Focus on the Final Rule
Focus on the Final Rule EHR Certification & Meaningful Use Please submit all questions via the WebEx Q&A function.  Additi...
Daniel Gottlieb Partner, McDermott Will & Emery LLP Final Rule Legal Restrictions & Guidance
Agenda <ul><li>Who is an eligible hospital (EHs)? </li></ul><ul><ul><li>Medicare Incentives </li></ul></ul><ul><ul><li>Med...
Agenda (cont’d) <ul><li>Changes to Medicare and Medicaid incentive calculations </li></ul><ul><li>Registration and attesta...
Medicare Eligible Hospitals  <ul><li>Medicare EHs: a hospital located in one of the 50 states or D.C. that participates in...
Medicare Eligible Hospitals <ul><li>Excludes IPPS-excluded hospitals and hospital units such as: </li></ul><ul><ul><li>Psy...
Medicare Eligible Professionals <ul><li>Medicare EPs include doctors of: medicine or osteopathy; dental surgery or dental ...
Medicaid Eligible Hospitals <ul><li>EHs include “acute care hospitals” and children’s hospitals </li></ul><ul><li>An “acut...
Medicaid Eligible Hospitals <ul><li>Acute care hospital must have at least 10 percent Medicaid Patient Volume based on pat...
Medicaid Eligible Professionals <ul><li>Medicaid EPs are the following professionals (other than hospital-based profession...
Medicaid Eligible Professionals <ul><li>A PA leads an FQHC or RHC under any of the following circumstances:  </li></ul><ul...
Medicaid Eligible Professionals <ul><li>Medicaid EP must satisfy one of three Patient Volume thresholds: </li></ul><ul><ul...
Medicaid Eligible Professionals <ul><li>Needy Individuals are persons who: </li></ul><ul><ul><li>received medical assistan...
Inapplicable MU Objectives <ul><li>Some MU objectives do not apply to every provider so provider would not have any eligib...
Inapplicable MU Measures <ul><li>For example, an EH or CAH that did not have request for electronic copy of discharge inst...
Medicaid Incentive Calculation <ul><li>CMS clarified that employer’s or FQHC’s purchase of EHR for use by employed EPs is ...
Registration <ul><li>To participate in incentive programs, eligible provider must register on incentive program website at...
Registration <ul><li>Registration requirements include: </li></ul><ul><ul><li>Name, National Provider Identifier, business...
Attestation for Medicare FFS <ul><li>Eligible providers demonstrate MU to CMS through attestation in 2011 and attestation ...
Attestation for Medicare FFS <ul><li>CMS will provide a web-based tool for attestation </li></ul><ul><li>CMS has not relea...
Attestation to States <ul><li>States must identify attestation and/or electronic reporting mechanism in their State Medica...
Attestation and Reporting <ul><li>FY 2011: EH or CAH must attest that during the EHR reporting period, it: </li></ul><ul><...
Attestation and Reporting <ul><li>FY 2012 and after: EH or CAH must attest that during the EHR reporting period, it: </li>...
EP’s Attestation and Reporting <ul><li>For CY 2011: EP must attest that during the EHR reporting period, EP: </li></ul><ul...
EP’s Attestation and Reporting <ul><li>For CY 2012 and after: EP must attest that during the EHR reporting period, EP: </l...
Medicare EH Payment Process <ul><li>Single payment contractor pays an EH or CAH a preliminary, estimated EHR incentive pay...
Medicare EP Payment Process <ul><li>Single payment contractor makes annual incentive payment to an EP when EP demonstrates...
EHR Certification <ul><li>ONC published the temporary EHR certification program final rule on 6/24/2010, which establishes...
Review of Medicare’s Timeline <ul><li>Fall 2011 : Certified EHR technology on EHR incentive program website </li></ul><ul>...
Stark EHR Donation Exception <ul><li>Stark Law provides an exception for subsidies for EHR items and services </li></ul><u...
Other Resources <ul><li>Comprehensive McDermott White Paper regarding final EHR certification and meaningful use regulatio...
Daniel F. Gottlieb Partner, McDermott Will & Emery LLP [email_address] 312-984-6471
Ralph Llewellyn Partner, Eide Bailly Final Rule Accounting Requirements &  Incentive Guidelines
Reimbursement Topics <ul><li>Medicare </li></ul><ul><ul><li>Medicare Share </li></ul></ul><ul><ul><li>PPS Hospitals </li><...
Medicare Share <ul><li>Based on inpatient volume </li></ul><ul><ul><li>Numerator </li></ul></ul><ul><ul><ul><li>Medicare  ...
