The Centers for Medicare and Medicaid Services has modified a frequently asked question relating to the electronic health records meaningful use program, and the HIMSS Electronic Health Records Association is strongly objecting.

In essence, CMS appears to have changed the reporting period for several Stage 2 measures. “We are concerned that this FAQ introduces a restriction that is not specified in the Final Rule and has not been previously publicized in CMS or ONC guidance,” according to the letter to the association sent to Elizabeth Holland, director of the HIT Initiatives Group, and Elisabeth Myers, policy and outreach lead, both in the CMS Office of eHealth Standards and Services.

“It is not reasonable to expect EHR developers to reprogram reports and undertake the expense of recertifying reports, especially given that this revision was made in the middle of the 2014 reporting periods,” the letter contends. “Continuing to make changes through FAQs, especially mid-way through the reporting year, and indeed, in the middle of the period in which already certified EHR technology is being rolled out, is very concerning to us. In addition, we consider the clarification added to FAQ8231 to be an inappropriate deviation from regulation, past guidance and certification requirements, and ask that CMS rescind this revision as quickly as possible.”

If revision is not possible, EHRA asks for a detailed explanation and rationale for the change, as well as guidance for providers and auditors so providers consistent with the previous version of the FAQ are not penalized.

Here is FAQ8231 as created on April 26, 2013, with the original language that later was changed highlighted:

Question: "While the denominator for measures used to caluculate meaningful use in the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs is restricted to patients seen during the EHR reporting period, is the numerator also restricted to patients seen during the EHR reporting period or can actions for certain meaningful use measures be counted in the numerator if they took place after the EHR reporting period has ended?"

Answer: "The criteria for a numerator is not constrained to the EHR reporting period unless expressly stated in the numerator statement for a given meaningful use measure. The numerator for the following meaningful use measures should include only actions that take place within the EHR reporting period:  Preventive Care (Patient Reminders) and Secure Electronic Messaging.

"For all other meaningful use measures, the actions may reasonably fall outside the EHR reporting period timeframe but must take place no later than the date of attestation in order for the patients to be counted in the numerator."

Here is the FAQ answer as changed on June 23, 2014, with the changes highlighted:

"The criteria for a numerator is not constrained to the EHR reporting period unless expressly stated in the numerator statement for a given meaningful use measure. The numerator for the following meaningful use measures should include only actions that take place within the EHR reporting period:  Preventive Care (Patient Reminders) and Secure Electronic Messaging.

"For all other meaningful use measures, the actions may reasonably fall outside the EHR reporting period timeframe but must take place no earlier than the start of the reporting year and no later than the date of attestation in order for the patients to be counted in the numerator, unless a longer look-back period is specifically indicated for the objective or measure."

A spokesperson for CMS was not immediately available for comment late in the afternoon on July 11. Text of the EHRA letter is here.

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