Ohio Health Information Management Association

CMS Releases Final 2012 Home Health Rule
Posted November 10, 2011

An update to the CMS home health prospective payments system rates will decrease Medicare payments to home health agencies by 2.31 percent in calendar year 2012. This is the first of two installments that will equal 5.06 percent. This first decrease is justified by a 2.4 percent market basket update, a 1.0 percent cut mandated by the Patient Protection and Affordable Care Act, a wage index update, and a 3.79 percent coding offset to adjust for changes in case mix. The final rule will also allow hospital and post-acute care physicians to comply with the home health requirement for a face-to-face encounter by informing the certifying physician of their encounters with the patient.

Physician Fee Schedule Final Rule Published
Posted November 10, 2011

CMS has issued a final rule outlining the requirements for payment policies under the physician fee schedule, five-year review of work relative value units, clinical laboratory fee schedule: signature on requisition, and other revisions to Part B for CY 2012. The rule will be published on November 28, a display copy can be viewed here.

CMS Releases Final 2012 OPPS Rule
Posted November 10, 2011

A final rule has been established by the Centers for Medicare and Medicaid Services (CMS) to update the Medicare payment policies and rates for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical centers for calendar year 2012. Not only did this increase OPPS payments by 1.9 percent, but the final rule prolongs the period of non-enforcement of the direct supervision requirements for outpatient therapeutic services for critical access hospitals and small rural hospitals. The intention is to help give CMS time to put in place an expanded ambulatory payment classification panel to make independent recommendations to the agency regarding the supervision level for individual hospital outpatient therapeutic services. Additionally, CMS will not include the hospital-acquired condition measures, Agency for Healthcare Research and Quality composite measures, or the efficiency measure for the fiscal year 2014 Value Based Purchasing program.

Shared Savings Regulations Published
Posted October 28, 2011

The Centers for Medicare and Medicaid Services (CMS) issued a final rule outlining the implementation of accountable care organizations (ACO) and an interim final rule removing certain barriers to ACO participation by establishing waivers to federal physician self-referral and anti-kickback laws. Changes in the Shared Savings program under the final rule include:

The proposed rule called for the reporting of 65 quality performance measures, many of which presently do not exist or have not been adequately tested. In the final rule CMS picked 33 quality measures "which will be scored as 23 measures."
Meaningful use of electronic health records will be a measure, but the 50 percent threshold of physicians achieving meaningful use has been removed.
ACO participation by rural health centers and federally qualified health centers has been added.
New flexibility in the start date of ACOs, which was proposed as Jan. 1, 2012. Now, CMS will accept applications for an April 1, 2012 or July 1, 2012 start date, with all ACOs starting in 2012 having agreement periods that terminate at the end of 2015.

The rules, which can be downloaded from the Office of the Federal Register, will be published in the Federal Register on November 2.

CMS Revises ASC’s Conditions for Coverage
Posted October 28, 2011

On October 24 CMS issued a final rule that would update the conditions for coverage regulations for ambulatory surgical centers (ASC) based on a proposed rule CMS issued in April 2010. This new final rule simplifies requirements that ASCs must follow in notifying patients about their rights. Specifically, the final rule will allow ASCs to provide the patient, the patient's representative or the patient's surrogate with patient rights information before the start of the surgical procedure.

CMS Revises CAH’s Requirements for Conditions of Participation
Posted October 28, 2011

On October 24 CMS issued a proposed rule revising the requirements that hospitals and critical access hospitals (CAH) must meet to participate in the Medicare and Medicaid programs. The Conditions of Participation are federal health and safety requirements ensuring high-quality care for all patients. The proposed rule is designed to reduce the regulatory burden on hospitals by:

Establishing requirements for provider authentication of verbal orders
Enabling hospitals to have a single, interdisciplinary care plan that supports coordination of care instead of requiring a separate stand-alone nursing care plan
Allowing hospitals to determine the best ways to oversee and manage outpatients by removing the unnecessary requirement for a single director of outpatient services
Increasing flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system

If you would like to participate in the regulatory review and comment activity please contact Allison Viola, AHIMA’s director of federal relations.