Medicare Share <ul><li>Based on inpatient volume </li></ul><ul><ul><li>Denominator </li></ul></ul><ul><ul><ul><li>Total in...
Medicare Share <ul><li>Based on inpatient volume </li></ul><ul><ul><li>Denominator </li></ul></ul><ul><ul><ul><li>Total in...
PPS Hospitals <ul><li>Initial Amount </li></ul><ul><ul><li>Base payment for each PPS hospital = $2,000,000 </li></ul></ul>...
PPS Hospitals <ul><li>Payment Process </li></ul><ul><ul><li>Hospital data last filed 12 month cost report </li></ul></ul><...
PPS Hospitals <ul><li>Transition Factor (FFY 2011 – 2013) </li></ul><ul><ul><li>Year 1 = 1 </li></ul></ul><ul><ul><li>Year...
PPS Hospitals <ul><li>Transition Factor (FFY 2014 – 2015)  </li></ul><ul><ul><li>If the facility’s first year of eligibili...
PPS Hospitals Fiscal Year Fiscal Year that Eligible Hospital First Receives the Incentive Payment 2011 2012 2013 2014 2015...
Critical Access Hospitals <ul><li>Allowed to expense their costs associated with the purchase of certified EHR technology ...
Critical Access Hospitals <ul><li>Continued </li></ul><ul><ul><li>Reimbursement based on Medicare Share + 20 percentage po...
Critical Access Hospitals <ul><li>Continued </li></ul><ul><ul><li>Payments up to 4 consecutive years </li></ul></ul><ul><u...
Critical Access Hospitals <ul><li>Allowable expense </li></ul><ul><ul><li>Reasonable cost – “computers and associated hard...
Critical Access Hospitals <ul><li>Allowable expense </li></ul><ul><ul><li>Incentive payment in lieu of depreciation AND in...
Eligible Providers <ul><li>Incentive </li></ul><ul><ul><li>75% of secretary’s estimate of allowed charges for covered serv...
Eligible Providers Calendar Year First CY in which EP Receives an Incentive Payment 2011 2012 2013 2014 2015 + 2011 $18,00...
Eligible Providers <ul><li>HPSA incentive </li></ul><ul><ul><li>10% increase in incentive </li></ul></ul><ul><ul><ul><li>P...
Eligible Providers Calendar Year First CY in which EP Receives an Incentive Payment 2011 2012 2013 2014 2015+ 2011 $19,800...
Eligible Providers <ul><li>Single consolidated payment </li></ul><ul><ul><li>Ascertain professional has demonstrated meani...
Medicaid <ul><li>PPS Hospitals and Critical Access Hospitals can participate in Medicare and Medicaid </li></ul><ul><li>El...
Medicaid - Hospitals <ul><li>PPS and CAHs reimbursed under same methodology as Medicare PPS </li></ul><ul><ul><li>Medicaid...
Medicaid – Eligible Providers <ul><li>Incentive payment to EP equals Net Average Allowable Costs for EHR </li></ul><ul><li...
Medicaid – Eligible Providers
Medicaid – Eligible Providers Calendar  Year Maximum Incentive Payment for Medicaid EPs Who Are Meaningful Users in the Fi...
Ralph Llewellyn Partner, Eide Bailly LLP [email_address]   701-239-8594
Robert Forrest Healthland ARRA Task Force Healthland’s Role in  Getting you to MU
Meeting Meaningful Use <ul><li>Eligible hospitals must  </li></ul><ul><li>Implement certified EHR technology </li></ul><ul...
<ul><li>For more information </li></ul><ul><li>Email:  [email_address] </li></ul><ul><li>Phone: 800.323.6987  xt.3211 </li...
QUESTIONS? <ul><li>Enter your questions into the Q&A now. </li></ul>
Thank you.
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ARRA Update Webinars

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  • Hello and welcome to today’s webcast “Focus on the Final Rule”. My name is Josie Tober and I am the Manager of Marketing Communications at Healthland and I will be moderating the event. NEXT SLIDE
  • Before we begin our event, we would like to remind you that: All lines have been muted for the duration for the presentation. Please submit any questions you may have during our presentation via the WebEx Q&amp;A function. Questions will be answered in the order that they are received at the end of the presentations. Additional questions may be submitted at the close of the presentation via email to: [email_address]
  • It is our privilege today to have attorney Daniel Gottlieb, who is a partner in the law firm of McDermott Will &amp; Emery LLP based in the Firm’s Chicago office. Daniel represents a wide range of health industry clients, including health care providers, EHR vendors and others that service the industry. He specializes in advising clients on compliance with federal and state health care laws as well other transactions involving health care providers. Daniel speaks and writes extensively about privacy and health information technology issues. In fact, he recently published an article in the July 2010 issue of Healthcare Informatics regarding the donation of electronic health record items and services to referring physicians. Daniel thank you for making this very important presentation today. At this time, I will turn the presentation over to you.
