• Doctors of optometry
• Chiropractors

TO CMS
Eligibility
Are you eligible?
CMS has developed a web tool that can help you determine
whether or not you are eligible to participate in the EHR Incentive
Programs. Click on the image at right to try out the tool on our
website, https://www.cms.gov/Regulations-and-Guidance/
legislation/EHRIncentivePrograms/eligibility.html.

TO CMS
Eligibility
Can practices participate?
NO
Incentive payments for the Medicare EHR Incentive Program are made to individual
providers, not to practices or medical groups. Although a provider can designate a
practice to receive the incentive funds on their behalf, it is up to the provider to make
this decision—the practice or medical group cannot claim the money or make the
decision for the provider, even if the EHR belongs to the practice.

TO CMS
Eligibility
Are you hospital-based?
Eligible professionals who are hospital-based cannot participate in the EHR

Incentive Programs.
A provider is considered hospital-based if he or she provides more than 90% of

their covered professional services in either an inpatient (Place of Service 21) or
emergency department (Place of Service 23) of a hospital.
CMS makes the determination if you are hospital-based. You will find out your
status when you register for the program.

TO CMS
Registration
How do you register?

Make sure you are
If you fall into one of the eligible professional categories and you have decided eligible.
Register.
to participate in the Medicare EHR Incentive Program, the next step is to get
Meaningful use.
registered for the program. Attest.
You can register online at: Registering does not By registering, you can
mean that you have see if you are hospital-
https://ehrincentives.
cms.gov to participate. You can based or if there are
cancel your registration other issues that could
at any time. interfere with or delay
your participation.

TO CMS
Registration
Click the image on the right to download a

Registration User Guide that will give you step-
by-step directions on how to register online,
https://www.cms.gov/EHRIncentivePrograms/
Downloads/EHRMedicareEP_RegistrationUserGuide.pdf.
The Registration User Guide also contains

instructions for how a provider can let a 3rd party,
such as an office manager, register on his or
her behalf.

TO CMS
Registration
Click on the image on the right to watch a

video tutorial that will walk you through CMS’s
registration system,
http://www.youtube.com/watch?v=kL-d7
zj44Fs&list=UUhHTRPxz8awulGaTMh3S
AkA&index=167

TO CMS
CHAPTER 3: MEANINGFUL USE
What do you have to do for

meaningful use?
To show CMS that they have meaningfully used their certified EHR, providers must
meet all of the Stage 1 requirements that CMS has established.
Make sure you are
eligible.
For the first year they participate, eligible professionals have to meet Register.
the requirements for and report data on a continuous Meaningful use.
Attest.
90-day period during the calendar year (any 90 days from January 1st to
December 31st).
For the remaining years they participate, eligible professionals have to meet the requirements for the
entire calendar year. Both of these are called the reporting periods.
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.

TO CMS
How will certified EHR help you?
You probably think there is a lot of information you’re going to have to keep track of in
order to get an incentive payment, but that’s where your certified EHR will help you meet the
requirements for meaningful use.
• All certified EHR technology adheres to the standards and criteria of the EHR
Incentive Program—which means it is certified to include functionality that will
help you accomplish the core and menu objectives you must meet.
• Certified EHR technology includes the ability to calculate the numerators and
denominators for all of the objectives based on the patient information you
enter as part of your everyday workflow.

TO CMS
What are the requirements?
CMS has established objectives that all providers must meet in order to show that they are using
their EHRs in ways that can positively affect the care of their patients—in other words, so that
providers can demonstrate meaningful use.
Some of the objectives have a minimum percentage that providers have to meet. Other objectives
specify an action that must be taken or a functionality of the EHR that must be enabled for the
duration of the reporting period.

TO CMS
OBJECTIVES AND MEASURES
Objectives Measures
What every eligible professional is The minimum requirement to achieve

required to achieve in order to be able each objective. Every objective has an
to show that they are meaningfully associated measure, which the eligible
using their EHR. professional must meet or surpass.