CMS Issues Final Rule for Medicaid RACs
Posted September 22, 2011

This final rule, published on September 16 by the Centers for Medicare and Medicaid Services (CMS), provides guidance to states related to federal/state funding of state start-up, operation, and maintenance costs of Medicaid recovery audit contractors (RACs) and the payment methodology for State payments to Medicaid RACs. This rule also directs states to assure that adequate appeal processes are in place for providers to dispute adverse determinations made by Medicaid RACs. Lastly, the rule directs states to coordinate with other contractors and entities auditing Medicaid providers and with state and federal law enforcement agencies. You can download a copy of the rule here.

New ICD-9-CM Procedure Codes for FY 2012
Posted September 6, 2011

The new ICD-9-CM procedure codes go into effect October 1. This date marks the last regular annual update to the ICD-9-CM code set before the partial code freeze. You can review highlights of the 2012 updates in an online-only article on the Journal of AHIMA Web site. Updates to the 2012 diagnosis codes appear in the September print issue of the Journal, which is also available in the AHIMA Body of Knowledge.

FY 2012 ICD-9-CM Guidelines Posted
Posted August 18, 2011

The ICD-9-CM Official Guidelines for Coding and Reporting (effective October 1) have been posted to the Centers for Medicare and Medicaid Services (CMS) Web site. These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-9-CM: the American Hospital Association (AHA), AHIMA, CMS, and the National Center for Health Statistics (NCHS). These guidelines are included on the official government version of the ICD-9-CM, and also appear in Coding Clinic for ICD-9-CM published by the AHA. The most significant changes were the new sections added to describe the appropriate coding of post-procedural infection and post-procedural septic shock (I.C.1.b.10.c.), proper coding and sequencing of types and stages of glaucoma (I.C.6.b.), and general guidelines for complications of care (I.C.17.f.1.).

FY 2012 Inpatient PPS Final Rule on Display
Posted August 4, 2011

The hospital inpatient PPS (IPPS) final rule for fiscal year (FY) 2012 went on display at the Federal Register on August 1. It is expected to be published in the Federal Register on August 18. To provide hospitals with an incentive to reduce preventable hospital readmissions and improve care coordination, the Affordable Care Act requires the Centers for Medicare and Medicaid Services (CMS) to implement a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 (for discharges on or after October 1, 2012) to certain hospitals that have excess readmissions for certain selected conditions. The final rule finalizes readmissions measures for three conditions (acute myocardial infarction, heart failure, and pneumonia) as well as the methodology that will be used to calculate excess readmission rates for these conditions.

The final rule also adopts a Medicare spending per beneficiary measure for both the Hospital Inpatient Quality Reporting Program and the new Hospital Inpatient Value-Based Purchasing program required by the Affordable Care Act. The new measure will assess Part A and Part B beneficiary spending during a period of time that spans from three days prior to a hospital admission through 30 days after the patient is discharged. The goal is to encourage hospitals to provide high quality care to Medicare beneficiaries at a lower cost and to promote greater efficiencies across care settings and throughout the entire US healthcare system.

The final rule also lays the groundwork for a quality reporting program under the Long Term Care Hospital Prospective Payment System, by establishing the first measure set for reporting beginning October 1, 2012.View the complete final rule and read AHIMA's comment letter on the IPPS proposed rule.

CMS Publishes IFR for HIPAA Transactions
Posted July 14, 2011

The Centers for Medicare and Medicaid Services (CMS) published an interim final rule with comment period [76FR40458], “Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions.” The Patient Protection and Affordable Care Act (ACA) established new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs.

This interim final rule with comment period adopts operating rules for two HIPAA transactions: eligibility for a health plan and healthcare claim status. This rule also defines the term ‘‘operating rules’’ and explains the role of operating rules in relation to the adopted transaction standards. In general, transaction standards adopted under HIPAA enable electronic data interchange through a common interchange structure, thus minimizing the industry’s reliance on multiple formats. This rule became effective June 30, with a compliance date of January 1, 2013. For a copy of the rule, go to the Federal Register.

