Learn about New Requirements for Participation in EHR Incentive Programs


The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) recently announced the release of final rules for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and the 2015 Edition Health IT Certification Criteria. The rules will be published on October 16, 2015, and are currently on display in the Federal Register. 

The EHR Incentive Programs final rule provides new criteria that eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR Incentive Programs. The final rule outlines program requirements in 2015 through 2017 (Modified Stage 2) and Stage 3 in 2018 and beyond, and includes a comment period for Stage 3. 

The 2015 Edition Health IT Certification Criteria final rule builds on past editions of adopted health IT certification criteria, and includes new and updated IT functionality and provisions that support the EHR Incentive Programs' care improvement, cost reduction, and patient safety across the health system.

EHR Incentive Programs Final Rule Provisions
Through the new requirements of the EHR Incentive Programs, CMS will expand meaningful use of certified EHR technology to promote health information exchange and improved outcomes. The rule also includes changes to the structure of the EHR Incentive Programs to improve efficiency, effectiveness, and flexibility.

Major policy provisions include:

  • Program modifications to reduce reporting burden, eliminate redundant and duplicative reporting, and to better align the objectives and measures of meaningful use with the Stage 3 requirements.
  • A revised single set of objectives and measures, including a reduction of the overall number of objectives to which a provider must attest.
  • Changes in EHR reporting periods, including a shift to calendar year for all providers and 90-day reporting for 2015.
  • Revisions to attestation and payment adjustment deadlines.
  • Optional Stage 3 reporting in 2017.

For more information about the EHR Incentive Programs final rule, view the Final Rule Fact Sheet that highlights key changes to the EHR Incentive Programs.

To learn more about the ONC 2015 Edition Health IT Certification Criteria final rule, visit:

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Physicians Still Watching and Waiting for 2015 Meaningful Use Program Requirements


Physicians Still Watching and Waiting for 2015 Meaningful Use Program Requirements

For immediate release:
Oct. 1, 2015

CHICAGO —Because the Centers for Medicare and Medicaid Services (CMS) has yet to issue the so-called “modification rule” for the electronic health record (EHR) Meaningful Use program for 2015, the AMA is calling on the agency to create an automatic hardship exemption for physicians who did not have the opportunity to report successfully this year.

In April, CMS proposed modifications to stages 1 & 2 of the program that reduced the reporting period from a full calendar year to 90 days. Stakeholders believed this was necessary since many physicians could not update systems, change products, or accommodate Internet outages or other disruptions under a 365-day reporting program. 

“The AMA welcomed and supported the proposed changes, but it’s now Oct. 1 and CMS has left physicians without any guidance or assurances that they will be capable of meeting program requirements before the end of the year,” said AMA President Steven J. Stack, M.D. “The AMA has regularly stressed that CMS must finalize Meaningful Use modifications well ahead of Oct. 1 to provide the time that physicians need to plan for and accommodate these changes, yet CMS has continued to delay finalizing this rule. As a result, many physicians who were counting on this flexibility will be subject to financial penalties under the rules currently in place. The AMA is asking CMS to create an automatic hardship exemption as soon as possible so that physicians are not penalized for regulatory delays that are outside their control.”

Previous AMA efforts to shape the Meaningful Use program can be found at AMA Wire. For additional information, or join the discussion on Twitter using #FixEHR.

ICD-10 Issues


ICD-10 Issues

As the clock ticks down to the ICD-10 deadline on Oct. 1, the AMA has revised its online ICD-10 information and resources. If physicians experience any problems with the processing of their claims or other administrative transactions, they should take the following steps.

The AMA has created an ICD-10 complaint form that will be available on the AMA ICD-10 web page on Oct. 1 to report problems with Medicare claims.

Please note: Forms will be forwarded to the Centers for Medicare & Medicaid Services (CMS).  The American Medical Association will not provide individual responses to each complaint.

Physicians can also contact their Medicare Administrative Contractor (MAC) or monitor their MAC’s website for information on problems with ICD-10. 

You may also contact CMS directly by emailing the ICD-10 ombudsman Dr. William Rodgers, whose contact email is [email protected]

Check the state Medicaid website for information about ICD-10 implementation and a method of contact for issues. 

Commercial Payers
Check the payer’s website for information about ICD-10 implementation and a method of contact for issues.

  • For UnitedHealth Group, physicians can use the following email address [email protected]
  • For Humana, physicians can use the following email address [email protected]
  • For Anthem, physicians should contact the Provider Service Call Center for the locality and line of business involved (telephone numbers can be found on
  • Vendors

Any issues with practice management systems, electronic health records (EHR), billing vendors, or clearinghouses, should be directed to the company.

Physicians should also contact their state or specialty medical society for advice on handling problems and to find out if other practices are experiencing similar issue.

Note:  CMS announced on Sept. 25 that the ICD-10 Coordination Center and claims processing will continue to operate even if there is a government shutdown due to the budget.

Medicare Advanced Payment

CMS has announced that MACs will issue advanced payments in situations where the MAC is unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems. An advanced payment is a conditional partial payment and will require repayment.

To apply for an advance payment, the physician will be required to submit the request to their appropriate MAC. Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information on how to access advance payments. CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered.

Updated Clarifying questions and answers for cms ICD-10 flexibilities

On September 22, CMS released updated “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.”  Information added includes the naming of the CMS ICD-10 Ombudsman, Dr. William Rodgers, whose contact email is [email protected] and additional information about prior authorizations, Medicare Advantage plans, application to other provider types, Medicare advanced payments, cross-over claims, and audits.

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Revised CMS Guidance on ICD-10 Implementation


CMS has revised their FAQs on ICD 10 coding  after extensive dialogue with AMA Advocacy staff.   The revisions were posted on the CMS website on 7/31 and are consistent with the original announcement regarding flexibility when the right “ family of codes” are submitted. Revisions were made to questions 3 and 5.