Part ONE- 1 page AMA format-due 9/17 by 10:00 pm EST Evaluate meaningful use regulations for recovery audit contractors (RACs) and electronic health records (EHRs), as well as the impact on either case management or performance incentives. What is the purpose of these regulations? How effective are they in meeting the purpose? Support your answer with course resources-attached Part TWO In response to your peer-provided below, agree or disagree with their assessments of the effectiveness of RAC and EHR meaningful use regulations. Be sure to justify your answer. Classmate Chiwaula’s post: Top of Form           MEANINGFUL USE REGULATIONS FOR RECOVERY AUDIT CONTRACTORS & ELECTRONIC HEALTH RECORDS                                   IMPACT ON CASE MANAGEMENT OR PERFORMANCE INCENTIVES. In 2015 the Board of Registration in Medicine introduced a set of regulations requiring physicians to demonstrate proficiency in the use of electronic medical records, as well as the skills to achieve the federal Meaningful Use standard. Under the regulations, physicians are considered to have demonstrated proficiency if they meet any one of the following conditions: · Participating in the Meaningful Use program as an Eligible Professional · Having a relationship with a hospital that has been certified as a Meaningful Use participant. This relationship would be satisfied by any oneof the following conditions: . Employed by the hospital . Credentialed by the hospital to provide patient care . Having a “contractual agreement” with the hospital · Completing at least three hours of accredited CME program on electronic health records. Such a program must, at a minimum, discuss the core and menu set objectives, as well as the clinical quality measures for Meaningful Use.1 The Recovery Audit Contractor, or RAC, program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to health care providers under fee-for-service (FFS) Medicare plans. The United States Department of Health and Human Services (DHHS) is required by law to make the program permanent for all states by January 1, 2010, under section 302 of the Tax Relief and Health Care Act of 2006.2 The main goals for RAC include: • Minimize Provider Burden • Ensure Accuracy • Maximize Transparency RACs are authorized to investigate claims submitted by all physicians, providers, facilities, and suppliers—essentially, everyone who provides Medicare beneficiaries in the fee for service program with procedures, services, and treatments and submits claims to Medicare (and/or their fiscal intermediaries (FI), regional home health intermediaries (RHHI), Part A and Part B Medicare administrative contractors (A/B/MACs), durable medical equipment Medicare administrative contractors (DME MACs), and/or carriers.2 Benefits of Electronic Health Records (EHRs) Providers who use EHRs report tangible improvements in their ability to make better decisions with more compreh.

1. Part ONE-
1 page AMA format-due 9/17 by 10:00 pm EST
Evaluate meaningful use regulations for recovery audit
contractors (RACs) and electronic health records (EHRs), as
well as the impact on either case management or performance
incentives. What is the purpose of these regulations? How
effective are they in meeting the purpose? Support your answer
with course resources-attached
Part TWO
In response to your peer-provided below, agree or disagree with
their assessments of the effectiveness of RAC and EHR
meaningful use regulations. Be sure to justify your answer.
Classmate Chiwaula’s post:
Top of Form
MEANINGFUL USE REGULATIONS FOR RECOVERY
AUDIT CONTRACTORS & ELECTRONIC HEALTH
RECORDS
IMPACT ON CASE MANAGEMENT OR
PERFORMANCE INCENTIVES.
In 2015 the Board of Registration in Medicine introduced a set
of regulations requiring physicians to demonstrate proficiency
in the use of electronic medical records, as well as the skills to
achieve the federal Meaningful Use standard. Under the
regulations, physicians are considered to have demonstrated
proficiency if they meet any one of the following conditions:
· Participating in the Meaningful Use program as an Eligible
Professional
· Having a relationship with a hospital that has been certified as
a Meaningful Use participant. This relationship would be
satisfied by any oneof the following conditions:
. Employed by the hospital
. Credentialed by the hospital to provide patient care
. Having a “contractual agreement” with the hospital

