In the United States, the federal mandate for Electronic Medical Records (EMR) or Electronic Health Records (EHR) was established as part of the American Recovery and Reinvestment Act. All public and private healthcare providers and other eligible professionals were required to adopt EMR/EHR by 2014 to maintain their existing Medicaid and Medicare reimbursement levels. Those who didn’t implement EMR/EHR systems and demonstrate their meaningful use by 2015 faced penalties.
Medicare and Medicaid Promoting Interoperability Programs
The Centers for Medicare and Medicaid Services (CMS) established the Medicare and Medicaid Promoting Interoperability Programs in 2011. These programs encourage eligible hospitals, and critical access hospitals (CAHs) to adopt, implement, upgrade, and demonstrate meaningful use of certified electronic health record technology (CEHRT).
The calendar year (CY) 2023 EHR reporting period closes on December 31, 2023. Medicare Promoting Interoperability Program participants may begin reporting and attesting their CY. The period to report and attest will close on February 29, 2024.
The 21st Century Cures Act
The 21st Century Cures Act, signed into law in 2016, aimed to improve the flow and exchange of electronic health information, prohibiting information blocking, and enhancing the usability, accessibility, and privacy and security of health information technology. As of October 6, 2022, health care organizations must give patients unfettered access to their full health records in digital format.
In order to be considered a meaningful user and avoid a downward payment adjustment, eligible hospitals and critical access hospitals (CAHs) may use (1) existing 2015 Edition (2) the 2015 Edition Cures Update criteria, or (3) a combination of the two in order to meet the CEHRT definition, as finalized in the CY 2021 PFS final rule. The CEHRT functionality must be in place by the first day of the EHR reporting period and the product must be certified by ONC by the last day.
Under the HIPAA Privacy Rule, a covered entity must act on an individual’s request for access no later than 30 calendar days after receipt. If the covered entity is not able to act within this timeframe, the entity may have up to an additional 30 calendar days, as long as it provides the individual – within that initial 30-day period – with a written statement.
Penalties For Not Implementing EMR / EHR
The penalties for not implementing Electronic Medical Records (EMR) or Electronic Health Records (EHR) can be significant and vary depending on the specific circumstances.
- Medicare Reimbursement Reductions: If Medicare eligible professionals do not comply with EMR requirements, the reimbursement of Medicare claims will be reduced by 1% annually. This downgrade in coverage will continue each year that the provider fails to demonstrate compliance until 2017, when the penalty jumps to 3%. For example, noncompliant providers in 2015 will be covered for only 99% of claims. In 2016 they will be covered for only 98% of claims.
- Information Blocking Penalties: The 21st Century Cures Act established penalties for information blocking. If the Office of Inspector General (OIG) determines that an individual or entity has committed information blocking, they may be subject to a penalty of up to $1 million per violation.
- Promoting Interoperability Program Penalties: Under the Medicare Promoting Interoperability Program, an eligible hospital or critical access hospital (CAH) that is not a meaningful user of certified EHR technology could face significant penalties. For example, the impact on eligible hospitals could be the loss of 75 percent of the annual market basket update. For CAHs, payment could be reduced to 100 percent of reasonable costs instead of 101 percent.
- Merit-based Incentive Payment System (MIPS) Penalties: Under the Promoting Interoperability performance category of MIPS, an eligible clinician or group that is not a meaningful user of certified EHR technology in a performance period could face penalties. The Promoting Interoperability performance category score can be a quarter of a clinician or group’s total MIPS score in a year.
- Medicare Shared Savings Program Penalties: A health care provider that is an Accountable Care Organization (ACO), ACO participant, or ACO provider or supplier could be deemed ineligible to participate in the program for a period of time if they are found to be non-compliant. This may result in a health care provider being removed from an ACO or prevented from joining an ACO.
It’s important to note that these penalties can be avoided by demonstrating meaningful use of EMR/EHR systems, qualifying for hardship exceptions, or achieving a minimum level of compliance.