  • We are also privileged to have with us today CPA, Ralph Llewellyn, who is a partner with Eide Bailly’s Health Care Services division.   Ralph has more than 18 years health care experience, including five years as chief financial officer for a 49-bed hospital and 116-bed skilled nursing facility.   In his role at Eide Bailly, Ralph conducts reimbursement enhancement studies and billing process review for critical access hospitals. He also conducts operational improvement projects for hospitals and assists with the implementation of financial strategies for financial turnaround. Ralph is also a frequent presenter and lecturer on various health care topics at state and national conferences for HFMA, NRHA and state hospital associations. Ralph thank you for making this very important presentation today. At this time, I will turn the presentation over to you.  
  • Josie – Next up we will hear from Robert Forrest, one of our ARRA Task Force members here at Healthland. Robert – Thanks, Josie. Wow, what a great wealth of information we have received today. Thanks to our speakers today, you now have a clearer view of what it will take to get to MU; but what is Healthland’s role in getting you to MU?
  • To meet meaningful use, Eligible hospitals must Implement certified EHR technology Use it in a “meaningful manner” To ensure that you are able to do that, Healthland Has develop EHR technology that meets Stage 1 meaningful use requirements and we will develop EHR technology that meets Stage 2 &amp; Stage 3 – once those standards have been finalized Obtain Certification from an ONC-ATCB for Stage 1 Meaningful Use Healthland is currently awaiting authorization from the ONC of a testing &amp; certification body to begin the certification process. Healthland has been certified before. In fact, our Inpatient and Ambulatory EHR products are both currently certified with CCHIT. What that means is that Healthland is familiar with EHR testing and certification process, and this experience will enable us to be at the forefront of EHR solution providers with a certified product for ARRA. In the coming years, Healthland will also certify for Stage 2 and Stage 3. We are prepared to do just that and we are staying involved throughout this evolving process. You can be confident knowing that as these regulations evolve, you have an advocate because Healthland has a seat at the table. Our CTO, Odell Tuttle is on the HITSP Tiger Team which sets the standards for interoperability One of our Product Managers, Jennifer Lane is on the CCHIT committee setting ED certification criteria And, our SVP of Sales &amp; Market Development, Angie Franks is on the MN e-Health Initiative committee – although it is specific to MN, it also is proving to be influential at the federal level The bottom-line is this: Healthland is well aware of the requirements for rural community and critical access hospitals to achieve MU and we can provide you with the tools that you need to not only meet meaningful use, but to provide better patient care more efficiently.
  • Healthland not only wants to be your advocate, but we want to be your resource for meaningful use information. If you have additional questions or would like more information about how the Final Rule for Meaningful Use will affect your organization, you can reach us - Via Email at: [email_address] Or by Phone at: 800.323.6987 xt.3211 Or find us on the Web at: www.healthland.com/stimulus At this time, I will turn the presentation back over to Josie to take questions.
  • At this time we would like to invite you to submit your questions for our presenters today by typing them into the WebEx Q&amp;A feature. We will answer as many questions today as our time limit will allow. Daniel and Ralph, it looks like we have already received a number of questions during your presentations today. So, lets start with those. How confident is the panel on CCHIT’s likelihood to become an ONC-ATCB? (Ralph/Daniel) We are a critical access hospital and we are planning to purchase our EHR software through a lease. How will that affect our incentive payments? Does the lease type (operational or capital) make a difference? (Ralph) We are considering a hosted solution, such as an ASP (application software provider) or SaaS (software as a service) solution. Will that affect our incentive payments as a critical access hospital? (Ralph) We are a parent hospital that will be hosting the EHR solution for other facilities that are eligible to receive incentives. A few are PPS and a few are CAHs. How does that affect incentive payments for our hospitals? (Ralph/Daniel) Please verify that in order for a critical access to receive more than one year of payments, they must continue to meet MU and incur additional EHR costs? (Ralph) If we provide the EHR for a physician clinic, can we require that the physician incentive payments are remitted as payment back to (or directly to) the hospital upon receipt? (Daniel)
  • That is all the time that we have today. Thank you for taking valuable time our of your already busy schedules. We hope that you found today’s presentation helpful and informative. I would especially like to thank Daniel and Ralph for providing us with such great content and for helping us all better understand the requirements of meaningful use. Remember that if you have additional questions or would like more information about how the Final Rule for EHR Certification and Meaningful Use will affect your organization, you can reach us Via Email at: [email_address] Or find us on the Web at: www.healthland.com/stimulus Thanks again for joining us and we hope to have you attend our next Meaningful Use presentation.