2. · Completing at least three hours of accredited CME program on
electronic health records. Such a program must, at a minimum,
discuss the core and menu set objectives, as well as the clinical
quality measures for Meaningful Use.1
The Recovery Audit Contractor, or RAC, program was created
through the Medicare Modernization Act of 2003 (MMA) to
identify and recover improper Medicare payments paid to health
care providers under fee-for-service (FFS) Medicare plans. The
United States Department of Health and Human Services
(DHHS) is required by law to make the program permanent for
all states by January 1, 2010, under section 302 of the Tax
Relief and Health Care Act of 2006.2 The main goals for RAC
include:
• Minimize Provider Burden
• Ensure Accuracy
• Maximize Transparency
RACs are authorized to investigate claims submitted by all
physicians, providers, facilities, and suppliers—essentially,
everyone who provides Medicare beneficiaries in the fee for
service program with procedures, services, and treatments and
submits claims to Medicare (and/or their fiscal intermediaries
(FI), regional home health intermediaries (RHHI), Part A and
Part B Medicare administrative contractors (A/B/MACs),
durable medical equipment Medicare administrative contractors
(DME MACs), and/or carriers.2
Benefits of Electronic Health Records (EHRs)
Providers who use EHRs report tangible improvements in their
ability to make better decisions with more comprehensive
information. EHR adoption can give health care providers:
Accurate and complete information about a patient's health.
This enables providers to give the best possible care, whether
during a routine office visit or in a medical emergency, by
providing the information they need to evaluate a patient's
current condition in the context of the patient's health history
and other treatments.
The ability to quickly provide care. In a crisis, EHRs provide

3. instant access to information about a patient's medical history,
allergies, and medications. This can enable providers to make
decisions sooner, instead of waiting for information from test
results.
The ability to better coordinate the care they give. This is
especially important if a patient has a serious or chronic
medical condition, such as diabetes.
A way to share information with patients and their family
caregivers. This means patients and their families can more
fully take part in decisions about their health care.
The main goal of health IT is to improve the quality and safety
of patient care.
EHR Incentives: As part of the reinforcement of the regulations
all eligible professionals who successfully satisfy meaningful
use program requirements are to receive incentives and for
those falling short get penalties (reduction in payments). 4
References:
1. Overview of Final EHR/Meaningful Use
Regulations. http://www.massmed.org/Advocacy/Regulatory-
Issues/Overview-of-Final-EHR/Meaningful-Use-
Regulations/#.WbxrosiGO1t. Accessed September 15, 2017.
2. Recovery Audit Contractors (RACs) and
Medicare. https://www.cms.gov/Research-Statistics-Data-and-
Systems/Monitoring-Programs/Medicare-FFS-Compliance-
Programs/Recovery-Audit-Program/Downloads/RACSlides.pdf.
Accessed September 15, 2017.
3. What are the advantages of electronic health
records?. https://www.healthit.gov/providers-
professionals/faqs/what-are-advantages-electronic-health-
records. Accessed September 15, 2017.
4. Medicare and Medicaid EHR Incentive Program
Basics. https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Basics.html.
Accessed September 15, 2017.
Bottom of Form

4. 9/16/2017 Massachusetts Medical Society: Overview of Final
EHR/Meaningful Use Regulations
http://www.massmed.org/Advocacy/Regulatory-
Issues/Overview-of-Final-EHR/Meaningful-Use-
Regulations/#.Wb1y57KGOYl 1/2
MENU
Overview of Final EHR/Meaningful Use Regulations
Action Center
Key Issues
Regulatory Issues
MMS Testimony
State Advocacy
Federal Advocacy
Legislative Updates
January 21, 2015
Full Text of Regulations
Download the regulations here.
(.pdf, 63 pages) New EHR regulations are found on pages 8-9.

5. The Board of Registration in Medicine has finalized regulations
that implement a state law requiring physicians to demonstrate
proficiency in the use of electronic medical records, as well as
the skills to achieve the federal Meaningful Use standard.
The new regulations became effective January 2, 2015, but all
physicians renewing their licenses before March 31, 2015 will
receive a
one-time waiver from the requirements.
In addition, physicians with renewal dates up to 60 days after
March 31, 2015, could submit a renewal application prior to
March 31,
and be within the window for an automatic waiver.
Demonstrating Proficiency
The regulations establish multiple ways in which physicians
would be in compliance with the requirement.
There are also a broad set of exemptions for certain license
categories, where electronic health record use is intrinsic or not
relevant.
Under the regulations, physicians are considered to have
demonstrated proficiency if they meet any one of the following
conditions:
Participating in the Meaningful Use program as an Eligible
Professional
Having a relationship with a hospital that has been certified as a
Meaningful Use participant. This relationship would be satisfied
by any one of the following conditions:
Employed by the hospital

