Frequently Asked Questions on Compliance With E-notifications Condition of Participation included in CMS’s Interoperability and Patient Access Rule
Have Questions? PatientPing Guarantees Compliance with the E-notifications Condition of Participation (CoP) Included in CMS’s Interoperability and Patient Access Rule
Frequently Asked Questions
What constitutes e-notifications CoP compliance?
The e-notifications condition of participation rule requires all hospitals (including psychiatric hospitals and Critical Access Hospitals) utilizing an electronic medical records system or other electronic administrative system that is conformant with the content exchange standard HL7 v2.5.1 (i.e., most hospitals) to send real-time electronic notifications:
At: Inpatient admit, discharge, and transfer (ADT) and emergency department (ED) presentation and discharge
To: Established primary care physicians (PCPs), established primary care practice groups or entities such as accountable care organizations (ACOs), federally qualified health centers (FQHCs), physicians organizations, POs, etc.), post-acute service providers and suppliers like skilled nursing facilities (SNFs), home health aide (HHAs), hospices, inpatient rehabilitation facility (IRFs), long-term acute care (LTACs), etc., and other practitioners/groups/entities identified by the patient as primarily responsible for his or her care.
These real-time electronic notifications must include the patient name, treating practitioner name, and sending institution name.
Notifications must be sent to all included providers in the rule that:
Have an established care relationship with the patient
Are able to receive e-notifications
Need the information for treatment, care coordination, or quality improvement purposes
How can I be sure that my hospital is in compliance with the e-notifications CoP included in CMS’s Interoperability and Patient Access rule?
There are two main requirements: First, a hospital must have the ability to send patient-directed e-notifications to PCPs and other patient-identified practitioners, a process that requires access to a directory of PCP and other provider digital contact info and a mechanism to push direct notifications to correctly matched providers in real time. Additionally, a hospital must have the ability to respond to post-acute and primary care group provider requests for e-notifications, a complex process that involves the setting up of data share agreements, processing and matching of diverse roster types, and the execution of frequent roster changes.
What happens if hospitals do not meet the CoP e-notifications requirements?
Medicare CoPs are federal regulations that hospitals must comply with in order to participate in – that is, to receive payment from – the Medicare and Medicaid programs, the largest payers for healthcare in the U.S. If hospitals do not meet CoP requirements, they will be unable to bill Medicare or Medicaid.
What headaches might I not be aware of when planning for compliance?
The e-notification rule text alone is more than 100 pages long, and while hospital IT executives know that CoP compliance is critically important to continue to receive Medicare and Medicaid reimbursement, many don’t fully understand the rule requirements and the practical challenges ahead. Some of the more common challenges include:
Hospitals may not fully realize that they have CoP compliance gaps today with their current solutions.
Achieving compliance can be extremely time and resource consuming for already stretched IT executives and staff.
Managing trust/security with the various entities who need to receive ADTs exposes the hospital/health system to potential data breaches that could cost millions.
Matching the various types of provider rosters to patients seen at your hospital to enable required real-time notifications introduces tremendous complexity.
For every provider a hospital will be required to send real-time e-notifications to, the hospital must sign a data share agreement, build a connection to the provider, be able to consume their roster(s) of patients, troubleshoot those rosters, manage changes to those rosters that occur at the frequency the provider entity chooses (daily, weekly, monthly…), and then send them a filtered ADT feed on the patients on their roster.
If hospitals rely only on their local health information exchange (HIE), required notifications that must be sent to out-of-state or other out-of-HIE-reach providers could expose the hospital to risk of non-compliance.
The compliance deadline for the e-notifications CoP is May 1, 2021. This means that many health systems will need to initiate any required changes now to give them time to come into compliance by the deadline.
There will likely be additional modifications or clarifications to the rule by CMS in the future, and the ongoing burden of monitoring these changes and addressing internally will be cumbersome and could expose the hospital to risk of non-compliance if not handled proactively.
Does PatientPing’s Route guarantee compliance?
Yes! Route guarantees full compliance under the e-notifications CoP. With this guarantee, if a Route customer is ever found to have e-notification CoP deficiencies during a CMS survey, we will deploy a PatientPing Compliance Expert onsite to help the hospital resolve the issue and develop the required corrective action plan within 10 calendar days at no cost.
If I am already sending our ADT feed to multiple HIEs, do I need to do anything else to be compliant?
Yes. Just working with existing HIE relationships does not ensure your organizations is 100% compliant. Some things to consider:
What happens when you are required to send ADT notifications to out-of-state providers?
Can the HIE handle required notifications to different types of providers such as those coming from post-acutes, ACOs, FQHCs, and individual PCPs and other practitioners?
Is your HIE able to scale their services to handle the potential volume of requests and associated roster processing due to the new rule?
If I send my data to HIE(s) or other intermediaries like CommonWell / Carequality, is the compliance burden on them or me as the hospital?
The burden is on the hospital.
Shouldn’t my EMR vendor be able to handle this for me?
While some EMRs may be equipped to handle patient-directed notifications to PCPs and other patient-identified practitioners, they may not be able to handle the complex roster processing required to fulfill post-acute and primary care group e-notification requests for full compliance. PatientPings’s EHR-agnostic solution can connect disparate care sites, including post-acute, no matter the incumbent technology, and we have extensive experience processing rosters of patients. EMRs likely can’t offer a solution that enables full rule compliance that handles both the patient-directed e-notifications as well as provider requested notifications.
Can’t our hospital just manage the e-notifications ourselves?
Hospitals do have the option to manage e-notification requests directly. However, you should consider the technical and administrative burden these compliance requirements will have on your organization. You will have to vet each required requesting provider that you must send e-notifications to, enter into a BAA with the provider to comply with HIPAA, build a connection to them, be able to consume their roster(s) of patients, troubleshoot those rosters, manage changes to those rosters that occur at the frequency the entity chooses (daily, weekly, monthly…), and then send them a filtered ADT feed on the patients on their roster.
Other considerations include:
Will your internal teams be able to handle different types of requests such as those coming from post-acute sites or primary care groups?
Are you able to scale your internal resources to handle the potential volume of requests?
How will you vet each requesting provider?
We are resource-constrained. How much time is needed to implement Route/PatientPing?
We recognize how time-constrained IT teams are and have a simple onboarding process. ADT implementations for a full, unfiltered ADT feed are scheduled to be completed in 6-8 weeks or less, with just 10-12 hours of work required from your IT team. No software to install. No upgrades to do. No additional FTEs needed.