TO CMS
There are EXCLUSIONS that exempt you from having to meet specific objectives. If you meet the
qualifications for an exclusion, then you will not have to report on that objective and can still receive
a full EHR incentive payment.
These exclusions may be applicable to certain specialists who do not perform the actions specified
in the objective as a normal scope of practice. Check the exclusion for each objective to see if you
can qualify for it.

TO CMS
• As you will see, there is a lot of flexibility about what providers have to report.
• But you have to meet the thresholds for ALL of the objectives
(or qualify for an exclusion to objectives) in order to be able to show meaningful use.
• If you fail to meet even one of the measures, you will not receive a payment. There are
no partial incentive payments.

TO CMS
Eligible Professionals have to meet the measures for the following in
order to receive a payment:
13 CORE OBJECTIVES—These are objectives that everyone who participates in the program
must meet. Some of the core objectives have exclusions that could exempt you from having to meet
them, but many of them do not. You have to report on all 13 core objectives and meet the thresholds
established by those objectives.
9 MENU OBJECTIVES—You only have to report on 5 out of the 9 available menu objectives.
You can choose objectives that make sense for your workflow or practice. Again, some of these
objectives have exclusions that could exempt you from having to meet them.
Please note: The Stage 2 rule for the EHR Incentive Programs changed several Stage 1 meaningful use objectives,
measures, and exclusions for eligible professionals for the 2013 reporting cycle. These changes took effect on January 1,
2013 for eligible professionals. This guide reflects updated information on meaningful use requirements per the Stage 2 rule.

TO CMS
In addition to meeting the thresholds for the 13 core and 5 menu objectives, all eligible
professionals have to report on Clinical Quality Measures.
We’ll review the Clinical Quality Measures later, but for now you should know that
Clinical Quality Measures are different from core and menu objectives.
There are no thresholds to meet for Clinical Quality Measures—you simply report the data
exactly as it is calculated by your certified EHR.
Meaningful Use
13 + 5 + 9 = MU
Core Menu CQMs Meaningful
Measures Measures Use

TO CMS
Stage 1 meaningful use:
13 core objectives
Below are the 13 core objectives that every eligible professional must meet in order to
receive an EHR Incentive Payment.
1. Computerized provider order entry (CPOE)
2. Drug-drug and drug-allergy checks
3. Maintain an up-to-date problem list of current and active diagnoses
4. E-Prescribing (eRx)
5. Maintain active medication list
6. Maintain active medication allergy list
7. Record demographics
8. Record and chart changes in vital signs
9. Record smoking status for patients 13 years or older
10. Implement clinical decision support
11. Provide patients with the ability to view, download, or transmit their health information online
12. Provide clinical summaries for patients for each office visit
13. Protect electronic health information

TO CMS
13 core objectives
Over the next 13 pages, we’ll take a quick look at each of these core objectives so that you can
see at a glance:
• What the objective requires
• What you have to do to meet the required threshold
• What exclusions exist for the objective
Keep in mind that this is only a quick guide. There are many details about meeting these objectives
that cannot be addressed here. Once you have a grasp of the program basics, we encourage
you to explore our Meaningful Use Specification Sheets (https://www.cms.gov/
Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
EP-MU-TOC.pdf), which give in-depth information on each of the objectives, including how to
calculate numerators and denominators, definitions of important terms, and additional information
about achieving the objectives.

TO CMS
CORE OBJECTIVES
1. Computerized provider
order entry (CPOE)
What the Measure What That Means Are You Excluded from
Requires for You Having to Do This?
More than 30% of all For at least 30% of your You can be excluded from
unique patients with at patients that have a meeting this objective if
least one medication in medication listed in the you write fewer than 100
their medication list seen EHR, you or a licensed staff prescriptions during the
by the EP have at least one person will have to use the reporting period.
medication order entered EHR’s CPOE module to
using CPOE. enter medication orders.
Optional alternate: More
than 30% of your medication
orders during the EHR
reporting period are recorded
using CPOE.