6. http://www.massmed.org/Default.aspx
http://www.massmed.org/Advocacy/Action-Center/Action-
Center/
http://www.massmed.org/Advocacy/Key-Issues/Key-Issues/
http://www.massmed.org/Advocacy/Regulatory-
Issues/Regulatory-Issues/
http://www.massmed.org/Advocacy/MMS-Testimony/MMS-
Testimony/
http://www.massmed.org/Advocacy/State-Advocacy/State-
Advocacy/
http://www.massmed.org/Advocacy/Federal-Advocacy/Federal-
Advocacy/
http://www.massmed.org/Advocacy/Legislative-
Updates/Legislative-Updates/
http://www.massmed.org/Advocacy/Regulatory-Issues/Board-
of-Registration-in-Medicine-Regulations-on-EHRs-and-
Meaningful-Use-(pdf)/
9/16/2017 Massachusetts Medical Society: Overview of Final
EHR/Meaningful Use Regulations
http://www.massmed.org/Advocacy/Regulatory-
Issues/Overview-of-Final-EHR/Meaningful-Use-
Regulations/#.Wb1y57KGOYl 2/2
Credentialed by the hospital to provide patient care
Having a “contractual agreement” with the hospital
Completing at least three hours of accredited CME program on
electronic health records. Such a program must, at a minimum,
discuss the core and menu set objectives, as well as the clinical
quality measures for Meaningful Use.

7. Online CME courses on EHRs from the MMS are available here.
Participating or being an authorized user in the Massachusetts
Health Information Highway (the state’s official health
information
exchange)
Exemptions
Applicants for a Limited License, such as interns and residents
Applicants for a Volunteer License
Applicants for an Administrative License
License applicants not engaged in the practice of medicine
Applicants on active duty in the National Guard, or in military
service who are called into service during a national emergency
or
crisis
Applicants for an Emergency Restricted License
Other Provisions
Physicians may ask the Board of Registration in Medicine for a
90-day waiver to delay implementation of the requirements due
to “undue hardship.” Except for “exceptional circumstances,”
this request must be made at least 30 days before the license
renewal date.
The demonstration of proficiency is a one-time requirement.
The MMS is grateful to the Board’s chair, Candace Sloane, MD,
and its members, who voted to implement the regulations in a

8. responsible manner that will help move physicians towards
adoption of electronic records without denying access to care
for patients
with physicians without access to meaningful use certified
systems.
The MMS is also grateful to those many physicians, specialty
societies, the Conference of Boston Teaching Hospitals and
Massachusetts Hospital Association who provided supportive,
constructive testimony on the regulations.
http://www.massmed.org/Continuing-Education-and-
Events/Online-CME/Online-CME-Courses/#EHR
Perspective
T h e N EW ENGL A N D JOU R NA L o f M EDICI N E
august 5, 2010
n engl j med 363;6 nejm.org august 5, 2010 501
this technology, they will de-
mand nothing less from their
providers. Hundreds of thousands
of physicians have already seen
these benefits in their clinical
practice.
But inevitability does not mean
easy transition. We have years of
professional agreement and bipar-
tisan consensus regarding the

9. potential value of EHRs. Yet we
have not moved significantly to
extend the availability of EHRs
from a few large institutions to
the smaller clinics and practices
where most Americans receive
their health care.
Last year, Congress and the
Obama administration provided
the health care community with
a transformational opportunity to
break through the barriers to
progress. The Health Information
Technology for Economic and
Clinical Health Act (HITECH)
authorized incentive payments
through Medicare and Medicaid
to clinicians and hospitals when
they use EHRs privately and se-
curely to achieve specified im-
provements in care delivery.
Through HITECH, the federal
government will commit unprece-
dented resources to supporting
the adoption and use of EHRs. It
will make available incentive pay-
ments totaling up to $27 billion
over 10 years, or as much as
$44,000 (through Medicare) and
$63,750 (through Medicaid) per
clinician. This funding will pro-
vide important support to achieve