  • ARRA Update Webinars

    1. 1. Focus on the Final Rule
    2. 2. Focus on the Final Rule EHR Certification & Meaningful Use Please submit all questions via the WebEx Q&A function. Additional questions may be submitted to: [email_address]
    3. 3. Daniel Gottlieb Partner, McDermott Will & Emery LLP Final Rule Legal Restrictions & Guidance
    4. 4. Agenda <ul><li>Who is an eligible hospital (EHs)? </li></ul><ul><ul><li>Medicare Incentives </li></ul></ul><ul><ul><li>Medicaid Incentives </li></ul></ul><ul><li>Who is an eligible professional (EP)? </li></ul><ul><ul><li>Medicare Incentives </li></ul></ul><ul><ul><li>Medicaid Incentives </li></ul></ul><ul><li>Exclusion of inapplicable meaningful use (MU) objectives </li></ul>
    5. 5. Agenda (cont’d) <ul><li>Changes to Medicare and Medicaid incentive calculations </li></ul><ul><li>Registration and attestation process and timelines </li></ul><ul><li>Certification of EHR Technology </li></ul><ul><li>Stark Law EHR Donation Exception </li></ul><ul><ul><li>Independent physicians on Medical Staff </li></ul></ul><ul><ul><li>Hospital-Owned Clinics </li></ul></ul>
    6. 6. Medicare Eligible Hospitals <ul><li>Medicare EHs: a hospital located in one of the 50 states or D.C. that participates in the Medicare Inpatient Prospective Payment System (IPPS) and Maryland acute care hospitals </li></ul><ul><li>CAHs are also eligible for incentives </li></ul><ul><li>Multi-campus hospital with a single provider number is a single hospital </li></ul>
    7. 7. Medicare Eligible Hospitals <ul><li>Excludes IPPS-excluded hospitals and hospital units such as: </li></ul><ul><ul><li>Psych hospital - Rehab hospital </li></ul></ul><ul><ul><li>Children's hospital - LTCHs </li></ul></ul><ul><li>Surgical and other specialty hospitals participating in IPPS are eligible for Medicare incentives </li></ul>
    8. 8. Medicare Eligible Professionals <ul><li>Medicare EPs include doctors of: medicine or osteopathy; dental surgery or dental medicine; podiatric medicine; optometry or chiropractry </li></ul><ul><li>Hospital-based physicians who provide 90% or more of their covered services in a hospital inpatient or ER setting are ineligible </li></ul>
    9. 9. Medicaid Eligible Hospitals <ul><li>EHs include “acute care hospitals” and children’s hospitals </li></ul><ul><li>An “acute care hospital” is a hospital where the ALOS is 25 days or fewer and a CCN that has the last four digits in the series 0001-0879 (short-term general hospitals and 11 U.S. cancer hospitals) and now under the final rule also 1300-1399 (CAHs) </li></ul>
    10. 10. Medicaid Eligible Hospitals <ul><li>Acute care hospital must have at least 10 percent Medicaid Patient Volume based on patient encounters </li></ul><ul><li>Like other Medicaid EHs, CAHs may receive both Medicare and Medicaid EHR incentive payments </li></ul><ul><li>If an EH meets Medicare MU requirements, it will be deemed to meet Medicaid MU requirements </li></ul>
    11. 11. Medicaid Eligible Professionals <ul><li>Medicaid EPs are the following professionals (other than hospital-based professionals): </li></ul><ul><ul><li>Physicians and dentists </li></ul></ul><ul><ul><li>nurse practitioners </li></ul></ul><ul><ul><li>certified nurse-midwives </li></ul></ul><ul><ul><li>physician assistants practicing in FQHCs or RHCs that are led by a physician assistant </li></ul></ul>
    12. 12. Medicaid Eligible Professionals <ul><li>A PA leads an FQHC or RHC under any of the following circumstances: </li></ul><ul><ul><li>when a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA </li></ul></ul><ul><ul><li>when a PA is a clinical or medical director at a clinical site of practice </li></ul></ul><ul><ul><li>PA is an owner of the RHC </li></ul></ul>
    13. 13. Medicaid Eligible Professionals <ul><li>Medicaid EP must satisfy one of three Patient Volume thresholds: </li></ul><ul><ul><li>Have ≥ 30% Patient Volume attributable to Medicaid recipients </li></ul></ul><ul><ul><li>Have ≥ 20% Patient Volume attributable to Medicaid recipients and be a pediatrician </li></ul></ul><ul><ul><li>practice predominantly in a FQHC or RHC and have ≥ 30% Patient Volume attributable to Needy Individuals </li></ul></ul>