TO CMS
CORE OBJECTIVES
2. Drug-drug and drug-allergy

checks
EP has enabled this Certified EHR comes with There is no exclusion for this
functionality for the entire the ability to automatically objective. Everyone has to
EHR reporting period. check for potentially adverse meet it.
drug-drug or drug-allergy
interactions. You have to
turn this functionality on and
keep it on.

TO CMS
CORE OBJECTIVES
3. Maintain an up-to-date problem

list of current and active diagnoses
More than 80% of all unique More than 80% of your There is no exclusion for this
patients seen by the EP patients have to have an objective. Everyone has to
have at least one entry or an entry in the EHR about meet it.
indication that no problems current diagnoses—either
are known for the patient actual problems or just an
recorded as structured data. indication that there are no
problems right now.

TO CMS
CORE OBJECTIVES
4. E-Prescribing (eRx)
More than 40% of all permissible More than 40% of the • You can be excluded from
prescriptions written by the EP prescriptions you write have to meeting this objective if
are transmitted electronically be sent electronically—not by you write fewer than 100
using certified EHR technology. phone and not by fax—using your prescriptions during the
certified EHR. reporting period.
• You can be excluded from

meeting this objective if there
is not a pharmacy within your
organization and there are
no pharmacies that accept
electronic prescriptions within
10 miles of your practice
location at the start of your
EHR reporting period.

TO CMS
CORE OBJECTIVES
5. Maintain active medication list

More than 80% of all unique More than 80% of your There is no exclusion for this
have at least one entry (or entry in the EHR about meet it.
an indication that the patient medications—either
is not currently prescribed medications they are currently
any medication) recorded as taking or just an indication
structured data. that they aren’t taking any
medications right now.

TO CMS
CORE OBJECTIVES
6. Maintain active medication

allergy list
More than 80% of all unique More than 80% ofyour There is no exclusion for this
have at least one entry (or entry in the EHR about meet it.
an indication that the patient medication allergies—either
has no known medication medication allergies they
allergies) recorded as have or just a note that
structured data. they don’t have any
medication allergies.

TO CMS
CORE OBJECTIVES
7. Record demographics
More than 50% of all unique For more than half of your There is no exclusion for this
patients seen by the EP have patients you have to record objective. Everyone has to
demographics recorded as the following in the EHR: meet it.
structured data. • Preferred language
• Gender
• Race
• Ethnicity
• Date of Birth

TO CMS
CORE OBJECTIVES
8. Record and chart changes

in vital signs
Measure: For more than 50 For more than half of your You can be excluded from this objective
percent of all unique patients patients, you have to record for either of these reasons:
seen by the EP during the the following in the EHR: • If you see no patients 3 years or older,
EHR reporting period have you are excluded from recording
• Height blood pressure;
blood pressure (for patients
age 3 and over only) and • Weight • If you believe that all three vital signs
of height, weight, and blood pressure
height and weight (for all ages) • Blood pressure (for patients have no relevance to your scope
recorded as structured data. age 3 and over only) of practice you are excluded from
recording them;
• Calculate and display body
• If you believe that height and weight
mass index (BMI)
are relevant to your scope of practice,
• Plot and display growth but blood pressure is not, you are
charts for children 0-20 excluded from recording blood
pressure; or
years, including BMI
• If you believe that blood pressure is
A certified EHR will chart relevant to your scope of practice,
changes in those vital signs but height and weight are not, you
for you. are excluded from recording height
and weight.

TO CMS
CORE OBJECTIVES
9. Record smoking status for

patients 13 years or older
More than 50% of all unique Smoking status is recorded You can be excluded from
patients 13 years old or in the EHR for over half of meeting this objective if you
older seen by the EP have your patients that are over don’t see any patients who
smoking status recorded as the age of 13. are 13 years or older.
structured data.