10. liftoff for the creation of a nation-
wide system of EHRs.
Equally important, HITECH’s
goal is not adoption alone but
“meaningful use” of EHRs —
that is, their use by providers to
achieve significant improvements
in care. The legislation ties pay-
ments specifically to the achieve-
ment of advances in health care
processes and outcomes.
HITECH calls on the secretary
of health and human services to
develop specific “meaningful use”
objectives. With the Centers for
Medicare and Medicaid Services
(CMS) in the lead, the Department
of Health and Human Services
(DHHS) has used an inclusive and
open process to develop these
criteria, providing an extensive
opportunity for public and pro-
fessional input. The department
published proposed meaningful
use requirements on January 16,
2010. The proposal prompted some
2000 comments. This week, the
The “Meaningful Use” Regulation for Electronic Health Records
David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N.,
M.H.A.
The widespread use of electronic health records (EHRs) in the
United States is inevitable. EHRs

11. will improve caregivers’ decisions and patients’ out-
comes. Once patients experience the benefits of
The New England Journal of Medicine
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personal use only. No other uses without permission.
Copyright © 2010 Massachusetts Medical Society. All rights
reserved.
P E R S P E C T I V E
n engl j med 363;6 nejm.org august 5, 2010502
DHHS is releasing a final regu-
lation for the first 2 years (2011
and 2012) of this multiyear in-
centive program. Subsequent rules
will govern later phases.
Although the intent of our Jan-
uary proposals has been retained
and indeed affirmed through the
rule-making process, the final
regulation also incorporates sig-
nificant changes — a response
to the comments and experience
that diverse stakeholders shared
with us. In particular, concerns
about the pace and scope of im-
plementation of meaningful use
led us to adopt a two-track ap-
proach regarding the objectives that

12. allow practices and hospitals to
qualify for incentive payments in
the first 2 years of the program.
The most important part of
this regulation is what it says
hospitals and clinicians must do
with EHRs to be considered
meaningful users in 2011 and
2012. In the original proposal,
we identified a broad set of ob-
jectives, all of which would need
to be met. This included 23 ob-
jectives for hospitals and 25 for
clinicians. The DHHS received
many comments that this ap-
proach was too demanding and
inf lexible, an all-or-nothing test
that too few providers would be
likely to pass.
In the final regulation, we
have divided these elements into
two groups: a set of core objec-
tives that constitute an essential
starting point for meaningful
use of EHRs and a separate
menu of additional important
activities from which providers
“Meaningful Use” Regulation for Ehrs
Summary Overview of Meaningful Use Objectives.*
Objective Measure

13. Core set of objectives to be achieved by all eligible
professionals, hospitals, and critical access hospitals to qualify
for incentive payments
Record patient demographics (sex, race, ethnicity, date of birth,
preferred language, and in the case of hospitals, date and
preliminary cause in the event of death)
Over 50% of patients’ demographic data recorded as structured
data
Record vital signs and chart changes (height, weight, blood
pres-
sure, body-mass index, growth charts for children)
Over 50% of patients 2 years of age or older have height,
weight, and
blood pressure recorded as structured data
Maintain up-to-date problem list of current and active diagnoses
Over 80% of patients have at least one entry recorded as
structured data
Maintain active medication list Over 80% of patients have at
least one entry recorded as structured data
Maintain active medication allergy list Over 80% of patients
have at least one entry recorded as structured data
Record smoking status for patients 13 years of age or older
Over 50% of patients 13 years of age or older have smoking
status
recorded as structured data
For individual professionals, provide patients with clinical sum-

14. maries for each office visit; for hospitals, provide an electronic
copy of hospital discharge instructions on request
Clinical summaries provided to patients for over 50% of all
office vis-
its within 3 business days; over 50% of all patients who are
discharged
from the inpatient department or emergency department of an
eligible
hospital or critical access hospital and who request an electronic
copy
of their discharge instructions are provided with it
On request, provide patients with an electronic copy of their
health
information (including diagnostic-test results, problem list,
medi-
cation lists, medication allergies, and for hospitals, discharge
summary and procedures)
Over 50% of requesting patients receive electronic copy within
3
business days
Generate and transmit permissible prescriptions electronically
(does not apply to hospitals)
Over 40% are transmitted electronically using certified EHR
technology
Computer provider order entry (CPOE) for medication orders
Over 30% of patients with at least one medication in their
medica-
tion list have at least one medication ordered through CPOE
Implement drug–drug and drug–allergy interaction checks

