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

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 one of 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 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 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

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