TO CMS
CORE OBJECTIVES
10. Implement clinical decision

support
Implement one clinical Certified EHRs have the There is no exclusion for this
decision support rule. ability to program clinical objective. Everyone has to
decision support that meet it.
can trigger alerts or clinical
information for providers
when they encounter
patients with certain
diagnoses or treatments.
You should implement
one of these rules that
makes sense for your
medical practice.

TO CMS
CORE OBJECTIVES
11. Provide patients with an electronic

copy of their health information
More than 50% of all You must provide patients There is no exclusion for this
patients are provided the the ability to view, download, objective. Everyone has to
ability to view, download or transmit their health meet it.
or transmit their health information (including
information online within diagnostic test results,
4 business days after it problem lists, medication
is available. allergies) online in a
timely fashion for over half
of all patients.

TO CMS
CORE OBJECTIVES
12. Provide clinical summaries

for patients for each office visit
Clinical summaries provided For more than half of your If you do not conduct any
to patients for more than 50% office visits, patients receive office visits, you can be
of all office visits within 3 a clinical summary within 3 excluded from meeting this
business days. days of the visit. objective.

TO CMS
CORE OBJECTIVES
13. Protect electronic health

information
Conduct or review a security You have to meet the There is no exclusion for this
risk analysis in accordance same HIPAA requirements objective. Everyone has to
with the requirements for protecting patient meet it.
under 45 CFR 164.308(a) information in your EHR as
(1) and implement security you do for paper records.
updates as necessary and To do this, you must
correct identified security conduct a security review
deficiencies as part of its of your system and correct
risk management process. any problems that could
make patient information
vulnerable.

TO CMS
9 menu objectives
Now that we’ve seen all of the core objectives that you have to meet, let’s look at the
9 menu objectives.
• You have to report on 5 of these 9 menu objectives

• At least one of the 5 you report must be a Public Health objective
Over the next 11 pages, we’ll take a quick look at all of the menu objectives. Again, once
you understand the program basics, we encourage you to explore our Meaningful Use
Specification Sheets (https://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf), which give
in-depth information on each of the objectives, including how to calculate numerators and
denominators, definitions of important terms, and additional information about achieving
the objectives.

TO CMS
Stage 1 public health objectives
When selecting your 5 menu objectives, at least one must come from the Public Health list, which
consists of the following:
1. Submit electronic data to immunization registries
OR
2. Submit electronic syndromic surveillance data to public health agencies
Let’s look at each of these objectives in turn.

TO CMS
MENU OBJECTIVES
1. Submit electronic data to

immunization registries
Performed at least one Your EHR comes equipped You could be excluded from
test of certified EHR with the ability to electronically meeting this objective for either
technology’s capacity to send immunization data. You of these reasons:
submit electronic data to have to test your EHR’s ability • You don’t administer
immunization registries and to electronically transmit that immunizations
follow up submission if the information to a public health
registry. Even if the test fails, • There’s no immunization
test is successful (unless registry to which you can send
you have successfully met this
none of the immunization information
objective!
registries to which the EP
• It is prohibited
submits such information
has the capacity to
receive the information
electronically), except where
prohibited.

TO CMS
MENU OBJECTIVES
2. Submit electronic syndromic

surveillance data to public health agencies
Performed at least one test Your EHR comes equipped with You could be excluded from
of certified EHR technology’s the ability to electronically send meeting this objective for either
capacity to provide electronic syndromic surveillance data (e.g., of these reasons:
syndromic surveillance data influenza population data). You
• You don’t collect any reportable
to public health agencies and have to test your EHR’s ability
syndromic data during the EHR
follow-up submission if the test to electronically transmit that
reporting period
is successful (unless none of the information to a public health
public health agencies to which agency. Even if the test fails, • There’s no immunization
an EP submits such information you have successfully met this registry to which you can send
has the capacity to receive the objective! information
information electronically) except
• It is prohibited
where prohibited.