15. Functionality is enabled for these checks for the entire reporting
period
Implement capability to electronically exchange key clinical
infor-
mation among providers and patient-authorized entities
Perform at least one test of EHR’s capacity to electronically ex-
change information
Implement one clinical decision support rule and ability to track
compliance with the rule
One clinical decision support rule implemented
Implement systems to protect privacy and security of patient
data
in the EHR
Conduct or review a security risk analysis, implement security
up-
dates as necessary, and correct identified security deficiencies
Report clinical quality measures to CMS or states For 2011,
provide aggregate numerator and denominator through
attestation; for 2012, electronically submit measures
The New England Journal of Medicine
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personal use only. No other uses without permission.
Copyright © 2010 Massachusetts Medical Society. All rights
reserved.

16. n engl j med 363;6 nejm.org august 5, 2010
P E R S P E C T I V E
503
“Meaningful Use” Regulation for Ehrs
will choose several to implement
in the first 2 years (see table).
Core objectives comprise ba-
sic functions that enable EHRs
to support improved health care.
As a start, these include the tasks
essential to creating any medical
record, including the entry of
basic data: patients’ vital signs
and demographics, active medi-
cations and allergies, up-to-date
problem lists of current and active
diagnoses, and smoking status.
Other core objectives include
using several software applica-
tions that begin to realize the
true potential of EHRs to im-
prove the safety, quality, and ef-
ficiency of care. These features
help clinicians to make better
clinical decisions — and avoid
preventable errors. To qualify
for incentive payments, clinicians
must start employing such clini-
cal decision support tools. They

17. must also start using the capa-
bility that undergirds much of
the value of EHRs: using records
to enter clinical orders and, in
particular, medication prescrip-
tions. Only when providers enter
orders electronically can the com-
puter help improve decisions by
applying clinical logic to those
choices in light of all the record-
ed patient data. And to begin
extending the benefits of EHRs
to patients themselves, the mean-
ingful use requirements will in-
clude providing patients with elec-
tronic versions of their health
information.
Summary Overview of Meaningful Use Objectives (Continued.)
Objective Measure
Eligible professionals, hospitals, and critical access hospitals
may select any five choices from the menu set
Implement drug formulary checks Drug formulary check system
is implemented and has access to at
least one internal or external drug formulary for the entire
reporting
period
Incorporate clinical laboratory test results into EHRs as
structured
data

18. Over 40% of clinical laboratory test results whose results are in
positive/
negative or numerical format are incorporated into EHRs as
struc-
tured data
Generate lists of patients by specific conditions to use for
quality
improvement, reduction of disparities, research, or outreach
Generate at least one listing of patients with a specific
condition
Use EHR technology to identify patient-specific education re-
sources and provide those to the patient as appropriate
Over 10% of patients are provided patient-specific education re-
sources
Perform medication reconciliation between care settings
Medication reconciliation is performed for over 50% of
transitions of care
Provide summary of care record for patients referred or transi-
tioned to another provider or setting
Summary of care record is provided for over 50% of patient
transi-
tions or referrals
Submit electronic immunization data to immunization registries
or immunization information systems
Perform at least one test of data submission and follow-up
submis-
sion (where registries can accept electronic submissions)

19. Submit electronic syndromic surveillance data to public health
agencies
Perform at least one test of data submission and follow-up
submission
(where public health agencies can accept electronic data)
Additional choices for hospitals and critical access hospitals
Record advance directives for patients 65 years of age or older
Over 50% of patients 65 years of age or older have an
indication of
an advance-directive status recorded
Submit electronic data on reportable laboratory results to
public
health agencies
Perform at least one test of data submission and follow-up
submis-
sion (where public health agencies can accept electronic data)
Additional choices for eligible professionals
Send reminders to patients (per patient preference) for pre
ventive
and follow-up care
Over 20% of patients 65 years of age or older or 5 years of age
or
younger are sent appropriate reminders
Provide patients with timely electronic access to their health
information (including laboratory results, problem list,
medication

