2013 EHR Incentive Program Changes

Below is a synopsis of the changes to the EHR Incentive program effective for the 2013 participation year.

Program/Definition Changes: 

  • Providers no longer have to of had a valid SoonerCare contract effective in the year prior to the participation year. As long as the provider has a valid SoonerCare contract at the time of attestation, the provider is eligible to participate in the EHR Incentive Program.
  • New definition of an encounter:  An encounter is now defined as any service rendered to a patient on any one day regardless of payment liability. A SoonerCare encounter is now defined as any service rendered to a Medicaid patient on any one day regardless of payment liability. What this means is; as long as the provider can prove an encounter occurred regardless if the encounter was paid, denied, billed, etc., it can be used to calculate patient volume.
    • Please note that OHCA will require the provider to distinctly identify the total number of billed Medicaid encounters and the total number of non-billed Medicaid encounters for purposes of prepayment verification.
  • Patient volume can now be calculated by using encounters from a 90 day period in either the previous calendar year or the most recent 12 months prior to the date of attestation.
  • Eligibility through the ‘hospital based exclusion’: Providers that can demonstrate he/she funds the acquisition, implementation, and maintenance of Certified EHR Technology, including supporting hardware and any interfaces necessary to meet meaningful use without reimbursement from an eligible hospital or CAH; and uses such Certified EHR Technology in the inpatient or emergency department of a hospital (instead of the hospital’s CEHRT) are now eligible for EHR Incentive Payments.
  • Revised definition of a children’s hospital: A children’s hospital is defined as: any separately certified hospital, either freestanding or hospital within hospital that predominately treats individuals under 21 years of age and; has a CMS certification number (CCN) that has the last 4 digits in the series 3300 – 3399; or does not have a CMS certification number (CCN) because they do not serve any Medicare beneficiaries but has been provided an alternative number by CMS for purposes of enrollment in the Medicaid EHR Incentive Program.

Changes to the Stage 1 Meaningful Use Measures: 

  • CPOE by CMAs: A credentialed medical assistant (CMA) is now considered a “licensed health care professional” for purposes of computerized provider order entry (CPOE). The CMA must still adhere to State, local and professional guidelines for order entry. The CMA’s credentialing must have been obtained from an organization other than the “employing organization.”
  • Alternative Measure for CPOE:
    • [Eligible Professionals] “More than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE.”
    • [Eligible Hospitals] “More than 30 percent of medication orders created by authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE.” 
  • New exclusion for Generate & Transmit permissible prescriptions electronically (eRx):
    • [Eligible Professionals] “Any EP who: does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her EHR reporting period.”
  • Alternative Measure for Vital Signs:
    • [Eligible Professionals] More than 50% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.”
    • [Eligible Hospitals] More than 50% of all unique patients admitted to the eligible hospitals or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.”
  • New Exclusions for Vital Signs:
    • [Eligible Professionals] Any provider who (1) sees no patients 3 years or older is excluded from recording blood pressure; (2) Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; (3) Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; (4) Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.
    • [Eligible Hospitals] No exclusion.
  • The objective for electronic exchange of key clinical information will no longer be required for Stage 1.
  • The reporting of Clinical Quality Measures is no longer a Core measure, but is now part of the definition of Meaningful Use.