    14. 14. Medicaid Eligible Professionals <ul><li>Needy Individuals are persons who: </li></ul><ul><ul><li>received medical assistance from Medicaid or the Children’s Health Insurance Program </li></ul></ul><ul><ul><li>were furnished uncompensated care or </li></ul></ul><ul><ul><li>were furnished services either at no cost or reduced cost based on a sliding scale determined by individuals’ ability to pay </li></ul></ul>
    15. 15. Inapplicable MU Objectives <ul><li>Some MU objectives do not apply to every provider so provider would not have any eligible patients or actions for the measure denominator </li></ul><ul><li>In these cases, provider may exclude (i.e., not meet) the measure </li></ul><ul><li>Exclusions do not count against the deferred measures in the menu set </li></ul>
    16. 16. Inapplicable MU Measures <ul><li>For example, an EH or CAH that did not have request for electronic copy of discharge instructions may exclude core MU Objective #12 and only comply with 13 of 14 objectives </li></ul><ul><li>An EH or CAH that is excluded from a menu set objective must only meet 4 rather than 5 of 10 objectives </li></ul>
    17. 17. Medicaid Incentive Calculation <ul><li>CMS clarified that employer’s or FQHC’s purchase of EHR for use by employed EPs is not a payment </li></ul><ul><li>CMS did not address whether payments from other sources could include EHR donation to independent physician practice under Stark EHR donation exception </li></ul>
    18. 18. Registration <ul><li>To participate in incentive programs, eligible provider must register on incentive program website at http://www.cms.gov/EHrIncentivePrograms/ </li></ul><ul><li>Medicaid programs will interface with program registration website </li></ul><ul><li>Registration begins in January 2011 </li></ul>
    19. 19. Registration <ul><li>Registration requirements include: </li></ul><ul><ul><li>Name, National Provider Identifier, business address and phone number </li></ul></ul><ul><ul><li>Taxpayer identification number </li></ul></ul><ul><ul><li>Hospital’s CCN </li></ul></ul><ul><ul><li>EPs must select Medicare or Medicaid </li></ul></ul><ul><ul><li>Medicaid providers must select one state </li></ul></ul>
    20. 20. Attestation for Medicare FFS <ul><li>Eligible providers demonstrate MU to CMS through attestation in 2011 and attestation and electronic reporting of clinical quality information in 2012 </li></ul><ul><li>Providers may submit attestations as early as April 2011 to CMS </li></ul><ul><li>Payment begins as early as May 2011 following attestation </li></ul>
    21. 21. Attestation for Medicare FFS <ul><li>CMS will provide a web-based tool for attestation </li></ul><ul><li>CMS has not released attestation tool </li></ul><ul><li>CMS is developing an audit strategy to verify attestations and prevent fraud and abuse </li></ul><ul><li>Providers should develop compliance and document retention procedures </li></ul>
    22. 22. Attestation to States <ul><li>States must identify attestation and/or electronic reporting mechanism in their State Medicaid HIT Plans, subject to CMS approval </li></ul><ul><li>States must develop audit and verification procedures </li></ul>
    23. 23. Attestation and Reporting <ul><li>FY 2011: EH or CAH must attest that during the EHR reporting period, it: </li></ul><ul><ul><li>Used certified EHR technology and specify technology </li></ul></ul><ul><ul><li>Satisfied required MU objectives and measures </li></ul></ul><ul><ul><li>Must specify the EHR reporting period and provide the result of each applicable measure for inpatients and ER patients during the reporting period </li></ul></ul>
    24. 24. Attestation and Reporting <ul><li>FY 2012 and after: EH or CAH must attest that during the EHR reporting period, it: </li></ul><ul><ul><li>Used certified EHR technology and specify EHR </li></ul></ul><ul><ul><li>Satisfied required MU objectives and measures except clinical quality reporting </li></ul></ul><ul><ul><li>Must specify the EHR reporting period and provide the result of each applicable measure </li></ul></ul><ul><li>EH or CAH must electronically report clinical quality measures through a portal (or, if feasible HIE or registry) </li></ul>