CMS Publishes Physician Fee Schedule Proposed Rule
Posted July 7, 2011

The Centers for Medicare and Medicaid Services (CMS) published a display notice of proposed rulemaking Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2012 on July 1. The rule addresses, implements, or discusses certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and discusses Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; and the EHR incentive program. The rule will be published in the Federal Register on July 19 but for a display copy, click here. If you are interested in a volunteer opportunity to participate in the review and comment period, please contact Allison Viola at allison.viola@ahima.org or 202-659-9440.

CMS Publishes OPPS Proposed Rule
Posted July 7, 2011

The Centers for Medicare and Medicaid Services (CMS) published a display notice of proposed rulemaking Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment. Of particular note, CMS is proposing to revise the requirements for the Hospital Outpatient Quality Reporting (IQR) Program, add new requirements for ASC Quality Reporting System, and make additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are proposing to allow eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. The rule will be published in the Federal Register on July 18 but for a display copy, click here. If you are interested in a volunteer opportunity to participate in the review and comment period, please contact Allison Viola at allison.viola@ahima.org or 202-659-9440.

CMS Publishes Final Rule for Medicaid HCACs
Posted June 9, 2011

The Centers for Medicare and Medicaid Services (CMS) published a final regulation implementing section 2702 of the Patient Protection and Affordable Care Act which directs the Secretary of Health and Human Services to issue Medicaid regulations effective as of July 1, prohibiting federal payments to states for any amounts expended for providing medical assistance for health care-acquired conditions specified in the regulation. It will also authorize states to identify other provider-preventable conditions for which Medicaid payment will be prohibited. Read a copy of the regulation.

OCR Releases Rule for Accounting of Disclosures and Access
Posted June 2, 2011

The HHS Office of Civil Rights (OCR) has published its notice of proposed rule making (NPRM) in the May 31 Federal Register (76FR31426-49). These changes come about from HITECH legislation passed in 2009. Comments on the NPRM are due on or before August 1.

The NPRM expands the HIPAA accounting of disclosure requirements (§164.528) to include disclosures of information from the electronic designated record set (§164.501) for treatment, payment, and operations. OCR also designates which disclosures (paper or electronic) must be accounted for rather than the current identification of exclusions to the requirement. In addition, OCR expands the HIPAA requirements to include reporting of access by individuals to electronic protected health information. Information regarding both access and disclosures would be required to be held for three years rather than the current HIPAA requirement for disclosures that lasts six years. The notice of privacy protection (§164.520) would require a revision to identify these patient rights.

OCR is proposing that covered entities and business associates comply with the modifications to the accounting for disclosures requirement beginning 180 days after the effective date of the final regulation (240 days after publication), and the accounting for access beginning January 1, 2013 for electronic designated record set systems acquired after January 1, 2009, and beginning January 1, 2014, for electronic designated record set systems acquired as of January 1, 2009.

More information on the NPRM can be found at the Journal of AHIMA Web site. AHIMA will comment on the requirements and urges readers to do the same. An analysis of the proposed rule will be available shortly on the AHIMA’s Advocacy and Public Policy Web site, and more information about a June 9 audio seminar on the proposed rule can be found here.

CMS Publishes Hospital VBP Final Regulation
Posted May 5, 2011

The Centers for Medicare and Medicaid Services (CMS) published the Hospital Inpatient Value-Based Purchasing program (Hospital VBP program), under which value-based incentive payments will be made in a fiscal year to hospitals that meet performance standards with respect to a performance period for the fiscal year involved. The program will apply to payments for discharges occurring on or after October 1, 2012. Scoring in the Hospital VBP program will be based on whether a hospital meets or exceeds the performance standards established with respect to the measures. By adopting this program, CMS will reward hospitals based on actual quality performance on measures, rather than simply reporting data for those measures. The regulations are effective on July 1. The regulation will be published in the Federal Register on Friday, May 6.