TO CMS
Other stage 1 menu objectives
After you have selected a public health objective, you still have to choose 4 more menu objectives
to report. You can select any 4 from the list below—or you could report on both public health objec-
tives and choose 3 from the list below:
3. Drug formulary checks
4. Incorporate clinical lab-test results
5. Generate lists of patients by specific conditions
6. Send reminders to patients for preventive/follow-up care
7. Patient-specific education resources
8. Electronic access to health information for patients
9. Medication reconciliation
10. Summary of care record for transitions of care
Let’s look at each of these.

TO CMS
MENU OBJECTIVES
3. Drug formulary checks

EP has enabled this Your certified EHR has the If you write fewer than
functionality and has access ability to check potential 100 prescriptions during
to at least one internal or medication orders against the EHR reporting period,
external formulary for the a drug formulary. If you you can be excluded from
entire EHR reporting period. choose this objective, then completing this objective.
you need to enable the
formulary check for the
entire reporting period.

TO CMS
MENU OBJECTIVES
4. Incorporate clinical lab-test results

More than 40% of all Results from over 40% of You can be excluded from
clinical lab tests results lab tests ordered during meeting this objective if you
ordered by the EP during the reporting period are did not order any lab tests
the EHR reporting period recorded in the EHR—as during the reporting period
whose results are either long as the tests yield or if none of the results from
in a positive/negative a number or a positive/ the tests you ordered came
or numerical format are negative response. Other back as a number or as a
incorporated in certified test results do not count positive/negative response.
EHR technology as toward this objective.
structured data.

TO CMS
MENU OBJECTIVES
5. Generate lists of patients by

specific conditions
Generate at least one report You can decide what There is no exclusion
listing patients of the EP condition is clinically relevant for this objective if you
with a specific condition. or useful to your practice, select it.
then generate a report
from your certified EHR of
patients with that condition.

TO CMS
MENU OBJECTIVES
6.Send reminders to patients for

preventive/follow-up care
More than 20% of all Over 20% of patients in You can be excluded from
patients 65 years or older these age ranges must be meeting this objective if you
or 5 years old or younger sent preventive or follow- have no patients 65 years
were sent an appropriate up care reminders. The or older or 5 years old or
reminder during the EHR information in the reminder younger whose information
reporting period. and how the reminder is sent is in your certified EHR.
(e.g., mail, email, telephone)
is up to you.

TO CMS
MENU OBJECTIVES
7. Patient-specific education
resources
More than 10% of all unique For over 10% of your There is no exclusion
patients seen by the EP are patients, you use your for this objective if you
provided patient-specific certified EHR’s ability to select it.
education resources. recommend educational
resources to your patients.
Your EHR is certified with
the ability to make these
recommendations based on
patient-specific variables,
such as chronic condition
(e.g., diabetes).

TO CMS
MENU OBJECTIVES
8. Medication reconciliation
EP performs medication For over half the patients You can be excluded from
reconciliation for more who see you after receiving meeting this objective if you
than 50% of transitions of care from another provider, did not see any patients
care in which the patient is after they received care from
you should update
another provider during the
transitioned into the care of medication information by
EHR reporting period.
the EP. comparing the patient’s
medical record to an external
list of medications obtained
from a patient, hospital, or
other provider.

TO CMS
MENU OBJECTIVES
9. Summary of care record for

transitions of care
EP who transitions or refers You send either an electronic You can be excluded from
their patient to another or paper summary of care meeting this objective if
setting of care or provider document that is generated you don’t refer any patients
of care provides a summary by your certified EHR for or transfer any patients to
of care record for more than over half of the patients you another setting for care
50% of transitions of care refer to another provider or during the reporting period.
and referrals. transfer to another setting
for care (e.g., nursing home).

TO CMS
What if none of the stage 1
menu objectives are relevant?
It’s rare, but it’s possible that none of the menu objectives are applicable to your
scope of practice. If that is the case for you and you qualify for all of the exclusions
for each of the menu objectives, then you can select 5 menu objectives and claim the
exclusion for each.