    25. 25. EP’s Attestation and Reporting <ul><li>For CY 2011: EP must attest that during the EHR reporting period, EP: </li></ul><ul><ul><li>Used certified EHR technology and specify technology </li></ul></ul><ul><ul><li>Satisfied required MU objectives and measures </li></ul></ul><ul><ul><li>Must specify the EHR reporting period and provide the result of each applicable measure </li></ul></ul>
    26. 26. EP’s Attestation and Reporting <ul><li>For CY 2012 and after: EP must attest that during the EHR reporting period, EP: </li></ul><ul><ul><li>Used certified EHR technology and specify EHR </li></ul></ul><ul><ul><li>Satisfied required MU objectives and measures except clinical quality reporting </li></ul></ul><ul><ul><li>Must specify the EHR reporting period and provide the result of each applicable measure </li></ul></ul><ul><li>EP must electronically report clinical quality measures through a portal (or, if feasible HIE or registry) </li></ul>
    27. 27. Medicare EH Payment Process <ul><li>Single payment contractor pays an EH or CAH a preliminary, estimated EHR incentive payment based on most recently filed 12-month cost report as early as May 2011 following successful MU attestation </li></ul><ul><li>Final payment determined at time of settling cost report that begins on or after start of payment year </li></ul>
    28. 28. Medicare EP Payment Process <ul><li>Single payment contractor makes annual incentive payment to an EP when EP demonstrates MU and earns the maximum annual incentive payment </li></ul><ul><li>Payments begin as early as May 2011 following successful demonstration of MU on attestation </li></ul>
    29. 29. EHR Certification <ul><li>ONC published the temporary EHR certification program final rule on 6/24/2010, which establishes : </li></ul><ul><ul><li>selection process for testing and certification bodies (ONC-ATCBs) </li></ul></ul><ul><ul><li>parameters under which the ONC-ATCBs will test and certify that EHR meets the EHR certification requirements </li></ul></ul><ul><li>ONC will make a Certified EHR list available this Fall </li></ul>
    30. 30. Review of Medicare’s Timeline <ul><li>Fall 2011 : Certified EHR technology on EHR incentive program website </li></ul><ul><li>January 2011 : Registration begins on incentive program website </li></ul><ul><li>April 2011 : Attestation of MU begins through web tool </li></ul><ul><li>May 2011 : Medicare incentive payments begin </li></ul>
    31. 31. Stark EHR Donation Exception <ul><li>Stark Law provides an exception for subsidies for EHR items and services </li></ul><ul><li>Exception applies to subsidies for EHRs used in private physician practice offices </li></ul><ul><li>Hospital may purchase inpatient or ambulatory EHR for use in hospital facilities to serve hospital patients without meeting exception </li></ul>
    32. 32. Other Resources <ul><li>Comprehensive McDermott White Paper regarding final EHR certification and meaningful use regulations to be issued shortly </li></ul><ul><li>Healthcare Informatics article regarding Stark EHR donation exception </li></ul>
    33. 33. Daniel F. Gottlieb Partner, McDermott Will & Emery LLP [email_address] 312-984-6471
    34. 34. Ralph Llewellyn Partner, Eide Bailly Final Rule Accounting Requirements & Incentive Guidelines
    35. 35. Reimbursement Topics <ul><li>Medicare </li></ul><ul><ul><li>Medicare Share </li></ul></ul><ul><ul><li>PPS Hospitals </li></ul></ul><ul><ul><li>Critical Access Hospitals </li></ul></ul><ul><ul><li>Eligible Professionals </li></ul></ul><ul><li>Medicaid </li></ul><ul><ul><li>Same </li></ul></ul>
    36. 36. Medicare Share <ul><li>Based on inpatient volume </li></ul><ul><ul><li>Numerator </li></ul></ul><ul><ul><ul><li>Medicare days + Medicare Advantage patient days </li></ul></ul></ul><ul><ul><ul><ul><li>IP, specialty care </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Psych and Rehab included in proposed rule, but eliminated in final rule </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Excludes Swing Bed </li></ul></ul></ul></ul>
    37. 37. Medicare Share <ul><li>Based on inpatient volume </li></ul><ul><ul><li>Denominator </li></ul></ul><ul><ul><ul><li>Total inpatient days TIMES </li></ul></ul></ul><ul><ul><ul><ul><li>Hospital charges less charity care DIVIDED BY hospital charges </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Worksheet C Part I Line 200 Column 8 </li></ul></ul></ul></ul></ul>