CMS Publishes IRF Proposed Regulation
Posted April 28, 2011

CMS published the proposed regulation for the Medicare Inpatient Rehabilitation Facility (IRF) Prospective Payment System for federal fiscal year 2012. The regulation is on file at the Office of the Federal Register (OFR) and will be published in the Federal Register on April 29. This proposed rule would implement section 3004 of the Affordable Care Act, which establishes a new quality reporting program that provides for a two percent reduction in the annual increase factor beginning in 2014 for failure to report quality data to the Secretary of Health and Human Services. This proposed rule would also update the prospective payment rates for IRFs for fiscal year 2012. Learn more. If you would like to participate in the review of the new quality reporting program, contact AHIMA’s Director of Federal Relations Allison Viola.

Hospital Inpatient PPS Proposed Rule for FY 2012 on Display
Posted April 28, 2011

The hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2012 has been placed on display at the Federal Register. CMS issued fact sheets providing more information about the proposed rule. The proposed rule would update payment policies and rates for acute care hospitals paid under the IPPS, as well as hospitals paid under the Long Term Care Hospital Prospective Payment System (LTCH PPS). The IPPS payment update includes a documentation and coding adjustment of -3.15 percentage points to account for changes in documentation and coding following adoption of the Medicare severity diagnosis related groups that did not reflect actual increases in patients’ severity of illness.

To provide hospitals with an incentive to improve care coordination, the Affordable Care Act directs CMS to implement a hospital readmissions reduction program that will reduce payments beginning in FY 2013 to certain hospitals that have excess readmissions for certain selected conditions. This proposed rule proposes measures for rates of readmissions for three conditions—acute myocardial infarction (or heart attack), heart failure, and pneumonia. CMS is also proposing a methodology that would be used to calculate excess readmission rates for the program.

CMS is proposing to add one category of conditions to the list of hospital-acquired conditions (HACs) in FY 2012 for purposes of the HACs payment policy. The proposed HAC is acute renal failure after contrast administration (also known as contrast-induced acute kidney injury or CI-AKI0). The proposed rule also includes proposals aimed at encouraging improvements in the quality of care in hospital inpatient settings and makes proposals that would align the existing inpatient quality reporting program with a proposed new hospital value-based purchasing program required by the Affordable Care Act. The proposed rule also establishes the framework for a new quality reporting program that would apply to hospitals paid under the LTCH PPS. CMS will accept comments on the proposed rule until the close of business on June 20. Access the display copy of the proposed rule.

CMS Raises RAC Record Request Limits
Posted March 10, 2011

The Centers for Medicare and Medicaid Services (CMS) recently increased the number of medical records that recovery audit contractors (RACs) can request in a 45-day period from hospitals with more than $100 million in annual Medicare payments. Under the revised policy, RACs can request up to 500 records per period from these hospitals, a significant increase from the standard cap of 300 records. In a recent letter to hospitals subject to the new cap, CMS claims facilities with DRG payments in excess of $100 million “have the capability to address a larger number of additional documentation requests.” AHA has expressed concern to CMS over the significant increase in administrative burden for hospitals impacted by the new policy. For more information, go to the CMS Web site.

CMS Delays Medicaid RAC Implementation Date
Posted March 10, 2011

The Centers for Medicare and Medicaid Services (CMS) issued a notice in a February bulletin clarifying their expectations for State implementation of the Medicaid Recovery Audit Contractor (RAC) programs. CMS states, “Out of consideration for State operational issues and to ensure States comply with the provisions of the Final Rule, we have determined that States will not be required to implement their RAC programs by the proposed implementation date of April 1.” CMS expects to indicate the new implementation deadline when the final rule is published later this year. A new Web site was developed to summarize the status of each state’s RAC program with updates on an ongoing basis.

2011 ICD-10-CM Official Coding Guidelines Posted
Posted March 10, 2011

The Centers for Disease Control and Prevention (CDC) have posted the 2011 version of the ICD-10-CM Official Guidelines for Coding and Reporting in the 2011 ICD-10-CM files.

CMS to Modify Meaningful Use Group Practice Registration Process
Posted February 17, 2011

The Centers for Medicare and Medicaid Services (CMS) announced that it will implement protocols in May that allow eligible professionals (EPs) to designate a third-party (such as a practice administrator) to register and attest for them as part of the EHR meaningful use incentive program. EPs are not currently allowed to designate a practice manager or any other person to register in their place. However, until CMS implements this new group practice “functionality,” each EP should register himself or herself separately for the Medicare and Medicaid EHR Incentive Programs.