TO CMS
Clinical quality measures
Clinical quality measures do not have thresholds that you have to meet—you simply have to
report data on them.
You don’t have to do any calculations for the clinical quality measures! Your certified EHR will
produce a report with clinical quality measure data, and you must enter that data exactly as
your certified EHR produced it.

TO CMS
The number of CQMs providers need to report in 2014 differs from previous years.
Beginning in 2014, you must select and report 9 of a possible list of 64 approved CQMs.
2011 through 2013: 6 of a possible

44 measures
In 2014 and beyond: 9 of
• 3 required core measures or 3 alternate
a possible 64 measures
core, as necessary
• 3 of 38 additional measures

TO CMS
For 2014, CMS is not requiring the submission of a core set of CQMs.
CMS has identified two recommended core sets of CQMs- one for adults and one for
children on high-priority health conditions and best-practices for care delivery.
• 9 CQMs for adult populations that meet all of the program requirements
• 9 CQMs for pediatric populations that meet all of the program requirements
These recommended core sets focus on conditions that contribute to the morbidity
and mortality of most Medicare and Medicaid beneficiaries and also focus on areas that
represent national public health priorities or disproportionately drive health care costs.
CMS encourages eligible professionals to report from the recommended core set to the
extent those CQMs are applicable to your scope of practice and patient population.

TO CMS
9 recommended measures
for adult populations
Adult Recommended Core Measures
• Controlling High Blood Pressure
• Use of High-Risk Medications in the Elderly
• Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
• Use of Imaging Studies for Low Back Pain
• Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
• Documentation of Current Medications in the Medical Record
• Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
• Closing the referral loop: Receipt of specialist report
• Functional status assessment for complex chronic conditions

TO CMS
9 recommended measures
for pediatric populations
Pediatric Recommended Core Measures
• Appropriate Testing for Children with Pharyngitis
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children
and Adolescents
• Chlamydia Screening for Women
• Use of Appropriate Medications for Asthma
• Childhood Immunization Status
• Appropriate Treatment for Children with Upper Respiratory Infection (URI)
• A
DHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity
Disorder (ADHD) Medication
• Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
• Children who have dental decay or cavities

TO CMS
2014 CQM Domains
2014 CQM Domains
1. Patients and Family Engagement

CQMs 2014 and Beyond
2. Patient Safety
3. Care Coordination • Choose from at least 3 different domains
4. Population/Public Health • CMS suggests that EPs choose a core set for
both adults and children
5. Efficient Use of Healthcare Resources
6. Clinical Process/Effectiveness

TO CMS
Things to remember about
clinical quality measures
Your certified EHR does all the work—it Select and Report 9 measures of a possible
calculates the measures and gives you the list of 64 approved CQMs.
numbers you report to CMS.
There are no minimum values that you must EPs are not excluded from reporting CQMs,
achieve for clinical quality measures. You but zero is an acceptable value.
only have to report on them, not achieve
a benchmark.

TO CMS
CHAPTER 4: ATTESTATION: HOW YOU REPORT TO CMS
What is attestation?
Attestation is a legal statement that you have met the thresholds and all of
the requirements of the Medicare EHR Incentive Program. The process of
attestation happens through an internet-based CMS system that allows you to
enter information on all of the following: Make sure you are
eligible.
• 13 core objectives Register.
Meaningful use.
• 5 out of 9 menu objectives
Attest.
• 9 measures from 64 approved CQMs

TO CMS
Steps to follow
Where do you go to attest?
You will attest through the same system

where you initially registered. Click here,
https://ehrincentives.cms.gov, to go to
the CMS EHR Registration and Attestation
system now.
During the attestation process, you will

enter data and answer yes/no questions
on the core objectives, menu objectives,
and clinical quality measures. Above is an
example of how the core objective for Drug-
Drug and Drug-Allergy Checks appears in
the attestation system.

