2019 Program Requirements Medicare

In the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-term Care Hospital (LTCH) Prospective Payment System Final Rule, CMS made changes to the Promoting Interoperability Programs for Medicare eligible hospitals, critical access hospitals (CAHs), and dual-eligible hospitals attesting to CMS.

The final rule adopted policies to continue the advancement of certified electronic health record technology (CEHRT) utilization, reduce burden, and increase interoperability and patient access to their health information. Eligible hospitals and CAHs must successfully demonstrate meaningful use of CEHRT to avoid reductions to their Medicare payments.

Some of these changes will affect 2019 reporting. For more information on these and other changes, review the final rule and fact sheet. CMS will be updating the Promoting Interoperability Programs website with additional 2020 program requirements details in the coming weeks.

EHR Reporting Period in 2019

The electronic health record (EHR) reporting period for new and returning participants attesting to CMS is a minimum of any continuous 90-day period in CY 2019. Visit the landing page for up-to-date information on the attestation deadline.

2015 Edition Certified EHR Technology

Beginning with the EHR reporting period in calendar year 2019, participants in the Medicare Promoting Interoperability Program are required to use 2015 Edition CEHRT. This requirement will be beneficial to health care providers to move to more up-to-date standards and functions that better support interoperable exchange of health information and improve clinical workflows. The 2015 Edition CEHRT did not have to be implemented on January 1, 2019. However, the functionality must be in place by the first day of the EHR reporting period. The eligible hospital or CAH must be using the 2015 Edition functionality for the full EHR reporting period. In many situations the product may be deployed, but pending certification.

Objectives and Measures 

In 2019, eligible hospitals, CAHs, and dual-eligible hospitals attesting to CMS will be required to report on four objectives, and their associated measures. The 2019 Medicare specification sheets are available here (PDF) or here.

Scoring Methodology 

In the FY 2019 IPPS LTCH final rule, CMS finalized changes to the scoring methodology to shift to a performance-based scoring methodology with fewer measures, instead of the previous threshold-based methodology. CMS believes this methodology will encourage hospitals to push themselves on measures that are most applicable to how care is delivered to patients, instead of increasing thresholds on measures that may not be as applicable to an individual hospital.

More information on the updated scoring methodology can be found below.

Extreme and Uncontrollable Circumstances

If your EHR vendor is unable to offer 2015 Edition CEHRT for the 2019 EHR reporting period, you can apply for a hardship exception to avoid a payment reduction. 

In order to receive this hardship exception, eligible hospitals and CAH(s) must have faced Extreme and Uncontrollable Circumstances that prevented them from demonstrating meaningful use, and attest to such circumstances. More information and hardship exception applications for the 2019 reporting year can be found here.

Additional Information for Clinicians

Beginning in 2017, all eligible clinicians who may have previously participated in the Medicare Promoting Interoperability Program are now required to report on Quality Payment Program (QPP) requirements. For more information on the QPP, visit this website.

Resources Now Available

• 2019 Medicare specification sheets (PDF)
• FY 2019 IPPS and Medicare Promoting Interoperability Program Overview Fact Sheet (PDF)
• Performance-based Scoring Methodology Fact Sheet (PDF)
• 2019 Medicare Electronic Prescribing Objective Fact Sheet (PDF)
• 2019 Medicare Health Information Exchange Objective Fact Sheet (PDF)
• 2019 Medicare Provider to Patient Exchange Objective Fact Sheet (PDF)
• 2019 Medicare Public Health and Clinical Data Exchange Objective Fact Sheet (PDF)
• 2019 Security Risk Analysis Fact Sheet  (PDF)

Contact Information

• Medicare EPs may contact the QPP help desk for assistance at qpp@cms.hhs.gov or 1-866-288-8292.
• Medicaid EPs and hospitals participating in the Medicaid Promoting Interoperability Program with inquiries about their participation should contact their State Medicaid Agencies.
• Medicare and dually eligible hospitals participating in the Medicare and Medicaid Promoting Interoperability Programs may contact the QualityNet help desk for assistance at qnetsupport@hcqis.org or 1-866-288-8912.