Meeting the government’s mandate and electronic medical records deadline will not be easy for everyone in the health industry. “Rural hospitals and small, independent physician practices will have a harder time meeting the [digital medical records] requirements,” writes the Milwaukee Journal Sentinel. “But the incentives and potential penalties under the Recovery Act have made it clear that they no longer can put off the challenging task of parting with their paper charts.”
Digital Medical Records Incentive
On the other hand, as part of the American Recovery and Reinvestment Act, physicians can receive up to $44,000 in Medicare incentive payments beginning in 2011 for implementing EMR systems. Physicians must be able to demonstrate “meaningful use.”
About Meaningful Use
The Medicare EHR Incentive Program, popularly known as Meaningful Use, defines a set of standards that must be maintained when it comes to electronic health records(EHR), and sharing patient information between various entities such as hospitals, doctors, and insurance companies.
The “meaningful use” standard is measured in stages:
- Data capture and sharing
- Started in 2011 and ended in 2012
- It requires that providers meet 14 to 15 core requirements and choose five more from a menu of 10 options. Some of these requirements include an electronic file system for all patients’ health records, medical billing system, and transcription services.
- Advanced clinical processes
- Extend capabilities of EHR
- Physicians will have until the end of 2014 to meet Stage 2
- Improved outcomes
- Enhance interoperability between EHR. Improve patient outcomes
- Yet to be defined clearly
Meaningful Use was introduced as a part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. It aims to address & strengthen the privacy & security concerns tied to the online sharing of confidential health information.
EMR Software Implementation Can Help Avoid Penalties
In order to avoid being penalized, physicians should prepare by understanding the EMR / EHR mandate, and knowing the process and requirements for implementing EMR systems. Experts predict that nearing the mid-decade, there will be more physicians looking to implement EMR/EHR than the support staff of certified EMR / EHR software providers can handle.
Since each physician’s digital medical records needs and requirements are different, the lead time for a certified EMR software provider to plan, install, and implement a system is around 2-4 months. There is also typically 6-8 months of training needed for each physician in a practice to qualify as a “meaningful EHR user.” This does not include the time it takes to select an EMR software provider that is effective and efficient for the physician.
FAQ
Here are some frequently asked questions on Electronic Medical Records Deadline.
What is Promoting Interoperability Program?
In 2011, the Promoting Interoperability (formerly known as the Medicare and Medicaid EHR Incentive Programs) was developed. The program encourages eligible professionals (EPs), hospitals, and critical access hospitals (CAHs) to adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified electronic health record technology.
According to the Centers for Medicare & Medicaid Services, 2022 Medicare Promoting Interoperability Program Requirements are:
- A minimum EHR reporting period of any consecutive 90 days for new and returning participants.
- Must report on the four objectives and their associated measures
- Electronic Prescribing
- Health Information Exchange
- Provider to Patient Exchange
- Public Health and Clinical Data Exchange
- Eligible hospitals and CAHs may use
- Existing 2015 Edition certification criteria
- The 2015 Edition Cure Update criteria
- A combination of the two in order to meet the CEHRT definition as finalized in the CY 2021 Physician Fee Schedule final rule (85 FR 84818 through 84828).
- Report on three electronic clinical quality measures (eCQMs) and the Safe Use of Opioids – Concurrent Prescribing eCQM using three self-selected quarters of data
- Attest to the following
- Security Risk Analysis measure
- Safety Assurance Factors for EHR Resilience (SAFER) Guides measure
- Actions to limit or restrict the compatibility or interoperability of CEHRT attestation
- Office of the National Coordinator for Health IT (ONC) direct review attestation
When did EMR become mandatory?
As a part of the American Recovery and Reinvestment Act, all eligible professionals (EP) including public and private healthcare providers are required to adopt and demonstrate “meaningful use” of electronic medical records (EMR) by January 1, 2014.