TO CMS
Steps to follow
How do you attest?
Just as with registration, there is also an attestation guide to

help you through the process.
Click the image on the right, or go to http://www.cms.

gov/Regulations-and-Guidance/Legislation/
EHRIncentivePrograms/downloads/EP_Attestation_User_
Guide.pdf, to download an Attestation User Guide that will give you
step-by-step directions on how to enter information and
attest online.
The Attestation User Guide also contains instructions for how a

provider can let a 3rd party register on his or her behalf.

TO CMS
Steps to follow
Want to practice?
Our Meaningful Use Attestation Calculator allows you to see

the language used during attestation and to enter your core
and menu objective information to see if you have met all of the
requirements for the Medicare EHR Incentive Program.
Click the image on the right to try it now, or go to

http://www.cms.gov/apps/ehr.

TO CMS
After you attest
As soon as you submit your attestation, you will find out immediately whether or not you have
successfully achieved the core and menu objectives of the program.
If you are not successful, you can edit any information that was entered incorrectly and resubmit
your attestation. Or you can resubmit for a different 90-day reporting period with new information.
If you are successful, CMS will perform a number of internal checks to be sure you are eligible
for payment. You should then receive your EHR incentive payment in approximately 4-8 weeks
following attestation.

TO CMS
CHAPTER 5: RESOURCES
Resources library
TOPIC TITLE DESCRIPTION
Health Information Technology Key dates of the Medicare EHR Incentive Programs and ICD-10
Timeline
Overview
My EHR Participation Timeline Interactive timeline to determine which year eligible professionals will demon-
strate each stage of meaningful use
Physician Quality Reporting System CMS webpage that provides information on the PQRS and how to
(PQRS) Homepage participate in it
Other CMS
Programs eRx Incentive Program Homepage CMS webpage that provides information on the eRx Incentive Program and
how to participate in it
Certified EHR CHPL Certified EHR List Webpage maintained by ONC that provides a comprehensive listing of certified
Technology EHRs and EHR modules
Eligibility Widget Helps eligible professionals determine their eligibility for the Medicare and
Medicaid EHR Incentive Programs
Eligibility Eligibility Flowchart Demonstrates the functionality of the online module for professionals to deter-
mine their eligibility for the Medicare and Medicaid EHR
Incentive Programs

TO CMS
Resources library
TOPIC TITLE DESCRIPTION
Medicare EHR Incentive Program EP Guidance to help eligible professionals through the registration process
Registration Users Guide
Registration Medicare EP PECOS Notification Helps eligible professionals participating in the Medicare program obtain a
PECOS account, which is necessary to register and receive an EHR Incentive
Program payment
Stage 1 EHR Meaningful Use Specifi- Each sheet provides details about a specific meaningful use measure that
cation Sheet for EPs needs to be met by eligible professionals
Meaningful Use
Guide for Reading the EHR Incentive Provides guidance for understanding and using the CQMs for eligible profes-
Program EP CQM Measures sionals
Medicare EHR Incentive Program EP Demonstrates the functionality of the online attestation module for eligible
Attestation User Guide professionals
Meaningful Use Attestation Calcula- Allows eligible professionals and hospitals to test whether or not they will suc-
Attestation tor (version 1) cessfully demonstrate meaningful use for the EHR Incentive Programs prior to
attestation
Attestation Worksheet for Eligible Allows eligible professionals to enter their meaningful use measure values, so
Professionals they have a quick reference tool to use while attesting