    38. 38. Medicare Share <ul><li>Based on inpatient volume </li></ul><ul><ul><li>Denominator </li></ul></ul><ul><ul><ul><li>Total inpatient days TIMES </li></ul></ul></ul><ul><ul><ul><ul><li>Hospital charges less charity care DIVIDED BY hospital charges </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Worksheet C Part I Line 200 Column 8 </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Charity Care </li></ul></ul></ul><ul><ul><ul><ul><li>As identified on Worksheet S-10 of the Medicare cost report for PPS Hospitals </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Not reported on Medicare cost report for CAH’s in the past </li></ul></ul></ul></ul>
    39. 39. PPS Hospitals <ul><li>Initial Amount </li></ul><ul><ul><li>Base payment for each PPS hospital = $2,000,000 </li></ul></ul><ul><ul><ul><li>Adjusted for discharges 1,150 to 23,000 </li></ul></ul></ul><ul><ul><li>$200 additional per discharge in this range </li></ul></ul><ul><ul><li>Times your Medicare Share </li></ul></ul>
    40. 40. PPS Hospitals <ul><li>Payment Process </li></ul><ul><ul><li>Hospital data last filed 12 month cost report </li></ul></ul><ul><ul><li>Settled based on the first 12 month cost reporting period that begins after the start of the payment year </li></ul></ul>
    41. 41. PPS Hospitals <ul><li>Transition Factor (FFY 2011 – 2013) </li></ul><ul><ul><li>Year 1 = 1 </li></ul></ul><ul><ul><li>Year 2 = ¾ </li></ul></ul><ul><ul><li>Year 3 = ½ </li></ul></ul><ul><ul><li>Year 4 = ¼ </li></ul></ul><ul><ul><li>Subsequent Years = 0 </li></ul></ul>
    42. 42. PPS Hospitals <ul><li>Transition Factor (FFY 2014 – 2015) </li></ul><ul><ul><li>If the facility’s first year of eligibility is after FFY 2013, the transition factor is the same as a facility with a first payment in FFY 2013 </li></ul></ul><ul><ul><li>If the first payment year is after FFY 2015, the transition factor </li></ul></ul>
    43. 43. PPS Hospitals Fiscal Year Fiscal Year that Eligible Hospital First Receives the Incentive Payment 2011 2012 2013 2014 2015 2011 1.00 --- --- --- --- 2012 0.75 1.00 --- --- --- 2013 0.50 0.75 1.00 --- --- 2014 0.25 0.50 0.75 0.75 --- 2015 --- 0.25 0.50 0.50 0.50 2016 --- --- 0.25 0.25 0.25
    44. 44. Critical Access Hospitals <ul><li>Allowed to expense their costs associated with the purchase of certified EHR technology in a single year </li></ul><ul><ul><li>Versus depreciating these costs on the cost report </li></ul></ul><ul><ul><li>Current year and prior year purchases (undepreciated value) </li></ul></ul><ul><ul><li>Includes only purchases for hospital specific EHR technology </li></ul></ul>
    45. 45. Critical Access Hospitals <ul><li>Continued </li></ul><ul><ul><li>Reimbursement based on Medicare Share + 20 percentage points (not to exceed 100%) </li></ul></ul><ul><ul><li>Lump sum prompt payment subject to reconciliation </li></ul></ul><ul><ul><ul><li>Initial based on last filed 12 month cost report </li></ul></ul></ul><ul><ul><ul><li>Final based on final cost report </li></ul></ul></ul>
    46. 46. Critical Access Hospitals <ul><li>Continued </li></ul><ul><ul><li>Payments up to 4 consecutive years </li></ul></ul><ul><ul><ul><li>Stages </li></ul></ul></ul><ul><ul><ul><li>Replacement equipment </li></ul></ul></ul>
    47. 47. Critical Access Hospitals <ul><li>Allowable expense </li></ul><ul><ul><li>Reasonable cost – “computers and associated hardware and software necessary to administer EHR technology” </li></ul></ul><ul><ul><ul><li>Vendor implementation costs not included in this incentive calculation </li></ul></ul></ul><ul><ul><ul><li>Communicate with MAC/FI </li></ul></ul></ul>
    48. 48. Critical Access Hospitals <ul><li>Allowable expense </li></ul><ul><ul><li>Incentive payment in lieu of depreciation AND interest </li></ul></ul><ul><ul><ul><li>“ Be smart about your interest” </li></ul></ul></ul><ul><ul><li>Cost not reportable on future cost reports </li></ul></ul><ul><ul><li>Subject to reconciliation </li></ul></ul>
    49. 49. Eligible Providers <ul><li>Incentive </li></ul><ul><ul><li>75% of secretary’s estimate of allowed charges for covered services furnished by eligible professional during relevant payment year </li></ul></ul><ul><ul><ul><li>Paid claims no later than 2 months after relevant year </li></ul></ul></ul><ul><ul><li>Up to 5 years </li></ul></ul><ul><ul><li>No incentive after 2016 </li></ul></ul>
