Medicare and Medicaid Promoting Interoperability Program Basics
Beginning in 2011, the Promoting Interoperability (formerly the Medicare and Medicaid EHR Incentive Programs) were developed to encourage eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) to adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified electronic health record technology (CEHRT).
On August 2, 2019 CMS published the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule which included program requirements for calendar year (CY) 2020. In this final rule, CMS continued its advancement of CEHRT utilization, focusing on burden reduction, and improving interoperability and patient access to health information.
2020 Medicare Promoting Interoperability Program Requirements
- Finalized a minimum EHR reporting period of any consecutive 90 days for new and returning participants.
- Converted the Query of Prescription Drug Monitoring Program measure from required to optional and eligible for five bonus points.
- Removed the Verify Opioid Treatment Agreement measure beginning in CY 2020.
- Requires all eligible hospitals and CAHs utilize 2015 Edition CEHRT.
- Requirement that EHR technology be certified to all electronic clinical quality measures (eCQMs) available to report for CY 2020 reporting period.
- Aligned the eCQM submission requirements with those of the Hospital Inpatient Quality Reporting (IQR) program for the reporting period in CY 2021.
- Finalized an eCQM reporting period of one, self-selected quarter of discharge data for four self-selected eCQMs in the Hospital IQR Program for CY 2020 and subsequent reporting years.
2020 Medicaid Promoting Interoperability Program Requirements
- All EPs, eligible hospitals and CAHs are required to use 2015 Edition CEHRT.
- Meaningful Use Requirements for 2020
- All EPs must report on a 90 day minimum EHR reporting period and meet the Stage 3 Meaningful Use requirements.
- Stage 3 requirements can be found here.
- eCQM Requirements for 2020
- The list of eCQMs can be found here.
- All returning EPs must report on a minimum 90 day eCQM reporting period..
- EPs are required to report on any six eCQMs related to their scope of practice.
- In addition, EPs are required to report on at least one outcome measure. If no outcome measures are relevant, EPs must report on at least one high-priority measure. If there are no outcome or high priority measures relevant to an EP’s scope of practice, they may report on any six relevant measures.
- Program Year 2021 Policies
- In 2021 all EPs will have 90-day EHR and eCQM reporting periods to allow states to meet the statutory deadline of December 31, 2021 for all incentives to be paid.