TO CMS
CHAPTER 6: GLOSSARY
Glossary of terms
TERM EXPLANATION
Attestation In order for EPs to receive an EHR incentive payment, they must attest (legally state) through the secure Medicare
website or their state’s secure Medicaid website, depending on the program they are participating in, that they’ve
demonstrated “meaningful use” with certified EHR technology.
Certified Electronic The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. Standards, imple-
Health Record (EHR) mentation specifications, and certification criteria for EHR technology have been adopted by the Secretary of the
Department of Health and Human Services. EHR technology must be tested and certified by an Office of the National
Coordinator (ONC) Authorized Testing and Certification Body (ATCB) in order for a provider to qualify for EHR incen-
tive payments.
Eligible Professional Medicare eligible professionals are listed on page 17 of this guide. Eligible professionals under the Medicaid EHR In-
(EP) centive Program include the health care providers below when they also meet the Incentive Program eligibility criteria.
• Physicians (primarily doctors of medicine and doctors of osteopathy)
• Nurse practitioner
• Certified nurse-midwife
• Dentist
• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic
that is led by a physician assistant.
Exclusion CMS allows providers to report that specific meaningful use measures do not apply to them because they have no pa-
tients, or no or insufficient number of actions that would allow calculation of the meaningful use measure. For example,
a physician who has no patients age 65 or older or age 5 or younger would not have to meet the requirement to send
an appropriate reminder to 20 percent or more of all patients in those age groups during the EHR reporting period.

TO CMS
Glossary of terms
TERM EXPLANATION
Meaningful Use The requirements for EHR use and reporting to qualify for the incentive payment within the Medicare EHR Incentive
Program. Meaningful use will be the standard by which providers will use EHR technology and build enhancements for
future reporting and quality measures to improve patient outcomes.
Provider Enrollment, PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information
Chain, and Ownership from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper
System (PECOS) form and electronically via the Internet. All EPs must be enrolled in PECOS in order to register to receive incentive
payments in the Medicare EHR Incentive Program.
Place of Service (POS) POS codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was
provided. CMS maintain POS codes used throughout the health care industry.
Reporting Period The reporting period is the period in which an EP must demonstrate meaningful use guidelines for the EHR Incentive
Programs. In the first year of the Medicare EHR Incentive Program, EPs have a reporting period of any continuous
90-day period within the calendar year.
Third-Party Reporting For the EHR Incentive Programs, CMS implemented functionality that allows an EP to designate a third party to
register and attest on his or her behalf. To do so, users working on behalf of an EP must have an Identity and Access
Management System (I&A) web user account (User ID/Password), and be associated to the EP’s NPI. Those working
on behalf of an EP(s) that do not have an I&A web user account can visit I&A Security Check to create one.

TO CMS
cms.gov/EHRIncentivePrograms

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Last Updated: April 2014

4. ATTESTATION: HOW YOU REPORT TO CMS.............................................................. 68

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals i

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 1

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 2

• An EHR Incentive Program • Eligibility

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 3

What is the EHR Incentive Program?

What is an EHR? An electronic health record (EHR)—sometimes called an

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 4

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

January 1 Reporting period begins for eligible professionals

December 31 Reporting year ends for eligible professionals.

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 5

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

CMS QUALITY IMPROVEMENT PROGRAMS

• Medicare EHR Incentive Program

• Medicaid EHR Incentive Program

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 6

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

To receive an EHR incentive payment, CMS has established the objectives

“meaningfully using” “meaningful use”

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 7

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 8

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 9

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

What kind of EHR do you need?

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 10

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

For more information

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 11

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

Medicare EHR Medicaid EHR

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 12

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

Run by CMS Every state runs its own program

Maximum incentive amount is $43,720 Maximum incentive amount is $63,750

Payment reductions begin in 2015 for No Medicaid payment reductions if you

In the first year, providers can receive an

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 13

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

For more information

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 14

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

Payment Amount in 2014 $3,920 $7,840 $11,760 $11,760

Payment Amount in 2015 $1,960 $3,920 $7,840 $7,840

Payment Amount in 2016 $1,960 $3,920 $3,920

TOTAL Incentive Payments $43,720 $43,480 $38,220 $23,520

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 15

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 16

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 17

1. PROGRAM 2. HOW TO 3. MEANINGFUL 4. ATTESTATION: 5. RESOURCES 6. GLOSSARY

• Doctors of medicine or osteopathy

An Introduction to the Medicare EHR Incentive Program for Eligible Professionals 18