    50. 50. Eligible Providers Calendar Year First CY in which EP Receives an Incentive Payment 2011 2012 2013 2014 2015 + 2011 $18,000 --- --- --- --- 2012 $12,000 $18,000 --- --- --- 2013 $8,000 $12,000 $15,000 --- --- 2014 $4,000 $8,000 $12,000 $12,000 --- 2015 $2,000 $4,000 $8,000 $8,000 $0 2016 --- $2,000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0
    51. 51. Eligible Providers <ul><li>HPSA incentive </li></ul><ul><ul><li>10% increase in incentive </li></ul></ul><ul><ul><ul><li>Provides services predominately in HPSA </li></ul></ul></ul><ul><ul><ul><li>Defined as greater than 50% </li></ul></ul></ul><ul><ul><ul><li>January 1 – December 31 frequency </li></ul></ul></ul><ul><ul><ul><li>If HPSA by December 31 of prior year </li></ul></ul></ul><ul><ul><ul><ul><li>No impact if HPSA lost during current year </li></ul></ul></ul></ul><ul><ul><ul><ul><li>No impact if HPSA obtained during current year </li></ul></ul></ul></ul>
    52. 52. Eligible Providers Calendar Year First CY in which EP Receives an Incentive Payment 2011 2012 2013 2014 2015+ 2011 $19,800 --- --- --- --- 2012 $13,200 $19,800 --- --- --- 2013 $8,800 $13,200 $16,500 --- --- 2014 $4,400 $8,800 $13,200 $13,200 --- 2015 $2,200 $4,400 $8,800 $8,800 $0 2016 --- $2,200 $4,400 $4,400 $0 Total $48,400 $48,400 $42,900 $26,400 $0
    53. 53. Eligible Providers <ul><li>Single consolidated payment </li></ul><ul><ul><li>Ascertain professional has demonstrated meaningful use </li></ul></ul><ul><ul><li>Reaches maximum payment limit </li></ul></ul><ul><ul><li>If maximum payment limit is not reached payment is processed 2 months after relevant payment year </li></ul></ul><ul><li>Multiple employers/contractual arrangements </li></ul><ul><ul><li>Assign incentive to 1 employer or entity </li></ul></ul>
    54. 54. Medicaid <ul><li>PPS Hospitals and Critical Access Hospitals can participate in Medicare and Medicaid </li></ul><ul><li>Eligible providers must elect, with option for one change </li></ul>
    55. 55. Medicaid - Hospitals <ul><li>PPS and CAHs reimbursed under same methodology as Medicare PPS </li></ul><ul><ul><li>Medicaid Share versus Medicare Share </li></ul></ul><ul><ul><li>Payment made over 3 – 6 years </li></ul></ul>
    56. 56. Medicaid – Eligible Providers <ul><li>Incentive payment to EP equals Net Average Allowable Costs for EHR </li></ul><ul><li>NAAC is Average Allowable Costs (capped at $25K in yr 1 and $10K in yrs 2-6) net of cash payments attributable to EHR technology or support services from sources other than state and local governments, subject to 15% EP responsibility </li></ul>
    57. 57. Medicaid – Eligible Providers
    58. 58. Medicaid – Eligible Providers Calendar Year Maximum Incentive Payment for Medicaid EPs Who Are Meaningful Users in the First Payment Year 2011 2012 2013 2014 2015 2016 2011 $21,250 --- --- --- --- --- 2012 $8,500 $21,250 --- --- --- --- 2013 $8,500 $8,500 $21,250 --- --- --- 2014 $8,500 $8,500 $8,500 $21,250 --- --- 2015 $8,500 $8,500 $8,500 $8,500 $21,250 --- 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 --- $8,500 $8,500 $8,500 $8,500 $8,500 2018 --- --- $8,500 $8,500 $8,500 $8,500 2019 --- --- --- $8,500 $8,500 $8,500 2020 --- --- --- --- $8,500 $8,500 2021 --- --- --- --- --- $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
    59. 59. Ralph Llewellyn Partner, Eide Bailly LLP [email_address] 701-239-8594
    60. 60. Robert Forrest Healthland ARRA Task Force Healthland’s Role in Getting you to MU
    61. 61. Meeting Meaningful Use <ul><li>Eligible hospitals must </li></ul><ul><li>Implement certified EHR technology </li></ul><ul><li>Use it in a “meaningful manner” </li></ul><ul><li>Healthland will </li></ul><ul><li>Develop EHR technology that meets meaningful use requirements </li></ul><ul><li>Obtain Certification from an ONC-ATCB </li></ul>
    62. 62. <ul><li>For more information </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Phone: 800.323.6987 xt.3211 </li></ul><ul><li>Web: www.healthland.com/stimulus </li></ul>
    63. 63. QUESTIONS? <ul><li>Enter your questions into the Q&A now. </li></ul>
    64. 64. Thank you.

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