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Interoperability Q&A with Ross Marguiles, Associate at Foley Hoag: Part 2

We recently shared part one of our interview with Ross Marguiles, a healthcare attorney at the law firm Foley Hoag, regarding CMS’s Interoperability and Patient Access Final Rule and changes to Medicare Conditions of Participation (CoPs). Ross participated in CarePort’s May 20th interoperability webinar – now available on-demand – and with extensive knowledge in Medicare and Medicaid, is a valuable resource on this topic.

Below, Ross provides further clarity on the CoPs – which hospitals are mandated to comply, how hospitals can achieve that compliance by the May 1, 2021 deadline and how CMS may plan to ensure hospitals abide by these new requirements.

If a hospital doesn’t have an EHR system capable of sending ADT notifications, does that hospital need to comply with CMS’s regulations as described within the final rule?

In short, no. This question is more applicable for smaller, more rural hospitals that don’t have EHRs capable of sending ADT notifications. While CMS is not adopting a specific standard for transmitting the notifications, they are adopting a specific standard – specifically, the HL7 standard – for purposes of determining whether a hospital needs to comply with the new CoPs. If a hospital doesn’t have the capability to transmit data in conformance with the HL7 standard (Health Level Seven (HL7®) Messaging Standard Version 2.5.1 (HL7 2.5.1)), it doesn’t need to comply with these new CoPs.

What if a hospital’s EHR system is capable of meeting the ADT messaging standard, but it relies on direct messaging for these types of communications?

Hospitals are not required to utilize the ADT messaging standard (HL7) to send patient event notifications. CMS is adopting the ADT standard solely to determine whether a hospital is subject to the CoPs, however CMS is not specifying a standard for the content, format, or delivery of the patient event notifications.

Why has CMS amended the CoPs? What are the implications?

CMS has reinforced its belief that “patient event notifications should be a fundamental feature of hospital medical record systems to support effective care transitions and promote patient safety during transitions.” This was arguably the most controversial piece of this policy, as failure to comply with applicable CoPs can ultimately result in termination from the Medicare program. As most hospitals know, what is clear by amending the Medicare CoPs for hospitals, critical access hospitals and psych hospitals is that CMS takes this ADT requirement very seriously.

By amending the CoPs and making this a requirement, hospitals will now be surveyed on this mandate for accreditation purposes.

Hospitals now have 11 months to achieve compliance, and I strongly encourage all hospitals to think very seriously about a solution that ensures they’re making a reasonable effort to comply.

How will CMS ensure compliance with this new requirement?

As I mentioned previously, because ADT notifications are part of the new CoP, hospitals will be surveyed. To ensure compliance, CMS will develop updated policies and procedures for its surveyors who will likely: (1) interview hospital and medical records staff to ask about policies and procedures for the ADT notifications, (2) review active and closed medical records for evidence of patient event notifications, (3) review patient event notification policies and procedures provided by medical record staff and (4) conduct observational interviews to determine if requirements are being met as set forth in those policies and procedures.

Is your organization prepared to comply with the CoPs by the May 1, 2021 deadline? CarePort can help. Contact us to learn more.

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