20. lists, medication allergies)
Over 10% of patients are provided electronic access to
information
within 4 days of its being updated in the EHR
* This overview is meant to provide a reference tool indicating
the key elements of meaningful use of health information
technology. It does
not provide sufficient information for providers to document
and demonstrate meaningful use in order to obtain financial
incentives from
the Centers for Medicare and Medicaid Services (CMS). The
regulations and filing requirements that must be fulfilled to
qualify for the
Health IT financial incentive program are detailed at
www.cms.gov.
The New England Journal of Medicine
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reserved.
P E R S P E C T I V E
n engl j med 363;6 nejm.org august 5, 2010504
In addition to the core ele-
ments, the rule creates a second
group: a menu of 10 additional
tasks, from which providers can
choose any 5 to implement in

21. 2011–2012. This gives providers
latitude to pick their own path
toward full EHR implementation
and meaningful use.
For example, the menu in-
cludes capacities to perform drug-
formulary checks, incorporate
clinical laboratory results into
EHRs, provide reminders to pa-
tients for needed care, identify
and provide patient-specific health
education resources, and employ
EHRs to support the patient’s
transitions between care settings
or personnel.
For most of the core and
menu items, the regulation also
specifies the rates at which pro-
viders will have to use particular
functions to be considered mean-
ingful users. Reflecting the views
and experiences shared during
the comment period, these rates
will enable significant progress
toward improving care — but
are also achievable by average
practices and providers in the
early years.
The HITECH legislation further
requires that meaningful use in-
clude electronic reporting of data
on the quality of care. In the final
regulation, we have simplified the

22. January proposals for quality re-
porting, while still building to-
ward a robust reporting capabil-
ity that will inform providers
about their own performance and
will eventually inform the public
as well. Clinicians will have to
report data on three core quality
measures in 2011 and 2012:
blood-pressure level, tobacco sta-
tus, and adult weight screening
and follow-up (or alternates if
these do not apply). Clinicians
must also choose three other
measures from lists of metrics
that are ready for incorporation
into electronic records.
The meaningful use rule is
part of a coordinated set of reg-
ulations to help create a private
and secure 21st-century electron-
ic health information system. On
June 18, 2010, the DHHS issued
a rule that laid out a process for
the certification of electronic
health records, so that providers
can be assured they are capable
of meaningful use. The depart-
ment has also issued still anoth-
er regulation that lays out the
standards and certification cri-
teria that EHRs must meet in
order to be certified. Finally, re-
alizing that the privacy and se-

23. curity of EHRs are vital, the
DHHS has been working hard to
safeguard privacy and security
by implementing new protections
contained in the HITECH legis-
lation.
The meaningful use rule strikes
a balance between acknowledg-
ing the urgency of adopting EHRs
to improve our health care sys-
tem and recognizing the chal-
lenges that adoption will pose
to health care providers. The reg-
ulation must be both ambitious
and achievable. Like an escala-
tor, HITECH attempts to move
the health system upward toward
improved quality and effective-
ness in health care. But the speed
of ascent must be calibrated to
ref lect both the capacities of
providers who face a multitude
of real-world challenges and
the maturity of the technology
itself.
As part of this process, the
DHHS is establishing a nation-
wide network of Regional Exten-
sion Centers to assist providers
in adopting qualified EHRs and
making meaningful use of them.
The DHHS is committed to the
support, collaboration, and on-

24. going learning that will mark our
progress toward electronically con-
nected, information-driven med-
ical care. We hope that providers
and consumers will now join us
in the effort to assure that we
make the best possible use of our
most precious health care resource:
information about the patients we
serve.
Disclosure forms provided by the au-
thors are available with the full text of this
article at NEJM.org.
Dr. Blumenthal is the national coordinator
for health information technology at the
Department of Health and Human Ser-
vices, and Ms. Tavenner is the principal
deputy administrator of the Centers for
Medicare and Medicaid Services — both in
Washington, DC.
This article (10.1056/NEJMp1006114) was
published on July 13, 2010, at NEJM.org.
Copyright © 2010 Massachusetts Medical Society.
“Meaningful Use” Regulation for Ehrs
The New England Journal of Medicine
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personal use only. No other uses without permission.
Copyright © 2010 Massachusetts Medical Society. All rights
reserved.