Bill Introduced to Cut Federal Spending Impacts ARRA-HITECH
Posted February 11, 2011

On January 24 Representative Jim Jordan (R-OH), introduced HR 408, the “Spending Reduction Act of 2011,” Public Law 111-5. The formal intent of the bill is to reduce federal spending by $2.5 trillion through FY 2021. The bill takes particular aim at the “American Recovery and Reinvestment Act” and does impact funding for ARRA-HITECH matters in sections 301 and 302:

Section 301 would rescind all unobligated balances of the discretionary appropriations made available by division A of ARRA. The HITECH language in division A included the $2 billion in discretionary funding for the Office of the National Coordinator. Whatever remains of these funds would be eliminated. This would negatively impact funding for Regional Extension Centers, workforce development, and other ONC initiatives. The HITECH language would not be eliminated, only the discretionary funding from ARRA.
Section 302 would repeal subtitles B and C of title II and titles III through VII of division B of ARRA. This would effectively eliminate the Medicare incentive plan for the implementation of electronic health records.

The bill has been referred to 14 House committees including the key health committees of Energy and Commerce, Ways and Means and Education and the Workforce.

The prospects for this legislation are comparable to those of repealing healthcare reform. Can it and will it pass the House of Representatives? That is certainly feasible. Can it and will it get through the Senate and be signed by the President? That will be a much more difficult undertaking. We are likely to see more of these types of bills introduced over the coming months. For further information on HR 408, visit the Action Center of the Advocacy Assistant.

CMS Publishes Proposed Rule for IPF PPS
Posted February 11, 2011

The Centers for Medicare and Medicaid Services (CMS) published a proposed rule for the inpatient psychiatric facilities prospective payment system (IPF PPS) update for rate year 2012. This proposed rule would update the prospective payment rates for Medicare inpatient hospital services provided by IPFs for discharges occurring during the rate year beginning July 1, 2011 through September 30, 2012. The proposed rule would also change the IPF PPS payment rate update period to a rate year that coincides with a fiscal year. In addition, the rule proposes policy changes affecting the IPF PPS teaching adjustment. It would also rebase and revise the Rehabilitation, Psychiatric, and Long-Term Care market basket, and make some clarifications and corrections to terminology and regulations text. Learn more.

2011 Copy Cost Fees
Posted February 8, 2011

Fees for providing copies of medical records in 2011 have been released by the Ohio Department of Health (ODH). The costs are for calendar year 2011 based on a 1.64% change in the Consumer Price Index (CPI) in accordance with Ohio Revised Code Section 3701.742. Click here for details.

2011 ICD-10-CM/PCS Files Posted
Posted January 14, 2011

The Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) have posted the 2011 versions of the ICD-10-CM and ICD-10-PCS code sets and general equivalence mappings (GEMs), including addenda files listing the changes. Click here to access the 2011 ICD-10-PCS files.

NQF Reports on Clinical Decision Support, Appropriate Health IT Use
Posted January 14, 2011

The National Quality Forum (NQF) released two new reports this week in support of the Health Information Technology for Economic and Clinical Health Act (HITECH).

The Driving Quality: A Health IT Framework for Measurement report, based on the work of NQF’s Health Information Technology Utilization Expert Panel, presents the Health IT Use Assessment Framework. This framework provides an approach to measuring the use of health IT tools and how that use improves care processes, quality, and safety. Additionally, as health IT use measures are developed, the framework will provide guidelines for the information needed to construct these measures.

In addition, NQF convened the Clinical Decision Support (CDS) Expert Panel to develop a CDS taxonomy to enable health IT system developers, system implementers, and the quality improvement community to develop tools, content, and policies compatible with CDS features and functions. The Driving Quality and Performance Measurement: A Foundation for Clinical Decision Support report provides a foundation for the description of an electronic infrastructure, bridging quality measurement and health IT.

CDC Issues Notice of Survey to Begin 2013
Posted January 14, 2011

The National Center for Health Statistics, Centers for Disease Control (CDC) announced in the Federal Register [75FR71708] plans to conduct the National Hospital Care Survey (NHCS), a new survey beginning in 2013 that combines the National Hospital Discharge Survey (NHDS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). This newly formed initiative aims to request data on the utilization of healthcare provided in emergency and outpatient departments (ED and OPD) and ambulatory surgery centers (ASCs), thus integrating the NHDS and NHAMCS into NHCS. NHCS will replace NHDS and NHAMCS but continue to provide nationally representative data on utilization of hospital care and general purpose healthcare statistics on inpatient care as well as care delivered in EDs, OPDs, and ASCs. For more information, go to the Federal Register.

CMS issues final regulation for ESRD Quality Incentive Program
Posted January 14, 2011

The Centers for Medicare and Medicaid Services (CMS) issued a final rule that implements a quality incentive program (QIP) for Medicare outpatient end-stage renal disease (ESRD) dialysis providers and facilities with payment consequences beginning January 1, 2012, in accordance with section 1881(h) of the Act (added on July 15, 2008 by section 153(c) of the Medicare Improvements for Patients and Providers Act (MIPPA)). Under the ESRD QIP, ESRD payments made to dialysis providers and facilities under section 1881(b)(14) of the Social Security Act will be reduced by up to two percent if the providers/facilities fail to meet or exceed a total performance score with respect to performance standards established with respect to certain specified measures. The regulations become effective on February 4. For more information, go to the Federal Register.

"Get Ready" Free Webinars Kick Off Final Year of HIPAA Transaction Compliance
Posted January 6, 2011

In January, HIPAA covered entities will have less than a year left to prepare for the HIPAA Transaction's X12-Version 5010 upgrade effective on January 1, 2012. This transition not only affects an organization's reimbursement activities and cash flow, but is a key milestone in the implementation of the ICD-9-CM transition to ICD-10-CM /PCS, now less than three years away.
To assist with compliance, AHIMA is supporting an education effort, "Get Ready 5010," that will kick off with a series of free webinars January 11-13. The webinars will feature speakers from the Centers for Medicare & Medicaid Services (CMS), provider and payer organizations, and will discuss:

The Get Ready 5010 initiative is supported by a broad group of healthcare industry stakeholders AHIMA is working with that represent providers, payers, government, and vendors. These webinars are added to the work the CMS is doing to ensure a coordinated effort to support a smooth and timely transition to Version 5010. Whether your organization is well along with your Version 5010 project or just starting, you will find value in one or more of these free webinars. For more information and to register for these webinars go to the Get Ready 5010 Web site.

CMS to Host National Provider Teleconference on Preparing for ICD-10 Implementation
Posted January 6, 2011

The Centers for Medicare & Medicaid Services (CMS) will host a national provider teleconference on Wednesday, January 12 from 1-3 EST on "Preparing for ICD-10 Implementation in 2011." Subject matter experts, including AHIMA's director of coding policy and compliance, Sue Bowman, will review basic information on the transition to ICD-10 and discuss implementation planning and preparation strategies for this year.

Registration will close at 1p.m. EST on Tuesday, January 11, or when available space has been filled; no exceptions will be made, so please register early. For more information and to register for this informative session, click here.

A Final Rule on Permanent Certification Program
Posted January 6, 2011

On January 3 the Office of the National Coordinator for Health IT released a final rule establishing the permanent certification program for the meaningful use incentive program. The rule introduces several significant changes from the temporary program currently in use, including greater separation of powers in approving organizations to test and certify products. Read more at the Journal of AHIMA Web site.

CMS issues correction amendments to meaningful use final rule
Posted January 6, 2011

The Centers for Medicare and Medicaid Services (CMS) recently issued a correction amendment to address typographical and technical errors identified in the final rule entitled "Medicare and Medicaid Programs; Electronic Health Record Incentive Program" that appeared in the July 28, 2010 Federal Register. These amendments became effective December 29, 2010. For more information, go to the Federal Register.

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